that a titanium cylinder fused together with the bone in the femur of a rabbit. He hypothesised that this fusion could be utilised in field of dental implants and placed the first dental implant made of commercially pure titanium in a human volunteer in 1965. This finding introduced the concept of osseointegration which forms the basis of today’s endo-osseous dental implants. Osseointegration became accepted as a worldwide phenomenon when the concept was launched at the Toronto World Conference in 1982. At around the same time, whilst Branemark was looking at a two-stage threaded implant, Schroeder and his group were independently evaluating the use of a one-piece root form implant made with a hollow design and a roughened surface (Figure 1.5a, b).
Figure 1.5 a, b: The Branemark two-piece implant fixture and the Shroeder one-piece hollow cylinder implant.
Since the introduction of osseointegration, in the late 1980s, as a predictable method of tooth replacement, growing confidence and predictability has led to the widespread use of dental implants moving from edentulism to partial edentulism including single teeth and those with extensive tissue and tooth loss usually seen in patients who have suffered traumatic injuries and congenital anomalies (e.g. Hypodontia). This progressive change has led to the focus changing from improving function to include aesthetics and psychological well-being alongside the need to address patient expectations.
Dental implantology continues to evolve with concomitant modification of implant screw designs, surfaces and techniques used for implant placement and restoration aimed at reducing integration healing times, optimising function and aesthetics alongside predictability. These changes have led to newer concepts for tooth replacement being considered which include the use of zygomatic implants in those with atrophic maxillae, the mini implants and the ‘All-on-Four’ concept whereby the teeth are extracted and implants placed and restored all on the same day. Additionally, the advent of digital technology has enabled clinicians and technicians to push this clinical envelop even further with digital systems being used for planning, surgical placement and restoration without any analogue interfaces being used. Whilst, we live in a fast-moving world driven by technology and systems geared to meet patient demands, the biological envelop in which we as clinicians have to work has seen little change and as clinicians we need to be cognizant of this challenge commonly referred to as ‘patient and site’ related factors.
Today there are in excess of 250 implant systems on the market with varying design features, many of which resemble either one or more features of the eight mainstream implant systems. Table 1.2 shows the development of different key implant systems since 1982.
Table 1.2 Some of the Mainstream Dental Implant Systems.
| 1977 | Branemark Implants |
| 1982 | Launch of Osseointegration |
| 1982 | Non-submerged implant system: ITICorevent implant system |
| 1985 | Biocon |
| 1987 | IMZ |
| 1989 | 3i |
| 1990 | Astra |
| 1999 | Straumann Synocta |
| Late 1990s | Frident (Frialit 2, Xive) |
| Early 2000 | Ankylos and similar |
| Mid-2000 onwards | Modification of the earlier implant systems with newer surfaces, shapes and designs |
Key Learning Points
Be able to describe the older systems, as patients may attend for treatment with these systems
Being able to recognise the older systems to assist with management
Be able to explain to patients possible problems and issues with infections
Be aware of challenges associated with evolution of the concept of dental implants
References
1 1 Abraham, C.(2014). A brief historical perspectice on dental implants, their surface coatings and their treatments. Open Dentistry Journal 8: 50–55.
2 2 Branemark, P.I. and Zarb, G.(1985). Tissue Integrated Prosthesis: Osseointegration in Clinical Dentistry. Quintessence Publishing.
3 3 Rajput, R., Chouhan, Z., Sindhu, M., Sundararajan, S., and Chouhan, R.(2016). A brief chronological review of dental implant history. International Dental Journal of Student’s Research 4 (3): 105–107.
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