Eval and Maintenance Flashcards
Why do we do maintenance if longitudinal implant studies seem to suggest that it is not required?
Report success based on survival not progression of bone loss and attachment loss. This is different from longitudinal periodontal studies which monitor attachment loss over time.
What are 2 main reasons for implant failure after loading?
- Bacterial infection
2. Mechanical failure
What is the key distinguisher between peri-implant mucocitis and periimplantitis?
Radiographic bone loss
A lot of mechanical failure is related to what?
Occlusion
Is there a biological width around implants?
Yes
Why is there a deeper probing depth around implants versus regular teeth?
No PDL
Is there more or less vascularization around an implant?
Less. Good because less inflammation, bad because less healing.
Should probing depth be considered a parameter for implant health?
No
Is bleeding on probing the same as for teeth and implants?
No
When is probing depth and bleeding on probing useful for implant health determination?
When compared over time
How is most diagnosis of implant health achieved?
Via X-rays
What is the cardinal sign of implant failure
Mobility (could be fractured or just a loose abutment)
What must make sure on radiograph with respect to threads?
Ensure bone is going in and out of threads
What is the recommended interval for radiographic assessment of your implant success?
Day of fixture insertion Day of uncovering/abutment placement 6-12 month intervals Annually for 1st 2 yrs Subsequent 2 yr intervals (if no complications)
What is a primary cause of implant failure?
Abnormal/excessive forces, e.g. cantilevers or lateral forces
What are 2 desires for implant occlusion?
Light centric contours, no excursive contacts
What are 4 criteria for implant success?
- No mobility
- No perifixtural radiolucency
- No more than 0.2mm bone loss annually after first year
- No signs or symptoms (Pain, infection, neuropathy, or paresthesia)
What is the only indication for using an instrument subgingivally around the implant?
Pathology or calculus
What can be used for peri-implant mucocitis?
Local debridement, locally delivered antimicrobials
Do implants require maintenance?
Yes (monitor them just like you monitor the health of natural teeth)
What must not be used on a titanium implant?
Metal instruments
What are the best monitoring method for implant health?
Radiographs
What are the characteristics of peri-implant mucositis?
Probing depth more than 4mm Inflammation No suppuration No radiographic bone loss No mobility (Like gingivitia)
What are the characteristics of peri-implantitis?
Probing depth more than 4mm Some or no suppuration Radiographic bone loss present Some or no mobility (Like periodontitis)
What should you watch for during implant maintenance?
Signs of ailing/failing implants
What is the definition of “ailing”?
No mobility
May be treatable
What is the definition of “failing”?
Not osseo-integrated
Possible mobility
May reverse torque
Must be extracted
What does radiographic bone loss around an implant indicate?
Peri-implantitis
What does mobility of the implant indicate?
Failure
Does plaque grow around implants?
Yes and in some cases it may be even more difficult to remove than calculus on teeth. Plaque index can be determined.
Does probing depth matter for implants?
Maybe, maybe not. You may get deeper probing depths around an implant because the probe can go alongside connective tissue parallel to the implant
Is bleeding on probing a sign of inflammation with implants?
Yes but it may also represent tissue wounding
Are probing depth and bleeding on probing the same with implants as they are with teeth?
Not completely.
Is probing depth related to long term SURVIVAL of implants?
No, according to the study cited in the lecture
Should plastic probes be used around implants?
Yes
What is a better indicator of implant attachment loss than probing depth?
Longitudinal measurements
Do we need keratinized tissue around implants?
Lack of keratinized tissue does not lead to increased progression of peri-implantitis BUT it is preferable.
Is bone loss right below the connection between the abutment and the implant in a two-stage abutment normal or a sign of pathology?
It is normal but it should not be too far below that connection.
Besides bone loss, what can you tell from radiographs?
Assess screw/fixture fit/fractures
In sudden onset failure, radiolucent changes may not be present
If failure is gradual, will see radiolucent peri-fixtural space
What are two examples of abnormal/excessive forces that may be primary cause of implant failure?
- Cantilevers
2. Lateral forces
What are NOT recommended for professional cleaning of implants?
Metal hand scalers
Metal ultrasonic scalers
Interdental brush with metal core
What are some ways to treat peri-implant mucositis?
- Local debridement
2. Locally delivered antimicrobials (Atridox or Arestin)
What are some ways to treat peri-implantitis?
Do the equivalent of root planing on the implant
