Dental Implants in India

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• INTRODUCTION
• Over the past 20 years, the number of dental
  implant procedures has increased steadily
  worldwide, reaching to about one million dental
  implantations per year.
• However, not all of these have achieved a
  favorable result.
• For an implant to be successful it must integrate
  with the surrounding hard tissues prior to
  prosthetic rehabilitation.

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CONVENTIONALLY EMPLOYED IMPLANT DESIGNS
GEOMETRY
SURFACE TOPOGRAPHY
coatings
Surface roughness
TPS
Grit blasting
Acid etching
Plasma spraying With HA ceramic particles
CYLINDRICAL
Anodization
THREADED
hollow-cylinders
hollow screws
solid-cylinders
solid screws
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• Any minor changes in the geometry of the implant
  can help enhance the potential area for
  osseointegration and thus affect the initial
  stability.
• Any changes in the surface topography of the
  implant in large determines the biologic reaction
  of the implant to the surrounding structures.

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RECENT ADVANCES
Recent Advances
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SOME ADVANCES IN SURFACE TOPOGRAPHY.

• HA SPLUTTER COATED IMPLANTS
• TISSUE ENGINEERING STRATEGIES
• HYDROPHILIC IMPLANT SURFACE TREATMENT

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HA-SPLUTTER COATED IMPLANTS
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• NANOTITE IMPLANTS
• The incorporation of nanotechnology into implant
  dentistry has been a major break through in
  implant surface technology.
• This technique makes use of an ion beam
  modification of the titanium alloy surfaces

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• The titanium alloy is modified using an Ion-Beam
  Assisted Deposition with a thin (less than 1
  micrometer) amorphous calcium phosphate compound
  with HA-like chemistry for enhancement of bone
  integration.

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• ADVANTAGES
• Formation of a nano-thin calcium phosphate
  compound on the titanium implant
• Surface thickness of less than 500 nanometers
• Maintenance of the rough micro topography of the
  implant surface.
• Enhancement of bone integration

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TISSUE ENGINEERING STRATEGIES
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• Aimed at growing a thin layer of Ca-P on the
  implant surface from a physiologically related
  supersaturated calcifying solution at ambient
  temperatures by mimicking the natural bone or
  tooth mineralization process.

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• Osteoinductive substances
• used as biomimetic coatings on the surface of
  dental implants.
• optimize the cascade of biological events that
  result in the bone formation appropriate for
  securing a dental implant.

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• This development has made it possible to
  incorporate therapeutic agents directly into the
  Ca-P coating
• BMP AND rhBMP
• BISPHOSPHONATES
• IGF 1 2
• PDGF

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• Most popular method is to load therapeutics and
  bioactive agents into the Ca-P coating.
• This allows diffusion of the respective agent(s)
  into the coating after processing.
• The degree and the type of bonding largely
  depends on the composition, microstructure and
  the properties of the finished coating products.

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• Coating with BMPs - accelerate initial healing
  times, reduce overall treatment time - improve
  implant success rate.

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• Experimental investigations with a BMP known as
  recombinant human BMP-2 (rhBMP-2) in animal
  models have shown that it promotes initial
  integration of dental implants and rescues
  implants affected by experimentally induced
  peri-implant bone loss.

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• Coating with pharmacological agents such as
  BISPHOSPHONATES may be a way of locally improving
  bone density in highly cancellous bone.

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• ADVANTAGES
• These coatings on the load-bearing dental
  implants has two main advantages of

The superior mechanical properties of the
substrates
The excellent biocompatibility of Ca-P
materials.
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• Conformal coating - on implants with a complex
  shape or porous structure
• Can be applied on temperature-sensitive
  substrates
• More controllable than plasma spraying
• Biomimetic apatite coating are more closer to the
  minerals in bone and have a higher bone-bonding
  ability than the PSHA coating

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HYDROPHILIC IMPLANT SURFACE TREATMENT
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• These exhibit a fundamentally improved surface
  chemistry.
• These implants are initially
• Sandblasted with Large grit
• Acid etching.
• Conditioned
• Immediately preserved in an isotonic saline
  solution. (helps maintain a high surface
  activity, which would otherwise be lost due to
  reaction with the atmosphere.)

achieve an optimal topography
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• Due to this ideal conditioning, the implant
  surface quickly attracts blood and proteins,
  potentially promoting the process of bone
  formation and thus increased early stability.

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SOME ADVANCES IN IMPLANT GEOMETRY.

• NANOTITE TAPERED IMPLANTS
• GROOVY IMPLANT SURFACE
• ONE PIECE IMPLANT WITH AGGRESSIVE THREADING

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NANO TITE TAPERED IMPLANTS
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• These closely approximates the shape of a natural
  tooth root.
• Clinically, it is said to achieve initial implant
  stability from threads that widen laterally
  extending to the apical end.

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• These threads maximize Bone-To-Implant Contact
  (BIC).
• The thread angle, depth and pitch produce an
  anchoring bite in bone response.
• Domed Apical End reduces trauma and is desirable
  in areas where implant placement closely
  approximates vital structures

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GROOVY IMPLANT SURFACE
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• As the name suggests, these implants have
  micro-grooves placed onto their surfaces.
• These integrate faster than implants without
  groove and are indicated whenever immediate or
  early loading is applied. 

CONVENTIONAL THREADED IMPLANT
GROOVES ON IMPLANT COLLAR
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• ADVANTAGES
• Bone forms preferentially within the grooves,
  compared to other parts of the implant
• Enhanced osseoconductive properties of the
  grooves form a guiding effect on bone forming
  cells
• Up to 30 increase in stability from mechanical
  interlock created by bone formation within the
  groove.

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ONE PIECE IMPLANT WITH AGGRESSIVE THREADING
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• The presence of little steps on the lower side of
  the thread on the implant body.
• These feature a very deep coil depth designed to
  provide increased primary stability even in soft
  bone.
• Blood gathers into these threads, promoting the
  precocious formation of bone tissue and thus
  faster osseointegration.

AGGRESSIVE THREADING
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• Double acid etched - allows fibrin retention and
  increases blood cell activity - enhance
  osteogenesis.
• The acid etched surface also helps create a
  hydrophilic surface, known to enhance the healing
  process by osteoblast activation.

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• CONCLUSION
• As current understanding of the
  bone-to-implant interface progresses, so will
  development of proactive implants that can help
  promote desired outcomes. However in the midst of
  all this excitement born out of this activity, it
  is necessary to remember that the needs of
  patient must remain paramount.

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