Chapter 9 Flashcards
What type of implant is shown?
Blade implant
What type of implant is shown here?
Cylindrical basket
What type of implant is shown here?
Titanium implant
What type of implant is shown here?
What does this image depict?
Radiographic appearance of a cylindrical root form implant
What does this image depict?
Soft tissue interface
What are the advantages of a titanium implant?
- Biocompatible
- Poor conductor
What are the disadvantages of a titanium implant?
- Soft, scratches easily
- Titanium particles in tissue causes an immunologic reaction in some patients: Periimplantitis, Periimplant mucositis
What is the purpose of an implant abutment?
- Attaches to the implant body
- Supports the restoration
- Transition btw crest of the bone and oral cavity
- Soft tissue adapts to the titanium or zirconia surface of the abutment
What is osseointegration?
- Implant to bone interface
- Absence of clinical mobility
- No pain or discomfort
- No increased bone loss
How is the implant to connective tissue interface characterized?
CT fibers are parallel to the implant surface
Fibers encircle the abutment like a drawstring
No PDL present
Keratinized tissue may or may not be present
Implications of an implant to CT interface?
Periodontal pathogens can cause inflammation and bone loss more rapidly along the implant surface
What is the biological seal?
- Where the soft tissue (epithelium) adapts to the abutment
- Acts as a barrier between the implant and oral cavity
areWhat is the differences between the tissue interface with a natural tooth vs. a dental implant?
- Implant has a biologic seal
- Implant lacks cementum
- CT around implant runs parallel, encircling implant
- Implant is osseointegrated, no PDL
What are the 4 periimplant diseases and conditions?
- Peri-implant health
- Peri-implant mucositis
- Peri-implantitis
- Peri-implant hard and soft tissue deficiencies
What characterizes peri-implant health?
- No real difference from periodontal health
- Absence of: erythema, swelling, purulent exudate, BOP
- Probing depths may be deeper at a healthy implant site due to orientation of CT fibers
- Pinpoint bleeding in the absence of redness is not an indication of disease
What is peri-implant mucositis?
Plaque biofilm-induced inflammation of the mucosal tissues around the implant w/ no loss of suporting bone
Reversible w/ removal of causative agent
Diagnostic signs of peri-implant mucositis
Visual signs of inflammation: redness and swelling
Bleeding/supuration on probing
Increased PD compared to prior measurements
Absence of bone loss
What is peri-implantitis?
Chronic plaque biofilm-induced inflammation in peri-implant mucosal tissues and progressive loss of supporting bone
Onset may occur early
Implant does not become mobile until the final stages of peri-implantitis- patient will likely be unaware of condition until mobility occurs
Diagnostic signs of peri-implantitis
Visual inflammation
Presence of suppuration or BOP
Increased PD compared to past measurements
Progressive BL in successive radiographs over time
In absence of baseline PD and radiographs: radiographic evidence of bone levels >3mm and/or PD >6mm in conjunction w/ profuse bleeding
What condition is shown here?
Advanced periimplantitis
What happens to bone following tooth loss?
Bone resorption
What are some hard tissue deficiencies?
Bone resorption following tooth loss
Lack of buccal bone
Bony dehiscence (absence of bone over the facial root surface)
Bony fenestration (bony coverage of the root surface is lost)
What are some soft tissue deficiencies?
Insufficient soft tissue thickness
Inadequate keratinized tissue
Soft tissue recession
Soft tissue fenestration
What may cause a fractured implant body like this? What is it influenced by?
Biomechanical overload
* Influenced by position, number of implants, and distribution of forces between implants and any remaining natural teeth
* Lack of PDL
What is the etiology or peri-implant diseases?
Bacterial infection
Etiology of periimplant mucositis
Plaque biofilm
Etiology of periimplantitis
- Overwhelming bacterial infection and subsequent host response.
- Conversion from mucositis not completely understood
Is the rate of tissue destruction more rapid in periodontal tissues or periimplant tissues?
Periimplant tissues
What are the 7 species of bacterial cluster found in patients with periimplantitis?
- Tannerella forsythia
- Porphyromonas gingivalis
- Treponema socranskii
- Staphylococcus aureus
- Staphylococcus anaerobius
- Streptococcus intermedius
- Streptococcus mitis
Risk factors for periimplant disease
- History of previous periodontal disease
- Poor plaque control/lack of regular maintenance
- Smoking
- Residual cement
- Biomechanical overload
Signifiers of a failing implant
Pocketing and bleeding of soft tissue after gentle probing
Implant mobility: lack of osseointegration, loose abutment or cement failure
Severe mobility w/ pain may indicate fracture of implant
What are the radiographic signs of a failing implant?
- Vertical destruction of crestal bone around the implant while the apical portion remains osseointegrated
- Alternately: wedge-shaped defects around the implant
- Periimplant radiolucency
How is probing done around implants?
- No probing until healing is complete, around 3 months
- Light force should be used since biologic seal is weakley adhered
- Plastic probe should be used to avoid scratching surface
Not possible to define a healthy probing depth range but still essential to the exam
How is attachment level measured for periimplant health?
Initial PD is recorded from the base of the sulcus to the crest of the soft tissue, then measure teh crest of the soft tissue to a fixed reference point on the implant crown margin
How is periimplant health measured using radiographs?
Vertical BL less than 0.2mm annually following the first year of function
Baseline radiogrpahs should be taken on day of surgical placement, day of prosthesis insertion and then annually
Radiopaque cements should be used to ensure complete removal of excess
