Blocks 1-2 Flashcards
Garaicoa-Pazmiño 2014 explored the relationship between C/I ratio and marginal bone loss. What was the main **conclusion?
Conflicting and limited information on the C/I ratio was found in the literature. Significant negative association between the C/I ratio and the MBL was found
C/I ratio of implant-supported restorations has an effect on peri-implant marginal bone level.
Within the range of 0.6/1 to 2.36/1, the higher the C/I ratio, the less the peri- implant MBL.
The ITI Consensus Report on 2018 elaborated on the performance of short implants versus longer implants. Please state the clinical recommendations of short implants versus standard implants.
*Short implants are suitable for cases with reduced bone height.
*When to Choose Short Implants:
*When avoiding morbidity associated with augmentation procedures is crucial. *To reduce treatment time.
*When the risk of damaging adjacent structures (maxillary sinuses, blood vessels,
nerves, tooth structures, existing implants) should be minimized.
Preference for Longer Implants:
*Site-Specific Decision: Implant length selection depends on local anatomical and patient conditions.
*Longer implants (>6 mm) are preferred when there is sufficient bone height without increasing surgical risk.
Clinical recommendations
Immediate Loading of Short Implants:
* Loading Times: Literature reports loading times ranging from 6 weeks to 6 months.
* No Clear Recommendation: Currently, there is no evidence-based recommendation for
immediate loading.
Implant Diameter for Short Implants:
* Recommendation: Short implants with a diameter of 4 mm or greater should be used.
Splinting Adjacent Short Implants:
* Clinical Recommendation: Restorations involving adjacent short implants should be splinted
based on findings in reviewed studies.
Occlusal Considerations for Short Implants:
* Occlusion Risk: Short implants may carry a higher risk of occlusal overload.
* Caution Needed: Especially in cases of single missing molars and parafunctional habits.
* Regular Assessment: Changes in occlusion should be evaluated and adjusted during routine
maintenance visits.
ADVANTAGES NDI
* NDI should be considered when it is important to ensure maintenance of adequate tooth‐implant and implant‐implant distances in sites with reduced mesio‐distal width.
* The use of NDI can be considered to reduce the need or complexity of lateral bone augmentation procedures to reduce morbidity.
* The use of NDI may allow simultaneous rather than staged bone augmentation procedures.
* The use of NDI may provide increased prosthetic flexibility in certain clinical situations.
DISADVANTAGES NDI
Biological
* One‐piece NDI with ball attachments might be difficult to manage at the onset of dependency.
* The use of NDI may compromise optimal prosthetic designs allowing the maintenance of peri‐implant tissue health.
Mechanical
* Reducing implant diameter brings an increased risk of implant or component fracture.
* Caution is recommended for the use of NDI in patients with parafunctional habits and malocclusions.
SPLINTING
* Given the reduced implant strength and bone contact offered by NDI, it may be advisable to use splinted restorations based on the individual clinical situation.
CLASSIFICATION of NDI
Category 1 <2.5 mm:
- Support of definitive complete mandibular overdentures
- Support of interim prostheses, both fixed and removable
Category 2 2.5mm to <3.3mm:
- Support of definitive complete mandibular overdentures
- Support of single tooth replacement in the anterior zone with narrow interdental width (maxillary lateral incisors and single mandibular incisors).
Category 3 3.3mm to 3.5mm:
- Support of definitive complete overdentures
- Support of single tooth replacement in sites with reduced interdental and/or buccal‐lingual width.
- Support of multiple unit restorations
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- Personalized informed consent should include the possibility of more technical and biological complications.
Chen 2019 evaluated the risk factors associated to failed short implants. According to this retrospective study, please state the factors significantly associated with a lower survival rate of those implants.
Associated with an increasing rate of short implants loss
1. Infection (84%)
2. Male gender
3. TA surface treatment
4. Single crown restoration
5. Maxillary posterior area to be a risk factor
Regarding narrow vs. regular diameter implants:
- Please state the main clinical indications regarding the following diameters: <3 mm, 3-3,25 mm and 3,3-3,5 mm (According to Schiegnitz 2018).
Catgory 1: (<3.0) Performed statistically significantly worse. Mainly for rehabilitation of highly atrophic maxilla / mandible.
Catagory 2: (3-3.25) rehabilitation of limited interdental spaces in anterior single‐tooth restorations
Catagory 3: (3.3-3.5) all regions, including posterior single‐tooth restorations
Regarding narrow vs. regular diameter implants:
- According to the RCT of Souza 2018, explain their main results.
No statistically significant difference regarding MBL between groups at implant placement.
Mean MBL at 3y follow-up was −0.58 NDI & −0.53 RDI.
Implant success rates at 3y were in 95% NDIs and 100% RDIs.
Prosthesis success rates were 90% NDI & 95% RDI.
Roccuzzo et al. (2012) performed a prospective cohort study in periodontal patients:
-Please state the % of sites with bone loss > or equal to 3 mm in periodontally healthy as well as compromised and severely compromised patients.
-was it any significant difference between groups?
A) Sites w/ BL ≥3mm:
* PHP 5%
* Moderate PCP: 11%
* Severe PCP: 15%
B) In the percentage of sites, with bone loss ≥3 mm, a statistically significant difference between PHP and severe PCP.
Attieh et al. (2018) performed a meta-analysis to explore they differences between tapered and parallel walled implants. Did the observed any difference in the parameters evaluated? Elaborate on their results.
Higher stability for tapered implants at placement & 8w but no stat differences
At 12w lower stability for tapered, but no stat differences
Tapered had higher torque
Tapered -> less MBL
No differences regarding failure rate
systematic review by Romandini et al 2019:
-What was the implant failure in patients taking antibiotic vs. no antibiotic after implant placement?.
-In the network meta-analysis, what antibiotic regimen was the best in preventing implant failure (OR)?.
- The implant failure rate was 5.6% in patients not receiving antibiotics and 1.8% in the receiving ones.
- The use of antibiotic prophylaxis was protective in terms of implant loss (OR = 0.4) best regimen was single dose 3g amoxicillin 1hr pre-operatively.
What was the mean MBL observed by Strietzel 2014 in the meta-analysis for platform matched and platform switched implants? Was the difference statistically significant?
- Significantly less mean MBL around implants with PS compared to PM-implant-abutment connections.
- Significantly less mean MBL change PS (0.5 mm), compared with PM (1.mm).
Patient of 65 years old, clinical history: no medication, former smoker (>10 years ago, 1 paq/day).
-With respect to the implant in the third quadrant, which is the most common complication of screw retained single crowns?
-In the fourth quadrant, there is a vertical defect caused by a previously failed implant (with 3 mm distance to the dental nerve). Comment the options for the rehabilitation with fixed prosthesis.
- According to Sailer et al. 2012,Technical complications were generally more often observed with screw-retained reconstructions than with cemented reconstructions. More specifically, higher rates for loosening of abutment/ reconstruction screws and chipping of the veneering ceramic were found at screw-retained reconstructions compared to cemented ones.
- According to Papaspyridakus et al. 2018 The favorable option would be a vertical GBR if possible to allow placement of a >6mm legnth implant which has 95% surv.rate vs <6mm w/ 85% surv.rate. & RR 1.29. HOWEVER SPLINTING of short implants will reduce the mecanical forces on the implants and their components.
