Historical Review and Evolution of Dental Implants

The first evidence of implants dates back to 600 A.D. in the Mayan population.There are reports that the ancient Egyptians attempted intra-osseous implantation of animal teeth or teeth carved from ivory in to the mouth of their court women.

Mandible showing implanted shell pieces replacing incisors

Fig.illustrates the implantation of pieces of shell to replicate three lower incisors in a mandible. The medieval period (1000 to 1799 A.D.) of implant dentistry was primarily concerned with transplantation of teeth. Albucusis, an Arab surgeon fabricated implants made of ox bone, ivory and shells.In 1809, Maggiolo described a process of fabricating and inserting gold roots into freshly extracted sockets. The implant was constructed from the three pieces of gold which were soldered together, in the approximate proportion of the socket created by the extraction of the tooth it would replace.

In 1906, Greenfield described the fabrication and insertion of an endossoeus implant. He for the first time, used a basket shaped, round, hollow implant made ofn an iridium-platinum alloy, soldered with 24 carat gold. This implant model can be considered a prototype of the hollow cylinder implants still used today.

Greenfield’s Hollow implant

In 1939, Strock succeeded in anchoring a Vitallium screw within the bone and mounting a porcelain crown on the implant. Strock for the first time achieved long term survival.

Strock’s Vitallium screw implant

 In 1943, Dahl placed a metal structure on the maxillary alveolar crest with four projecting posts. He suggested the construction of subperiosteal type of implant

In 1948, Goldberg and Gershkoff refined the subperiosteal implant with an extension of the framework to the external oblique ridge.

Subperiosteal Implant

In the early 1960’s, Orlay utilized Vitallium posts that were placed into the canals of endodontically treated teeth with extension beyond the apex. This reportedly enhanced the crown root ratio of the compromised teeth.


 Linkow in the mid 1960’s introduced the blade vent implant. This “plate” type of endosseous implant was originally designed for the knife edge type of ridges which was later adapted for use in most of the clinical situations.

Linkow’s blade implant

Roberts and Roberts in the late 1960’s developed the ramus blade endosseous implant, constructed of surgical grade 316 stainless steel and was positioned to be anchored distally between the cortical plates in the ramus of the mandible. It was to serve as “Synthetic Lower Third Molar”. Later in the early 1970’s, they designed the mandibular staple implant to rehabilitate the edentulous atrophic mandible.

Ramus Blade Implant-The mandibular staple implant

In the early 1970’s, Roberts and Roberts developed the ramus frame implant which received stabilization from its anchorage in the ramus area bilaterally and in the mandibular symphysis area.

Ramus Frame Implant

In the early 1970’s the use of intramucosal inserts was popularized for the retention of maxillary removable prosthesis by Weiss and Judy.

Intramucosal Inserts

In the early 1970’s, Schroeder and his group designed a single stage implant system known by the name of ITI Implant System. They demonstrated that one-stage implant can also result in direct bone to implant contact and named this phenomenon as “functional ankylosis”. The initial surface characteristics was plasma sprayed titanium coating which in recent years have changed to a sand blasted acid etched surface.

ITI Implant

Then came the IMZ Implant System (Interpore IMZ) in 1974. The major difference between the IMZ System and all other relevant implant systems is that an elastic compensating component is inserted between the osseointegrated implant and the prosthetic superstructure. The IMZ implant consisted of two parts: the implant body and the intra-mobile connector (IMC). The latter consisted of the titanium and the intramobile element. The elastic intramobile element was intended to assume the role of periodontal ligament of the natural tooth and provide shock absorption as well as force distribution in order to prevent exceeding the adaptive tissue tolerancewhen chewing forces are applied. The implant was a cylinder with a half spherical apex; the rounded shape was intended to avoid stress peaks and overloading of the osseous bed in the apical region. Perforations through the base of the implant permitted the ingrowth of bone in the apical region.

Cylindrical non-threaded implants poorly distribute compressive forces and generate shears forces that may fragment and break the bone surrounding the implant during function. To overcome these problems were the threaded implants introduced.The threaded type implant provides, at least initially, more stability than a press-fit attachment, but the implant is still vulnerable to movement and high levels of shear forces can be established between the implant and the alveolar bone during function.Consequently, it is usually necessary to rely on growth of new bone tissue and connective tissue to further stabilize the inserted position of the implant.

Threaded Endosseus root form implants

Fig. : Threaded Endosseus root form implantsWith the development of electron microscopy, it was possible to have an in depth knowledge of the interface between the implant and the tissues. Branemark was the pioneer in the field of implantology. While conducting studies regarding the vascularity of bone marrow in rabbit fibula, he discovered the phenomenon named “osseointegration” which was later defined as “a direct structural and functional connection between ordered, living bone, and the surface of a load carrying implant”.

He developed the first two stage threaded titanium implant. Brånemark developed the Nobelpharma Implant Company of Goteberg, Sweden. The implant system began with research dating back to 1965. Brånemark introduced their first commercial implant in 1982 made of pure titanium. They quickly became the standard by which all root form implants and manufacturers were to be measured. It took only a few years for him to reverse the image of dental implants from experimental and risky to credible and promising.Niznick in the early 1980’s introduced the Core-Vent Implant which is a hollow basket implant with a threaded component to engage bone.


Niznick, became the pioneer of prosthetic development and fixed prosthesis. He developed and patented an internal hex threaded design that was about 2 times longer than the external hex on the Brånemark implant. It increased the stability of the prosthesis. The internal hex allowed the neck of the implant to be reduced to a 3.5 mm diameter thus eliminating the need for countersinking that seems to have a detrimental effect on crestal bone.The Screw-Vent implant was later introduced by the same company as an endosseous screw type implant. The Screw-Vent Implant is also manufactured with a hydroxyapatite coating to allow quicker osseous adaptation to the implant surface.

In the late 1980’s cylindrical plasma spray titanium and hydroxyapatite coated implants were introduced .

Titanium Plasma Spray (TPS) coated Implant

The Frialit 2 system gained popularity in the early 1990’s due to its design (stepped screw) and the excellent prosthetic options. It was result of the research carried out at University of Tubingen since mid 1970’s and was the first root shaped implant system adapted to the socket to be used earliest possible following extraction.The Dental Implant scenario has really evolved from the initial crude shell or bone implants, to state of the art materials machined precisely, In addition to titanium new materials like zirconia oxide ceramic are also being explored for manufacturing implants, the surface treatment of implants has also come a long way. From Machined surfaces to coatings,blasting and acid treatment; we are now entering a stage of bio engineered surfaces doped with bone morphogenic proteins. The implant designs are being optimized to support immediate loading and the prosthetic options have increased manifold. Even an approach to utilize the zygomatic bone for implants is currently available for patients with poor bone in the maxilla. The current systems will be reviewed in the next block and will acquaint you with the current scenario.The predictability and success of implants to support prosthesis in today’s time is indeed a tribute to the hardwork and untiring research of the pioneers a few of whom were discussed in this section and lot many more who have contributed to this cause. After this, we will discuss the scope of implants, their use and application in various fields of Dentistry.