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Classic Literature > 17 - Implants 1 > Flashcards

17 - Implants 1 Flashcards

1
Q

IAN loop

A

Ritter

31% overall
Males slightly higher
Average 1.6mm
Biggest 4.6mm

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2
Q

Mental foramen distance from crest of ridge without atrophy

A

12.4mm

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3
Q

Suggested horizontal distance between implants

A

Tarnow - machined implants >3mm apart

Siqueira - horizontal distance 4mm or greater

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4
Q

Suggested alveolar crest to contact point for papilla presence

A

Implant/tooth - <4.5mm (Salama)

Implant/implant - <3.5mm (Tarnow)

Implant/pontic - <5.5mm (Salama)

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5
Q

How tall is the papilla between 2 implants?

A

Tarnow - 3.4mm, with a range of 1-7mm

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6
Q

What is the biologic width around implants

A

Cochran - 3.08mm

Kan Joe - 3.63mm in maxillary anterior buccal

**Level of interproximal papilla is dependent on the bone level of the adjacent tooth and independent of bone level next to implant

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7
Q

What are the old implant success criteria

A

Albrektsson

Non-mobile
No radiolucency
<0.2mm/year RBL 1 year after loading
No pain/infection

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8
Q

How do implants compare to FDPs?

A

Torabinejad - 6+ year success is endo 84%, implant 95%, and FDP 80%

Salinas - 5 year success in implant 95%, FDP 84%, and FDP 94% when exclude resin bonded prostheses

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9
Q

What is the prevalence of peri-implantitis and mucositits?

A

Atieh

With a definition of PD 5mm or greater and RBL 2mm or greateror 3 threads exposed

Mucositis: Subject 63%, implant 30%
Implantitis: Subject 18%, implant 9%

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10
Q

What is the definition of peri-implantitis in the new classification?

A

Bleeding/suppuration
Increased PD compared to previous exam
Bone loss beyond remodeling

In the absence of previous exam, BOP/suppuration, PD 6mm or greater, bone level 3mm or greater from implant platform

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11
Q

What is the definition of peri-implant mucositis in the classification?

A

Bleeding/suppuration
No increase in PD compared to previous exam
No bone loss beyond remodeling

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12
Q

When is the likely onset of peri-implantitis? How does it progress?

A

Derks

81% within 3 years

Non-linear, accelerated bone loss

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13
Q

What are site and subject level factors for peri-implantitis?

A

Kumar

PI 1.5 or greater
Offset placement of restoration on fixture
Platform depth 6mm or greater from tooth
Tooth loss due to ChP
ChP on adjacent teeth
Smoker
A1C 6 or greater
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14
Q

Is a history of periodontitis a risk factor for peri-implantitis?

A

Yes
SLA implants in patients with no ChP or treated ChP there was a survival of 96.6% vs 90% (ROCUZZO).
GAP, the RR was 4 for failure rate in a SR (MONJE)
Even with maintenance a history of ChP has a WMD of 0.50mm RBL (LIN)

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15
Q

Is smoking a risk factor for peri-implantitis?

A

YES
SR MA, 3/4 studies with worse treatment outcomes in smokers (HEITZ-MAYFIELD)

Often implicated in smooth surface implants (BALSHE)

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16
Q

Is glycemic control a risk factor for implantitis?

A

Kumar - A1C >6 YES

Shi - A1C <8 vs 7-14. NO

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17
Q

Is osteoporosis a risk factor for peri-implantitis?

A

NO

With a 3+ year exposure to oral BP, no difference in implant complications (FUGAZZATTO)

With a T-score less than -2, survival 91% vs 100% (NOT SS) (TEMMERMAN)

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18
Q

Is HIV a risk factor for peri-implantitis?

A

With a preplacemnet CD4% <20%, protease inhibitor, smoking, or anterior maxilla

Controlled HIV, no difference

SABBAH

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19
Q

Is radiation a risk factor for peri-implantitis?

A

> 45 grays

Disruption of blood supply
Periosteum loses cellularity/vascularity
Hematopoietic proliferation sparse in BM

COLELLA

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20
Q

What medications are implicated in peri-implant failure

A

PPI OR 2
SSRI OR 3
BP OR 1.2

CHAPPUIS

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21
Q

SSRI mechanism with peri-implant failure

A

Increase osteoclast differentiation due to increased peripheral serotonin levels

Sertraline/Zoloft implicated (CARR)

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22
Q

PPI mechanism with peri-implant failure

A

Inhibit H/K pump

Alter bone homeostasis and calcium metabolism

Failure 2% vs 5.5% (URSOMANNO)

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23
Q

Is age a factor in implant placement?

A

NO

Srinivasan

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24
Q

How are titanium particles implicated in peri-implantitis?

A

Particles 2-8um, phagocytized and inflammatory reaction

Peri-implantitis implants with greater PI/PD/GI and mean titanium levels when adjusted for amount of plaque (SAFIOTI)

Increased titanium particles wtih stainless steel, titanium, or PEEK scaler in vitro (HARRELL)

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25
Q

What is the effect of cover screw perforation?

A

Higher prevalence of MBL of 2mm

Impinge BW

VAN ASSCHE

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26
Q

Describe the association between excess cement and peri-implantitis

A

In a private practice endoscopic study, 100% of implants with peri-implant disease and overall 81% with excess cement. 75% recovery after get rid of excess cement (WILSON)

Methacrylate 61% with excess cement and 100% suppuration with excess cement. Temp-Bond (ZOE) 0% excess cement, no suppuration because it washes out over time (KORSCH)

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27
Q

What is the effect of vestibular depth on implants?

A

Shallow vestibule <4mm risk-indicator for peri-implant disease due to greater recession, RBL, BOP, GI, and lower KMW

HALPERI-STERNFELD

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28
Q

What is the effect of lack of maintenance on peri-implantitis?

A

In a population with peri-implant mucositis and no periodontal maintenance over 5 years, OR 5.9 for peri-implantitis (COSTA)

Even with 1 annual prophy vs no prophy for >1.5 years was protective with 4% vs 17% peri-implantitis (OR 4) (FRISCH)

29
Q

How common is early implant failure?

What is it associated with?

A

5% patient, 1.7% implant

Cigarettes/day
Smoking OR 2.2
Antidepressants

CHRCANOVIC

Maxilla, smooth collar. Require surgery, survival 33%. CAMPS-FONT

30
Q

What is the success of implants at previously failed sites?

A

MACHTEI - 83.5%

CHRCANOVIC - 93.6%, 73.5%, 64%

NGUYEN - 91% 1 year, 88% 5 year, 83% 10 year (University)

31
Q

Should antibiotics be prescribed for implants?

A

A NTT of 24 (BRAUN) and 50 (LUND) has been seen

Failure % of 1.8 vs 5.6 (Romandini) and 2.2 vs 7.5% (Kashani)

MAYBE?

32
Q

How long does it take for the CT barrier to form?

A

8 weeks

TOMASI

33
Q

What is the importance of keratinized tissue on implants?

A

<2mm with increased GI/PI/BOP (SR MA, GOBBATO)

Thicker tissue WMD -0.8mm MBL vs thin tissue (SUAREZ-LOPEZ)

Implants in alveolar mucosa vs KT require more surgery (FGG), recession, poorer plaque control, higher BOP, and greater brushing discomfort (ROCCUZZO)

34
Q

What is the critical temperature for bone? Is this reached during implant surgery?

A

47 degrees Celsius (Rabbits) (ERICSON)

Irrigation w/ room temperature saline should be sufficient, greatest temperature near crest (SENER)

35
Q

How accurate is guided surgery?

A

2.1 angular deviation, 0.3-0.5mm linear deviation

BEHNEKE

36
Q

Can implants be placed in “infected” sites

A

YES

WAASDORP - SR, success w/ ABC/debridement
FUGAZZOTTO - Split mouth w/ PARL, no differences

37
Q

How long to wait after adjacent RCT?

A

ZHOU - when RCT <4 weeks ago and <2mm away from adjacent tooth, retrograde peri-implantitis 7.8%

38
Q

Does augmented bone stand up to implants like native bone?

A

YES

BUSER - Horizontal augmentation w/ block autograft, similar load bearing capacity

SIMION- Vertical augmentation w/ ePTFE/DFDBA/autograft, similar load bearing capacity

39
Q

How does subjective bone quality relate to torque?

A

ALSAADI - Placement torque, ISQ, and PTV share a relationship w/ bone quality assessment by Lekholm & Zarb

40
Q

How do you manage cantilever restorations?

A

KIM - <8mm is KEY. >8mm in mandible with increased biologic complications

GREENSTEIN - Implant supported FDP cantilever, 2+ implants, >3.5mm diameter, >8mm between implants

41
Q

Do narrow diameter implants work for overdentures?

A

JAWAD - SR MA, 2-4 iplants w/ 1.8-2.4mm diameter

93% survival

42
Q

Do short implants work?

A

POHL - Posterior maxilla, 6mm vs 11mm+. No difference

RAVIDA - SR MA of <6mm. Splinted crowns w/ less prosthetic complications like screw loosening and implant failure. Little difference in survival and MBL

43
Q

Do tilted implants work?

A

MONJE - Yes, no differencein MBL or biomechanical complicatinos

CRESPI - All on 4, 95% survival for axial and tilted implants

44
Q

What are the critical and subcritical contour?

A

Critical - immediately below gingival margin. Facial convexity determines gingival scallop. Interproximal contour convex to increase papilla height

Subcritical - concave to increase tissue volume

SU

45
Q

What are complications for full arch prostheses?

A

Papaspyridakos - 25%

Plaque, papilla hypertrophy, screw loosening, material chipping

46
Q

How common are open contacts in implants?

A

VARTHIS - Retrospective, 52%

PAPAGEORGIOU - SR MA, implant infraposition 50% and open contact 46%

47
Q

Does the crown/implant ratio have an effect?

A

NO

SR MA of restorations of crown/implant ratio up to 2:1, no difference (GARAICOA-PAZMINO)

SR MA of C/I ratio 0-2.5, no difference (MEIJER)

May see more prosthetic complications

48
Q

Is multiple abutment connections harmful?

A

YES, slightly less MBL when final abutment connected at time of implant placement (KOUTOUZIS)

NO, no difference of 1 year MBL rate (BORGES)

49
Q

Do bacteria penetrate the microgap?

A

YES, in all types of abutment connections (external, internal, conical)

CANULLO

50
Q

What are the 4 sagittal root position classifications?

A

1 - root against labial (81%)
2 - root centered w/o engaging labial/palatal at apical 1/3 (7%)
3 - root against palatal (1%)
4 - root centered (12%)

KAN

51
Q

What is the thickness of the buccal plate?

A

87% of anterior and 60% of premolar buccal wall extraction sockets 1mm apical to crest were 1mm or less in width

52
Q

What is expected for mid-buccal recession with immediate implants?

A

HUYNH-BA - 1mm in type 1 and type 2 at 1 year
COSYN - <10% risk for advanced mid-facial recession with thick phenotype, immediate, intact buccal plate, flapless, provisional

53
Q

Is buccal contour grafting effective?

A

DEGROOT - At time of immediate implant, width increase to 2.94mm vs 2.32mm

54
Q

Are there differences between immediate/early/conventional loading?

A

ESPOSITO - SR MA

NO difference for prosthetic or implant failures and MBL.

55
Q

Where should an immediate implant be placed?

A

TOMASI

1mm subcrestal and minimum 2mm gap from buccal plate

56
Q

Are we good at covering recession around implants?

A

BURKHARDT

NO, get improvement w/ CAF/CTG but not full coverage

57
Q

Are immediate molar implants successful?

A

URBAN

83% success

Smoking, buccal dehiscence, and infection increased risk for immediate molar failure

58
Q

What implant collar may be best for soft tissue attachment?

A

Biohorizons LaserLok laser microtextured implant collar

Less MBL and PD compared to machined-surface collar

CHEN

59
Q

What are advantages and disadvantages of HA surface implants?

A

GOOD - rapid integration, better maintenance of crestal bone height. Good for immediate, type IV bone, grafted sinus, or short implants

BAD - rapid peri-implantitis, hard to clean exposed threads

60
Q

What is Dr. Deas favorite implant study

A

LAZZARA

1/2 Osseotite (3i) vs half commercially pure titanium in a half and half mini implant in posterior maxilla

BIC 73% Osseotite, 34% machined

61
Q

What is the advtange of microthread implant collars?

A

HUDIEB

Increase surface area, more favorable load distribution especially for off axis load

62
Q

What is the benefit of platform switching? How much?

A

ANNIBALI

SR MA, mismatch >0.45mm on each side w/ less MBL

63
Q

How much force should be used for implant probing?

A

GERBER

0.15N

64
Q

Are bacteria the same in ChP and peri-implantitis?

A

LAFAURIE - SR MA, PG/PI/PN more frequent at PI sites

DAUBERT - Perio 2000, ChP and PI microbiome fundamentally difference

65
Q

Are radiographs good for examining implants?

A

Grondahl - PPV 83% for implant PARL and peri-implantitis

Vanderstuyft - 12-15% blooming in vitro

Schwindling - lose dose CBCT for implant defects

66
Q

Describe peri-implant HARD tissue healing

A

2 hours - primary stability, void between threads filled with blood
4 days - clot replaced w/ granulation tissue
1 week - angiogenesis and contact osteogenesis of bone in contact w/ titanium
2 weeks - woven bone circumferentially and osteoclasts for resorption of bone adjacent to implant surface at pressure areas
4 weeks - spongiosa between threads
6-12 weeks - bone remodeling and lamellar bone w/ load capcity at 6-8 weeks

67
Q

Describe peri-implant SOFT TISSUE healing

A

2 hours - 4 days - NP degrade coagulum, fibrin network forms seal between wound surface of flap and implant
1-2 weeks - epithelial proliferation
2 weeks - JE formation
4 weeks - decrease fibroblast
4-6 weeks - oragnize collagen fibers
6-8 weeks - epithelial barrier established

68
Q

Who described implant healing

A

Berglundh (DOGS)

Classic Literature (38 decks)

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