Implant dentistry

Titanium is an ideal material for dental implants. Titanium is biologically inert; thus, it does not trigger foreign
body reactions. For an implant to have intimate contact with bone, the implant site must be prepared with a precise
technique. Implant placement kits include designated drills that are used in sequence to remove the bone as atraumatically as possible. Implant insertion is performed in accordance with the normal practices of aseptic surgery.
Limiting thermal damage requires using sharp dental implant drills run at very low speeds and providing copious
cooling irrigation. The goal is to not allow the temperature of the bone being cut to increase to greater than 47
C
(117
F) during implant site preparation.
Ideally, once inserted, the implant should have minimal movement while bone is allowed to biologically adhere
to the implant surface. This is achieved by limiting the amount of pressure placed on the implant while osseointegration is occurring. The primary (initial) stability of an implant at the time of placement depends on the nature of
the bone (Fig II-2). Cortical bone provides more primary stability than cancellous bone. An implant placed into
bone with a high percentage of cortical bone component will have greater primary stability and therefore be
less susceptible to movement during osseointegration. Engaging 2 cortical plates is another means of achieving
initial stability (Fig II-3). In contrast, an implant site that has a more cancellous nature will provide less primary stability, making the implant–bone interface more susceptible to occlusal and other forces. This difference is managed
clinically by having a period after implant placement when the implant is not loaded (no prosthesis is attached to
the implant). Such implants can be kept covered by soft tissue during this period and uncovered when sufficient
osseointegration is likely to have occurred (Fig II-4). In areas where implant primary stability is good, some clinicians will load the implant immediately after surgery