03 Implants in the Zone of Esthetic Priority Flashcards
In your own words, please discuss the following phrase: “The results of a long‐term follow‐up study concluded that 9–12 years after implant installation, implant survival rates are high and implant loss seems to cluster within patients. In contrast, after the same period of observation, peri‐implant lesions seem to be a common clinical entity. “
As we discussed in previous lectures, there is a difference between survival rate and success rate of an implant. Success rate is more important. Survival rate is whether the implant is there or not. When you lose the implant the survival rate drops. Success is whether there are biological or technical complications. An implant can have peri-implant pathologies and still survive for a long time. Survival rate is high, but the success rate is low.
prevalence of peri-implant mucositis and peri-implantitis
Many studies have reported the varied prevalence of peri-implant mucositis
- 23.9%– 88.0% at the patient level and
- 9.7%–81.0% at the implant level and
peri-implantitis
- 9.8.9%–45% at the patient level and
- 4.8%–23.0% at the implant level
Discuss in your own words the importance of:
- Patient trust
- Patient’s informed knowledge
Patient trust:
It is an important requirement for accepting a treatment plan based on implant placement. The clinician might not provide the adequate information to allow the patient to make an informed decision but, if a patient trusts their surgeon, they may be less likely to seek other sources of information. Therefore, if there is trust then there are higher chances for the patient to accept any treatment plan provided by their surgeon.
Patient’s informed knowledge:
For each situation in the consent, they should provide details about what patients need to know and include any potential information gaps they might have. They should have information also regarding surgical decisions, their alternatives, outcomes and risks regarding the surgery.
Which are the clinical parameters that should be noted before final decisions are made to place an implant?
Clinical assessment of:
1. oral hygiene habits (plaque accumulation)
2. plaque score - biofilm formation in the marginal area of implants – very important
3. presence of bleeding on probing (should be less than 20%) absence of bleeding is a good indicate of health (100% healthy) - IMPORTANT
4. periodontal probing depth and soft tissue levels
5. thick and thin gingival biotypes (thick is preferred)
6. restorative conditions of adjacent teeth
7. edentulous regions (horizontal or vertical defects)
What is the recommended radiographic technique for assessing the possibility or replacing a single missing tooth with an implant?
In the upper anterior maxilla, the recommended standard radiographic technique consists of an intraoral radiograph before replacing a missing single tooth .
When would a panoramic and a CBCT image be indicated?
OPG for partially dentate and edentulous patients .
CBCT indications:
1. when clinical examinations or conventional radiography have failed to adequately identify the relevant anatomic boundaries or the absence of pathology
2. such an image can provide additional information and help to minimize the risk of damage to important anatomic structures
3. these are judged to be clinically borderline , with limited bone , and the surgeon considers that the morphology of the defect requires a more extensive augmentation procedure
4. implant positioning can be improved so that esthetic results are optimized .
- This information can be enhanced by using radiographic templates and surgical guides which help to translate the information from the radiographic evaluation into the clinical procedure. These surgical guides may be a prerequisite when multiple teeth are missing and a fixed reconstruction with implant‐supported crowns and bridges is planned
The information that radiographs can be enhanced by
The information that radiographs can provide can be enhanced by using radiographic templates and surgical guides which help to translate the information from the radiographic evaluation into the clinical procedure. These surgical guides may be a prerequisite when multiple teeth are missing and a fixed reconstruction with implant‐supported crowns and bridges is planned.
What would influence the perception of a patient and a clinician of an ideal esthetic result? Bullet points
Patient is influenced by their:
1. self-perception
2. social environment
3. media
4. dental history
Clinician is influence by:
1. current dental knowledge
2. empirical experience – mistakes that were previously made by you
3. available medical checklists – evidence based
What would be a method for the patient to visualize the final esthetic result before treatment begins?
Mock-up
Which alternative treatment modalities are available to replace a tooth in the esthetic zone?
- Conventional fixed partial dentures comprising cantilever units
- Adhesive, RBB (cantilever)
- Conventional RPDs
- Tooth-supported overdentures
- Orthodontic therapy (closure of edentulous spaces)
- Implant-supported prostheses (fixed, retrievable or removable suprastructures)
- Combinations of the above
How can orthodontic treatment be used to enhance the final esthetic result in a patient with missing teeth in the anterior zone?
- With forced eruptions to increase the retention for placement of a conventional crown or to condition the site for later implant placement
- Changing the distribution pattern of the edentulous spaces by turning a neighboring two‐unit space into two one unit spaces
- The temporary implant may serve as an ideal anchor in many situations to firmly fix a provisional without any visible attachments on the anterior incisors and canines
In which cases an implant supported solution is preferred?
- unrestored, healthy neighboring teeth – in order to not to prepare healthy teeth
- overly prepared teeth or compromised risky abutments – you don’t trust them to support a bridge
- diastemata – you cannot do a bridge here
Risk factors for implant placement in the zone of esthetic importance
Mention the various options of provisional prosthesis following tooth extraction prior to implant placement. Briefly discuss advantages/ disadvantages of each option.
temporary solution before placing implants:
Removable partial acrylic denture:
Advantages
1. Simple to construct
2. Relatively inexpensive
3. Easy to adjust and fit
4. Easily modified (adding provisional teeth to their existing removable dentures at minimal cost)
Disadvantages
1. May apply too much pressure to the healing site
2. Not comfortable
Mention the various options of provisional prosthesis following tooth extraction prior to implant placement. Briefly discuss advantages/ disadvantages of each option.
temporary solution before placing implants:
Essix provisional splint (removable prosthesis):
Advantages
1. Doesn’t apply pressure on the healing site
2. Protects the underlying soft tissue and implant during healing phase
3. Can be used in cases of limited interocclusal space or in deep anterior overbite
Disadvantages
1. Unable to mold the surrounding soft tissue
2. Lack of patient compliance can cause rapid occlusal wear from the vacuum form material
Mention the various options of provisional prosthesis following tooth extraction prior to implant placement. Briefly discuss advantages/ disadvantages of each option.
– temporary solution before placing implants:
Resin-bonded pontics or bridge (Maryland):
Advantages
1. More comfortable from a functional and phonetic point of view
2. More esthetic
Disadvantages
- Their removal and rebonding after the surgical intervention requires more time and work from the dentist
