DENTAL IMPLANT

Introduction & Basic Knowledge

Dental Implant history

Perkembangan Implan Gigi

Abad 16 ; fosil tengkorak implan sederhana - pengganti gigi Material : Black stone ( Sandhaus,1975 )
Awal 1990 material (metal) : alumunium, silver,

magnesium, red copper, gold, nikel

1940 ( Bothe dkk )

bone fusing to TITANIUM

1952 ( Branemark ) penyembuhan tulang sec microskopis Awal 1960an implan gigi diaplikasi pada manusia

Pada 1970an istilah Osseointegeration

Tipe implan
Subperiosteal

Root Form

Jaringan Periodonsium Periodontitis Gingiva Gingivitis

= Jaringan Periimplant = Periimplantitis = Periimplant Mukosa = Periimplant Mukositis

The Father of Dental Implant

In 1952, in a modestly appointed laboratory in the university town of Lund, Sweden, Professor Per-Ingvar Brnemark had a lucky accident -- what most scientists call serendipity. Much to his irritation, Dr. Brnemark discovered that it was impossible to recover any of the bone-anchored titanium microscopes he was using in his research. The titanium had apparently bonded irreversibly to living bone tissue, an observation which contradicted contemporary scientific theory. His curiosity aroused, Dr. Brnemark subsequently demonstrated that -- under carefully controlled conditions -- titanium could be structurally integrated into living bone with a very high degree of predictability and, without long-term soft tissue inflammation or ultimate fixture rejection. Brnemark named the phenomenon osseointegration. The first practical application of osseointegration was the implantation of new titanium roots in an edentulous patient in 1965. More than thirty years later, the non-removable teeth attached to these roots are still functioning perfectly.

Root Form (modern design)

Implant abutment connection

External connection

Internal connection

Short Implant !!

Crown : Root ratio ??

Implant surface
Smooth surface / Turned surface

Surface coating HA coated Titanium Plasma Spray

Sand blasted (SLA)

Zirconia (ZrO2)

Interface enhancement *various interface topography impressed textured, diffusionbonded microspheres, hydroxyapatite (HA) ceramic coating, grit blasted/acid etched,plasma sprayed metal,plasma sprayed hydroxyapatite/calcium phosphate

Increase Bone to Implant Contact area

PERLEKATAN IMPLAN DENGAN JARINGAN LUNAK & OSTEOINTEGRASI

PERLEKATAN KE JARINGAN LUNAK

A. Jaringan Ikat Ada 2 kemungkinan: Fiber berorientasi sejajar/sirkular dgn permukaan implan permukaan implan halus. Fiber berorientasi tegak lurus permukaan implan permukaan implan kasar.

B. Jaringan Epitel

Jar epitel barrier antara lingkungan luar (rongga mulut) dan lingkungan dalam jaringan = periimplant seal. Perlekatannya junctional epithelium = pada gigi asli disebut juga epithelial attachment . Biologic Width pada implan = gigi asli tidak boleh dilanggar.

Biologic Width

OSTEOINTEGRASI
Osteointegrasi = penyatuan tlg dgn implan Berbeda dgn gigi tidak memiliki jar perio Apabila terbentuk jar ikat antara implan dgn tulang (fiberosteointegrasi) considered failure

SIFAT-SIFAT & BIOKOMPATIBILITAS DENTAL IMPLANT

Sifat mekanik implan

Tensile strength mendekati stainless steel

Lebih kuat dari tulang kortikal, sehingga dengan diameter yang kecil dapat menerima beban yang besar Liat dan dapat ditempa, sehingga dapat menyesuaikan bila mendapat tekanan mendadak

Commercially pure titanium grade 4

Kandungan O2 dan Fe nya lebih banyak dari grade 1, 2, dan 3 properti mekanikalnya lebih baik tanpa mengurangi biokompatibilitasnya

Mengapa titanium sangat cocok sebagai implan gigi?

1. Dapat membentuk lapisan titanium oxide bila terkena udara, air dan cairan elektrolit melindungi metal terhadap reaksi kimia ( cairan tubuh ) Bersifat bioinert molekul jaringan mencegah ion metal bereaksi dengan

2.

3.

Mempunyai mekanikal properti yang baik ( tensile strength baik, lebih kuat dari tulang kortikal, liat ) Osseointegration dapat menyatu dengan tulang

4.