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Implantology > Dx and Tx Planning/Implant Placement > Flashcards

Dx and Tx Planning/Implant Placement Flashcards

1
Q

Factors for Implant Tx Planning

A
  • Restorative Space
  • Molar Tipping
  • Infection
  • Gingival biotype
  • Alveolar Bone (Quality and Quantity)
  • Adjacent Structures
  • Number of Implants
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2
Q

Restorative Space dimensions for implant

A
  • Mesiodistal space
    • must know avg tooth widths
    • Implant: Adjacent Tooth: 1.5 mm (1.5-2 mm)
    • Implant: Implant: 3 mm
  • Occlusogingivally
    • 10 mm (6-10 mm)
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3
Q

Implant factors: Molar Tipping

A
  • ≤ 25 °
    • fixed with Ortho or enameloplasty
  • If not fixed
    • Black triangle (poor esthetics)
    • Foot trap
    • Periodontal inflammation
    • periodontitis
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4
Q

Implant Factors: Gingival Biotype

A
  • Thicker= better
  • Thin Biotype
    • place more apical & lingual
    • use non-metallic abutment→ prevents grey shadow
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5
Q

Existing Infection

A
  • Remove before implant placement
    • adjacent teeth
  • Perio Infection or inflammation
  • peri-apical inflammation
    • effects healing & long term success & survival
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6
Q

Implant factors: Alveolar Bone

A
  • Quality= Bone Density (D1, D2, D3, D4)
    • affects initial stability of implant → osseointegration
  • Quantity= Alveolar Ridge Resorption
    • 2 mm Lingual & Buccal to implant
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7
Q

Bone Density

A
  • affects initial stability of implant → osseointegration
  • D1 (most dense)
    • Dense cortical bone
      • marrow spaces barely visible
    • anterior mandible
    • very difficult to drill
  • D2
    • Thick porous cortical bone
      • coarse trabecular bone
    • anterior & posterior Mandible
      • anterior Maxilla
  • D3
    • Thin porous cortical bone
      • fine trabecular bone
    • Anterior & posterior maxilla
      • Posterior Mandible
  • D4 (least dense)
    • fine trabecular bone (primarily)
      • very thin cortical bone
    • posterior maxilla
    • Big marrow spaces
      • poor initial stability of implant
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8
Q

Alveolar Ridge Resorption

A
  • 2 mm Buccal & Lingual to Implant
  • Ridge Classification
    • Normal → Minimal resorption
    • Class 1 → Only Faciolingual resorption (Horizontal)
      • normal height
    • Class 2 → Only Vertical resorption
      • normal width
    • Class 3 → Both
  • The greater the Loss of Bone Height→ Need prosthetic gingiva
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9
Q

Lip Effect

A

Hides non-esthetic parts of implant/gingiva

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10
Q

Bone Graft

A
  • Clinical & radiographic exam to determine if bone graft is needed
    • Graft options:
      • Ridge Augmentation (bone resorption)
        • Horizontal Ridge Augmentation=Better success (vs vertical)
      • Sinus Lift (Pneumitization)
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11
Q

Adjacent Structures

A
  • IAN
    • 2 mm away
    • Minimum= 1mm
  • Mental Foramen
    • 4 mm away
  • Sinuses
    • 2 mm away
    • Minimum= 1 mm
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12
Q

Criteria for Number of Implants

A

Criteria:

  1. Occlusal Forces: Avoid Overloading
    1. Bruxism (Parafunctional habits) → more implants
    2. posterior placed implants → ⇡ occlusal forces
      1. “closer to the joint”
  2. Prosthetic type (removable vs fixed)
    1. Removable
      1. less implants
      2. mandibular overdenture → 1 implants at canine
      3. Maxillary overdenture → 4 implants; canine & 2nd premolar
  3. Segmented vs one piece prosthesis
    1. Segmented→ more implants
      1. implant at each end
        1. saves prosthesis if it breaks
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13
Q

Required Diagnostics needed to tx plan a implant case

A
  • Med hx
  • Diagnostic cast mounts
    • checks for space
  • Diagnostic wax up
    • esthetics
  • Periodontal status
    • prognosis
  • Radiographs
    • bone quality/prognosis
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14
Q

Indications vs Contraindications for Implant

A
  • Indications
    • 1.5 - 2mm from adjacent teeth
    • 3 mm from adjacent teeth
    • 1 mm of lingual & buccal bone around implants
    • 2 mm from IAN
    • 5 mm bone height
      • implant is embedded 5 mm
    • 5 mm anterior to Mental Foramen
  • Contraindications:
    • Active Periodontal disease
    • Active Gingival Inflammation
    • Poor bone height & quality (density)
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15
Q

Implant placement: Single vs multiple implants

(Where are Implants placed)

A
  • Single implant
    • center of restoration
  • Multiple implants
    • center of proposed retainer
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16
Q

Complications from poor implant planning?

A
  • Implant Placement is:
    • too facial
      • see grey shadow through gingiva
    • Not centered
      • can’t place restoration
    • Minimal Bone
      • perforate bone
    • Pneumatized Sinus (low sinus0
      • not enough height to place nerve
    • IA Nerve
      • might hit nerve
17
Q

What drives implant placement?

A

Restorative tx plan

18
Q

SAC assessment tool: General info

A
  • based on guidelines from ITI conference
  • Classifies cases as
    • Straightforward
    • Advanced
    • Complex
  • Helps dentist to:
    • degree of difficulty
    • risks
    • cases for their skill & experience
    • Develops knowledge
19
Q

SAC assessment tool: Components

A
  • General
    • Clinical experience
    • Pt general health
    • oral hygiene/health
    • Perio
    • Smoking
    • Growth
    • Iatrogenic factors
  • Esthetics
    • expectations
    • smile line
    • gingival biiotype
    • soft tissue volume
  • Surgical:
    • Bone volume (Quality & Quantity)
  • Restorative
    • Oral enviroment
    • Restorative volume (spacing)
    • Occlusion
    • Provisional
20
Q

Placement Considerations:

A
  • 6 mm of Horizontal bone
    • 1 mm facial bone
    • 1 mm Lingual bone
    • 4 mm diameter of implant & body
  • 3 mm implant: implant
  • 1.5 mm implant: tooth
  • Antibiotics
    • complex graft or immunocompromised
21
Q

Placement Considerations: Esthetic zone

A
  • Esthetic Zone: Ant teeth
    • Platform is 3-4 mm from planned CEJ of future restoration
    • Buccal part of implant is 1-2 mm lingual to adjacent tooth emergence profile
22
Q

Interproximal Papilla depends on

A
  • interproximal bone of adjacent tooth.
    • Bone Defect=No papilla
      • Avg Height: 4.5 mm when I:T=1.5mm apart
  • distance b/w contact & bone crest
    • 5 mm=Full coverage
    • 6 mm= 56% coverage
    • 7 mm= 27 %
23
Q

What is the minimum occlusal clearance to allow for different prosthetic components assuming MI?

A
  • Screw retained crown→ 6 mm
  • Cement retained crown→ 8 mm
  • Locator overdenture→ 9 mm
  • Hybrid denture→ 16 mm
24
Q

What are the different types of placement? (Protocol)

A
  • Type 1= Immediate
    • placed in socket during ext
      • good w/premolars
    • Know bone resorption patterns & predict
      • B/L= 1st 3 months
      • Does NOT stop bone remodeling
  • Type 2= Early
    • 4-8 wks after extraction
      • No pathology
      • primary healing and remodeling of tissues
    • ESTHETIC AREAS
  • Type 3= Delayed/Conventional
    • 12-16 wks
      • Complete Bone Remodel
      • can be longer depending on previous procedures done (3-6 months)
        • Site preservation
        • GBR for ridge or sinus augmentation
25
Q

What are the different types of loading? (Protocol)

A
  • Immediate Loading
    • <1 wk after placement
    • ex: changing denture to overdenture
  • Early
    • 1 wk - 2 months
  • Delayed/Conventional
    • > 2 months
    • most predictable & best
    • recommend if:
      • Poor primary stability
      • compromised host conditions
      • substantial bone augmentation
      • reduced dimensions of implant
26
Q

Implant placement Healing: Stage 1 vs Stage 2

A
  • Stage 1
    • Healing Abutment
  • Stage 2
    • Cover screw → healing Abutment
27
Q

What are the steps to prepare the osteotomy and deliver Implants?

A
  • Follow Drilling sequence
  • Screw retained
    • hand screw
    • check occlusion
    • x-ray
    • Torque down
28
Q

How does the bone density affect the implant bed preparation?

A
  • Medium Density
    • adequate blood supply
    • Enough bone support to retain implant long term
29
Q

What is the difference between 1 stage vs 2 stage surgery?

A
  • 1 stage (healing Abutment)
    • pts with:
      • primary stabilty
      • predictable healing
  • 2 stage: (Cover Screw→ Healing Abutment)
    • Needs Graft
    • Smoker
    • Surgery Site needs closure to heal
30
Q

What are the selection criteria for the loading protocols?

A
  • Immediate and Early
    • Good Primary Stability
  • Conventional/Delayed
    • predictable
    • poor primary stability
    • compromised host

Implantology (15 decks)

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