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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
What is the effect of cover screw perforation?
Higher prevalence of MBL of 2mm Impinge BW VAN ASSCHE
26
Describe the association between excess cement and peri-implantitis
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)
27
What is the effect of vestibular depth on implants?
Shallow vestibule <4mm risk-indicator for peri-implant disease due to greater recession, RBL, BOP, GI, and lower KMW HALPERI-STERNFELD
28
What is the effect of lack of maintenance on peri-implantitis?
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
How common is early implant failure? What is it associated with?
5% patient, 1.7% implant Cigarettes/day Smoking OR 2.2 Antidepressants CHRCANOVIC Maxilla, smooth collar. Require surgery, survival 33%. CAMPS-FONT
30
What is the success of implants at previously failed sites?
MACHTEI - 83.5% CHRCANOVIC - 93.6%, 73.5%, 64% NGUYEN - 91% 1 year, 88% 5 year, 83% 10 year (University)
31
Should antibiotics be prescribed for implants?
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
How long does it take for the CT barrier to form?
8 weeks TOMASI
33
What is the importance of keratinized tissue on implants?
<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
What is the critical temperature for bone? Is this reached during implant surgery?
47 degrees Celsius (Rabbits) (ERICSON) Irrigation w/ room temperature saline should be sufficient, greatest temperature near crest (SENER)
35
How accurate is guided surgery?
2.1 angular deviation, 0.3-0.5mm linear deviation BEHNEKE
36
Can implants be placed in "infected" sites
YES WAASDORP - SR, success w/ ABC/debridement FUGAZZOTTO - Split mouth w/ PARL, no differences
37
How long to wait after adjacent RCT?
ZHOU - when RCT <4 weeks ago and <2mm away from adjacent tooth, retrograde peri-implantitis 7.8%
38
Does augmented bone stand up to implants like native bone?
YES BUSER - Horizontal augmentation w/ block autograft, similar load bearing capacity SIMION- Vertical augmentation w/ ePTFE/DFDBA/autograft, similar load bearing capacity
39
How does subjective bone quality relate to torque?
ALSAADI - Placement torque, ISQ, and PTV share a relationship w/ bone quality assessment by Lekholm & Zarb
40
How do you manage cantilever restorations?
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
Do narrow diameter implants work for overdentures?
JAWAD - SR MA, 2-4 iplants w/ 1.8-2.4mm diameter 93% survival
42
Do short implants work?
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
Do tilted implants work?
MONJE - Yes, no differencein MBL or biomechanical complicatinos CRESPI - All on 4, 95% survival for axial and tilted implants
44
What are the critical and subcritical contour?
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
What are complications for full arch prostheses?
Papaspyridakos - 25% Plaque, papilla hypertrophy, screw loosening, material chipping
46
How common are open contacts in implants?
VARTHIS - Retrospective, 52% PAPAGEORGIOU - SR MA, implant infraposition 50% and open contact 46%
47
Does the crown/implant ratio have an effect?
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
Is multiple abutment connections harmful?
YES, slightly less MBL when final abutment connected at time of implant placement (KOUTOUZIS) NO, no difference of 1 year MBL rate (BORGES)
49
Do bacteria penetrate the microgap?
YES, in all types of abutment connections (external, internal, conical) CANULLO
50
What are the 4 sagittal root position classifications?
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
What is the thickness of the buccal plate?
87% of anterior and 60% of premolar buccal wall extraction sockets 1mm apical to crest were 1mm or less in width
52
What is expected for mid-buccal recession with immediate implants?
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
Is buccal contour grafting effective?
DEGROOT - At time of immediate implant, width increase to 2.94mm vs 2.32mm
54
Are there differences between immediate/early/conventional loading?
ESPOSITO - SR MA NO difference for prosthetic or implant failures and MBL.
55
Where should an immediate implant be placed?
TOMASI 1mm subcrestal and minimum 2mm gap from buccal plate
56
Are we good at covering recession around implants?
BURKHARDT NO, get improvement w/ CAF/CTG but not full coverage
57
Are immediate molar implants successful?
URBAN 83% success Smoking, buccal dehiscence, and infection increased risk for immediate molar failure
58
What implant collar may be best for soft tissue attachment?
Biohorizons LaserLok laser microtextured implant collar Less MBL and PD compared to machined-surface collar CHEN
59
What are advantages and disadvantages of HA surface implants?
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
What is Dr. Deas favorite implant study
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
What is the advtange of microthread implant collars?
HUDIEB Increase surface area, more favorable load distribution especially for off axis load
62
What is the benefit of platform switching? How much?
ANNIBALI SR MA, mismatch >0.45mm on each side w/ less MBL
63
How much force should be used for implant probing?
GERBER 0.15N
64
Are bacteria the same in ChP and peri-implantitis?
LAFAURIE - SR MA, PG/PI/PN more frequent at PI sites DAUBERT - Perio 2000, ChP and PI microbiome fundamentally difference
65
Are radiographs good for examining implants?
Grondahl - PPV 83% for implant PARL and peri-implantitis Vanderstuyft - 12-15% blooming in vitro Schwindling - lose dose CBCT for implant defects
66
Describe peri-implant HARD tissue healing
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
Describe peri-implant SOFT TISSUE healing
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
Who described implant healing
Berglundh (DOGS)

Classic Literature (38 decks)

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