Dental Implants and Their Placement - I Flashcards
What are examples of adjunctive therapy that needs to be completed prior to implant placement
Perio therapy
Endo therapy
Ortho therapy
What should be taken into consideration when choosing between implant and FPD?
Prognosis of the restoration
Restoration needs for adjacent teeth
Pt age
What are some characteristics that we look for when selecting a site for an implant?
Sufficient bone to surround the implant to provide adequate stability during healing
Adequate plaque control
Absence of inappropriate funcitonal loading during healing
What can we use to evaluate bone support for an implant?
Pano and a complete set of PAs and BWs for most cases
Lateral tomograms with a template
Cone-beam CT
How much bone should be on each side of the implant?
At least 1 mm
T/F - in dense bone, longer and wider implants are needed
False - fewer and shorter implants are needed
When are longer and wider implants useful?
Patients who grind or clench
Where are wider implants useful?
Posterior sextants
What is important for long-term success of an implant-supported prosthesis
Crown:Root ratio
How much space is needed interocclusally from the shoulder of the implant to the occlusal surface of the opposing tooth
7mm
How much space is needed between two adjacent implants?
at least 3mm
How much space is needed between an implant and an adjacent tooth?
at least 2-3 mm
Implant system choice should be based on what?
A system with well-documented long-term success
Easy to sue
Proven strength and accurate fitting
Screw design and root form
Titanium alloy with or without coating
Various micro and nanoporous surface properties
What are some maxillary anatomic considerations for implants?
Incisive foramen
Greater palatine foramen
Floor of the nose
Floor of the maxillary sinus
What are some mandibular anatomic considerations for implants?
Sublingual vessels Mental nerve Mandibular nerve Incisive branch of mandibular nerve Genial tubercles Inferior alveolar nerve
Immediate Implant Placement
The implant is placed immediately following the extraction of a tooth
Immediate Implant Placement Advantages
Less surgeries
Less overall treatment time
Optimal use of available/existing bone
Immediate Implant Placement Disadvantages
Site morphology may complicate optimal placement (we already have a hole there, which may not be what we need)
Tissue biotype may compromise optimal outcome
Potential lack of keratinized mucosa for flap adaptation
Adjunctive surgical treatment may be required
Technique-sensitive procedure
T/F - Immediate Implant Placement may effect bone healing
False
Early Implant Placement Advantages
Easier flap adaptation
Allows for the resolution of local pathology
Early Implant Placement Disadvantages
Site morphology may complicate optimal placement
Longer treatment time
Varying amount of bone resorption at socket walls
Technique sensitive procedure
Early Implant Placement technique
Soft tissue healing will be completed within 4-8 weeks
The mucosa may remain adherent via scar tissue to the underlying bone and CT
Only a small amount of new bone will form in the socket
GBR will be required around the implant at the time of placement
For early and immediate implant placements, how much bone height do we need?
At least 3mm - anything less makes primary stability impossible
How many socket walls must be intact to place an immediate or early implant?
at least 3 of 4
How long do you need to wait for Delayed Implant Placement?
12-16 weeks
Substantial clinical and radiographic bone fill of the socket
Delayed Implant Placement Advantages
Substantial bone sill of the socket that facilitates implant placement
Mature soft tissues facilitate flap management
Delayed Implant Placement Disadvantages
Increased treatment time
Adjunctive surgical procedures may be required
Varying amounts of resorption of the socket walls
How long do you need to wait for Healed site implant placement?
> 16 weeks
Healed Site Implant Placement Advantages
Clinically healed ridge
Mature soft tissues, leading to easier flap management
Healed Site Implant Placement Disadvantages
Increased treatment time
Adjunctive surgical procedure may be required
Large variation in available bone volume
What are the Pros of Immediate/Early implant placement of a single-rooted tooth
Single Socket
Easier extraction
Adequate soft tissue/flap adaptation
Generally, it is a manageable gap following immediate placement
What are the Cons of Immediate/Early implant placement of a single-rooted tooth
Oval shape socket diameter
Rotated tooth/tooth in malocclusion
Anatomical landmarks
Root length
What are the Pros of Immediate/Early implant placement of a multi-rooted tooth
Intact large septum if roots are divergent
Non-esthetic zone
What are the Cons of Immediate/Early implant placement on a multi-rooted tooth
More than one socket
Lack of soft tissue for good flap adaptation
Heavy occlusal forces
Anatomic landmarks
What do we need to be mindful of when placing an implant in an esthetic zone?
Soft and hard tissue biotypes Lip and smile ines Remaining dentition and perio support Emergence profile Mesial-distal and buccal-lingual/palatal dimensions Occlusion Anatomic landmarks
One-staged surgical protocol
The mucosal flap can be adapted to the neck of the implant
Two-staged surgical protocol
The mucosal flap is sutured on top of the implant obtaining primary wound closure
