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GENERAL REVIEW
B. Guillaume a,b,∗
a
Collège Français d’Implantologie (CFI), 6, rue de Rome, 75005 Paris, France
b
Groupe d’Études sur le Remodelage Osseux et les bioMatériaux (GEROM), IRIS-IBS Institut de biologie en
santé, Université d’Angers, CHU d’Angers, 49933 Angers cedex, France
KEYWORDS Summary A high number of patients have one or more missing tooth and it is estimated that
Dental implants; one in four American subjects over the age of 74 have lost all their natural teeth. Many options
Implantology; exist to replace missing teeth but dental implants have become one of the most used biomaterial
Dental prosthesis; to replace one (or more) missing tooth over the last decades. Contemporary dental implants
Maxillo-facial made with titanium have been proven safe and effective in large series of patients. This review
surgery; considers the main historical facts concerned with dental implants and present the different
Bone graft critical factors that will ensure a good osseo-integration that will ensure a stable prosthesis
anchorage.
© 2016 Elsevier Masson SAS. All rights reserved.
Résumé Un nombre élevé de patients ont une ou plusieurs dents manquantes et on estime
MOTS CLÉS qu’un Américain, âgé de plus de 74, sur quatre a perdu toutes ses dents naturelles. Plusieurs
Implants dentaires ; options existent pour remplacer les dents manquantes, mais les implants dentaires sont devenus
Implantologie ; l’un des biomatériaux le plus utilisé pour remplacer une (ou plusieurs) dents manquantes au
Prothèses dentaires ; cours des dernières décennies. Les implants dentaires actuels sont composés de titane et se sont
Chirurgie avérés sûrs et efficaces dans de larges séries de patients. Cette revue présente les principaux
maxillo-faciale ; faits historiques concernant les implants dentaires ainsi que les différents facteurs critiques
Greffe osseuse qui assureront une bonne ostéo-intégration, permettant une fixation stable de la prothèse.
© 2016 Elsevier Masson SAS. Tous droits réservés.
Introduction
http://dx.doi.org/10.1016/j.morpho.2016.02.002
1286-0115/© 2016 Elsevier Masson SAS. All rights reserved.
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Dental implants 3
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Figure 4 Different aspects of the surface of dental implants viewed by scanning electron microscopy. A. Original machined implant
from Nobel Biocare with a smooth surface. B. Rough surface of an ETK implant which was sandblasted and acid-etched. C. Surface
of a Ti UniteTM implant from Nobel Biocare with a thick layer of titanium creating smooth asperities. D. High magnification of an
implant surface after sandblasting and HF acid etching. E. Surface of a TA6 V implant whose surface was sandblasted with corundum
particles. F. Surface of a titanium implant, which was sprayed with titanium beads with a plasma torch.
Différents aspects de surface des implants dentaires vus en microscopie électronique à balayage. A. Implant original usiné par
Nobel Biocare et présentant une surface lisse. B. Surface rugueuse d’un implant ETK qui a été sablé et mordancé à l’acide. C.
Surface d’un implant TiUniteTM de Nobel Biocare présentant une couche épaisse d’oxyde de titane créant des aspérités et des
porosités douces. D. Analyse à fort grossissement de la surface d’un implant qui a été sablé et mordancé par l’acide fluorhydrique
HF. E. Surface d’un implant dentaire en TA6 V dont la surface a été sablée avec des particules de corindon. F. Surface d’un implant
en titane qui a été recouvert de billes de titane projeté une torche à plasma.
Indeed, a residual mobility will not permit the stability of expansion of the peri-implant osteolysis of the alveolar
the implant and it will be necessary to remove it (Fig. 5). bone. As previously mentioned, the surgical protocol is now
At the end of surgery, two possibilities exist: (i) Bury no more strictly based on the Brånemark’s concepts pro-
the implant on bone for several months under the sutured posed thirty years ago. The timing for loading the implant
gingiva. Proponents of this method consider that such a has raised a considerable amount of articles and can be done
quiescent condition is more favorable without mechanical in several ways. It has been advocated that after implant
stress, risk of infection or epithelial invasion. (ii) Other placement, the surgical site should be left undisturbed for
authors prefer to immediately place the implant collar 4 to 5 months to allow a good wound healing between the
inside the oral environment by fixing a cover screw at the implant and the bone. This period is in accordance with bone
top of the implant until the impression procedure. Overall, cell physiology: osteoblasts elaborate woven bone rapidly
there is no consensus on the superiority of either of these to ensure the primary bone anchorage and this bone (being
two methods. As mentioned above, the concept of osseo- of poor quality) is secondarily remodelled and replaced by
integration is defined by the tolerance into the living bone lamellar bone which possesses a better quality [15,17]. More
of a foreign and inert body (the titanium implant) which recently, other authors have proposed the concept of imme-
will provide a sustainable and stable bone anchor. An X-ray diate loading of the implant to support provisional fixed
follow-up must confirm the absence of peri-implant osteol- crowns or prosthesis [30,31]. Immediate loading is the place-
ysis (appearing as a radiolucent edging around the implant). ment of a temporary prosthesis on the implants just after
Osteolysis is also associated with a painful inflammatory the implant placement. The benefit of this protocol is to
reaction and an implant mobility. This situation requires immediately correct the tooth loss and to favor maturation
removal of the implant as soon as possible to limit the of the gingival tissues at the implant’s base. The obvious
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Figure 5 Implant placement in clinical practice. A. X-ray of the edentulous mandible. B. CT-scan section of the mandible showing
the alveolar bone. A dot has been placed on the dental canal. C. Clinical aspect of the edentate region. D. Drilling with calibrated
devices; E. Implant placement. F. The implant has been screwed with its healing screw.
Détail de la mise en place d’un implant dentaire en pratique clinique. A. Radiographie panoramique de la région édentée à
implanter. B. Coupes tomographiques de la région montrant la présence de l’os alvéolaire. C. Aspect clinique de la région édentée
avant la pose d’implant. D. Forage avec des mèches calibrées. E. Mise en place de l’implant. F. L’implant est en place avec sa vis
de couverture.
disadvantage of this procedure is that loaded implants are done in adulthood except in case of congenital maxillo-facial
exposed to the chewing force immediately after implan- syndrome [32,33].
tation, a situation that may delay osseo-integration. This
protocol is not the subject of a consensus and the exact defi-
nition of immediate loading may vary from same-day implant In the adult patient and in the elderly
loading to a shortly-delayed loading (usually three days to
one week), making published results difficult to compare. Periodontal diseases are frequent and are characterized by
an alteration of the tooth supporting tissues; changes in the
desmodontal ligament result in both a reduction of bone vol-
Indications ume, tooth mobility and finally a tooth loss at medium-term.
In some cases, it can be a congenital periodontitis but usually
local factors are the rule (poor dental or oral hygiene, dental
Replacement of missing tooth is nowadays common in the
plaque, untreated tooth decay, gingivitis, diabetes, heavy
odonto-stomatological practice.
smoking or alcoholic consumption). Implants can therefore
replace the missing tooth roots, however, the clinical situa-
tion needs to be carefully analyzed in case of a periodontal
In the young patient disease.
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Complete edentulism
It can interest one or both dental arches and causes a
profound change of the masticatory function. There are
a number of criteria that will influence the therapeutic
choice. It can be either fixed prosthetic systems (bridge
with three or more crowns) or removable appliances with
enhance retention. These treatments associate surgery
and prosthetics and are influenced by several factors:
anatomical conditions (e.g., the amount of bone available,
especially in the posterior region), occlusal factors (e.g.,
the inter-arch volume available to allow any type of pros-
thesis), the general condition of the patient (considering it is
a more or less long surgery), additional surgery (bone graft,
local conditions of the harvesting site in case of autograft)
and the financial aspect which is not supported by the public
healthcare system in France (Fig. 7).
Contraindications
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Conclusion
Disclosure of interest
Figure 9 Peri-implantitis. A. Clinical aspect of an implant
with advanced peri-implantitis and bone loss. B and C. X-ray The author declares that he has no competing interest.
images depicting loss of supporting bone around the implant, a
radiolucent area at the periphery of the implants (green arrow).
Péri-implantite. A. Aspect clinique d’un implant avec péri-
Acknowledgments
implantite avancée et large perte osseuse vestibulaire. B et
C. Radiographies montrant une zone radio transparente à la Many thanks to Mrs. Lechat for secretarial assistance.
périphérie des implants correspondant à une lyse osseuse.
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