Many  people  suffer  from  tooth  loss  all  over  the  world  due  to  numerous  causes  such  as  tooth  decay, periodontal disease, or even injuries. Throughout history some solutions were presented to manage these problems, they date back to approximately 2500 BC when ancient Egyptians used a ligature wire of gold in order to stabilize their teeth. Sometime around 500 BC,  oxen teeth    were  used   in  replacement  of    real  teeth  by  Etruscans     and in 300  AD , innovative   Phoenicians  used  ivory carved teeth stabilized by gold wire to create a fixed bridge.

However, the first evidence of dental  implants  throughout  history  dates  back  to 600 AD  when  Mayan  women used tooth‐like  pieces   of shell,  hammered  into  their  jaw  as  a  substitution  of  their  lost  teeth.  Radiographs taken  in the 1970´s of Mayan  mandibles  are  quite  fascinating   as  they  reveal  compact  bone  formation  around    the implants‐ bone surface similar to blade implants. Furthermore, around 800 AD, during the early Honduran culture the first stone implant was prepared and placed in a mandible.

But what is a dental implant?

Doctors at the Glasgow Dental Hospital and School define dental implants as “inert, alloplastic materials embedded    in the maxilla  and/or  mandible  for the  management of tooth loss and to aid    replacement of lost orofacial  structures as a result of trauma, neoplasia or congenital  defects.”

In  the  middle  of  the  1600´s in Europe,   periodontal  compromised  teeth  were  stabilized  with  various substances while  in  the 1700’s,  Dr. Hunter, who  for  many    years  had  observed  and  documented  the anatomy    of  the  mouth  and  jaw  on  corps,  suggested  transplanting  teeth  from  one  human  to  another.  He achieved  his  goal by with the  implantation  of  an  incompletely  developed  tooth  into  the  comb  of  a  rooster  as he  observed  that  the  tooth  firmly  embedded  into  the  comb.  His study  was  later  continued by J.   Maggiolo  as  he  inserted  a  gold  implant  tube  into  a  fresh extraction  site.  However,  as  the  site  was allowed  to  heal  and  the  crown  was  added,  extensive  inflammation  of  gingiva  was  observed.   During  this time diverse substances were used as implants, for instance; silver capsules, corrugated porcelain, and iridium tubes. Discoveries in the field of dental implantology continued by Dr. EJ Greenfield, Drs. Alvin and Moses Strock. These brothers were acknowledged for their work in selecting a biocompatible metal to be used in the human dentition, as well as suggesting an orthopedic screw fixture as an implant. Their model was later  enhanced  by  Dr.  P. B.  Adams, Formigginin,  Zepponi  and  Dr.  Perron  Andres.  Further  on,  Dr.  Raphael Chercheve  eased  the  insertion by  creating  burs  with a  spiral  design  of  the  implant.  Dahl  developed  sub  periosteal (on  the  bone)  implant  in  the   1940’s.  His  work  was  carried  on  and further researched by Gershkoff, Goldberg, Weinberg, Lew, Bausch, and Berman. Eventually in 1978 the most  well  maintained  dental  implants  were    presented  by  Dr.  P.  Brånemark  using  pure  titanium screws as  he  discovered  that  the  bone  actually  bonds  to  the  titanium  surfaces.  The concept  of “Osseointegration”, was  introduced  as  he  observed  that  a  piece  of  titanium  embedded  in rabbit  bone  became  firmly  anchored  and  difficult  to  remove.  By  observing  the  bone  for  over  a  year, Brånemark did not observe any inflammation of the  bone attaching  to  the  titanium.  To  further  explain  the  term “Osseointegration”, we  can  rely  on  the definition presented by Brånemark himself in his papers. “Intraosseous Anchorage of Dental Prostheses Experimental Studies” and “Osseointegrated Titanium Implants and Requirements for Ensuring a Long‐Lasting Direct Bone‐to‐Implant Anchorage in Man”. After endosseous implant fixtures are surgically inserted into bone, the  process  of  osseointegration  begins.  Osseointegration  is considered  a  direct,  structural and functional connection between organized vital bone and the surface of a titanium implant, capable of  bearing  the  functional  load.  This is possible  as  the  titanium  surface  oxide  layer (mainly  titanium dioxide) is biocompatible, reactive and spontaneously forms calcium‐phosphate apatite. Furthermore, the  titanium  oxide  surface  of  implants  achieves  a  union  with  the  superficial  gingivae restricting    the ingress of oral microorganisms.

The most  common  type  of  dental  implant  nowadays  is  “Endosseus”  which  is  basically  a screw  or cylinder‐shaped discrete implant unit placed in a drilled space within dent alveolar or basal bone. Common substances used as implants are commercially pure titanium or titanium alloy but it is worth-noting  that alternatives  such  as  ceramics  including  aluminum  oxide, gold, nickel and chrome  vanadium  were  used  as  well.    Generally,     endosseous  implant’s  coating  comprises  of  plasma‐sprayed titanium or a layer of hydroxyl apatite to enhance early osseointegration.  Annually one million endosseous dental implants are placed worldwide thanks to Brånemark’s discovery. The ITI‐sprayed implant, the Stryker implant, the IMZ implant and the Core‐Vent implant were introduced after the Brånemark implant, but never matched the level of osseointegration needed in a longlasting stable result. Most common brands of dental endosseous implants are sold and manufactured by companies such as Camlog, MIS, Anthogyr, Straumann, Noble Biocare, Biohorizons, Astra Tech, 3i and Zimmer, just to name a few.  Worldwide, more than 300 different brands of implants are commercialized.