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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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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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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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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As the practice of dental implantology keeps growing exponentially worldwide, implantologists face an ever-increasing challenge to manage peri-implant diseases and complications. At present, the approaches to diagnose, classify, and treat peri-implant diseases are not uniform, standardized, or systematic. To address these limitations, a classification for peri-implant diseases and conditions was presented in the Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions in 2017 organized by the American Academy of Periodontology and European Federation of Periodontology. Since its inception in 2017, this comprehensive classification system has become the new standard of clinical practice around the world. The article provides an overview and description of peri-implant diseases, their classification criteria, diagnostic techniques, and management approaches based on the 2017 Classification System. The flowcharts and decision trees presented can guide implantologists on how to deal with implant complications, in particular peri-implant diseases, including peri-implant mucositis, peri-implantitis, and implant soft- and hard-tissue deficiencies. Future long-term studies in this area are definitely needed to establish the effectiveness of various treatment approaches.

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Introduction: Implant restorations should endure a variable range of forces over a long period of time. Some commercial brands offer the implant together with an accessory called “implant mount” or “implant holder,” which might be used as a temporary abutment. However, scientific literature in the use of implant holders as abutments for restorations is scarce. Objectives: The purpose of this in vitro study was to compare the load at which implant holders of Implant Direct^® and Zimmer^® fail under static compression after being subjected to fatigue, and to compare the gap produced between the implant–holder complexes after dynamic loading. Materials and Methods: The test protocol was based on the recommendation of ISO 14801. Five implant–implant holder assemblies of each brand were subjected to dynamic loading. A load of 250 N was applied at 5 × 10⁶ cycles and at 15 Hz stress frequency (Eden Prairie, MN, USA). The gap (μm) at the interface was measured postfatigue using scanning electron microscopy (S-3700N, HITACHI, Japan), and afterward, static loading was applied and the maximum load (N) after the point of failure was established. Implant–definitive abutment complexes were used as controls. Data were analyzed by means of a central tendency measurement test Mann–Whitney U-test (nonparametric). Results: There was no difference between both the implant holder groups (P ≤ 0.05); however, a slight trend of greater resistance was observed for the Zimmer^® group. The gap in the interface was greater for Implant Direct^® implants, but the difference was not statistically significant. Conclusion: No significant differences were found in terms of the maximum load under compression or the interface gap after the dynamic loading in the two experimental groups.

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Aim: The aim of this study is to evaluate the radiographic assessment of alveolar bone loss around customized root analog zirconia implants placed in fresh extraction sockets using the cone-beam computed tomography at predetermined intervals. Subjects and Methods: The present study comprised twenty individuals all above 18 years with at least one tooth indicated for extraction. The twenty participants were considered in a single group who underwent single tooth extraction followed by the placement of root analog zirconia implant after 7 days which was fabricated using computer-aided design and computer-aided manufacturing technology. The participants were evaluated radiographically using Cone-Beam Computed Tomography (CBCT) at predetermined intervals: • Within 48 h of implant placement (CBCT I) • At the time of composite crown cementation on zirconia implant after 4 months of placement (CBCT II) • After 4 months of composite crown cementation (CBCT III). The alveolar bone loss was measured on all the four surfaces of the implant. CBCT was used only for the required area so to avoid total radiation exposure to the patient. Statistical Analysis Used: The survival of dental implants was computed using the Kaplan–Meier method. The comparison of the mesial, distal, buccal, and lingual bone height at 3 different time intervals was analyzed using the repeated-measures analysis of variance. Results: Radiographic assessment of alveolar bone loss around customized root analog zirconia implants placed in fresh extraction sockets in predetermined time interval using the cone-beam computed tomography (CBCT) was taken to be statistically significant (P ≤ 0.05). Conclusions: An innovative technique for immediate replacement of extracted tooth using customized Zirconia root analog implant was introduced. In future, long-term evaluation with more sample size is necessary to assess the success and survival of implant placed using this technique.

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Context: Implant-retained prosthodontic rehabilitation of the posterior maxilla poses a unique challenge due to deficiency in bony characteristics in many cases, thereby requiring elaborate adjunctive surgical procedures to aid in implant placement. Aims: We aimed to evaluate the efficacy of hybrid implants in the prosthodontic rehabilitation of edentulous posterior maxilla. Subjects and Methods: Prospective clinical evaluation of 27 patients (30 implants) rehabilitated using hybrid implants at 1 and 4 weeks after implant placement and 3, 6, and 12 months after functional loading was conducted. Statistical Analysis Used: Descriptive statistics were used for statistical analysis. Results: The average pain score on the Visual Analog Scale was 4.53 and 0.76 at the end of 1^st week and 4 weeks. Four implants (13.33%) were found unstable by 4 weeks. Two implants (6.67%) had exposure by 12 months. Less than 1 mm of mobility was seen in one implant (3.33%) by 3 months, four implants (13.33%) by 6 months, and five implants (16.67%) by 12 months. One implant (3.33%) developed mobility up to 2 mm by 12 months. Seven implants (23.33%) showed a probing depth of ≥5 mm but none more than 6 mm. Gingival recession of 2 and 3 mm was seen in two implants (6.67%) and one implant (3.33%), respectively, at the end of 12 months. The average bone loss was 0.17, 0.31, and 0.46 mm by 3, 6, and 12 months. The average rate of bone loss was 0.02 mm per month. Conclusions: Hybrid implant is an excellent alternative in patients with inadequate bone in the posterior maxilla precluding the requirement of maxillary sinus lift and grafting.

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Introduction: To accelerate the process of restoring dental implants, achieving primary stability is of prime importance for effective osseointegration. The various bone substitute materials such as autograft (golden standard), allograft, xenograft, and alloplast are used to improve the stability of an implant and also as an aid in bone formation. The use of bone cements, among the alloplast material, is a relatively new premise in oral implantology. These have been extensively used in orthopedic surgery to secure an implanted prosthesis and to replace or bind bone fragments, resulting from trauma, and to fill cavities. This article aims to review the literature for the use of bone cements in oral implantology and evaluate its prospective use in future to secure dental implants. Materials and Methods: PubMed search was carried out using keywords such as “Bone Cements,” “Oral Implantology,” “Cements Fix Implants with Bone,” and “Cements to Grow Bone.” Of the 1422 articles, 1015 were selected after eliminating the duplicates. After applying the inclusion and exclusion criteria, 383 abstracts were assessed for relevance, of which 17 full-text articles were selected. Five articles were excluded with reasons and 12 eligible articles were included in the systematic review. Results: Eight studies out of the 12 concluded that bone cement could be a viable alternative to allogenic or other graft materials tested. Four articles were inconclusive or showed no significant difference. However, the quality of available evidence was poor as 10 out of the 12 studies were animal trials and 2 were in vitro studies. Due to considerable heterogeneity of data, meta-analysis could not be done. Conclusion: Bone cements can be considered a possible alternative to the existing graft materials. However, further research including controlled trials with human subjects needs to be undertaken to establish its potential.

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Dental implants play a pivotal role in the rehabilitation of missing teeth and have been revolutionary in the field of dentistry. However, clinical and biological complications may be associated with dental implants and may occur primarily due to bacterial infection in the soft and hard tissue around the implants. These are known as peri-implant mucositis and peri-implantitis. Management of peri-implant and peri-apical infections, so as to achieve re-osseointegration of the exposed implant surfaces, is often challenging for the treating dentist. Various treatment modalities of peri-implant diseases include nonsurgical and surgical therapy. This case report describes successful management and a 2-year follow-up of a case of advanced peri-implantitis using a protocol that involves thorough debridement, decontamination, and guided bone regeneration.

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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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The peri-implant tissue remodeling just after implant surgery forms a coagulum that occupies the space between mucosa and implant. This is invaded by neutrophils and a barrier forms around implant consisting of dense fibrin network. In another 2 weeks post surgery, it is replaced by connective tissue and vascular structures. In the crestal area, the proliferation of epithelium takes place and forms a junctional epithelium. The barrier epithelium around the implant matures in 6–8 weeks. Formation of biological width begins when the implant gets exposed to the oral environment. This could be through healing screw or prosthetic abutment depending on connection to the implant. It is said that thin or thick tissues have different approaches to healing as the blood supply is varied. Flap is raised during the second stage of implant surgery damaging the blood supply of surrounding tissues. Thin mucosa present around the implant crestal area might lead to more bone loss but not thick tissues as more blood vessels are present here. Bone turnover can lead to crestal bone loss up to 3.2 mm apical to soft-tissue margin. The thickness of the tissues may be a recognized biological factor that might lead to crestal bone stability. In this report, we describe three cases where bone remodeling was camouflaged by thick soft tissues around implant-supported restorations.

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The immediate load procedures in immediate implants have become routine in dental offices because of high esthetics demand by clients. Nevertheless, in some cases, it is not possible to perform immediate load procedures. The purpose of this article was describing the technique for creating a customized healing abutment to preserve the contours of peri-implant soft tissues and maximize peri-implant esthetics in immediate implants when it is not possible to place provisional crowns directly onto the implant. This technique is simple and easily performed and is an interesting alternative treatment for maintaining the stability of the peri-implant tissues while the osseointegration time.

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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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