CHAP 4-IMPLANTS BASIC CONCEPTS

Question 1

It’s made of biocompatible material

Answer 1

TITANIUM

Question 2

Its DESIGN can be:

Answer 2

• Macro design: threaded, microspires, cylindrical-conical-pseudoconical
• Micro design : engraved surface, sandblasted..

Question 3

No aggressive surgery procedures to bone

Answer 3

no bone suffering, Drilling technique, preparation
refrigeration during prep

Question 4

Loading time?

Answer 4

• Immediate
• Early
• Conventional /Delayed

Question 5

Loading Period: bone remodeling

Answer 5

• 1,1-1,2 mm first year
• 0,1-0,2 mm/year

Question 6

M a c r o d e s i g n :

Answer 6

—cylindrical or conical designs —
internal or external connection to the prosthesis , polished or textured necks,more or less aggressive coil

Question 7

MICRODESIGN

Answer 7

—more bioactive—
surfaces have been achieved with influence on tissue responses and greater adhesion: there is
—coating on the titanium surface by addition—-
or by subtraction of the titanium surface

Question 8

HISTORY

Answer 8

1965 Branemark type threaded implants made of grade 1 Titanium

Question 9

S I N G L E - S T A G E S U R G E R Y

Answer 9

One single surgurgical procedure for the patient
with or without prosthetic loading at the moment
increased risk :
-implant is exposed to oral cavity
-Microtrauma and masticatory loads can affect the osseointegration

Question 10

T W O - S T A G E I M P L A N T S U R G E R Y

Answer 10

==>Implant is embedded/covered by soft tissue.
==>It requires a second surgical intervention to place the healing abutments.
==>Chosen method when:
-Advanced/difficult surgeries
-Patients with bad hygiene/oral habits
-When soft tissues around the implants need to be modified in a second intervention.

Question 11

Immediate Implant

Answer 11

1)Its performed at the same time as the exodontia
2)only one surgery for the patient
3)Greater preservation of the osseogingival architecture
4) More difficulty for primary stability
5)Increased probability of infection due to alveolitis :caution in smokers and poor hygiene

Question 12

Conventional implant

Answer 12

1) In mature bone
2) Increase the total time for definitive prosthetic restoration
3) Easier (except in bone atrophy)
4)Greater stability ( also easier immediate loading/aesthetics)
5)Loss of gingival architecture

Question 13

Immediate load

Answer 13

The prosthesis is placed and fitted at the same time (right after) as the implants are placed or up to 7 days after surgery

Question 14

Early load

Answer 14

New loading protocols in reduced bone healing time (one week to twelve weeks)
-Maxillae: loading after 8-12 weeks of implant placement
-Mandible : loading after 6-8 weeks

Question 15

Delayed/conventional loading

Answer 15

 The prosthesis is designed once the conventional healing
period of the bone has elapsed.
 4 to 6 months in maxilla
 2 to 4 months in the mandibula

Question 16

INDICATIONS I

Answer 16

 It makes possible to place fixed prostheses when there is no posterior prosthetic pillars.
==>Kennedy Class I and II.
In those edentulous posterior areas to the remaining natural teeth
where we only can place removable Prosthesis.
 To avoid preparation of adjacent teeth
 To improve retention, stability and support of complete dentures
(full-mouth prostheses)

Question 17

INDICATION II

Answer 17

 Enables fixed prostheses in completely edentulous patients in one or both arches.
 Avoids overloading of the prosthetic pillars both by fixed prostheses on teeth and by the retainers of skeletal prostheses.
 Reduce the resorption of the alveolar edges, mucosa and gingiva caused by the trauma of the removable prosthesis.

Question 18

ABSOLUTE CONTRAINDICATIONS

Answer 18

1. Systemic pathologies that
   negatively influence the bone
   healing: Intravenous
   bisphosphonates, head and neck
   radiotherapy…
2. Chronic pathologies or neoplastic
   diseases of bone or mucous
   membranes.
3. Non-regenerable bone atrophies.

Question 19

Width

Answer 19

Mandible

Question 20

height

Answer 20

maxilla

Question 21

Density

Answer 21

Mandible

Question 22

Milling

Answer 22

Maxilla

Question 23

Irrigation

Answer 23

Maxilla

Question 24

Primary stability

Answer 24

Max: Less Mand : more

Question 25

Aesthetics

Answer 25

Max : less Mand :More

Question 26

Blood Analysis

Answer 26

Complementary test INR
Up to 3 : surgery can be performed
Better if below 2.5
Do not treat w/o interconsultation

Question 27

Bone drilling =>CONVENTIONAL

Answer 27

high revolution (900-1.200 rpm)
Always with irrigation
Always in the first drills at least
in very hard bone

Question 28

Bone drilling => BIOLOGIC

Answer 28

Low revolution (50-450 rpm)
With or W/o irrigation
last drill
Always soft bone

Question 29

Implant placement

Answer 29

Controlled torque: between 20 and 50 N/cm2
Low speed : 15-30 rpm
W/o irrigation
In contact with blood if possible
Last coils with ratchet in some cases

Question 30

Intraoperative complication

Answer 30

1) Intraoperative bleeding
2) Swallowing aspiration and instrument fracture
3) Cavity penetration
4) Cortical Fracture: mandibular fracture
5) Injury to adjacent teeth
6) Incorrect technique resulting in surgical trauma
7) Fenestration or bone dehiscence

Question 31

Delayed complications

Answer 31

1) Implant failure: periimplantitis, Mobility
2) Infection : Osteitis
3) Mucosal : gingivitis , gingival hyperplasia
4) Nerves : dysesthesia or aneshesia
5) Cavity penetration : sinus and nostrils
6) Fracture of the fixation : loads , design , prosthesis