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Available online at ajdhs.com 

Asian Journal of Dental and Health Sciences 
Open Access to Pharmaceutical and Medical Research 

Copyright  © 2022 The  Author(s): This is an open-access article distributed under the terms of the CC BY-NC 4.0 
which permits unrestricted use, distribution, and reproduction in any medium for non-commercial use provided the 

original author and source are credited 
 

 

 

Contemporary Trends in Dental Implants 

Sanyam Jain, Sani Soni, Shivani Lodhi, Rubeena Khan *, Anushree Jain, Basant Khare, Bhupendra Singh 
Thakur, Prateek Kumar Jain 

Adina College of Pharmacy, ADINA Campus Rd, Lahdara, Sagar, MP, 470001 

Article Info: 
_______________________________________ 
Article History: 

Received 13 Sep 2022      
Reviewed 08 Nov 2022 
Accepted 27 Nov 2022 
Published 15 Dec 2022 

_______________________________________ 
Cite this article as:  

Jain S, Soni S, Lodhi S, Khan R, Jain A, Khare B, 
Thakur BS, Jain PK, Contemporary Trends in 
Dental Implants, Asian Journal of Dental and 
Health Sciences. 2022; 2(4):48-54 

DOI: http://dx.doi.org/10.22270/ajdhs.v2i4.25   

_______________________________________

*Address for Correspondence:   

Rubeena Khan, Adina College of Pharmacy, 
ADINA Campus Rd, Lahdara, Sagar, MP, 470001 

Abstract 
___________________________________________________________________________________________________________________ 

A high number of patients have one or more missing tooth and it is estimated that one in four world 
subjects over the age of 74 have lost all their natural teeth. Many options exist to replace missing teeth 
but dental implants have become one of the most used biomaterial to replace one (or more) missing 
tooth over the last decades. Therefore, the use of dental implants is also a common practice. Although 
research on dental implant designs, materials and techniques has increased in the past few years and is 
expected to expand in the future, there is still a lot of work involved in the use of better biomaterials, 
implant design, surface modification and functionalization of surfaces to improve the long-term 
outcomes of the treatment. This paper provides a brief history and evolution of dental implants. It also 
describes the types of implants that have been developed, and the parameters that are presently used in 
the design of dental implants. Finally, it describes the trends that are employed to improve dental 
implant surfaces, and current technologies used for the analysis and design of the implants. 

Keywords:  Dental implants, History, Design, Surfaces, Osseointegration, Biopolymers.  

 

Introduction 

In our society of appearance, teeth must be white and the 
dentition harmonious. Teeth participate primarily as one of 
the main attributes of smile. When decayed, grey or blackish, 
they can scare and must be hidden. Today, patients are still 
suffering from this evil of another age confining to archaism. 
Total edentulism is the ultimate degree of the parodontal 
disease and is still observed nowadays1. A poorly treated 
decay, a genetic alteration of enamel or dentine (e.g., 
amelogenesis or dentinogenesis imperfecta) and a trauma are 
sufficient to lose a tooth. Fortunately, in most cases, a solution 
exists for a tooth replacement such as bridge, dental implant, 
pivot tooth or denture. The solution depends of the local 
conditions of the dental status and also of the financial aspect 
of the treatment. Uncemented endosseous implants have 
become a most valuable alternative to dental prostheses 
supported by remaining teeth or adjacent oral soft tissues. The 
method started in the late sixties. During the last decades, 
metallic implants have become the most frequently used 
treatment. Titanium is one of the most commonly used 
biomaterial in oral and maxillo-facial surgery. Excellent 
clinical results have been obtained with threaded titanium 
implants by pioneer workers2-4. After more than four decades, 
dental implantology is now a well-recognized therapeutic 
advance in the treatment of partial or complete teeth loss5. 
The technique is reliable and suppresses the use of fixed or 
removable dentures, which invariably alter the supportive 
adjacent teeth after a short or medium period. The 
sustainability of dental implantology is primarily based on the 
overall analysis of the patient’s clinical situation (periodontal 

condition, occlusion, available bone volume, general health 
condition) and the appropriate adaptation of surgical-
prosthetic options. The threaded implants currently available 
meet strict criteria of manufacturing and surgical procedures 
for their bone fixation and adaptability are now done 
according to specific prosthetic concepts. The pre-implant 
bone site is the most important point to consider in its ability 
to favor the implant osseointegration (i.e., primary bone 
anchorage of this metallic biomaterial) and its long-term 
stability. However, a reduced bone volume (constantly 
observed in the edentulous patient) impairs the placement of 
implants1; this has led to develop bone grafting techniques 
and the use of synthetic biomaterials6. Statistics provided by 
the American Association of Oral and Maxillofacial Surgeons 
show that 69% of adults ages 35 to 44 have lost at least one 
permanent tooth to an accident, gum disease, a failed root 
canal or tooth decay. Furthermore, by age 74, 26% of adults 
have lost all of their permanent teeth7. Therefore, the use of 
dental implants reveals that about 100,000-300,000 dental 
implants are placed per year, which approximates the 
numbers of artificial hip and knee joints placed per year8. 
Research on dental implant designs, materials and techniques 
has increased in the past few years and is expected to expand 
in the future9 due to the recent growth of the global market for 
dental implants and the rising in the demand for cosmetic 
dentistry. 

Historical Overview 

The history of dental implants can be traced back to ancient 
Egypt, where carved seashells and/or stones were placed into 
human jaw bone to replace missing teeth. Other documented 

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examples of early implants are those fabricated from noble 
metals and shaped to recreate natural roots10. Dental implants 
have a history of several centuries starting with the early 
civilizations more than 2,000 years ago in South and North 
America and regions of the Middle Asia and Mediterranean. 
Archeological findings have indicated that these civilizations 
replaced missing teeth using carved stone, shells, bones and 
gold11. Around 1930s, archaeological excavations in Honduras 
revealed that the Mayan civilization had the earliest known 
examples of dental implants, dating from about 600 AD, when 
a fragment of mandible with implants was found. The 
specimen had three pieces of shells carved into tooth shapes 
placed into the sockets of three missing lower incisor teeth. 
Later on, it was also observed that there was compact bone 
formation around two of the implants12,13.  In the middle Ages, 
dental implantation was performed by using allografts and 
xenografts. However, this practice didn’t become very popular, 
since it was identified as the reason for infectious diseases and 
even deaths12,14. Modern dental implant history starts during 
World War II when in the years of service in the army, Dr. 
Norman Goldberg thought about dental restoration using 
metals that were used to replace other parts of the body. Later 
on in 1948, in association with Dr. Aaron Gershkoff, they 
produced the first successful sub-periosteal implant13. This 
success formed the foundation of implant dentistry in which 
they were pioneers in teaching techniques in dental schools 
and dental societies around the world13. One of the most 
important developments in dental implantology occurred in 
1957, when a Swedish orthopedic surgeon by the name of Per-
Ingvar Branemark began studying bone healing and 
regeneration and discovered that bone could grow in 
proximity with the titanium (Ti), and that it could effectively 
be adhered to the metal without being rejected15. Therefore, 
Brånemark called this phenomenon ‘osseointegration’, and he 
carried out many further studies using both animal and 
human subjects. In 1965, he placed the first Ti dental implants 
into a 34-year-old human patient with missing teeth due to 
severe chin and jaw deformities. Branemark inserted four Ti 
fixtures into the patient’s mandible, and several months later 
he used the fixtures as the foundation for a fixed set of 
prosthetic teeth4. The dental implants served for more than 
40 years, until the end of the patient’s life. Branemark 
published many studies on the use of Ti implants, and between 
1978 and 1981, he cofounded a company for the development 
and marketing of dental implants. Branemark’s discovery had 
such a profound impact in dentistry that to the present day, 
over 7 million Branemark System implants have now been 
placed and hundreds of other companies produce dental 
implants15,16. In May of 1982, Branemark presented the results 
of his 15 years of human and animal research at the Toronto 
Conference on Osseointegration in Clinical Dentistry, and 
shortly after the conference, researchers from the United 
States were trained in Branemark’s methods in Sweden. In 
1982, the US Food and Drug Administration approved the use 
of Ti dental implants, and in 1983, Dr. Matts Andersson 
developed the Procera (Nobel Biocare, Zurich, Switzerland) 
computer-aided design and computer-aided manufacturing 
(CAD/CAM) method of high precision, repeatable 
manufacturing of dental crowns. Recent progress in the past 
century has focused on materials and techniques to improve 
quality and anchorage17 and after the mid-1980s, other im-
portant developments in dental implantology have been fo-
cused in the esthetic restorations. The development of modern 
ceramics started in 1992; and from that time on, dental 
implant companies, have incorporated ceramic surface 
treatments and ceramic-like elements to implants with the 
purpose of further enhancing osseointegration18. Today, 
approximately 450,000 osseointegrated dental implants are 
being placed every year, with an expectation of 95% success 
rate (in the case of single tooth replacement with an implant 

supported crown), with minimum risks and associated 
complications12. 

The Dental Implants 

The vast majority of implants that have been placed in patients 
all over the world in 2015 have a similar shape: a hollow 
supporting screw that receives, in a second time, a supra-
prosthetic device. There are numerous variations in the 
overall shape of the implants (e.g., a rounded or pointed apex; 
more or less spaced threads, cylindrical or conical body) 
(Figure 1). The surface quality of an oral implant is one of the 
essential features for a successful early clinical outcome. The 
manufacturers have developed a number of specific processes 
to improve the rate of osseo-integration and the long-term 
biomechanical anchorage of the implant on the bone matrix. 
Implants with a rough surface have a better osseo-integration, 
evaluated by histomorphometric parameters, than the original 
machined titanium implant of Nobel Biocare, which had a 
smooth surface19. Roughness results in a better interlocking 
between the implant and bone on growth by increasing the 
developed surface at the micrometer scale. However, an 
excess of roughness, especially in the upper threads can 
increase peri-implantitis as well as ionic leakage20. It is 
generally accepted that a moderate roughness of 1-2µm is the 
most suitable condition21,22. Several methods have been pro-
posed by the manufacturers to produce a rough surface on a 
dental implant23. 

Titanium plasma-spraying 

The method uses a plasma torch under argon (hot titanium 
powder is explosive in the air) to project titanium particles 
onto the surface of the implant. They fuse and constitute a 
layer more or less uniform. However, some inconveniences 
have been described with filaments of metals, an increased 
risk of wear debris and the leakage of metal ions24. 

Particle blasting and acid etching 

Blasting the implant surface with hard ceramic particles 
(corundum) at high velocity causes numerous impacts and 
tears at the material surface creating irregularities. However, 
the surface is made by defects with acute angles and can retain 
impacted foreign particles. For these reasons, an additional 
acid treatment using strong acids such as HF, HCl and HNO3 is 
usually done after the blasting step. This produces a very 
typical rough surface with the appearance of waves and 
valleys, a condition that favor osseo-integration25. Other 
treatments can also induce surface irregularities such as 
sodium fluoride since titanium can be attacked by halogens. 

Anodization of the implant surface 

Anodization can produce micro or nano-textured rough 
surfaces. This causes an increase in the passivation layer of 
titanium oxide associated with pores26. 

Coatings 

Several coating methods have been also proposed to modify 
the roughness and improve cell attachment27. Hydroxy-apatite 
can be deposed by plasma-spraying but the layer tends to 
delaminate, leading to implant failure in mid-term studies28. 
These implants are nowadays abandoned. Similar problems 
were also encountered with coatings made of other 
orthophosphate calcium salts. Biomimetic calcium phosphate 
have also been electro-deposited or created by immersion in 
synthetic body fluids (gel-sol technique) 29.Whatever the 
mechanisms used to induce a surface roughness, this favors 
fibronectin deposition, cell attachment and spreading as 
evidenced by in vitro and in vivo studies30,31. 

 



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Placement methods 

The placement of a dental implant can be done under local or 
general anaesthesia; the local anaesthesia being the most 
commonly used in daily practice. The implantation protocols 
are totally painless regardless of the maxillary or mandibular 
location. Occurrence of intra-operative pain is the result of 
incomplete anaesthesia or an iatrogenic act. Although 
occurring in the oral cavity which contains many of 
saprophytic bacteria, the asepsis protocol must be strict and 
similar to the general rules of surgery with the use of sterile 
implant packages and sterile drapes to cover the patient. CT 
scans are necessary to ensure a correct implant placement in 
bone at distance from nerves or vessels which would be a 
source of complication. The principle for an implant placement 
is based on the use of calibrated drills with increasing size 
until the width of the implant is obtained. Depending of the 
bone density, drilling is more or less intensive. This step ends 
with a control of locking the implant on the bone with a torque 
wrench. Indeed, a residual mobility will not permit the 
stability of the implant and it will be necessary to remove it. At 
the end of surgery, two possibilities exist: (i) Bury the implant 
on bone for several months under the sutured gingiva. 
Proponents of this method consider that such a quiescent 
condition is more favorable without mechanical stress, risk of 
infection or epithelial invasion. (ii) Other authors prefer to 
immediately place the implant collar inside the oral 
environment by fixing a cover screw at the top of the implant 
until the impression procedure. Overall, there is no consensus 
on the superiority of either of these two methods. As 
mentioned above, the concept of osseo-integration is defined 
by the tolerance into the living bone of a foreign and inert 
body (the titanium implant) which will provide a sustainable 

and stable bone anchor. An X-ray follow-up must confirm the 
absence of peri-implant osteolysis (appearing as a radiolucent 
edging around the implant).Osteolysis is also associated with a 
painful inflammatory reaction and implant mobility. This 
situation requires removal of the implant as soon as possible 
to limit the expansion of the peri-implant osteolysis of the 
alveolar bone. As previously mentioned, the surgical protocol 
is now no more strictly based on the Branemark’s concepts 
pro-posed thirty years ago. The timing for loading the implant 
has raised a considerable amount of articles and can be done 
in several ways. It has been advocated that after implant 
placement, the surgical site should be left undisturbed for4 to 
5 months to allow a good wound healing between the implant 
and the bone. This period is in accordance with bone cell 
physiology: osteoblasts elaborate woven bone rapidly to 
ensure the primary bone anchorage and this bone (being of 
poor quality) is secondarily remodelled and replaced by 
lamellar bone which possesses a better quality. More recently, 
other authors have proposed the concept of immediate 
loading of the implant to support provisional fixed crowns or 
prosthesis32,33. Immediate loading is the placement of a 
temporary prosthesis on the implants just after the implant 
placement. The benefit of this protocol is to immediately 
correct the tooth loss and to favor maturation of the gingival 
tissues at the implant’s base. The obvious disadvantage of this 
procedure is that loaded implants are exposed to the chewing 
force immediately after implantation, a situation that may 
delay osseo-integration. This protocol is not the subject of a 
consensus and the exact definition of immediate loading may 
vary from same-day implant loading to a shortly-delayed 
loading (usually three days to one week), making published 
results difficult to compare. 

 

 

Figure 1: Different types of dental implants proposed by several companies 

Implant Requirements and Design 

Since the use of dental implants has a long history, there are 
many factors that have been recognized as critical for the 
successful performance of the implants9. One of the most im-
portant factors is biocompatibility; which not only involves 
compatibility of the material with the tissue but its ability to 
perform a specific function. Therefore, this property is not 
dependent just on the physical, chemical and mechanical 
properties of the material, but also by the application in which 

the material is used. In the case of dental implants, the 
biocompatibility of materials is evaluated by studying the di-
rect interactions between the implant and the tissues, which is 
a measurement of the degree of osseointegration34. In order to 
improve osseointegration; therefore long-term success of the 
implants, the following variables are critical and should be 
considered in the design of dental implants include bio-
materials composition, implant width length and geometry, 
biomechanical factors, surface characteristics, medical status 
of the patient, bone quality and surgical technique35. 



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1. Biomaterials 

The biomaterials used for manufacturing dental implants 
include metals, ceramics, carbons, polymers, and combina-
tions of these. Polymers are softer and more flexible than the 
other classes of biomaterials. They also present with low 
mechanical strength, which makes them prone to mechanical 
fractures during function under high loading forces. Polymeric 
materials were reported to have very little application in 
implant dentistry and were only used to fabricate shock-
absorbing components placed between the implant and the 
suprastructure35. Ti, including alloy Ti-6Al-4V (Ti-6 
aluminum-4 vanadium), is the first modern material used for 
dental implants, and it is still one of the most used in 
contemporary dental implants. Commercially pure Ti is a light 
metal with excellent biocompatibility, relatively high stiffness 
and high resistance to corrosion. However, when exposed to 
air, a surface oxide is formed and this layer of oxide 
determines the biological response. This oxide layer is a 
dynamic interface that acts as platform for the apposition of 
bone matrix35. Other metals have been used for 
osseointegration, including zirconium, gold and Ti-aluminum-
vanadium alloys. These alloys may strengthen the implant but 
have been shown to have relatively poor bone-to-implant 
contact. Bioceramics such as hydroxyapatite are also used 
because although their low strength, excellent 
biocompatibility, and capacity to integrate with hard tissue 
and living bone8. Besides their brittle nature, hydroxyapatite, 
tricalcium phosphate, and aluminum oxide ceramics are 
currently used as plasma-sprayed coatings onto a metallic 
core. This results in union of the implant with the host tissue35.  

2. Implant design 

A wide variety of different sizes and shapes of implants have 
evolved to fit current surgical concepts and improve patient 
treatment. Continuous research has revealed that subtle 
changes in shape, length, and width of the implants could 
influence success rates36. 

Length 

Implant length and diameter have an influence on the stress 
distribution at the bone-implant interface, as well as on 
success rates37. Implant length is the dimension from the 
platform to the apex of implant9. Implant length varies from 6-
20 millimeters. The most common length employed is 
between 8-15 millimeters36. Research in implant dentistry has 
shown that longer implants guarantee better success rates and 
prognosis; and that shorter implants have statistically lower 
success rates due to reduced stability, which can be explained 
in terms of less bone to implant contact and smaller implant 
surface36. However, short or narrow implants are preferred 
for the prosthetic solution of the extremely resorbed alveolar 
bone areas38. 

Diameter 

The diameter of the implant is measured from the widest 
point of a thread to the opposite point on the implant and 
typically ranges from 3 to 7 mm; although narrower diameter 
implants can be used in small spaces. For clinical applications, 
physicians select implant diameter depending on the patient’s 
bone quantity and quality to yield optimal stability and to 
prohibit over-instrumentation. For example, wider implants 
allow for interaction with a larger amount of bone. Ivanoff et 
al39 concluded from animal studies that larger diameter 
implants are more stable in removal torque tests, and that 
they may be more useful in the clinical setting since there is a 
larger contact area with cortical bone. In addition, it has been 
shown in mechanical simulations that larger diameter 
implants can resist larger vertical loads40. Using FEA, it was 
determined that the implant diameter was much more 

important in stress dissipation than implant length, especially 
in cortical bone41, though other groups have reported that the 
length of the implant was more important in controlling stress 
distribution in the cancellous bone42. Based off of the litera-
ture, implant lengths ranging from 8 mm to 12 mm are used 
clinically.  

Geometry 

One of the main concerns in terms of design is the shape of the 
implant, since the geometry affects the interaction between 
the bone and implant, the surface area, the distribution of 
forces to the bone and the stability of the implant. Therefore, 
commercial dental implants are classified into different groups 
according to their shape. The main types of implants are 
cylindrical, conical, stepped, screw-shaped, and hollow 
cylindrical. Several studies revealed that conical implant 
surfaces or surfaces with geometric discontinuities resulted in 
higher stresses than smoother shapes such as cylindrical or 
screw-shaped. For this reason, the cylindrical screw threaded 
implants are the most commonly used9,10. 

Threads 

As mentioned before, threads are incorporated into implants 
in order to improve initial stability, enlarge implant surface 
area, distribute stress favorably while minimizing the amount 
of extreme adverse stresses to the bone-implant interface. The 
thread profile is characterized by the depth, pitch (number of 
threads per unit length), flank angle, the top radius of 
curvature, and the straight part at the bottom of the thread1. 
Different modifications in thread patterns such as 
microthreads near the neck of the implant, macrothreads on 
the mid-body, and variety of altered pitch threads have been 
employed to accentuate the effect of threads and induce a de-
sired biomechanical behavior34,43. 

3. Biomechanical factors 

Dental implants are primarily anchored in bone by means of 
mechanical interlocking1; therefore, implant stability is 
considered to play a fundamental role in successful osseo-
integration. It has been found an implant failure rate of 32% 
for implants with inadequate initial stability. As mentioned 
above, major contributors to dental implant stability are the 
design parameters such as length, diameter, geometry and 
threads have important effects on biomechanical stability, load 
transfer mechanisms and either success or failure of implants. 
Other factors that affect the stability are the material 
properties and the quality and quantity of surrounding bone. 
Masticatory forces acting on dental implants can also result in 
undesirable stress within the surrounding jawbone, and this 
can cause bone rejection and eventual failure of the implant8. 
Moreover, bone resorption can be activated by surgical trau-
ma or bacterial infection, as well as by the design parameters 
used42,43. 

4. Surface characteristics 

When a material is placed in the body, there will be a 
biological response that will be mediated by the interaction of 
the implant through its surface. Micro-level features are 
included to impart osseointegration or direct bone to implant 
contact at the micro level44. At the points of contact between 
cells and biomaterials there is an exchange of information 
leading to activation of specific genes and remodeling. The 
first step in this response involves the adsorption of specific 
proteins, lipids, sugar, and ions that can activate cells 
mechanisms to induce either acceptance or rejection of the 
implant by determining which and how many cells populate 
the surface45,46. 

Therefore, a high percentage of bone-implant contact is 
necessary to create sufficient anchorage of the implant, which 



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is a determinant factor in osseointegration. Two of the most 
important factors that affect the quality and speed of osseoin-
tegration are the physical and chemical nature of the surface 
of the implant. These properties also have an effect on the 
maintenance of soft tissue and surrounding bone around the 
implant. In order to increase the success rate of dental 
implants, research has focused on the control of surface 
properties such as morphology, topography, roughness, 
chemical composition, surface energy, residual stress, the 
existence of impurities, thickness of Ti oxide film, and the 
presence of metallic and nonmetallic compounds on the 
surface. These properties profoundly influence the osseous 
and tissue response to the implant by either increasing or 
decreasing healing times and osseointegration37. Research 
has shown that osteoblastic cells adhere more quickly to 
rough surfaces than to smooth surfaces1. This property can 
also produce orientation and guide locomotion of specific cell 
types and has the ability to directly affect cell shape and 
function47. There are two broad types of chemical alterations: 
1) addition of inorgainic phases (e.g., hydroxyapatite or 
calcium phosphates) and 2) addition of organic phases 
(growth factors). In both cases, the goal is to impart direct 
bone to implant contact. The addition of inorganic phases such 
as calcium phosphates imparts osteoconductive properties to 
the implant48,49. Coating Ti implants with calcium phosphates 
increases the speed at which bone formation occurs and also 
serves to span a gap between bone and the implant50,51. Ti im-
plants are typically coated with hydroxyapatite using plasma-
spraying to form an inorganic film. Though this coating serves 
to increase osteoinduction, the bond between the film is a 
limiting factor in the efficacy of inorganic coatings; the micron-
sized film can delaminate or loosen and release large particles, 
causing implant failure18. Secondly, the addition of organic 
molecules or bioactive molecules also influences the 
surrounding cells. For those reasons most commercial dental 
implants have a microroughened surface (0.5-1μm) obtained 
by techniques such as grit-blasting and/or acid-etching54. 
Although many studies have demonstrated the importance of 
roughness in osseointegration, there is no standard for the 
roughness of dental implants1. However, many animal studies 
support that bone ingrowth into macro rough surfaces (2-
3μm) enhances the interfacial and shear strengths. Surface 
roughness can also induce orientation and guide locomotion of 
cells and has the ability to directly affect cell shape and 
function52,53. 

Contraindications 

They are now well identified and classified. General 
contraindications are psychiatric disorders, severe cardio-
vascular troubles, hematological malignancies and ongoing 
therapeutic trials. A special attention is given to patients 
receiving intravenous amino-bisphosphonates for a malignant 
disease. Due to the high risk of inducing an osteonecrosis of 
the jaw, scientific societies and health agencies consider that 
dental implants are prohibited in these particular cases. 
However, bisphosphonate treatment for other metabolic bone 
disease such as osteoporosis is not a contraindication and 
recommendations should be care-fully followed. Local 
contraindications are represented by an absent oral hygiene, a 
massive bone loss and occlusal disorders. Smoking is a 
discussed contraindication: it has been shown that a 
significantly higher percentage of implant failures may occur 
in smokers (particularly at the maxilla) 54-56 but smoking do 
not preclude implant placement; smokers should be informed 
that they are more at risk for peri-implantitis. 

Limits and Complications of Dental Implants 

The limits of implantology derive from careful analysis of the 
contraindications but nowadays, there are fewer and fewer 

taboos. As an example, a limited bone volume is typical of the 
evolution and adaptation of the therapeutic strategies. At the 
beginning of implantology, a minimum of bone volume was 
required for the placement of the fixtures. The development of 
new grafting techniques was proposed to overcome the 
problem of bone insufficiency. During the1990s, filling or 
apposition grafts were extensively developed at the maxilla or 
the mandible after having harvested a bone autograft at the 
skull or iliac bone. The history of sinus lift is characteristic of 
the huge amount of progress made with bone grafts. In this 
technique, a bone autograft is added between the jaw and the 
olfactory epithelium covering the maxillary sinus (Schneider’s 
membrane).After healing, an increased bone volume is 
obtained allowing the placement of the implants after 6 to 9 
months. The use of biomaterials as bone substitute has led to 
the development of this protocol by eliminating the first 
surgical time (harvesting of the autograft). This led to a more 
easy and reliable technique ensuring a high level of success 
and a better anchorage of the implant with prosthetic devices. 
At that time, the most recommendable biomaterial to use for 
making a sinus lift is beta tricalcium phosphate (β-TCP), which 
is gradually resorbed and induces bone osteoconduction. In 
the past, implant placement was a source of infectious 
complications and had a reputation of an ill-fitting. Since 3-4 
decades, implant outfits are the rule, explaining the interest of 
dentists and maxillo-facial surgeons for these techniques. The 
present complications are mainly infectious. After nearly four 
decades of implant practice, it is possible to observe a bone 
lesion, termed peri-implantitis, which can threaten the 
implant holding. This leads to a peri-implant osteolysis 
associated with an inflammation of soft tissues. Bone loss 
occurs around the implant as a saucer defect and its 
progression is non-linear and accelerated by risk factors 
(tobacco, poor oral hygiene). Removal of the implant before 
the bone loss is too pronounced may represent a preventive 
and conservative action to protect the bone volume. Fractures 
of the prosthetic elements are not rare and can be easily 
corrected. However, it should be noted that iatrogenic 
complications are not uncommon. They can be due to a 
surgical fault, after a poor X-ray analysis, a defective 
positioning of the implant, the fracture of an instrument, the 
compression or section of the inferior alveolar nerve, the 
migration of an implant in the maxillary sinus or the lack of a 
global therapeutic evaluation. These cases usually have 
medico-legal consequences. The lifetime of dental implants is 
exceedingly high, generally in the order of two decades if the 
protocols are correctly followed. The percentage of 
complications (loss of implants) remains low because, usually 
less than 5% in the first 5 years for the majority of authors57. 

Conclusion 

At the end of the 20th century, a major advance in the 
treatment of tooth loss is represented by the discovery of 
dental implants. Although implantology has not the same 
importance that other surgical techniques concerned with life-
threatening diseases, the correction of a dental deficit 
influences the physiological and psychological condition of the 
patients and improves their quality of life. Rigorous 
manufacturing processes, the recognition of an operative 
consensus and the numerous prosthetic adaptations available 
have really accomplished a technological revolution. The 
technique remains; however, poorly known among all the 
other organ grafts but its therapeutic value is now well 
admitted. 

References 

1. Bodic F, Hamel L, Lerouxel E, Baslé MF, Chappard D. Bone lossand 
teeth. Joint Bone Spine 2005; 72:215-21. 
https://doi.org/10.1016/j.jbspin.2004.03.007 

https://doi.org/10.1016/j.jbspin.2004.03.007


Jain et al                                                                                                                                        Asian Journal of Dental and Health Sciences. 2022; 2(4):48-54 

[53]                                                                                                                                                                                                                                                 AJDHS.COM 

2. Adell R, Lekholm U, Rockler B, Brånemark PI. A 15-year study of 
osseo-integrated implants in the treatment of the edentulous jaw. 
Int J Oral Surg 1981; 10:387-416. 
https://doi.org/10.1016/S0300-9785(81)80077-4 

3. Albrektsson T, Brånemark P-I, Hansson H-A, Lindström J. 
Osseointegrated titanium implants: requirements for ensuring a 
long-lasting, direct bone-to-implant anchorage in man. Acta 
Orthopaedica 1981; 52:155-70. 
https://doi.org/10.3109/17453678108991776 

4. Brånemark PI, Zarb GA, Albrektsson T. Tissue integrated pros-
theses. Chicago: Quintessence Int; 1985. 

5. Guillaume B. Les implants dentaires- techniques- prescriptions 
advantages. Ellebore; 2011. 

6. Guillaume B. Autogreffe, xénogreffe et allogreffe: utilisa-tion 
clinique. In: Guillaume B, Audran M, Chappard D, editors.Tissu 
osseux et biomatériaux en chirurgie dentaire. Paris:Quintessence 
Int; 2014. p. 337-66. 

7. Oral and maxillofacial surgeons: the experts in face, mouth and jaw 
surgery [Internet]. Rosemont (IL): American Association of Oral 
and Maxillofacial Surgeons. Available from: 
http://www.aaoms.org/conditions-and-treatments/dental-
implants. 

8. Gupta A, Dhanraj M, Sivagami G. Status of surface treatment in 
endosseous implant: a literary overview. Indian J Dent Res 2010; 
21:433-8. https://doi.org/10.4103/0970-9290.70805 

9. Seth S, Kalra P. Effect of dental implant parameters on stress 
dis¬tribution at bone-implant interfaces. Inter J Sci Res 2013; 
2:121-4. 

10. Lee JH, Frias V, Lee KW, Wright RF. Effect of implant size and shape 
on implant success rates: a literature review. J Prosthet Dent 
2005; 94:377-81. 
https://doi.org/10.1016/j.prosdent.2005.04.018 

11. DiGiallorenzo D. History of dental implants [Internet]. 
Colleg¬eville (PA): Lanap & Implant Center of Pennsylvania. 
Available from: http://www.perioimplants.us/history-of-dental-
implants.html. 

12. Sullivan RM. Implant dentistry and the concept of 
osseointegration: a historical perspective. J Calif Dent Assoc 2001; 
29:737-45. 

13. History [Internet]. Chicago (IL): American Academy of Implant 
Dentistry. Available from: 
http://www.aaid.com/about/History.html. 

14. Dental implants: histroy of dental implants [Internet]. [place 
un¬known]: Manoimplantai. Available from: 
http://www.manoimplantai.lt/dantu-implantai/dantu-implantu-
istorija/?lang=en. 

15. Find out who was responsible for starting dental implant history 
[Internet]. [place unknown]: Dental-Health-Advice. Available 
from: http://www.dental-health-advice.com/dental-implant-
history.html. 

16. Dental implant history [Internet]. Albufeira: Cris Piessens Clinic. 
Available from: 
http://www.crispiessensclinic.com/implant_history.html. 

17. Rethman MP. Introduction & historical perspectives on dental 
im¬plants. Chicago: Hu-Friedy; 2010:1-4. 

18. Khatri S, Jain DK. Autism spectrum disorder (ASD): past, present 
and future. CIBTech Journal of Pharmaceutical Sciences. 2018; 
7(4):1-25. 

19. Grizon F, Aguado E, Huré G, Baslé MF, Chappard D. Enhancedbone 
integration of implants with increased surface roughness:a long-
term study in the sheep. J Dent 2002; 30:195-203. 
https://doi.org/10.1016/S0300-5712(02)00018-0 

20. Patel NS, Jain DK, Nagar H, Patel A, Chandel HS. Evaluation of 
analgesic and antipyretic activity of Tridax procumbens leaves 
extract. RGUHS J Pharm Sci. 2011; 1(3):226-31. 
https://doi.org/10.5530/rjps.2011.3.9 

21. Albrektsson T, Wennerberg A. The impact of oral implants - 
pastand future, 1966-2042. J Can Dent Assoc 2005; 71:327. 

22. Khatri S, Dhanoriya C, Jain DK. Zika virus (ZIKV) disease: past, 
present and future. Journal of Drug Delivery and Therapeutics. 
2018; 8(6-s):320-7. https://doi.org/10.22270/jddt.v8i6-s.2076 

23. Yadav R, Jha M, Prasad S, Jat D, Jain DK. Mayaro virus (MAYV) 
Disease: Past, present and future. J Pharm Biol Sci. 2022; 10(1):7-
16. 

24. Browne M, Gregson P. Effect of mechanical surface pretreat-ment 
on metal ion release. Biomaterials 2000; 21:385-92. 
https://doi.org/10.1016/S0142-9612(99)00200-8 

25. Cochran D, Schenk R, Lussi A, Higginbottom F, Buser D. 
Boneresponse to unloaded and loaded titanium implants with 
asandblasted and acid-etched surface: a histometric study inthe 
canine mandible. J Biomed Mater Res 1998; 40:1-11. 
https://doi.org/10.1002/(SICI)1097-4636(199804)40:1<1::AID-
JBM1>3.0.CO;2-Q 

26. Sul Y-T, Johansson C, Albrektsson T. Which surface 
propertiesenhance bone response to implants? Comparison of 
oxidizedmagnesium, TiUnite, and Osseotite implant surfaces. Int 
JProsthodont 2005; 19:319-28. 

27. Roy M, Bandyopadhyay A, Bose S. Induction plasma sprayednano 
hydroxyapatite coatings on titanium for orthopaedic anddental 
implants. Surf Coat Technol 2011; 205:2785-92. 
https://doi.org/10.1016/j.surfcoat.2010.10.042 

28. Liao H, Fartash B, Li J. Stability of hydroxyapatite-coatingson 
titanium oral implants (IMZ). Clin Oral Implants Res1997; 8:68-
72. https://doi.org/10.1111/j.1600-0501.1997.tb00009.x 

29. Peltola T, Pätsi M, Rahiala H, Kangasniemi I, Yli-Urpo A. 
Calciumphosphate induction by sol-gel-derived titania coatings on 
tita-nium substrates in vitro. J Biomed Mater Res 1998; 41:504-
10. https://doi.org/10.1002/(SICI)1097-
4636(19980905)41:3<504::AID-JBM22>3.0.CO;2-G 

30. Degasne I, Baslé MF, Demais V, Huré G, Lesourd M, GrolleauB, et al. 
Effects of roughness, fibronectin and vitronectin onattachment, 
spreading, and proliferation of human osteoblast-like cells (Saos-
2) on titanium surfaces. Calcif Tissue Int1999; 64:499-507. 
https://doi.org/10.1007/s002239900640 

31. Mustafa K, Wroblewski J, Lopez BS, Wennerberg A, Hul-tenby K, 
Arvidson K. Determining optimal surface roughnessof TiO2 
blasted titanium implant material for attach-ment, proliferation 
and differentiation of cells derived fromhuman mandibular 
alveolar bone. Clin Oral Implants Res2001; 12:515-25. 
https://doi.org/10.1034/j.1600-0501.2001.120513.x 

32. Chiapasco M, Gatti C, Rossi E, Haeflige W. Implant-
retainedmandibular overdentures with immediate loading. Clin 
OralImplants Res 1997; 8:48-57. https://doi.org/10.1111/j.1600-
0501.1997.tb00007.x 

33. Ericsson I, Nilson H, Lindh T, Nilner K, Randow K. 
Immediatefunctional loading of Brånemark single tooth implants. 
Clin OralImplants Res 2000; 11:26-33. 
https://doi.org/10.1034/j.1600-0501.2000.011001026.x 

34. Vidyasagar L, Apse P. Dental implant design and biological effects 
on bone-implant interface. Stomatologija 2004; 6:51-4. 

35. Triplett RG, Frohberg U, Sykaras N, Woody RD. Implant ma¬terials, 
design, and surface topographies: their influence on os-
seointegration of dental implants. J Long Term Eff Med Implants 
2003; 13:485-501. 
https://doi.org/10.1615/JLongTermEffMedImplants.v13.i6.50 

36. Searson LJ. History and development of dental implants. In: Narim 
L, Wilson HF, eds. Implantology in general dental practice. Lon-
don, Chicago: Quintessence Publishing Co; 2005:19-41. 

37. Guan H, van Staden R, Loo YC, Johnson N, Ivanovski S, Meredith N. 
Influence of bone and dental implant parameters on stress distri-
bution in the mandible: a finite element study. Int J Oral Maxillofac 
Implants 2009; 24:866-76. 

38. Mandhane SS, More AP. A review: evaluation of design parameters 
of dental implant abutment. Inter J Emerging Sci Eng 2014; 2:64-7. 

https://doi.org/10.1016/S0300-9785(81)80077-4
https://doi.org/10.3109/17453678108991776
https://doi.org/10.4103/0970-9290.70805
https://doi.org/10.1016/j.prosdent.2005.04.018
https://doi.org/10.1016/S0300-5712(02)00018-0
https://doi.org/10.5530/rjps.2011.3.9
https://doi.org/10.22270/jddt.v8i6-s.2076
https://doi.org/10.1016/S0142-9612(99)00200-8
https://doi.org/10.1002/(SICI)1097-4636(199804)40:1%3C1::AID-JBM1%3E3.0.CO;2-Q
https://doi.org/10.1002/(SICI)1097-4636(199804)40:1%3C1::AID-JBM1%3E3.0.CO;2-Q
https://doi.org/10.1016/j.surfcoat.2010.10.042
https://doi.org/10.1111/j.1600-0501.1997.tb00009.x
https://doi.org/10.1002/(SICI)1097-4636(19980905)41:3%3C504::AID-JBM22%3E3.0.CO;2-G
https://doi.org/10.1002/(SICI)1097-4636(19980905)41:3%3C504::AID-JBM22%3E3.0.CO;2-G
https://doi.org/10.1007/s002239900640
https://doi.org/10.1034/j.1600-0501.2001.120513.x
https://doi.org/10.1111/j.1600-0501.1997.tb00007.x
https://doi.org/10.1111/j.1600-0501.1997.tb00007.x
https://doi.org/10.1034/j.1600-0501.2000.011001026.x
https://doi.org/10.1615/JLongTermEffMedImplants.v13.i6.50


Jain et al                                                                                                                                        Asian Journal of Dental and Health Sciences. 2022; 2(4):48-54 

[54]                                                                                                                                                                                                                                                 AJDHS.COM 

39. Ivanoff CJ, Sennerby L, Johansson C, Rangert B, Lekholm U. 
In¬fluence of implant diameters on the integration of screw 
implants. An experimental study in rabbits. Int J Oral Maxillofac 
Surg 1997; 26:141-8. https://doi.org/10.1016/S0901-
5027(05)80837-9 

40. Shemtov-Yona K, Rittel D, Levin L, Machtei EE. Effect of den¬tal 
implant diameter on fatigue performance. Part I: mechanical 
behavior. Clin Implant Dent Relat Res 2012. 
https://doi.org/10.1111/j.1708-8208.2012.00477.x 

41. Himmlová L, Dostálová T, Kácovský A, Konvicková S. Influence of 
implant length and diameter on stress distribution: a finite ele-
ment analysis. J Prosthet Dent 2004; 91:20-5. 
https://doi.org/10.1016/j.prosdent.2003.08.008 

42. Baggi L, Cappelloni I, Di Girolamo M, Maceri F, Vairo G. The 
influence of implant diameter and length on stress distribution of 
osseointegrated implants related to crestal bone geometry: a 
three-dimensional finite element analysis. J Prosthet Dent 2008; 
100:422-31. https://doi.org/10.1016/S0022-3913(08)60259-0 

43. Lan TH, Du JK, Pan CY, Lee HE, Chung WH. Biomechanical analysis 
of alveolar bone stress around implants with different thread 
designs and pitches in the mandibular molar area. Clin Oral 
Investig 2012; 16:363-9. https://doi.org/10.1007/s00784-011-
0517-z 

44. Stanford CM. Surface modifications of dental implants. Aust Dent J 
2008; 53(Suppl 1):S26-33. https://doi.org/10.1111/j.1834-
7819.2008.00038.x 

45. Kumar K, Ramesh Bhat TR, Harish PV, Sameer VK, Gangaiah M. 
Nanobiotechnology approaches to design better dental implant 
materials. Trends Biomater Artif Organs 2011; 25:30-3. 

46. Palmquist A, Omar OM, Esposito M, Lausmaa J, Thomsen P. 
Ti¬tanium oral implants: surface characteristics, interface biology 
and clinical outcome. J R Soc Interface 2010; 7(Suppl 5):S515-27. 
https://doi.org/10.1098/rsif.2010.0118.focus 

47. Bonfante EA, Marin C, Granato R, Suzuki M, Hjerppe J, Witek L, et 
al. Histologic and biomechanical evaluation of alumina-
blasted/acid-etched and resorbable blasting media surfaces. J Oral 
Implan¬tol 2012; 38:549-57. https://doi.org/10.1563/AAID-JOI-
D-10-00105 

48. Dohan Ehrenfest DM, Coelho PG, Kang BS, Sul YT, Albrektsson T. 
Classification of osseointegrated implant surfaces: materials, 
chemistry and topography. Trends Biotechnol 2010; 28:198-206. 
https://doi.org/10.1016/j.tibtech.2009.12.003 

49. Yuan H, Yang Z, Li Y, Zhang X, De Bruijn JD, De Groot K. 
Os¬teoinduction by calcium phosphate biomaterials. J Mater Sci 
Mater Med 1998; 9:723-6. 
https://doi.org/10.1023/A:1008950902047 

50. Søballe K. Hydroxyapatite ceramic coating for bone implant 
fixa¬tion. Mechanical and histological studies in dogs. Acta Orthop 
Scand Suppl 1993; 255:1-58. 
https://doi.org/10.3109/17453679309155636 

51. Barrère F, van der Valk CM, Meijer G, Dalmeijer RA, de Groot K, 
Layrolle P. Osteointegration of biomimetic apatite coating applied 
onto dense and porous metal implants in femurs of goats. J 
Biomed Mater Res B Appl Biomater 2003; 67:655-65. 
https://doi.org/10.1002/jbm.b.10057 

52. Ota-Tsuzuki C, Datte CE, Nomura KA, Gouvea Cardoso LA, Shibli JA. 
Influence of titanium surface treatments on formation of the blood 
clot extension. J Oral Implantol 2011; 37:641-7. 
https://doi.org/10.1563/AAID-JOI-D-09-00125.1 

53. Ahn SJ, Leesungbok R, Lee SW. Histomorphometric analysis and 
removal torque of small diameter implants with alternative 
surface treatments and different designs. J Oral Implantol 2010; 
36:263-72. https://doi.org/10.1563/AAID-JOI-D-09-00052 

54. Bain CA, Moy PK. The association between the failure of 
dentalimplants and cigarette smoking. Int J Oral Maxillofac 
Implants1993; 8:609-15. 

55. Moy PK, Medina D, Shetty V, Aghaloo TL. Dental implant 
failurerates and associated risk factors. Int J Oral Maxillofac 
Implants2005; 20:569-77. 

56. Karoussis I, Salvi G, Heitz-Mayfield L, Brägger U, Hämmerle C,Lang 
N. History of treated periodontitis and smoking as risksfor 
implant therapy. Int J Oral Maxillofac Implants 2009; 24:39-68. 

57. Guillaume B. Dental implants: A review. Morphologie. 2016 Dec 1; 
100(331):189-98. https://doi.org/10.1016/j.morpho.2016.02.002

 

 

 

 

https://doi.org/10.1016/S0901-5027(05)80837-9
https://doi.org/10.1016/S0901-5027(05)80837-9
https://doi.org/10.1111/j.1708-8208.2012.00477.x
https://doi.org/10.1016/j.prosdent.2003.08.008
https://doi.org/10.1016/S0022-3913(08)60259-0
https://doi.org/10.1007/s00784-011-0517-z
https://doi.org/10.1007/s00784-011-0517-z
https://doi.org/10.1111/j.1834-7819.2008.00038.x
https://doi.org/10.1111/j.1834-7819.2008.00038.x
https://doi.org/10.1098/rsif.2010.0118.focus
https://doi.org/10.1563/AAID-JOI-D-10-00105
https://doi.org/10.1563/AAID-JOI-D-10-00105
https://doi.org/10.1016/j.tibtech.2009.12.003
https://doi.org/10.1023/A:1008950902047
https://doi.org/10.3109/17453679309155636
https://doi.org/10.1002/jbm.b.10057
https://doi.org/10.1563/AAID-JOI-D-09-00125.1
https://doi.org/10.1563/AAID-JOI-D-09-00052
https://doi.org/10.1016/j.morpho.2016.02.002

