11 - Implant planning and placement Flashcards

1
Q

Define osseointegration.

A

Direct functional and structural connection between load bearing dental implant and living (organised) bone

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2
Q

What are the stages of osseointegration?

A
  • primary, implant anchored in bone by friction between osteotomy and implant design features
  • secondary, process of functional connection between bone and implant, living bone grows onto surface to heal and remodel into surface of bio-inert material
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3
Q

Describe the healing after implant placement.

A
  • blood clot forms around implant surface
  • blood clot is reorganised into new bone
  • bone matures in close proximity to implant surface design
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4
Q

Compare the supra-crestal soft tissue of a tooth vs an implant.

A

Tooth
- more fibroblasts
- less collagen
- collagen fibres are orientated perpendicular to root surface (insert to root surface)

Implant
- less fibroblasts
- more collagen
- collagen fibres oriented parallel to implant crown (do not insert)

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5
Q

Compare the sub-crestal tissue of a tooth vs an implant.

A

Tooth
- tooth anchored by visco-elastic periodontal complex (bone, PDL, cementum)
- capable of physiologic adaptation
- resilient tissue attachment

Implant
- implant anchored to bone with direct functional contact
- no physiological adaptation possible
- rigid connection (if occlusion incorrect, components or opposing teeth may fracture)
- no proprioception (problem in bruxism)

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6
Q

What materials are commonly used for dental implants?

A
  • titanium
  • titanium zirconium
  • ceramic implants (yittra stabilised zirconia)
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7
Q

What is the concentration of Ti in implants?

A

> 85% to produce titanium dioxide layer

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8
Q

What are the component percentages for Ti-Zr implants?

A

85% Ti
15% Zr

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9
Q

What are the benefits of ceramic implants?

A
  • non-metallic coloured so can be placed in thin tissue biotype or thin underlying bone with no shine through
  • less technique sensitive
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10
Q

What are the benefits of Ti-Zr implants?

A
  • increased strength compared to Ti implants
  • can reduce diameter of implant for narrower spaces
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11
Q

What is the most commonly used length for implants?

A
  • short
  • 8-10mm
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12
Q

What are the tissue types of implant design?

A
  • bone level vs tissue level
  • tapered vs parallel
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13
Q

When are bone level implants indicated?

A

Aesthetic zone

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14
Q

When are tissue level implants indicated?

A

Posterior region

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15
Q

When are tapered implants indicated?

A
  • provide increased primary stability
  • root convergence apically
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16
Q

What are the difference surfaces designs for implants?

A
  • machined vs turned
  • roughness (smooth, mild, moderate, rough)
  • surface treatment (sandblasting, acid etch, plasma spray)
17
Q

How does the surface design influence the performance of the implant?

A
  • rougher surfaces is better for retention
  • rougher surface is more prone to peri-implantitis due to bacteria within the biofilm binding to implant
18
Q

What is the purpose of a dental implant?

A
  • replace missing teeth (aesthetic, function)
  • preservation of alveolar bone
19
Q

What what age are anterior implants suitable?

20
Q

What medications can impact the implant success?

A
  • SSRIs
  • PPIs
  • bisphosphonates
  • steroids
21
Q

What other medical history can impact implant success?

A
  • radiotherapy
  • poor controlled diabetes
  • CV disease (increases success)
22
Q

How does smoking impact implants?

A
  • increased risk of implant failure and peri-implantitis
  • dose dependant, <10 = medium risk, >10 = high risk
  • affects the vascularity, fibroblast and osteoblast function and neutrophils
23
Q

Define a high smile line.

A
  • > 2mm soft tissue show
  • do not place implants
24
Q

Define VME.

A

Vertical maxillary excess

25
Define a medium smile line.
<2mm of soft tissue show
26
Define a low smile line.
Lip covers >25% of teeth
27
What are the different gingival phenotypes?
- thick flat - thick, scalloped - thin, scalloped
28
How do you differentiate gingival phenotype?
Probe visibility through gingiva
29
What is the ideal bone crest to contact point?
30
What is the impact of the bone crest to contact point?
- determines the gingival aesthetics - if distance is too large, papilla will not be present
31
How does infection at the implant site impact success?
- no infection is best - chronic infection has little impact
32
What is the relevant local anatomy when placing implants in the maxilla?
- maxillary sinus - nasal floor - nasopalatine canal - infraorbital nerve
33
What is the relevant local anatomy when placing implants in the mandible?
- inferior alveolar canal - mental foramen - incisive canal - lingual perforation vessels - submandibular fossa
34
What is meant by prosthetically driven planning?
- implant placement is planned from the final planned prosthesis position - ensures that implant is placed in correct orientation
35
What is the safe margin from adjacent teeth for implant placement?
- 1.5mm - lowers risk of damage to adjacent teeth and bone necrosis or soft tissue defects - if 2 adjacent implants, double the biologic width
36
What is the ideal buccal and palatal positioning of an implant?
- 1-2mm bone labially - consider GBR if dehiscence, fenestration or inadequate contour
37
What is the ideal apical/coronal positioning of an implant?
If bone level implants, most coronal part of implant should be 2mm from planned gingival margin
38
What are the different placement protocols?
- immediate implant placement - early implant placement with ST healing (4-6 weeks) - early implant placement with partial bone healing (12-16 weeks) - late implant placement in healed site (>6 months)
39
What special investigations are required for implant placement?
- mounted study models - diagnostic wax up - surgical template - essix (provisional) - clinical photographs - CBCT