Dental implants are commonly used in clinical situations for replacement of natural teeth. Despite many advances in materials, techniques, and implant design, implant failure is a significant concern for the dentist and patient. Peri-implantitis and lack of osseointegration are considered to be the major factors leading to implant failure. Occlusal overloading, medical status of the patient, smoking, and implant characteristics are among the other causes for implant failure. The purpose of this concise review is to discuss the etiology of implant failures by highlighting the various classification put forth by different authors and formulating a new classification.

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Pure titanium (Ti) and Ti alloys are well-established standard materials in dental implants due to their favorable combination of mechanical strength, chemical stability and biocompatibility. The concept of osseointegration was discovered by Brεnemark and his co-worker and has had a dramatic influence on clinical treatment of oral implants. The first generation of successfully used clinical Ti implants, which were machined with a smooth surface texture, now approach 50 years in the clinical use. Since then, implant surfaces have long been recognized to play a vital role in molecular interactions, cellular response and osseointegration and scientists all over the world have developed the second generation implants with surfaces which can accelerate and improve implant osseointegration.

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This article is a case report of removal of a dental implant using electrosurgery. A discussion will outline a possibly less invasive method to remove the dental implant. This involves the use of electrosurgery unit to cause a thermo-necrosis of the bone and therefore a weakening of the bone-implant interface. It is suggested that a controlled laboratory experiment be carried out to look at the effects of mono-polar electrosurgery on osseointergration on dental implants and the possible use of this method to allow for simple removal of poorly positioned fixtures and also fixtures with significant bone loss but no mobility.

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Dental specialists today are facing a major influx of completely edentulous patients and patients with generalized compromised teeth who ask for cost-effective full mouth rehabilitation. The choice of overdenture as a treatment modality is significantly less expensive and is within the reach of many patients who are on a limited financial support. Various types of attachment systems are currently available to restore implant-supported over-denture. Clinicians have selected various attachment systems based on factors such as durability, patient demand, cost-effectiveness, technical simplicity, and retention. The decision-making process to select certain types of attachment system still remains unclear. This article explains about various attachment system available, their advantages and disadvantages and their use in different clinical conditions.

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Achieving and maintaining implant stability are prerequisites for a dental implant to be successful. Implant stability can be defined as the absence of clinical mobility, which is also the suggested definition of osseointegration. Primary implant stability at placement is a mechanical phenomenon that is related to the local bone quality and quantity, the type of implant and placement technique used. Secondary implant stability is the increase instability attributable to bone formation and remodeling at the implant/tissue interface and in the surrounding bone. There are many ways in which the implant stability can be evaluated such as clinical measurement of cutting resistance during implant placement, reverse torque test, the periotest. This article aims to throw light on the various methods to determine implant stability.

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Aim: The study evaluates the stress formed around an implant and a natural tooth under occlusal forces, on different tooth implant-supported fixed prosthesis (TIFP) designs in order to suggest a design, which transmits less stress to the bone. Materials and Methods: A distal extension situation was utilized in this study to evaluate stress distribution around a natural tooth and an implant in TIFP models with three connection designs (i.e., rigidly connected to an abutment tooth, connected to an abutment tooth with a nonrigid connector [NRC], and connected to an abutment implant with an NRC). The stress values of the three models loaded with vertical forces (300 N) were analyzed using three-dimensional finite element analysis. Results: The highest level of stress around the implant and natural tooth was noted on the TIFP models with the RC. On the other hand, NRCs incorporated into the prostheses reduced the stress in the bone around the implant and natural tooth. Conclusion: The present study recommends the use of NRCs on the implant abutment-supported site, if the tooth and implant abutment are to be used together as fixed prosthesis supports. The NRC placed on the implant abutment site reduces the stress around the implant and natural tooth in a fixed prosthesis supported by tooth and implant increasing the life span of both.

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Aim: This in vitro study was performed to evaluate and compare stresses applied to the implants retaining mandibular complete overdenture with telescopic attachments of different materials. Materials and Methods: Three identical clear acrylic resin models of completely edentulous mandibular arch were selected for this study. One implant was installed in each canine region of each model. The models were scanned to design telescopic attachment using computer-aided design/computer-aided manufacturing technology. According to material used for telescopic attachments fabrication, models were categorized as follows: All Zirconia (ZrO₂) telescopic group (zz): Primary and secondary crowns were made of ZrO₂, all polyetheretherketone (PEEK) telescopic group (pp): Primary and secondary crowns were made of PEEK, and Zirconia-PEEK telescopic group (zp): Primary crown was made of ZrO₂, and secondary one was made of PEEK. Three identical mandibular complete overdentures were constructed. The secondary telescopic crowns were picked up within the intaglio surface of each overdenture. Four strain gauges were installed parallel to each implant. Bilateral and unilateral loads were applied, and strain values were recorded. Results: Comparison of recorded stresses values revealed a significant difference between groups where the highest stresses were recorded with all-PEEK group, followed by all-zircon group and the lowest stresses were noted with Zirconia-PEEK group for both bilateral and unilateral loading tests. Conclusion: Within the limitation of this in vitro study, it could be concluded that: telescopic attachments that fabricated from ZrO₂ primary crown and PEEK secondary crown is a promising attachment regarding reductions of stresses transmitted to the implants retaining mandibular complete overdenture.

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Spark erosion is a metal removal process using electric current under carefully controlled conditions. It is used for precise and accurate fabrication in the field of fixed, removable and implant prostheses. The scope of this article is to discuss the mechanism of action of the process and its significance in implant dentistry along with critical evaluation of its merits and demerits.

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Improved skills, techniques and materials, case selections and proved designs have witnessed higher rates of success and survivals of osteointegration with dental implants. But prosthesis failures especially mechanical types have been constantly reported. These prostheses have been secured to the integrated implants with cement or screws. Controversies are rife in literature regarding the choice of retention. This review article provides an overview of the various clinical aspects, abutment designs and materials and procedures used, which contribute to selection of type of retention whether screw or cement and highlighting their clinical significance. The clinician can then use these information for optimizing the retention in an given clinical condition and minimize the risk of complications.

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Background: The long-term success of an implant depends on the stability of bone support for the implant. Most crestal bone loss occurs in the first year of implant placement. Platform switching is an approach which can be clinically applied to preserve the crestal bone. Purpose: The purpose of this review is to discuss the literature dealing with the platform switching concept to preserve the crestal bone, the mechanism by which it contributes to maintenance of marginal bone, its clinical applications, advantages and disadvantages, in order to assess its survival rates. Materials and Methods: PubMed and Google Scholar were used to find studies involving platform switching concept from 2005 up to October 2009. Results: Literature search revealed studies involving concepts of platform switching, comparison of platform-switched and non-platform-switched implants, case reports on platform switching and studies with histological and finite element analyses regarding platform switching. Conclusion: Platform switching helps preserve crestal bone around the implants and this concept should be followed when clinical situations in implant placement permit.

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An implant-supported restoration offers a predictable treatment for tooth replacement. Reported success rates for dental implants are high. Nevertheless, failures that mandate immediate implant removal do occur. The consequences of implant removal jeopardize the clinician's efforts to accomplish satisfactory function and esthetics. For the patient, this usually involves further cost and additional procedures. The main objective of this paper is to describe different failures in dental implants and treatment modalities to deal with implant failure. The main topics for discussion include identifying the failing implant, management of implant failures and higher stress on the implant maintainance methods. This article describes the many failures and complications that can occur when using implants to support restorations. Most of these failures can be prevented with proper patient selection and treatment planning

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Patients wearing conventional removable dentures often complain particularly about the instability of the mandibular denture. Due to instability of mandibular dentures, there is an increase in the severity of mandibular atrophy. Furthermore, denture instability leads to a feeling of insecurity, inefficient mastication, and overall dissatisfaction with the prosthesis. Placement of endosseous dental implants to retain and support mandibular overdentures or fixed complete dentures have been developed and studied as a method for solving the problem of instability associated with conventional dentures. Implant-retained dentures have many advantages compared to conventional removable dentures. Occasionally, anatomical or financial limitations may prohibit the patient to use of a fixed implant-retained prosthesis. In these cases, a removable implant-retained denture with a limited number of implants may be the possible choice. The aim of this article is to review the literature to compare implant-retained or supported dentures versus conventional dentures in terms of masticatory efficiency, stability, and patient satisfaction.

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Aims: To survey the current radiographic prescriptions in dental implant assessment among dentists in Libya. Settings and Design: Eighty dentists were interviewed during a dental meeting by two calibrated graduate students, using a 19-question questionnaire, considering imaging modality options for preoperative implant site assessment with respect to cost, patient radiation dose, and broad coverage of facial bones and teeth. Statistical Analysis Used: Epi-Info 6.04 software was used to analyze the database file. Results: The radiographic examinations more often prescribed for dental implant assessment were the panoramic radiograph (70%), followed by panoramic plus periapical radiographs (15%). Only 6.25% of the dentists prescribed computed tomography as a single examination. The most common reason for prescribing a specific radiographic examination was the desire for broad coverage of the facial bones and teeth (44.64%), cost (14.3%) was the second most common cause. Conclusions: The interviewed dentist in this study prescribed panoramic radiographs in dental implant assessment based on broad coverage and cost.

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Background: During treatment planning for dental implant placement, there is a need for assessment of alveolar bone. Bone evaluation limited to the use of panoramic and or periapical radiographs may be insufficient, as it provides only two-dimensional information about the implant sites. Computed tomography (CT) provides three-dimensional information. The measurement of alveolar ridge dimensions can be accomplished using ridge-mapping technique. This technique involves penetrating the buccal and lingual mucosa down to the alveolar bone (following the administration of local anesthetic) with calipers and measures the bucco-lingual width of the underlying bone. Purpose: The aim of the study is to compare the techniques, i.e. ridge mapping, direct surgical exposure, and CT scan, which are used to measure the alveolar ridge bone width, and determine their accuracy in the clinical application. Materials and Methods: The study was conducted on 20 patients who reported to the Out-patient Department (OPD) of Prosthodontics and Crown and Bridge, PGIDS, Rohtak (Haryana) for replacement of edentulous span with dental implant. Width of alveolar ridge was studied by three techniques, i.e. CT scan procedure, ridge mapping, and direct surgical exposure at two points (3 mm from the crest of ridge and 6 mm from the crest of ridge), and then taking measurements of surgical exposure as the control group, the measurements obtained from the other two techniques were compared and then accuracy of these methods was assessed. The mean, standard deviation, standard error of mean, and degree of freedom were calculated and subjected to statistical analysis using Student's unpaired " t" test. Results: Results suggested that there is no significant difference in the measurements obtained by direct surgical exposure technique, ridge-mapping technique, and CT technique. Conclusion: Use of ridge-mapping technique along with panoramic and intraoral radiograph is adequate in cases where the pattern of resorption appears more regular and where mucosa is of more even thickness. It is suggested to use CT scan technique in situations where the alveolar ridges are resorbed, there is presence of maxillary anterior ridge concavities, vestibular depth is inadequate, and ridge mapping is not feasible.

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Dentitions damaged by periodontal disease and dental caries often cause problems to the patients and to the dentists, at least regarding the choice of therapy. A recent trend in the replacement of missing teeth is by dental implant. The role of various factors that would affect the prognosis of dental implants should be carefully considered before attempting to rehabilitate the patients with implants. Prognosis is a prediction of probable course, duration, and outcome of a specific disease based on a general knowledge of the pathogenesis of the disease and presence of risk factors for the disease. Factors that could determine the prognosis of implants are (1) periodontally compromised patients, (2) age, (3) bone density, (4) occlusion, (5) smoking, (6) genetics, (7) systemic diseases, (8) microorganisms, (9) antibiotics, and (10) type of implants.

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The dental implant therapy has a phenomenal rise and has occupied the summit in today's dentistry. The scientific societies and researchers are in constant effort toward improvement, excellence, and simplification of implant therapy. Today, the practitioners are enthusiastic to imbibe the simplified implant procedures and techniques and would like to carry out the same in their private practice. Implant design, bone biology, primary stability, osseointegration, prosthetic options etc., are the several issues taken into account for successful implant therapy. The factors which influence integration are design of implant, material composition of implant, variance in the bone quality (soft or hard), and type of surgical procedure employed (simple or complex). The primary stability is the initial engagement between the bone and implant and one has to ensure that it should be strong and paramount. Implantologists completely monitor the primary stability by synchronizing the above factors. The primary stability is unique and having singular expression is considered as the "password of Implant Integration Account." If the primary stability is good, implant can be loaded quickly and to the maximum.

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Dental implants have been shown to be an excellent method for replacing natural teeth. Dental implants like natural teeth can be affected by microorganisms. Various terms have been proposed to describe inflammation around dental implant. The ones that are commonly used include peri-implantitis and peri-implant mucositis. Studies were conducted that described the bacteriology of dental implants. Most studies reported that the microbiota associated with stable implants is similar to the one seen in periodontal health. Similarly, bacteria associated with failing implants have also been studied. These studies predominantly showed that the bacteria associated with failing implant are similar to the ones seen in periodontal disease. One should be very cautious in placing dental implants in subjects with significant periodontal disease as there is a risk for failure. Implants are not immune for infections. The present review briefly describes the bacteriology associated with stable and failing implants.

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Purpose: Patients with moderate to severe atrophy challenge the surgeon to discover alternative ways to use existing bone or resort to augmenting the patient with autogenous or alloplastic bone materials. The objective of the following study was to review the published literature to evaluate treatment success with zygomatic implants in patients with atrophic posterior maxilla. Study Selection: Medline/PubMed searches were conducted using the terms atrophic maxilla, zygomatic implant, zygomatic bone, grafts, maxillary sinus, as well as combinations of these and related terms. The few articles judged to be relevant were reviewed. Results: Based on the current literature review, zygomatic implants show excellent survival rates (>90%) and a low incidence of complications. Conclusion: With proper case selection, correct indication and knowledge of the surgical technique, the use of zygomatic implants associated with standard implants offers advantages in the rehabilitation of severely resorbed maxillae, especially in areas with inadequate bone quality and volume, without needing an additional bone grafting surgery, wherefore shortening or avoiding hospital stay and reducing surgical morbidity.

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Purpose: The pattern of entry of mental nerve into the mental foramen after its emergence from the inferior alveolar nerve bundle is an important presurgical landmark in the mandibular premolar region. Various patterns of entry of mental nerve have been identified. As panoramic radiographs are routinely used in presurgical evaluation, the present study was undertaken to evaluate the various entry patterns of mental nerve into the mental foramen. Materials and Methods: Total 300 panoramic radiographs taken for routine diagnostic purposes were selected for the study. The radiographs were assessed independently by two observers and the position and the entry pattern of the mental nerve on the left and right side were recorded. The entry patterns recorded were categorized as straight, looping, or perpendicular. Results: The study revealed that the most common pattern of entry of mental nerve was a straight one accounting for a total of 79% on at least one side of the total radiographs examined, followed by the presence of an anterior loop on at least one side in 21% and perpendicular pattern on at least one side in 6% of the total radiographs examined. Conclusion: Panoramic radiography may not be a very reliable imaging modality for identifying the presence of anterior loop which needs to be determined for preoperative planning of surgical procedures in the mandibular premolar region. Other modalities, such as cone beam CT, can be used for better visualization of the area.

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Introduction: Dental implants are considered one of the best treatment options for completely or partially edentulous patients. But due to lack of knowledge and education many patients especially in the region of underdeveloped or developing countries do not opt for this. In current study the knowledge, attitude and awareness about dental implants was studied in a referral center and its outreach centers in Nepal. Purpose: To determine the status of knowledge, attitude and awareness about dental implants in a tertiary care hospital and its outreach centers. Materials and Methods: 192 patients were asked about dental implants using a standard questionnaire. Their response were recorded and analyzed statistically. Results: Among the respondents 52.6% were aware of implant therapy, however in specific knowledge only 24.5% could attribute the jaw as site for implant placement. It was also found that rather than dental professionals (17.7%), friends and acquaintances (30.2%) play a role in awareness. Conclusion: Within the limitations of this study limited knowledge and awareness about dental implants was noticed and role of dentists for the information is lacking in our part of world.

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Purpose: This in vitro study was to investigate the accuracy of two kinds of impression techniques (open and closed tray) with three impression materials (polyvinylsiloxane [PVS]/polyether [PE]/vinylsiloxanether [VSE]) on angulated implants. Materials and Methods: The reference model was a stainless steel die with six analogs placed at 0°, 10°, and 20° toward the center axis. Custom acrylic trays were made on a stone model replica of the reference die. A total of sixty samples of twenty each were made under each type of impression material. Each group was divided into open and closed tray groups. Two types of splinting were carried out in the open tray: Group 1 - with floss and pattern resin and Group 2 - with a plastic rod (coffee stirrer) and resin. Impressions were poured with Type IV stone to obtain experimental casts and were evaluated for positional accuracy by coordinate measuring machine in three dimensions (X, Y, and Z). Differences in measurements were analyzed using analysis of variance and Tukey's test. Results: The lowest mean deviation was found in casts made from open tray splinted with floss and resin. There was also a significant difference in the measurements of PVS, PE, and VSE. Conclusion: VSE impression material yielded more accurate casts than those of PVS and PE. Splinting with floss and pattern resin was found to be more accurate than stirrer and resin.

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Prosthetically driven implant prosthesis assures good aesthetics, function and more importantly hygiene maintenance enabling long time success. Accuracy in treatment planning and implementation of planned treatment is vital for this success. Following advancements that have occurred in treatment planning (virtual software) for implant prosthesis; an equal rise is to be expected in transferring the planned therapy to surgical fruition. In this regard, surgical templates have enabled clinician to deliver predictable surgical & prosthetic rehabilitation. Surgical guides have not only decreased the chances of iatrogenic damage of critical anatomic structures; they also increase the esthetic and functional advantages of prosthodontic-driven implant. Within the constraints of this article, the authors describes an over view of use of surgical guides in clinical situation. If clinician is considered a pilot, then surgical guide is his navigator.

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Implant overdenture (OD) is the common treatment modality for the rehabilitation of complete mandibular edentulism with dental implants. The purpose of this review was to collect the data regarding various factors contributing to the selection of implant OD design and to provide comprehensive guidelines for the clinicians in planning the OD design.

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Esthetics has taken a prime position in dentistry today.People are getting more diverged to tooth coloured materials for good esthetics.This article stresses on newer metal free implant materials which have been developed due to increased demand for improved esthetics and biocompatibility along with the preference among the general population for non-metal implant materials.

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Immediate implants are positioned in the course of surgical extraction of the tooth to be replaced. The percentage success of such procedures varies among authors from 92.7-98.0%. The main indication of immediate implantation is the replacement of teeth with pathologies not amenable to treatment. Its advantages with respect to delayed implantation include reduced postextraction alveolar bone resorption, a shortening of rehabilitation treatment time, and avoidance of a second surgical intervention. The inconveniences in turn comprise a general requirement for membrane-guided bone regeneration techniques, with the associated risk of exposure and infection, and the need for mucogingival grafts to seal the socket space and/or cover the membranes. The surgical requirements for immediate implantation include extraction with the least trauma possible, preservation of the extraction socket walls and thorough alveolar curettage to eliminate all pathological material. Primary stability is an essential requirement, and is achieved with an implant exceeding the alveolar apex by 3-5 mm, or by placing an implant of greater diameter than the remnant alveolus. Esthetic emergence in the anterior zone is achieved by 1-3 mm subcrest implantation. Regarding guided regeneration of alveolar bone, the literature lacks consensus on the use of membranes and type of filler material required. While primary wound closure is desirable, some authors do not consider it to be of great relevance.

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