Occlusion is the key in Implants

Osseo integrated implant being the most sought after modality of treatment, optimal occlusion plays a key role in implant supported prosthesis. The probable reason for peri-implant disease or crestal bone loss & failure of implant prosthesis is occlusal overloading of implants.

This is a review to discuss the clinical guidelines for various occlusal schemes like balanced, group function, mutually protected occlusion. Appropriate occlusion is the foremost mandatory for long term survival of implants in absence of sound clinical situations. This is because poor occlusion increases the magnitude of mechanical stress & strains at the crestal bone.

Misch proposed implant-protective occlusion which states that by decreasing the occlusal forces increases the clinical success of implants & its prosthesis.

Keeping aside the conventional occlusal concepts, refinements proposed to reduce stress at the implant interface are

Ø Mutually protected articulation

Ø Implant body angle to occlusal load

Ø Crown height

Ø Quality of implant crowns

Ø Timings of Occlusal contacts

The biggest question of the hour is why occlusion is the most important factor? Since the periodontal ligament – mediated proprioception doesn’t occur with implants as in natural teeth; occlusal forces are to be carefully accomplished in order to regulate mandibular displacement.

Each of the prosthesis i.e implant supported prosthesis, tooth or tissue supported prosthesis exerts different range of forces in both the functional & resting movements. The implant supported prosthesis is designed as that of tooth supported single fixed partial prosthesis with an adequate interarch space with bilateral stability in centric occlusion & no interferences between retruded & centric position. In terms of posterior fixed implant prosthesis reduced inclination of cusps, narrow occlusal table, and increased proximal contacts provides stability to the restorations.

The current accepted paradigm shift is mid retrognathia-flat lingual incisal platform in skeletal class II div II, raise vertical dimension at occlusion to flatten anterior guidance in skeletal class II Div II, to slightly disocclude posterior or mild anterior disocclusion in skeletal class III.

In cases of natural dentition little degree of flexibility is acceptable but in implants the flexibility degree is supposed to be decreased to zero for the success of prosthetic rehabilitation.

Dr. Prof. Rajat Sachdeva

Director & Mentor

Dr.Sachdeva’s Dental Institute

I-101 Ashok Vihar Phase 1 Delhi 110052





Nowadays increase in patient’s demand in terms of good quality of life & appearance makes it necessary for the dentists to aim for a dental prosthesis which restores the speech, health, functional, esthetic requirements. Dental implants have surfaced as a promising option for this objective.

Firstly introduced into the market evolving from conical to cylindrical surface, self drilling to sand-blasted and acid etched surface treatments, immediate implants and loading in fresh sockets after extraction has a success rate proportionate to that of implants introduced under mainstream protocols, if the surgical site meets the prerequisites.

 Immediate implants prefer precise preparation of the osteotomy site. The required primary stability allows vital  bone  to  be  in  contact  with  the  implant  surface  facilitating  immediate  loading. With new age advancements in implant designs and surface modifications treatment time have been reduced.

Henceforth the beau ideal has thus repositioned from “No load on implants during osseointegration” to “No micro movements of implants”. Immediate loading loads the implant with a provisional crown at the same appointment or shortly later eliminating the second stage implant surgery. The advantages of placement of a temporary restoration as an immediate loading of dental implants include:  greater acceptance of patients, better esthetics, function, most importantly reduced treatment time. Immediate loading of implants refers to a superstructure being attached to the implants no later than 72 hours after implant placement. Misch stated immediate occlusal loading within 14th days of implant insertion. The terminology ‘non-functional immediate loading’ and ‘immediate restoration’ are used when prosthesis is fixed to the implants within 72 hrs without establishing full occlusal contact with the opposing tooth.

 The criterion for success of Implants includes primary implant stability, quality & quantity of cortical & trabecular bone, surgical technique, occlusal factors, implants design surface textures & design.

As per the procedure at the time of first stage of surgery, the implant is inserted into the socket.  After implant insertion the final abutment is positioned. Final abutments are formulated intraorally for appropriate height & parallelism. The transitional prosthesis is accessed for harmonious occlusal contact in centric occlusion. This is followed by impression with additional silicone to record implant body position. After the impression, the abutments are removed from the implant body and replaced with gingival former/healing abutment/healing cap. The laboratory inserts the implant body analogs into the impression, pours the impression with die stone, and prepares the abutment to fabricate a transitional prosthesis.

Further, the surgical procedure can be accomplished without flap, decreasing morbidity and surgical procedures patients require reducing undermining esthetics.

Regards :

Dr. Prof. Rajat Sachdeva

I-101 Ashok Vihar Phase 1 Delhi 110052


PRP in Dental Implantology

Platelet-rich plasma therapy can be used to accelerate the healing process for dental implant treatments.  PRP procedures use the body’s own regenerative abilities to enhance the growth of bone and soft tissue.  They jumpstart the process and reduces the time between implant placement and crown fitting.

The patient’s own blood is used and centrifuged to separate the platelet growth factors from the red blood cells.  The platelets help improve the rate of growth of new bone and soft tissue.  There is minimal risk because the healing process of the body is completely natural.  Since the patient’s own blood is used, an allergic reaction or infection is unlikely.

In dental surgery, PRP is mixed into gels and applied to treatment sites and tooth sockets.  It is effective in supporting the integration of implants with bones. The grafts become bonded faster with the patient’s bone thanks to the growth factors in PRP.  Implant dentistry can be a more natural and effective process with the professional use of plate-rich plasma growth factors.


Dr. Prof. Rajat Sachdeva 

Director & Mentor : Dr.Sachdeva’s Dental Institute

I-101 Ashok Vihar Phase 1 Delhi 110052



Classification of Molar Extraction Sites for Immediate Dental Implant Placement

Dental implants may be successfully placed immediately into fresh extraction sockets when primary implant stability can be attained. This article presents a new classification system for molar extraction sites that describes extraction sockets based upon the bone available within the socket for stabilization of an immediately placed implant. Three categories–types A, B, and C–are employed: the type A socket, which allows for the implant to be placed completely within the septal bone, leaving no gaps between the implant and the socket walls; the type B socket, which has enough septal bone to stabilize but not completely surround the implant, leaving gaps between one or more surfaces of the implant and the socket walls; and the type C socket, which has little to no septal bone, thus requiring that the implant engage the periphery of the socket. Treatment protocols and relevant clinical examples are presented based upon the characterization of the socket according to this classification system.

Dr. Rajat Sachdeva
Dr. Sachdeva’s Dental Aesthetic & Implant Centre
I – 101, Ashok Vihar,
New Delhi -110052
Mobile: +919818894041

Clinic: 011-42464041, +918527017175