The use of dental implants has revolutionized the treatment procedure for over last 25 years. Implants now have been widely accepted by patients as their treatment plan and have become a routine procedure by dental surgeons. Owing to the remarkable success, there have been various researches going on to find out factors responsible for the failure of implants. With the growing use of tobacco among patients, its ill effects on bone quality and quantity it arises a keen interest to associate effect on the success of implants. To establish a relationship between smoking and implant success and its long term survival and compare the result with non-smokers based on the literature. Relevant clinical studies and reviews published in English literature published between 1990 and 2012 were reviewed. The articles were located through EBSCO host and manually through the references of peer reviewed literature. Most of the literatures supported the fact that smoking is a prominent risk factor affecting the success of implants. Studies reported that implant failure and its complications associated are twice in smokers as compared to non-smokers. Literatures also revealed that maxillary implant are more affected than mandibular in smokers. Studies suggested that effects of smoking were reversible in smokers who followed the smoking cessation protocol prior to the procedure. Smokers have a greater chances of implant failure and more prone to the complications following implants and related procedures. Surgeons should stress on counseling of patient willing for implant for smoking cessations protocols.

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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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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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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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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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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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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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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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Overdenture treatment provides an esthetic and functional result that allows proper access for hygiene and maintenance. In addition, with their improved strength, zirconia ceramics may be used to restore removable partial denture abutments in areas previously limited to metal or metal-ceramic restorations. The electroforming process makes for a viable, convenient, and economic alternative to cast metal substructures. However, limited data are available on the use of telescopic crowns on implants. Compared with the use of fixed implant-supported dentures, this treatment modality may improve esthetics and oral hygiene access, reduce the need for implants, and provide sufficient denture support in cases where single abutments have failed. Furthermore, the high retention obtained with telescopic crowns leads to good mastication and phonetics.

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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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Morphology of the peri-implant soft tissue adjoining the implant components plays a pivotal role in displaying the implant esthetics. Creating an implant restoration that cannot be distinguished from the rest of the natural dentition is the ultimate goal. Second stage surgery is often overlooked and is considered non essential phase but actually could determine the health of the peri-implant tissue .This phase gives an excellent opportunity to preserve, reconstruct and even maneuver the soft tissue to optimize the soft tissue profile around the implant components. The article aims at enumerating the various modalities available to contour the soft tissue profile around implants and thus help the practioners in optimizing esthetics during second stage surgery.

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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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In the past few years, the prosthodontic educational and research focus evolved beyond traditional therapeutic approaches. This progress resulted from three major initiatives. First, materials research has simplified impression-making protocol and denture relining technique. Second, improved understanding of the role and particularly the limitations of mechanical analogs for the masticatory system (i.e., articulators). The third initiative, and the major research and educational catalyst, has been the technique of osseointegration, which has had a profound impact on research and education in virtually all our clinical endeavors. As a result, the consequences of an aging edentulous environment or a terminal dentition have been more successfully addressed than ever before and many clinicians even began to forecast the demise of the complete denture technique. Thankfully though, the initial euphoria resulting from the availability of implant-supported solutions has now ablated, and a more realistic assessment has emerged. In this article, emphasis more on correlation of senile osteoporosis and role of Vitamin D in relation to the success of oral implantology.

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Dental implants require healthy bone for successful osseointegration. However, bone health can become compromised by aging and/or the presence of underlying medical conditions. The severity and complications associated with these medical conditions usually indicate that they require medication for successful management. Some of these medications may undoubtedly exert effects on bone through direct or indirect mechanisms and, therefore, may also affect osseointegration. These include antihypertensive drugs, oral hypoglycemic agents/insulin, hormones (corticosteroid, thyroxin, and tamoxifen), and anti-resorptive agents including bisphosphonates and anti-angiogenic agents. Part two of this paper reviews the current knowledge regarding the effects of corticosteroids, thyroxin, and tamoxifen on the outcome of implant therapy.

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Dental implants require healthy bone for successful osseointegration. However, bone health can become compromised by ageing and/or the presence of underlying medical conditions. The severity and complications associated with these medical conditions usually indicate that they require medication for successful management. Some of these medications may undoubtedly exert effects on bone through direct or indirect mechanisms and therefore, may also affect osseointegration. These include antihypertensives, oral hypoglycaemic agents (OHAs)/insulin, hormones (corticosteroid, thyroxin and tamoxifen) and anti-resorptive agents including bisphosphonates and anti-angiogenic agents. Part One of this paper reviews the current knowledge regarding the effects of antihypertensives, OHAs and insulin on the outcome of implant therapy.

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Context: Marginal bone loss around implants still is difficult to avoid and the great influence of the size of the implant/abutment micro-gap on crestal bone level maintenance have been reported in the literature. The internal conical Morse taper connection has been demonstrated to be an effective system for minimizing inflammatory reactions and maximizing peri-implant bone stability. Aims: The primary aim of this study was to evaluate the marginal bone change around dental implants with a platform-switched (PS) Morse taper connection and a medium rough surface over a 4-year follow-up period. Settings and Design: The data for this study were obtained from the clinical records of a private periodontal practice exclusively in Periodontics and Implantology (Vicenza, Italy), treated by one EFP certified periodontist (C.S). The same operator (C.S) performed all the surgeries. Subjects and Methods: Marginal bone loss around PS Morse taper connection implants was retrospectively analysed on standardized radiographs after 1 year and 4 years from the prosthesis connection. Statistical Analysis Used: The statistical unit of observation was the single implant. The influence on MBC of the number of implants for the same patient was tested using the Kruskal Wallis non parametric test. The main effects of the follow-up times (T1 and T4) and of each individual factor on MBC were evaluated using the non-parametric Wilcoxon and Mann-Whitney tests respectively. The interaction effect between follow-up time and each individual factor was graphically tested considering the MBC median values in the time level for each factor. Statistical significance was taken at the ≤0.05 level (two-sided). All analyses were performed using the STATA/IC for Windows, version 14.2. Results: Ninety implants were examined in fifty patients. Mean bone change was −0.06 ± 0.31 mm after 1 year and −0.2 ± 0.45 mm after 4 years. The cumulative survival rate at 4 years was 100%, and a low prevalence of implants with clinical signs of mucositis (12.2%) or peri-implantitis (1.1%) was reported. Conclusions: In implants where the prosthesis is correctly place and the patient are compliers to their maintenance therapy, the contemporary presence of a Morse taper connection and a switching platform seems to offer good results for the maintenance of peri-implant bone in the short and medium term.

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Ridge resorption is unavoidable sequelae of tooth extraction, which leads to soft and hard tissue deficiencies and formation of black triangles. Pedicled grafts inherently have advantage of intact vascular supply over free conventional grafts. A vascularized interpositional periosteal-connective tissue (VIP-CT) graft comprises pedicled connective tissue which is rotated anteriorly to the recipient site. It maintains intact vascular supply thus minimizes chances of graft necrosis and the amount of graft shrinkage. The objective of this case series was to achieve stable, esthetically pleasing pontic site using VIP-CT graft in the anterior maxillary region. In the present case series, the pontic site was developed successfully in three patients having ridge deficiency using a modified approach of VIP-CT. After soft-tissue augmentation, the site was altered by placing a cantilevered provisional ovate pontic. Once the emergence profile had achieved by molding the grafted area, permanent restoration using the adjacent implant as an abutment was delivered to patient. Esthetically pleasing anterior restorations, satisfying the patient's esthetic demands were obtained, and results were found stable up to a period of 9–24 months and thus can be concluded that modified VIP-CT is a predictable approach in anterior esthetic areas to enhance the emergence profile.

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The use of dental implants to treat edentulous maxilla and mandible is a well-accepted concept in modern dentistry. However, it is difficult and challenging in atrophic jaws. All-on-four implant concept is an alternative for resorbed jaws, as it obviates extensive bone grafting and waiting time and often provides immediate function. In our article, we describe the use of narrow platform implants (3.3 mm) for a moderate atrophic complete edentulous case with the above concept. The studies with narrow-diameter implants for complete reconstruction are inadequately reported. We followed our case for 3 years after the delivery of final prosthesis.

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Context: Implant-retained prosthodontic rehabilitation of the posterior maxilla is challenging owing to the compromised characteristics of the residual alveolar bone which might require several adjunctive surgical procedures to augment the available alveolar bone. Aims: This study aims to evaluate the outcome of rehabilitated maxillary posterior edentulous space with lateral disc implants in subjects with inadequate bone height. Subject and Methods: Forty patients with edentulous span in posterior maxilla with inadequate volume of bone were rehabilitated with lateral disc implant-retained prosthesis. Follow-up was undertaken at the end of 06, 12, 24, and 36 months by allocating the implants into the groups assessed according to the Misch Implant quality scale. A total of 6 Single disc, 22 Double disc, and 12 triple disc implants were placed. Statistical Analysis Used: Descriptive statistics. Results: At the end of 06 months, 96.6% were in Group 1, 3.3% were assessed to be in Group 2. At 12 months, 95% were in Group 1, 1.6% in Group 2, and 3.3% in Group 3. At 24 months, 95% were in Group 1, 3.3% were in Group 2, and 1.6% were in Group 3. At 36 months, 96.6% were assessed in Group 1 while 1.6% each was in Group 2 and 4. Conclusions: A clinical success of 98.4% has been established and is concluded that Lateral disc implants provide a viable alternative to the contemporary management protocol involving a sinus lift.

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Immediate implant placement is becoming a routine procedure in esthetic dentistry. The need for placing the implant immediately post extraction helps reduce the alveolar ridge resorption and also maintain good soft-tissue contours post placing the implant and during rehabilitation. However, a cause of concern occurs when the buccal cortical plate is thin, especially in the upper anterior region. This poses a direct implication in the maintenance of primary stability and buccal contour of both hard and soft tissues, thus compromising esthetics. The socket-shield technique (SST) is a recent advancement in placing immediate implant post extraction. The maintenance of the buccal root section helps retain both the compromised buccal cortical plate and soft-tissue contour, thus providing a better esthetic profile. In view of the same, two patients were provided immediate implants with SST; one with immediate loading of implant and other with delayed loading method, and postoperative radiographic analysis was carried out to evaluate bone density around the implant.

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Statement of Problem: During the impression procedure, the implant's exact position in the oral cavity is transferred into the cast using impression post and implant analog. As the implant, analog is a lab component, it can be reused multiple times. Reuse of implant analogs may be desirable for both environmental and financial aspects. When implant analogs are reused, it is important to be assured that they are as accurate as new ones. Reusing of implant analog results in loss of precision which is the major key factor in the failure of implant prosthesis. Purpose of the Study: The purpose of the present in vitro study is to assess the effect of multiple reuse of implant analogs of three different materials (SS, Ti, Al) on the dimensional accuracy (external and internal diameter) of implant analogs and the marginal gap between analog and abutment by using two die materials at different time intervals (0, 3^rd, 6^th, 9^th, and 12^th). Materials and Methods: Three commonly used implant analog materials (stainless steel, titanium, and aluminum) and two type – IV die stone materials (Kalrock and Zhermack elite) are used to make the samples. A total of sixty implant analogs (20 each), sixty corresponding abutments (20 each) and 720 screws (240 each) were taken, which includes stainless steel, titanium, and aluminum manufactured by Adin, Genesis, and Equinox/Myriad plus, respectively. Addition silicone (light body consistency) was used to make an impression for the internal thread of implant analogues. The obtained samples are tested for external diameter and internal diameter of implant analogues, the marginal gap between analogue and abutment while reusing the implant analogues at the interval of times (0, 3^rd, 6^th, 9^th, and 12^th) using a stereomicroscope at ×50. Here the measured values at “0” interval were considered as the control group. The values obtained were statistically analyzed using the one-way ANOVA, independent t-test, and dependent t-test for multiple comparisons. Results: Based on the results obtained, there was no change in the external diameter of three materials of implant analog in both die materials. There was an increase in the internal diameter of implant analogs in which the aluminum material exhibits more increase from 0 to 12^th interval, and there was an increase discrepancy in the marginal gap between implant analog and abutment in which the aluminum material has more increase from 0 to 12^th interval followed by the stainless steel and titanium implant analogs in both die materials. In between the two die materials, no significant difference was observed in all three parameters. Conclusion: From the study, the following inferences are drawn: that titanium implant analogs can be used more than three times but not more than six times, stainless steel implant analogs can be used for not more than three times, and the aluminum implant analogs can be used for one time only. Hence, among the three materials, titanium implant analogs were most efficient for reuse. Clinical implications: Micromovements of the abutment screw due to discrepancy or loss of surface details of threads of implant analog leads to micro-leakage and bacterial infiltration due to marginal gap discrepancy which further causes increased inflammation at the connection level contributing to a marginal bone loss that may affect the long-term success of implant prosthesis/implant.

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Surgical guides (SGs) have been commonly used in full-mouth rehabilitation and numerous advances have been adopted in their development. However, they have been restricted to implant placement and are later rendered useless. They further add to the burden of biological waste management following their limited use. The quantum of technologies and materials used to make us ponder if they can be used further. This article establishes different ways of using SG in different stages of prosthetic phase of treatment by demonstrating the procedures clinically. It gives us an insight into how the guides can be used for implant localization and exposure during the secondary surgical phase and also during impression making, thereby enhancing the treatment outcome.

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Background: Understanding the changes in bone density after insertion of dental implants and their relation to immediate/early loading is essential to achieving improvements in their survival rate. Histological investigations of the bone bed in humans are limited, which in turn hampers opportunities to deepen knowledge about the remodeling process around dental implants. Purpose: The aim of this pilot study was to comparatively evaluate the bone density changes around root-form, threaded collar, two-piece endosseous implants at three different levels as influenced by early and conventional protocols using cone-beam computed tomography (CBCT). Methodology: Twenty implants were placed in 20 patients who were randomly assigned to two groups. Group A (n = 10 implants, 10 patients) received conventional loading protocol and Group B (n = 10 implants, 10 patients) followed early loading protocol following implant placement. Bone density changes were evaluated and compared as influenced by early and conventional protocols using CBCT (gray values).The gray values were measured at the apical level, middle region of radiological implant length, and at the crestal level. The measurements were made immediately (T0) and 36 weeks (T1) post implant placement. Results: Intergroup comparison of bone density changes was done between Group A (conventional loading) and Group B (early loading) from immediate post implant placement to 36 weeks post implant placement follow-up. From immediate post implant placement to follow-up, significant difference was seen in bone density of Group A and Group B at apical and middle levels as P < 0.05, but at crestal level, no significant difference was seen. Conclusion: Under the conditions of this study, early loading significantly densified more bone as compared to conventional loading. Further studies are required to determine CBCT gray values and its correlation with computed tomography Hounsfield units for quantification of the bone.

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