Category Archives: Dental Implant Surgery

Key Factors for Osseointegration

Osseointegration is defined as a direct bone anchorage to an implant body which can provide a foundation to support a prosthesis. There are many factors that influence osseointegration. Among the key factors for successful osseintegration of dental implants are: characteristics of implant material, design of the implant fixture, prevention of excessive heat during implantation etc.

The first factor pertains to characteristics of implant material. In titanium implant, an oxied layer forms when it comes into contact with the atmosphere. When the fixture has osseointegrated, this oxied layer is surrounded by a glycoprotein layer then a calcified layer.

The 2nd factor is the design of the implant fixture. The implant fixture has a threaded surface. The threads create a larger surface area. They also balance the force distribution into surrounding bone. The treads also play a role in initial implant fixation.

The 3rd factor for successful osseointegration is the prevention of excessive heat during implantation. Ideally, heat during drilling procedures should not exceed 39 C.The maximum speed during drilling should be under 2,000 r.p.m. Tapping for threading and fixture intallation should be between 15-20 r.p.m.

The 4th factor pertains pertains to “No loading while healing”. It is required that the implant fixtures left undisturbed for 6 months in maxilla and 3-4 months in the mandible.

The tapping procedure for threading and fixture installation into bone requires a drilling speed between 15-20 r.p.m. -

The tapping procedure for threading and fixture installation into bone requires a drilling speed between 15-20 r.p.m. –


Dental implant fixtures under occlusal loads are surrounded by cortical and spongy bone. When osseointegration is commenced and the denture is designed for good stress distribution, cortical bone forms along the implant fixture surface a few millimeters in thickness. The cortical bone to implant surface interface has canaliculi participating in electrolyte transportation near the oxide layer. A network of collagen fibers bundles surround the osteocytes and insert into a glycoprotein layer. The haversian bone is well organized and forms osteon.

Osseointegration in spongy bone occurs as bone trabeculae approach the implant and come into intimate contact with the oxide layer. Blood vessels providing nutrition and bone remodelling occur at the bone trabeculae and surround the fixture surface. Fibroblasts and osteoblasts increase in number and change shape when closer to the implant surface then attach to the oxide layer.

Ground substance forms and fills spaces between bone trabeculae. It fuses with the oxide layer.

Osseointegrated implants

Osseointegrated implants


All surgical techniques to elevate the maxillary sinus present the possibility of perforating the Schneiderian membrane. The complication can occur during osteotomy which performed with burs. It can also occur during the elevation of Schneiderian membrane using manual elevators.

Piezoelectric bone window osteotomy cuts bone without damaging the soft tissue. Piezoelectric membrane elevation separates the Schneiderian membrane without perforations.

The elevation of Schneiderian membrane from the sinus floor is performed using both piezoelectric elevators and the force of a physiologic solution subjected to piezoelectric cavitation.

One Stage Dental Implants

The evolution of dental implant related treatments in this era took its origin from the work of Branemark, who scientifically validated the entire process of placing an implant into bone, waiting a period of time for that bone to heal towards the implant, after which long-term functional loading adopted. Throughout the 70s and early 80s, a 1 stage threaded titanium plasma covered dental implant was adopted for overdenture retention with immediate loading. Also know as Swiss screw, the plasma coated dental implant was place into the anterior mandible and led to excellent long-term success. Other one stage implant systems were slow to emerge, but as they were proved with supporting data, the idea of a 1 stage endosseous dental implant therapy acquired credibility. The Strauman system has long-term data, showing that the one stage unloaded dental implant system can function in most regions of the mouth in distinction using the Swiss screw and also the Branemark methods.
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Computer Aided Dental Implant Treatment Planning

Modern implantology increasingly focuses on the reduction of treatment time and postoperative impairment while providing function, esthetics and comfort with a minimally invasive surgical approach. The advancement of 3D dental diagnosis by computer tomography allows precise planning for the surgical placement of dental implants that are prosthetically driven. The precise transfer of preoperatively determined implant positions to the patient’s mouth is of utmost imporatance to the dental practitioner as well as patients.

Prosthetic driven treatment planning and guided implant surgery can now be performed with the use of CAD-CAM surgical guides – from a single missing tooth to a completely edentulous jaw. Computer assisted / – guided / – aided implantology has been found to overcome the errors commonly encountered during implant site preparation and aid in positioning the implants more precisely.
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Hyaluronic Acid in Dental Implants

Hyaluronic Acid is a natural occurring substance found in our joints, eyes and neural tissues with the highest concentration in the connective tissue and skin. It plays an important role in tissue repair and regeneration but unfortunately it gets depleted as we age. Extensive research has shown that this can be reproduced and prescribed as a supplement to minimize inflammation and accelerate wound healing. Aside from dental implant placement, its various dental applications are for: gingivitis, periodontitis, tooth extraction and bone grafting.

Dental Implant Dentist

Dental Implantology is not a specialty yet. It is not correct to call a dentist as Dental Implant Dentist.

With adequate training, any dentist can perform a dental implant procedure.

A general dentist can perform basic dental implant surgery only if he has acquired the skills to do such procedure. A general practitioner can also carry out bone grafting, but he must have an additional training first.

Bone grafting is not a simple procedure. It requires special training and clinical experience before doing this procedure correctly in the patient’s oral cavity.

A Prosthodontist is one of the most qualified specialists to carry out a dental implant procedure. His specialty lies in dentures. Prosthodontics is a specialty that requires 2 to 3 years of university based or dental school based education. It is the dental specialty pertaining to the diagnosis, treatment planning, rehabilitation and maintenance of the oral function, comfort, appearance and health of patients with clinical conditions associated with missing or deficient teeth and/or oral and maxillofacial tissues using biocompatible substitutes. He is the most qualified to do the the prosthetic aspect of the dental implant treatment.
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