8/16 - Prosthetically-Driven Implant Tx Planning, Denture Duplication, Central Incisor Wax-Up Flashcards
during pre-treatment evaluation, you must identify what?
- patient chief concern
- treatment expectations
when do you identify prosthetic needs of patient
during comprehensive evaluation
what is done during comprehensive examination
- systemic evaluation
- clinical examination
- radiographic examination
- esthetic examination
- extra/intraoral photographs
- mounted diagnostic casts
what exams/assessments are done during clinical examination
- soft and hard tissue exam
- odontogram
- periodontal assessment
- caries risk assessment
what is the goal of a treatment plan
establish a prosthetic need
why obtain a panoramic radiograph?
allows you to look at the case as a whole, not tooth by tooth
examples of risk factors that may decrease success of implants
- medical hx
- perio/endo
- parafunction
- occlusion
- bone resorption
what must be done before considering any implant therapy
treat all pathologic conditions
implants are an ___ procedure
elective
implant procedures are based on patient’s ability to:
- withstand procedure
- heal
what are examples that prevent patient from completely healing from procedure
smoking, diabetes, chronic kidney disease, bisphosphonate therapy, radiation therapy
without risk factors, what is the success rate for implants at 5 years and 10 years?
5 years: 90-98%
10 years: 89-95%
why does smoking lead to increase failure of implant therapy
it impairs neutrophils, alters blood flow, and diminishes O2 perfusion
non-smokers have a ___ survival rate compared to smokers
3% higher
there is a higher failure rate of implant survival in smokers where? what percentage?
maxilla has a greater than 9% failure rate due to highly trabecular bone
is the failure of implant therapy in smokers dose dependent?
YES
what forms of diabetes are a risk factor for failed implants
BOTH! type I and type II
why does poor diabetic control lead to implant failure
leads to impaired wound healing and predisposition to infection
do HbA1c readings or daily readings provide better judgement of pt diabetic control
HbA1c
what HbA1c reading means pt has diabetes but is under long-term control
<7%
what percent of pts with diabetes has successful control? what percent of early failures and late failures?
success: 85.6-94.3%
early failure: 2.2%
late failures: 7.3%
how does chronic kidney disease lead to implant failure
increases serum FGF23 which can impair bone density
chronic kidney disease can lead to deficiency in what? resulting in what?
vitamin D deficiency which can impair bone metabolism and osseointegration
what supplement has been shown to improve healing in patients w/ chronic kidney disease
Vit D
when are IV bisphosphonate therapy used
management of cancer-relateda conditions
when is oral bisphosphonate therapy used
management of osteoporosis, Paget’s , osteogenesis imperfecta
examples of bisphosphonate therapy brands
- boniva
- fosamax
- reclast
what does BRONJ stand for
bisphosphonate-related osteonecrosis of the jaws
what is BRONJ
non-healing exposed bone in maxillofacial region
how long does BRONJ persist
> 8 weeks
what is a major risk for BRONJ (0.8-12% cases)
IV bisphosphonates
there is a 5-20x higher risk of BRONJ with what?
dentral procedures after IV
what is a lower risk med of developing BRONJ after 3+ years of use (0.0003-0.06%)
oral bisphosphonate
what is the half life of oral bisphosphonates
10 years
what is the best indicator of healing for patients using oral bisphosphonates
how pts dealt w/ previous extractions or surgeries
pts undergoing radiation therapy are at risk of developing what
osteoradiocrenosis (ORN)
what is prolonged non-healing exposure of bone that is similar to BRONJ
osteoradiocrenosis (ORN)
where does ORN primarily occur in the mouth
mandible
what are examples of dental risk factors for implant therapy
- perio disease
- endodontic pathology
- occlusion
- bruxism/parafunction
- home care
- gingival display/biotype
- esthetic expectations
does previous periodontal disease pose increased risk to long-term implant survival
YES - especially if patient is noncompliant
___ mm perio pockets, and __ mm of attached gingiva results in INCREASED risk of crestal bone loss
> 4 mm perio pockets
<2 mm attached gingiva
when are endotontic cases w/ periapical pathology successful
after thorough socket debridement
what is a symptomatic lesion at the apex of an implant
retrograde peri-implantitis
when does retrograde peri-implantitis develop
shortly after placement
does the APICAL region of implant achieve normal bone to implant interface in retrograde peri-implantitis?
NO! occurs in CORONAL region
retrograde peri-implantitis is found in ___ and ___
1.6% of maxillary implants
2.7% of mandibular implants
what is associated w/ previously existing periapical lesion
development of retrograde peri-implantitis
occlusion mantra :(
broad stable posterior support and effective anterior guidance
when looking at pt occlusion, what must you do
- reduce non-axial loading
- stress distribution between fixed and removable prostheses
- rule out bruxism/parafunction
parafunctional habits increase magnitude of stress by how much?
3-4x that regular chewing force
do you determine bone volume PRE or POST CBCT?
pre
what bone volume dimensions do you determine clinically?
B-L dimension and M-D dimension
what bone volume dimensions do you determine radiographically?
M-D dimension or vertical dimension
when determining the vertical dimension of bone volume thru radiographs, what must you look for?
- maxilary sinus
- inferior alveolar nerve/mental foramen
optimal B-L dimension for bone volume
1.5-2 mm on buccal plate
1.5-2 mm on lingual plate
minimal B-L dimension for bone volume
1 mm buccal plate
1 mm lingual plate
what is the equation for minimum width of ridge
1 mm tissue thickness + 1 mm buccal plate + implant diameter + 1 mm lingual plate + 1 mm tissue thickness
what is the minimal implant-implant distance?
> /= 3.0 mm
what is the minimum optimal distance from tooth to implants for emergence profile
3mm
what is the minimum distance from tooth to implant to prevent crestal bone and papilla loss for periodontal/tooth health
1.5 mm