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THIRD EDITION

Quality Resource Guide

Introduction to Dental Implant Therapy

MetLife designates this activity

for 1.0 continuing education credit

for the review of this

Quality Resource Guide and successful

completion of the post test.

Author Acknowledgements

Thomas W. Oates, DMD PhD

Assistant Dean for Clinical Research

Department of Periodontics

The University of Texas Health Science

Center at San Antonio

School of Dentistry

San Antonio, Texas

Dr. Oates has no relevant financial

relationships to disclose.

The following commentary highlights

fundamental and commonly accepted

practices on the subject matter. The

information is intended as a general overview

and is for educational purposes only. This

information does not constitute legal advice,

which can only be provided by an attorney.

New York, NY. All materials subject to

this copyright may be photocopied for the

noncommercial purpose of scientific or

educational advancement.

Originally published June 2009.

Updated

and revised July 2012 and November

2015. Expiration date:

December 2018.

The content of this Guide is subject to

change as new scientific information

becomes available.

MetLife is an ADA CERP Recognized Provider.

ADA CERP is a service of the American Dental

Association to assist dental professionals

in identifying quality providers of continuing

dental education. ADA CERP does not approve

or endorse individual courses or instructors,

nor does it imply acceptance of credit hours by

boards of dentistry.

Concerns or complaints about a CE provider

may be directed to the provider or to ADA

CERP at www.ada.org/goto/cerp.

Accepted Program Provider FAGD/MAGD

Credit 11/101/12 - 12/31/16.

Address comments to:

dentalquality@MetLife.com

MetLife Dental

Quality Initiatives Program

501 US Highway 22

Bridgewater, NJ 08807

Educational Objectives

Following this unit of instruction, the practitioner

should be able to:

Describe recent advances and trends in

implant placement.

Discuss the most common restorative options

for implant therapy.

Understand the evidence basis for treatment

planning implant cases.

Understand patient-centered outcomes for

implant therapy.

Introduction

ndosseous dental implants have dramatically

altered the practice of dentistry. Titanium

cylindrical endosseous dental implants were

introduced in the early 1980’s to facilitate the

construction of prostheses for atrophic edentulous

mandibles.

Since then, the materials, components and

applications of dental implants have continued to evolve.

There are now multiple implant systems, as well as

wide range of surgical and restorative options available

to the practitioner. The goal of this guide is provide an

overview of these options and enable the practicing

dentist to better appreciate the different implant therapy

choices that are currently available.

This guide will provide an evidence-based overview

of implant systems to assist the dentist in clinical

decision-making and answering patient questions

regarding therapeutic options. These considerations

will be provided relative to the surgical and restorative

phases of implant therapy. There will be no discussion

of specific implant system brands, but rather a more

generic consideration of the variations provided by the

many available systems.

Surgical Phase

Osseointegration

Implant therapy is founded on the predictability of

osseointegration. Osseointegration is the structural and

functional adaptation of the osseous tissues to an implant

surface. This process is often measured histologically

as the amount of mineralized bone in contact with the

implant surface. Implant integration is clinically identified

as an immobile implant that provides an “ankylotic” sound

on percussion. Radiographic assessment will identify an

intact bone/implant interface with no radiolucent area

surrounding the implant.

Following implant placement, the healing response

stimulates an increase in the metabolic activity of the bone

tissue leading to resorption, remodeling, and ultimately

the formation of new bone along the implant surface.

This is the osseointegration process. Our understanding

of the potential for the implant surface to influence

the osseointegration process is critical to selecting

applications for implant therapy in areas of compromised

bone quality, such as placement in extraction sites or

areas developed by bone grafting.

One of the major advances in implant surface technology

has been recognition of improved osseointegration

following placement of an implant with a roughened

surface compared to placement of an implant with

a smooth surface.

2,3,4

All manufacturers of current

implant systems recognize the benefits of a roughened

implant surface and offer some type of enhanced surface

topography.

It is thought that surface roughness enhances

the ability of the bone to heal along the implant surface,

improving the quantity or quality of osseointegration. The

advantages of surface roughness appear most evident

in placement sites with decreased bone density or when

shorter length implants must be used.

4,6

Research efforts

have focused more on the implant surface chemistry and

biology.

7,8

Currently, several implant systems offer some

type of chemical modification to the implant surface,

which is thought to improve osseous healing. The use of