Materials
Dental implantology is a comparatively young treatment concept, based on
fundamental experimental studies carried out by the Swedish group of scientists in the ‘60.
These studies triggered a chain of further researches aiming at finding suitable implant
material that would meet all demands required to replace natural teeth in the mouth
environment, which in effect led to introducing into the market different materials believed
to be able to exchange or replace lost teeth.
Consequently, speaking about successful implant material we have to mention two terms:
biocompatibility and
osteointegration
The first can be defined as the compatibility of a living organism with any material for
which the interaction between the living tissue is so minimal that the material is not
detrimentally affected by the tissue nor the tissue by the material, and going further it can
be divided into:
bio-inactivity and bio-activity
The second can be defined as a direct apposition of the bone to the surface of the implant
without intervening with connective tissue.
Metals such as stainless steel, Cr-Co-Mo alloys, noble metal alloys,
polymethylmethacrylate, and other polymers are only to certain degree tolerated by bone.
They do not “really” integrate (layer of connective tissue between) and therefore can not be
considered as good implant materials.
Titanium, tantalum and aluminium oxide are described as being bio-inert and the model of
bone apposition, that occurs in living organism, can be seen as direct.
Recently developed surface conditioning for titanium implants is also described as being
osseoinductive and the connection with the bone as physico-chemical.
The group of the materials like bio-glass, bio-ceramics, Ca-phosphates, apatite is the only
bio-active group of materials, which means that the connection between the bone and the
implant is chemical and the bone growth originates also at the implant surface. The
osseoinductivity of these materials is very interesting for the implantology. However, pure
materials show inadequate mechanical properties. Therefore they are used as coatings for
other bio-inert materials.
Eventually, taking into consideration physico-mechanical and biological properties of
the successful implant material (which must meet high standards being subjected to high
mechanical loads and contact with the living tissue), it is Titanium that become the material
of choice for dental implants.
1601-01.04 Dyna Pushin Implant Manual GB 8 / 144
Because of its characteristics it can be used in the mouth, but still it can not be considered to
be ideal. Therefore, the majority of the implants on the dental market, although made of
Titanium (or its alloy), have modified surface enabling them to have better fixation within the
bone. The surface conditioning can be divided into two main groups:
Covering the implant with a layer of material
Mechanical, chemical or physical modification of the implant surface.
In the first group you can find implants covered, usually in the process of Plasma Spraying,
with Titanium or hydroxylapatite, whereas the second group contains implants with surfaces
that can be polished, electro-polished, sand blasted, acid or alkali treated, heat treated or
combination of more of these factors.
fundamental experimental studies carried out by the Swedish group of scientists in the ‘60.
These studies triggered a chain of further researches aiming at finding suitable implant
material that would meet all demands required to replace natural teeth in the mouth
environment, which in effect led to introducing into the market different materials believed
to be able to exchange or replace lost teeth.
Consequently, speaking about successful implant material we have to mention two terms:
biocompatibility and
osteointegration
The first can be defined as the compatibility of a living organism with any material for
which the interaction between the living tissue is so minimal that the material is not
detrimentally affected by the tissue nor the tissue by the material, and going further it can
be divided into:
bio-inactivity and bio-activity
The second can be defined as a direct apposition of the bone to the surface of the implant
without intervening with connective tissue.
Metals such as stainless steel, Cr-Co-Mo alloys, noble metal alloys,
polymethylmethacrylate, and other polymers are only to certain degree tolerated by bone.
They do not “really” integrate (layer of connective tissue between) and therefore can not be
considered as good implant materials.
Titanium, tantalum and aluminium oxide are described as being bio-inert and the model of
bone apposition, that occurs in living organism, can be seen as direct.
Recently developed surface conditioning for titanium implants is also described as being
osseoinductive and the connection with the bone as physico-chemical.
The group of the materials like bio-glass, bio-ceramics, Ca-phosphates, apatite is the only
bio-active group of materials, which means that the connection between the bone and the
implant is chemical and the bone growth originates also at the implant surface. The
osseoinductivity of these materials is very interesting for the implantology. However, pure
materials show inadequate mechanical properties. Therefore they are used as coatings for
other bio-inert materials.
Eventually, taking into consideration physico-mechanical and biological properties of
the successful implant material (which must meet high standards being subjected to high
mechanical loads and contact with the living tissue), it is Titanium that become the material
of choice for dental implants.
1601-01.04 Dyna Pushin Implant Manual GB 8 / 144
Because of its characteristics it can be used in the mouth, but still it can not be considered to
be ideal. Therefore, the majority of the implants on the dental market, although made of
Titanium (or its alloy), have modified surface enabling them to have better fixation within the
bone. The surface conditioning can be divided into two main groups:
Covering the implant with a layer of material
Mechanical, chemical or physical modification of the implant surface.
In the first group you can find implants covered, usually in the process of Plasma Spraying,
with Titanium or hydroxylapatite, whereas the second group contains implants with surfaces
that can be polished, electro-polished, sand blasted, acid or alkali treated, heat treated or
combination of more of these factors.
Anatomy
Stomatognathic system defined by the Nomenclature Committee Academy of
Denture Prosthesis as combination of all the structures involved in speech and in the
reception, mastication, and deglutition of food is not a static system during all our lives.
The anatomic parts that form the system are the maxilla, the mandible, the activating
muscles of the mandible and the temporomandibular joint. Collective relation of all
elements of the system decides of the equilibrium that exists between them and any
change in this system occurs in new equilibrium.
Loss of teeth results in gradual resorption of alveolar ridge. The degree of it
seems to be related to a combination of physiological (e.g. osteoporosis, hyperfunction
of parathyroid glands) and local factors (e.g. denture pressure). In severe cases
resorption of the mandibular body and basal maxillary bone may occur. Consequences
of this are reduction of the denture bearing area, loss of retention and stability and
problems with functioning of prospective dentures. The mandible resorption is four
times higher than that of the maxilla. Moreover, the bearing area for lower denture is
generally lesser, which may be a heavy burden for some patients considering denture
retention. To help individuals with severe resorption some pre-prosthetic procedures
(e.g. deepening of the floor of the mouth, ridge augmentation, vestibuloplasty) may be
needed.
Oral implants provide reliable treatment in the above mentioned situations.
Moreover they can be used in full range of clinical situations replacing one or more teeth
or serving as an anchorage for overdentures. However, proper placement of implants
demands, from a clinician accurate knowledge of the anatomy and morphology.
Constant changes in stomatognathic system especially in relation between the mandible
and the maxilla may influence choosing potential place for implantation. Anatomical
structures (e.g. sinus maxillaries, mandibular canal, nasal floor) may also present
obstacles in the most favourable positioning of implants. One should also notice
differences in the bone quality of the mandible and the maxilla, structure of the alveolar
walls, teeth axes, innervation and blood supply of particular structures. All those factors
are crucial for planning and rehabilitation of the mouth.
For more detailed description we recommend referring to adequate anatomy texts.
Denture Prosthesis as combination of all the structures involved in speech and in the
reception, mastication, and deglutition of food is not a static system during all our lives.
The anatomic parts that form the system are the maxilla, the mandible, the activating
muscles of the mandible and the temporomandibular joint. Collective relation of all
elements of the system decides of the equilibrium that exists between them and any
change in this system occurs in new equilibrium.
Loss of teeth results in gradual resorption of alveolar ridge. The degree of it
seems to be related to a combination of physiological (e.g. osteoporosis, hyperfunction
of parathyroid glands) and local factors (e.g. denture pressure). In severe cases
resorption of the mandibular body and basal maxillary bone may occur. Consequences
of this are reduction of the denture bearing area, loss of retention and stability and
problems with functioning of prospective dentures. The mandible resorption is four
times higher than that of the maxilla. Moreover, the bearing area for lower denture is
generally lesser, which may be a heavy burden for some patients considering denture
retention. To help individuals with severe resorption some pre-prosthetic procedures
(e.g. deepening of the floor of the mouth, ridge augmentation, vestibuloplasty) may be
needed.
Oral implants provide reliable treatment in the above mentioned situations.
Moreover they can be used in full range of clinical situations replacing one or more teeth
or serving as an anchorage for overdentures. However, proper placement of implants
demands, from a clinician accurate knowledge of the anatomy and morphology.
Constant changes in stomatognathic system especially in relation between the mandible
and the maxilla may influence choosing potential place for implantation. Anatomical
structures (e.g. sinus maxillaries, mandibular canal, nasal floor) may also present
obstacles in the most favourable positioning of implants. One should also notice
differences in the bone quality of the mandible and the maxilla, structure of the alveolar
walls, teeth axes, innervation and blood supply of particular structures. All those factors
are crucial for planning and rehabilitation of the mouth.
For more detailed description we recommend referring to adequate anatomy texts.
Patient
Dentists who plan to restore their patients with dental implants should always take into
consideration all factors
that influence the final result. Therefore, it is important to see the patient as a whole.
Understanding patient’s needs and expectations is the start point for the successful treatment. On the
other hand, patient have to be fully aware of what he can expect. A careful planning including
available examination methods, followed by adequate surgical technique and precise prosthetics can provide long term success. However, this can be only achieved with the
complete cooperation between dentist, patient and technical laboratory. Patient – dentist relation
though important is not sufficient to guarantee long lasting results. Technical aspects should also be
taken into consideration and in this respect good communication between dentist and dental
technicians must be established. Eventually, technician have to be fully informed about patient’s
demands concerning desired shape, colour etc. of the future prosthesis.
Only when those elements are fulfilled can we expect predictable, long term success!
consideration all factors
that influence the final result. Therefore, it is important to see the patient as a whole.
Understanding patient’s needs and expectations is the start point for the successful treatment. On the
other hand, patient have to be fully aware of what he can expect. A careful planning including
available examination methods, followed by adequate surgical technique and precise prosthetics can provide long term success. However, this can be only achieved with the
complete cooperation between dentist, patient and technical laboratory. Patient – dentist relation
though important is not sufficient to guarantee long lasting results. Technical aspects should also be
taken into consideration and in this respect good communication between dentist and dental
technicians must be established. Eventually, technician have to be fully informed about patient’s
demands concerning desired shape, colour etc. of the future prosthesis.
Only when those elements are fulfilled can we expect predictable, long term success!
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