Differences between implant and nature tooth

(a) teeth (b) around implants typical of the Branemark system (c) the non-submerged ITI implant system

Natural: On enamel Implant: on titanium(abutment/implant)

Frontal view of gingival fiber groups (A) Circular (B) Dentogingival (C) Dentoperiostal (D) Alveologingival

PDL

PDL
0.1 to 0.2 mm in width support the teeth in a viscoelastic manner

Cells

osteoblasts, osteoclasts,cementoblasts an cementoclasts, fibroblasts, epithelial rests of Malassez,undifferentiated mesenchymal cells, neurovascular elements... Fibers (collagen fibers, oxytalan fibers) Ground substance

extracellular constituents

collagen fiber

type I collagen fiber Sharpey's fibres

in the root cementum and the alveolar bone

principal fibers
AC: alveolar crest fibers H: horizontal fibers OBL: oblique fibers PA: periapical fibers IR: interradicular fibers

Blood supply-natural tooth

Natural tooth

From the PDL to the connective tissue from the alveolar process to the PDL and then to the connective tissue from the alveolar process directly to the connective tissue

Blood supply-implant

time

After extraction

After implant placement

Due to the absence of a PDL dynamic process of bone remodeling

reason

Increase in cortical bone, decrease in

complication

Recession of buccal gingiva tissue is a common occurrence implant exposure (esthetic problem)
Evaluation of the patients (soft) tissue biotype and bone thickness should be conducted at the time of Tx planning The thicker the native hard and soft tissue, the more abundant the blood supply that can be expected after implant placement

Blood supply(bone remodeling)

tooth loss resorption in a palatal direction ridge thinning The thin bone remaining on the facial aspect of the implant tends to be cortical, with significantly less vascularity After implant placement, the biological width must be reestablished
Bone loss to 1st implant thread

Branemark/submerge/ two stage

bone margin: located at the first thread The JE: on the abutment The join between abutment and implant head : is located within a zone of non-arranged connective tissue of about 1mm to 2 mm in width

ITI Straumann type / nonsubmerged/single stage

roughened surface

within bone an integral part of the implant transmucosal collar located on the implant the implant/abutment join is located coronal to this level

smooth neck

JE

Bone

two-stage implant

vertical and horizontal bone loss occurring after abutment connection shifting the implant abutment junction inward and away from the peri-implant bone preservation of crestal bone (increase blood supply) support soft tissue

Platform-switching

Probing depth

natural teeth

health : probe penetrates the JE to some degree Inflammation: probe is stopped by the most coronal intact gingival connective tissue fibres, about 2 mm from the bone

Implant

sulcus depth is very much dependent upon the thickness of the soft tissue cuff generally deeper than around teeth the probe tip finishing short of the bone margin by about 2 mm

Probing depth

natural teeth

important part of dental examination

Implant

information questionable do not recommend probing radiographic assessment of bone levels digital pressure on soft tissue: bleeding or suppuration

> 10 Years:

a. Keep tooth and restore as indicated. a. Make independent implant restoration. b. If abutment must be included, make coping and retrievable prosthesis. c. Make tooth a "living pontic" by adding more implants or splinting to additional teeth. a. Extract and graft.

5-10 Years:

< 5 Years: