Chapter 4
What is implant?
For the person who hear the word ‘implant’ for the first time.
Question 1
We can find various kinds of implants on the internet, but they all get lumped together
as ‘implant.’
Can you tell me the sorts of implants and their merits and demerits?
Answer 1(1) What is implant?
An implant is an artificial tooth root.
We make a hole with a specialized drill in the jawbone (bone of the jaw) of the extracted
cavity and place an artifact (implant) which has the same figure as a tooth in order tosupplement function of the lost tooth.
The implant is composed of implant body and prosthesis (a cap called a crown).

The implant body is installed into the jawbone and the crown is placed on the implant
body like a hat. The crown takes charge of occlusion and it has the role of chewing,grinding, and cutting food.
Moreover, it also has important role in utterance such as speaking and singing.

Needless to say, the crown is also important in terms of aesthetics, ‘beautiful dentition’,as same as natural teeth.
The crown of an implant is similar to a natural tooth and it is completed beautifully,
therefore it is possible to laugh with your mouth wide open and your smile will get evenmore beautiful.
The implant body should be fixed into the jawbone well in order to play these roles.
It is required to have enough strength to withstand 80 kg of force per tooth.
Therefore, to integrate implant body with the bone as AQB implants is very important.

(2) Implants can be classified into some groups by their materials, manufacturingmethods or forms. However, I will explain implants by dividing into three groups fromtheir historical progress this time.
Classification by historical progress① Bioinert stage

Historically, it is the first stage of implant.
② Bioactive stage
Historically, it is the second stage of implant.
③ Bio affinity power stage
Historically, the one month implant is the third stage implant and it is completely new
osseointegration implant.
(3) Classification by form (or method)① One piece (which is also called one stage implant)
The implant body is consists of one part.
One piece requires only one time of gingival incision, therefore burden on patients will
be reduced.
② Two piece (which is also called two stage implant)
The implant body consists of two parts.
Regarding two piece implant, there are some cases where two times of gingival incision
is required.

Question 2
Are there various kinds of implant surgeries?
Answer 2

(1) There are some surgical methods according to the condition of oral.
(2) Firstly, the surgical method is decided by comprehending condition of thejawbone(alveolar bone※) since implant is placed on the jawbone.
Usually, implant is placed as it is if jawbone has enough thickness, height, andhardness, in a word, if jawbone is healthy.
(3) If the jawbone is insufficient to install an implant, for example, the jawbone is thinor not high and hard enough, the ‘hyperostosis※,’which is a surgery to increase bone,will be performed.
There are many kinds of hyperostosis such as bone grafting, guided bone regeneration
method (GBR), alveolar distraction osteogenesis, and regenerative therapy.
Any of them are not difficult and generally performed by dentists who are specialized inimplants.
(4) Kinds of hyperostosis can be summed up as follows.
① Bone grafting –AutograftThis is the method to use patient’s bone in order to increase the jawbone. Crushed bonewhich is gathered from one part of the body except for the oral (such as the ilium orshindone) is used.
In addition to an implant surgery, a minor surgery is required to gather bone.
② GBR (Guided bone regeneration method) –Autograft or artificial boneThe way to use crushed bone (autograft) that gathered from the oral (such as maxillaryand mandibular processes, mental region) and the way to increase the jawbone using
powder or granules of artificial materials which is as same as bone component (such asHA: hydroxyapatite).
There are some cases where the GBR is performed at the same time of the implant
surgery.
③ Alveolar distraction osteogenesis
This does not require bone grafting but distraction of gingiva (soft tissues) besides bone
is possible.
It is the way to plant a special device into a part where need to be distracted
horizontally and vertically to widen and extend the jawbone directly.
Therefore, a surgery to plant the special device into the jawbone is necessary.

In this case, the implant surgery will be performed after the jawbone hyperplasy
therapy is finished.
④ Regenerative therapy
It is the way of bone regeneration to work on the affected part of the body directly byusing various differentiation/growth factors which control forming of bone tissues in thebody.
Products such as ‘bone morphogenetic protein (BMP)’, ’fibroblast growth factor (FGF)’
and ’enamel matrix derivative (EMD)’ are mainly used as a growth factor at present.
However, except for EMD GEL, they are not approved by the Pharmaceutical Affairs
Law in Japan.
(5) In cases where an implant is installed into the maxillary molar region, necessary
bone quantity is not enough at times.
In such cases, the method of lifting and expanding patient’s bone by using special
technique is performed.
In general, it is the way to detach and elevate the schneiderian membrane of jawbone
cavities that is called maxillary sinus and to place an implant to the space between
cortical bone of the maxillary sinus floor.
This is also called ‘maxillary sinus floor elevation procedure’ and there are two kinds ofmethods.
According to quantity of bone which is elevated, the procedure is divided into ‘socket lift
procedure’ and ’sinus lift procedure’.
① Socket lift procedure
In general, this method is applied to cases where height of remained bone is more than
five mm.
At this time, the maxillary sinus membrane is detached and elevated by malleting witha special apparatus which is called osteotome.
It is widely applied in clinical practice as an easy maxillary sinus floor elevation
procedure because it gives a little surgical stress to a patient.
It is possible to place an implant at the same time.

② Sinus lift procedure
This method is applied to cases where height of remained bone is less than five mm.
It is the way to make a hole in the lateral wall of the maxillary sinus to perform bone
grafting and to detach and elevate the maxillary sinus membrane.
It gives large surgical stress to a patient but has merit that is able to perform a surgery
certainly under a direct vision.
Depends on the quantity of elevation, an implant is placed at the same time with thismethod or after healing the wound.

Question 3
Can anybody receive implant treatment if they want?
For example, I have heard that implant placement will be impossible if patient’s
jawbone is hollow because of his/her illness.
Is that true?

Answer 3(1) Regarding AQB implant, it has the function of osteoinduction, therefore it can be
widely applied to patients’ various oral conditions.
However, implant treatment should be custom-made because patients’ oral conditions
are completely different.
The reasonable treatment plan will be made after the careful individual meetings to fit
the patient and his/her oral condition.
A clinical policy and surgical method is decided to fit the patient’s condition considering
if he/she is healthy or suffering from diseases such as high blood pressure, heart diseaseor osteoporosis, etc. Moreover, thickness, length and number of implants, surgicalmethod and if necessary, hyperostosis is chosen according to condition of the patient’s
jawbone, and then an implant treatment will be performed.
(2) If a patient has serious disease, implant treatment should be avoided.
Question 4
I have been affected with chronic diabetes mellitus for 30 years.
This doctor said to me that implant treatment would be difficult because my bone wasthin.
He also said that implant treatment would likely to be fail because diabetics have lowbone density.
Do you think that ‘one month implant’ can be performed under this condition?
Answer 4
Your bone is certainly thin and bone density is low, however you can have 3 mm ofimplant, therefore you are fine.
In addition, low bone density is not a problem because the one month implant has bio
affinity power.
However, in regard to healthy people, usually the implant will be taken in the jawbone
owing to the bio affinity power therefore he/she will be able to start to eat in a month.
However, you will need to take a little more time.
Nevertheless, the implant will become your own tooth in two months and you will beable to eat.
Depends on the condition of patient`s illness, the implant might takes two months when
it usually takes about a month, but it will not take four or five months as other implants
take.