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Slide1: 

Kamolpan Nuangsri Prosthodontics Department Prince of Songkla U. Implant Materials

What is Implant ?: 

What is Implant ? What is Implant ? What is Implant ?

Implant: 

Implant Any object or material, such as alloplastic substance or tissue, which is partial or completely inserted or grafted into body for therapeutic, dianostic, or experimental purposes ( the grossary of prosthodontic term)

Dental implant: 

Dental implant A prosthetic device of alloplasttic material implanted into the oral tissue beneath the mucosal or/and periosteal for s fixed or removable prosthesis.

Implant material: 

Implant material I. Bone Grafting materials II. Dental implant materials

Biocompatible :- 3 basic requirements: 

Biocompatible :- 3 basic requirements 1. It must be nontoxic and noncarcinogenic. 2. It must not interfere with the healing of host tissue that were damaged during their surgical insertion. 3. Host tissues should tolerate the biomechanical properties of this material.

Degree of Biocompatibility: 

Degree of Biocompatibility I. Biotolerant II. Bioinert III. Bioactive

Biotolerant :- : 

Biotolerant :- Implants seperated form adjacent bone by a soft tissue layer along most of the interface Distance osteogenesis Characteristics of reactions of bony tissue

Biotolerant :-: 

Biotolerant :- Components of material (eg. Ions or monomer ) are leaching into the surrounding tissue Influcence of material on adjacent tissue Irritation of the differentiation of precursor cell into osteoblasts : formation of collagen-rich interlayer Result Stainless steels , PMMA , Co-Cr-Mo , Co-Cr-Mo-Ni alloy

Bioinert: 

Bioinert Direct contact to bony tissue Contact osteogenesis Characteristics of reactions of bony tissue

Bioinert: 

Bioinert “ Nothing goes into solution”. Leakage of ion and other matter form the surrounding tissue below deductibility by cells and without systemic effects Strong and fast absorption of molecules form body fluids so that the surface of the implant is covered completely (coated) by the body’s own matter Influcence of material on adjacent tissue

Bioinert: 

Bioinert No biochemical influence on cell diffrentiation and proliferation No biochemical information to an implant No enzyme reactions, the implant is “ camouflaged” against the host’s immune system No foreign body reaction Result Alumina ceramic, Zirconia ceramic, Ti, Tantalum, niobium, carbon

Bioactive: 

Bioactive Bonding to bony tissue Bonding osteogenesis Characteristics of reactions of bony tissue

Bioactive: 

Bioactive Deposition of collagen or HA form the surrounding bone onto the surface of the implant Bond formation in sense of a gluing effect ( without the necessity for addition of a glue) Influcence of material on adjacent tissue Result Calcium phosphate-containing glasses, glass-ceramics, ceramics

Bone Grafting Material: 

Bone Grafting Material

Bone Formation: 

Bone Formation

Mechanism of bone grafting: 

Mechanism of bone grafting Osteogenesis Osteoconduction Osteoinduction

Osteogenesis: 

Osteogenesis is the formation and develoment of bone an osteogenic graft is derived form or conposed of tissue involed the growth or repair bone Osteogenic cells differentiate and the different phases of bone regeneration, encourage bone formation in soft tissue, or active quicker bone growth

Osteoinduction: 

Osteoinduction is the act or process of stimulating osteogenesis It can be used to enhance bone regeneration, and bone may even grow or extend into anarea where it is not normally found

Osteoconduction: 

Osteoconduction Provides a physical matrix or scaffolding suitable for deposition of new bone an conductive to bone growth allow bone apposition form existing bone, but they do not produce bone formation when placed in soft tissue

Type of graft material: 

Type of graft material 1. Autogeneous bone 2. Allografts 3. Alloplasts

Autogeneous Bone: 

Autogeneous Bone an organic autologous material utilizes osteogenesis, osteoinduction, osteoconduction the best grafting material from intraoral, extraoral Disadv. Need for second operative site possibility of not being to obtain a sufficient amount of bone

Allografts: 

Allografts are obtained from other individuals of the same species are obtained from cadavers, living-related persons, living-unrelated person from tissue bank osteoinduction, osteoconduction

Types of Allografts: 

Types of Allografts Frozen Freeze-dried (FDBA) Demineralized freeze-dried (DFDBA) Irradiated bone (2.5 million rads)

FDBA VS DFDBA: 

FDBA VS DFDBA Reduces the antigenicity DFDBA removes the mineral phase and exposes the underlying bone collagen and purportedly, growth factors, BMPs FDBA hardens faster than DFDBA

Slide27: 

FDBA

Avd. of allografts: 

Avd. of allografts Ready availability elimination second surgery reduced anesthesia and surgery time decrease blood loss fewer complication Associated with the use of tissues from another individual immune respones Disadv.

Alloplasts: 

Alloplasts Which can be natural or synthetic material Typically are only osteoconduction Variety of textures, sizes, and shapes crystalline or amorphous granular or molded

Characteristics of ideal synthetic bone substitute: 

Characteristics of ideal synthetic bone substitute be compatible serve as a scaffold for new bone formation be resorbable in the long-term and have potential for replacement by host bone be radiopaque be easy to manipulate

Slide31: 

Not support growth of pathogens be hydrophilic be available in particulate and molded forms be microporous be ready available be nonallergenic have high compressive strength

Type of Alloplastic Bone Graft material: 

Type of Alloplastic Bone Graft material I. Ceramic :- HA, TCP II.Deorganified bovine bone:- Bio-Oss III.Calcium Carbonate :- Bio Coral IV.Biocompatible composite polymer :- Bioplant HTR V.Bioactive glass ceramic :- Bioglass

Ceramic Grafts: 

Ceramic Grafts Hydroxyapatite (HA) [Ca10(PO4)6(OH)2] Tricalcium phosphate (TCP) [Ca3(PO4)2]

Hydroxyapatite (HA): 

Hydroxyapatite (HA) 60-70 % in bone 98 % in enamel Ca : PO4 = 10:6 biocompatibility resorbable crytal, powder, granue, block

HA product: 

HA product Nanocrytals 20- 130 nm

HA powder: 

HA powder Av. Diameter of 5 um micro-spheres porous 100 nm

HA Granules: 

HA Granules Sizes 600-800 um, 800-1400 um,1400-3350 um dense / porous

HA Block: 

HA Block micro, macro porosity sizes 100-500 um shapes 1/2”, 1”, 2”

Ha product: 

Ha product Calcitete HA 2040 (dense particle) Osteogra/N (natural porous) Osteograf/LD (low density,synthetic) OsteoGen(porous,crystal) Interpore 200 ( a mixture of HA and TCP, natural macroporous, granule ,block)

Tricalcium Phosphate (TCP): 

Tricalcium Phosphate (TCP) Is not a natural component of bone mineral provide a physical matrix that is suitable for the deposition of new bone resorbable e.g. SynthoGragf (dense, small partical) Augmen (dense and larger partical)

II.Deorganified Bovine Bone: 

II.Deorganified Bovine Bone

Bi0-Oss: 

Bi0-Oss Is an anorganic bone (bovine) that is chemically treated to remove its organic component highly osteoconductive rapid revitalized through new blood vessels slowly resorbing matrix structure

III. Calcium Carbonate: 

III. Calcium Carbonate Resorbable, porous a natural coral in the from of aragonite more than 98 % CaCO3

IV. Biocompatible Composite Polymer: 

IV. Biocompatible Composite Polymer

Slide45: 

Is a patented nonresorbable co-polymer derived from a proprietary process combining polymethylmethcrylate(PMMA) and polyhydroxyethylmwthacrylate (PHEMA).Additionally,it contains very thin layers of barium sulfate (for radiopacity) and calcium hydroxide/carbonate which is the direct interface with bone. What is Bioplant ?

HTR product: 

HTR product

HTR Morphology: 

HTR Morphology

HTR Morphology: 

HTR Morphology

HTR Composition: 

HTR Composition

HTR Bone Regeneration I: 

HTR Bone Regeneration I

HTR Bone Regeneration II: 

HTR Bone Regeneration II

HTR Clinical application: 

HTR Clinical application

Slide55: 

Biological compatible Osteoconduction radiopaque easy to handle microporous hydrophilic dose not support growth of oral pathogen

V. Bioactive glass ceramic: 

V. Bioactive glass ceramic e.g. Bioglass composed of calcium sults and phosphate in similar proportions as found in bone and teeth, as well as sodium salts and silicon. Amorphous material no porous

Composite Grafts: 

Composite Grafts Combine different material to improve the outcome of grafting procedure e.g. Autogeneous and HA

Slide58: 

Dental Implant Materials

Dental Implant Materials: 

Dental Implant Materials Metal Stainless steel CoCrMo alloy (Vitalium) cp Ti Ti alloy Polymer : Polymethymethacrylate Ceramic

Osseoingration VS Fibrointegration: 

Osseoingration VS Fibrointegration

Osseointegration: 

Osseointegration Some direct bone contact of living bone with the surface of an implant

Fibrointegration: 

Fibrointegration Tissue-to-implant contact with healthy dense collageneous tissue between the implant and bone

Metal Dental Implant: 

Metal Dental Implant Commercial Pure Titanium (cp Ti) Titanium alloy (TI-6Al-4V) Stainless Steel CoCrMo alloy (Vitalium)

Cp Ti and Ti alloy: 

Cp Ti and Ti alloy First met 200 years ago natural from, TiO2, FeTiO3 named by Dr Wilhelm Kroll ‘father of the titanium industry’ mainly used in aircraft engines and aircraft frames, Sport marine automobile used in medical such as artificial joint, prosthetic limbs First used as dental implant by Dr Branemark in 1968 excellent corrosion resistance, high strength, light weight A historical perspective

Composition of cp Ti and Ti alloy: 

Composition of cp Ti and Ti alloy ASTM grade I 0.03 0.20 0.18 0.10 0.015 - - balance ASTM grade II 0.03 0.30 0.25 0.10 0.015 - - balance ASTM grade III 0.05 0.30 0.35 0.10 0.015 - - balance ASTM grade IV 0.05 0.05 0.40 0.10 0.015 - - balance Ti6Al4V 0.05 0.25 0.13 0.08 0.120 5.5 3.5 balance Type N Fe O C H Al V Ti impurity limit (wt %)

Properties of Materials: 

Properties of Materials Ti grade I 102 240 170 24 4.5 Ti grade II 102 340 280 20 4.5 Ti grade III 102 450 350 18 4.5 Ti grade VI 104 550 480 15 4.5 Ti6Al4V 113 930 860 10 4.4 Cortical bone 18 140 - - 0.7 Dentine 18.3 52 - - 2.2 Enamel 84 10 - - 3 CoCrMo 240 700 450 8 8.5 Stainless steel 200 965 690 20 7.9 Modulus Tensile st. Yield St. Elongation Density (Gpa) (Mpa) (0.2 %) (%) (g/cc)

Physical and mechanical properties: 

Physical and mechanical properties Density (g/cm3) 4.51 4.43 18.3-19.3 4.47-9.5 Hardness (VHN) 130-210 350 125-240 270-350 Elongation(%) 15-24 10 10-18 1.1-2.4 Yield St 0.1%(Mpa)241-548 890 ~420 ~450-760 Melting point (F) 3035 3200 ~1650 ~2600 Co. thermal 11.4 11.8 14.7-15.6 14.1-16.3 exp.(in/C*10-6 Porperty Ti Ti6Al4V Au alloy NiCr alloy

Oxide of Titanium: 

Oxide of Titanium Tio, TiO2, Ti2O3 TiO2 best stable Oxide layer 10 A in milisecond 50-100 A in 1 minute pasivity cpTi and Ti alloy have same oxide

Biocompatibity: 

Biocompatibity Bioinert Osseointration High biocompatibility

CoCrMo alloy (Vitalium): 

CoCrMo alloy (Vitalium) High strength High wear resistance Biotolerance Fibrointegration

Ceramic: 

Ceramic Alumina (Al2O3) Polycrystalline Single crystal Carbon Pyrolytic Vitreous

Ceramic: 

Ceramic Poor tensile St. extremely brittle biocompatible bioinert, bioactive

Slide77: 

Conclusion

Conclusion: 

Conclusion 1. Biocompatible 2.Degree of biocompatible 3.Mechanical of bone grafting 4.Types of graft material 5.Dental implant materials 6.Osseointegration VS Fibroingration 7.cpTi and Ti alloy