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Perio II Test 2 > Ch 19 Peri Implant Health & Diseases > Flashcards

Ch 19 Peri Implant Health & Diseases Flashcards

1
Q

Dental implant

A

-a nonbiological device surgically inserted into the jawbone to replace a missing tooth and/or provide support for a prosthetic denture

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2
Q

Implant body

A

The “root” of the implant that is surgically placed into the living alveolar bone

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3
Q

Abutment

A

-titanium post that attaches to the implant body
-protrudes partially or fully through the gingival tissue
-supports the crown or denture
-biocompatible (not rejected) with the body

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4
Q

Peri implant issues

A

The soft tissue surrounding the dental implant
-similar in many ways to the periodontium of a natural tooth, but there are important differences

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5
Q

Implant to epithelial tissue interface

A

-the epithelium adapts to the titanium abutment post, creating a biological seal
-the biological seal functions as a barrier between the implant and the oral cavity
-the sulcular epithelium surrounds the implant abutment post surgery

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6
Q

Implant to connective tissue interface

A

-significantly different than that of a natural tooth
-implant surface lacks cementum
-gingival fibers and periodontal ligament cannot insert into the titanium surface
-periodontal pathogens can destroy bone faster along a dental implant than a natural tooth

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7
Q

Implant to bone interface

A

-osseointegration is the direct contact of bone with the implant surface
-major requirement for implant success
-osseointegration is successful if no mobility, absence of inflammation of tissues, no discomfort or pain when functioning, no increased bone loss or radiolucency

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8
Q

Tissue surrounding a dental implant

A

-Junctional epithelium: attaches to the implant surface (biologic seal)
-Connective tissue: run parallel to or encircle the implant
-PDL: no periodontal ligament
-Cementum: no cementum
-Alveolar bone: makes direct contact with the implant surface (osseointegration)

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9
Q

Peri Implant Health

A

-characterized by an absence of erythema, bleeding upon probing, swelling, and suppuration
-does not appear clinically different from clinically healthy periodontal tissues
-probing depths may be deeper compared to a healthy tooth site (due to orientation of CT tissue fibers

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10
Q

Peri implant disease

A

Peri implant tissue inflammation
-plaque deposits on implants
-can result in inflammation of soft tissues around the implant
-as disease progresses, partial or total loss of osseointegration occurs

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11
Q

2 forms of peri implant disease

A

-peri implant mucositis: (also known as peri implant gingivitis) plaque-induced gingivitis in tissues surrounding the implant
-peri implantitis- periodontitis in tissues surrounding osseointegrated implant, resulting in bone loss

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12
Q

Peri implant mucositis

A

-also called peri implant gingivitis
-plaque biofilm induced inflammation of the soft tissues
-no loss of supporting bones
-reversible if plaque is removed; if not, may progress to peri implantitis
-occurs in 80% of patients and 50% of implant sites

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13
Q

Peri implant mucositis requires close monitoring to notice signs of mucositis. What are signs?

A

Red tissues
Swelling
bleeding
Increased probing depths may

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14
Q

Peri implantitis

A

-periodontitis affecting soft and hard tissues surrounding a functioning osseointegrated dental implant
-plaque biofilm-induced inflammation
-progressive loss of alveolar bone
-may progress in a nonlinear and accelerating pattern
-prevalence ranges from 6.61-47%

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15
Q

Peri implantitis diagnosis requires

A

-Signs of inflammation
-Presence of bleeding and suppuration upon probing
-increased probing depths
-progressive bone loss as seen on radiographs

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16
Q

Peri implantitis begins where?

A

Begins at the coronal portion of the implant while the apical portion continues to be osseointegrated
-the implant does not become mobile until final stages of diseases
-mobile implants that show signs of loss of osseointegration should be removed

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17
Q

Radiographic signs of implant failure

A

-vertical destruction of crestal bone around implant
-bottom portion of implant remains osseointegrated
-may be wedge shaped defects along implant

18
Q

Peri-implant disease etiology

A

Both forms share common etiology
-polymicrobial bacterial infection
-biomechanical factors

19
Q

Bacterial infection

A

-perio disease in both the periodontium in natural teeth and the peri implant tissues of implants progresses in a similar fashion
-both require bacterial plaque biofilm and host inflammatory response
-perimucositis does not always progress to peri implantitis
-rate of destruction is more rapid in peri implant tissues than in a natural dentition

20
Q

Risk factors for implant failure

A

-history of previous periodontal disease
-poor plaque biofilm control
-smoking
-residual cement
-biomechanical overload

21
Q

Biomechanical overload

A

-collective forces placed on an implant
-influenced by a number of factors: position of the implant fixture, number of implants supporting prosthesis, occlusal force distribution among implants and remaining teeth
-implants lack the protective structure of periodontal ligaments
-implants are in direct contact with the bone
-forces placed in an implant are transmitted directly to the bone
-it is critical to minimize forces placed on an implant

22
Q

Detection of a failing implant: clinical signs in soft tissue

A

-peri implant pocket
-bleeding
-suppuration
-possible swelling
-pain usually not present

23
Q

Detection of a failing implant: changes to bone support

A

-mobility is best indicator of implant failure
-should not be mobile if healthy
-may indicate presence of loose abutment or rupture of cement seal
-severe mobility associated with pain may indicate a fracture of the implant

24
Q

Radiographic signs of failure

A

-vertical destruction of crestal bone around implant
-bottom portion of implant may remain osseointegrated
-radiolucency indicates bone loss adjacent to implant

25
Q

Treatment modalities for failing implants

A

-nonsurgical periodontal instrumentation
-use of antiseptics
-local/systemic antibiotics
-flap surgery
-available evidence suggest Subgingival air polishing with glycine powder may reduce mucosal inflammation

26
Q

Clinical monitoring of dental implants

A

Routine monitoring of implants is part of a comprehensive examination and maintenance and is essential to effective management of peri implant disease

27
Q

Important data collecting procedure

A

-probing
-assessing clinical attachment levels
-assess for bleeding
-assess for evidence of suppuration
-collect routine radiographic evidence of health/disease

28
Q

Probing

A

-initial probing depths collected upon seating of final restoration
-probing does not jeopardize longevity of implant
-some surgeons may recommend postponing probing until healing is complete (3 months)
-use light force with either plastic or metal probe

29
Q

Clinical attachment levels

A

-must collect baseline data to use as a fixed reference point (initial probing)
-probing depths may be a deeper than 1-3mm considered normal for natural teeth
-healthy peri-implant sulcus ranges from 1.3-3.8mm
-depth is dependent upon thickness of tissue around the abutment

30
Q

Bleeding on probing

A

-good indicator of current tissue inflammation
-lack of bleeding upon gentle probing predicts health
-if bleeding is present biofilm removal will reduce inflammation

31
Q

Evidence of suppuration

A

Can be detected during probing
-record by specific area: tooth and surface
-can also detect by applying gentle pressure over the implant to see if pus is expressed

32
Q

Radiographs

A

-vertical bone loss of less than 0.2mm annually following first year of function
-baseline radiographs should include day of implant placement, a day of final restoration placement, and day of maintenance visit
-examine radiographs day of final restoration placement for presence of remaining cement
-radiograph implant at least once a year

33
Q

Maintenance of dental implants

A

-important for long term success of the implant
-similar to a maintenance visit for a patient treated for periodontitis
-meticulous patient self care is necessary to prevent peri implant disease

34
Q

Goals for implant maintenance

A

-maintenance of alveolar bone support
-control of inflammation
-maintenance of healthy functional implant
-maintenance of healthy and functioning periodontium surrounding neighbouring teeth

35
Q

Guidelines for professional recall and maintenance

A

-intervals determined on an individual basis
-3-month interval is usually appropriate for the first year
-schedule appointments as frequently as necessary to keep peri implant tissues healthy
-more frequent intervals if reduced bone support, inflammation, or host response due to systemic conditions

36
Q

Implant stability evaluation

A

Implants should not have mobility if they are osseointegrated and healthy
-assess mobility as a natural tooth
-use instruments with plastic handles if fixture must be touched
-radiographic evaluation is indicated for mobile implant

37
Q

Implant mobility indicates

A

-lack of osseointegration
-loose abutment
-loose internal screws attaching abutment post to implant fixture
-fracture of the implant
-prosthetic failure between components

38
Q

Guidelines for professional maintenance

A

-residue left on implant body is a significant cause of implant failure
-implant material is rough to allow for better osseointegration
-Subgingival cement/calculus deposits require slender instruments made of compatible metal
-titanium instruments are recommended

39
Q

Special considerations for polishing implants

A

-implants, abutments and components do not require routing polishing
-when indicated, rubber cups with no abrasive polishing paste can be used
-suprahingival air polishing either glycine powder is safe, effective and biocompatible and gentle on soft tissues

40
Q

Pt self care of dental implants

A

-meticulous self care is of utmost importance in preventing peri implant implant disease
-individualized self care developed for each patient
-porcelain, acrylic, or composite tooth fits over abutment
-crown covering an implant may be larger in circumference than the abutment post
-the bulky surface of the crown contacts the tissue and then “dips in” to meet the post

41
Q

Techniques and device for osc and implants

A

-standard tb are appropriate
-powered tb may also be used
-interdental brushed must have protective coating on the twisted wire
-tufted dental floss is an ineffective combination of tools for large embrassure spaces
-oral irrigators may be used
-daily antimicrobial mouth rinse may be beneficial

Perio II Test 2 (3 decks)

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