Final; Dental Implants Infections Flashcards
What is the pattern of early microbial colonization in regards to titanium implants and teeth
They follow the same pattern
What is the main difference between plaque build-up regarding implants and teeth
with increasing the duration of plaque build up (3 months) the duration of the peri-implant mucosa expands more and progresses further “apically
than in the case of the gingiva
What is the difference between peri-implantitis and periodontitis
peri-implantitis is a microbial heterogenous infection with predominantly gram-negative species and is less complex
True or False
the peri-implant micro biome differs significantly from the periodontal community in both health and disease
true!
What type of etiological factor is occlusal trauma regarding peri-implant disease
a PRIMARY etiological factor
This can create complications for peri-implant disease
bruxism
What are 4 possible risk factors for peri-implant disease
smoking
uncontrolled systemic disease (effect on healing)
radiation therapy
patients with a history of periodontitis
What are two etiological factors involved in tooth loss
deficiency in immune response
genetics
What is the difference between peri-implant mucositis and peri-implantitis
PIM - only at soft tissue level; like gingivitis
PI - bone loss around implant
What is the difference between early and late implant complications
early - before loading
late - after loading
What can cause an ailing implant
Peri-implantitis or Peri-implant mucositis
What can cause a failing implant
Peri-implantitis
What can cause a failed implant
Peri-implantitis with mobility and complete loss of osseointegration
This is the reversible inflammation of the mucosa surrounding the implant
peri-implant mucositis
What clinical manifestations are indicative of PIM
- presence of bacterial plaque and calculus
- edema, redness, and mucosal hyperplasia
- bleeding on probing
- exudate or pus formation on occasions
- no radiological evidence of bone resorption
The peri-implant mucosa seems less effective than the gingiva in what
encapsulating plaque-assocaited lesions; thus, the existence of gingivitis is riskier for implants
This is an inflammatory reaction associated with loss of supporting bone around an implant in function
peri-implantitis
PI lesions are characterized by what
the presence of numerous neutrophils in the tissue surrounding the implant (not seen in periodontitis)
In PI, there is direct contact between what
plaque on the implant surface and the inflamed connective tissue (not seen in periodontitis)
PIM occurs in what percentage of patients
75%
What are the 6 clinical factors used to evaluate peri-implant health
- absence of motility
- radiographic examination
- absence of bone loss ≥0.2mm/year follow the first year
- absence of any pain, complaint, or infection
- functional and esthetic acceptance of implant
- a success rate of 94-98% following 5 years, and 90-94% following 10 years
What are the factors that play into the decision making in tooth extraction and implant placement
anatomy/bone quality perio/restorative/endo status systemic health economics compliance and motivation
What are 5 diagnostic tools used regarding implants
probing of peri-implant mucosa bleeding on probing suppuration radiographic interpretation mobility
T/F
There is direct contact between plaque on the implant surface and inflamed connective tissue in peri-implantitis patients.
True
Mobility of an implant shows what
lack of osseointegration, but check the abutment first
The number of implants each year placed are (rising/declining)
Rising each year - 43 million placed in 2012 alone
What are the 4 rules of successful implants?
- Implant CAN’T move
- NO radiolucency around the implant
- NO pain or infection
- Long term - No bone loss and proper function later in life
Does the size matter?
Well yes! it does. In healthy patients it isn’t as big of a deal but in patients with Peri-implantitis it matters a great deal.
Is it better to place a mini implant on a patient with inadequate bone or to take the time and do a bone graft and put a larger implant?
Larger implant will be more secure if there is ever bone loss down the road.
If you have 6mm of bone buccal-lingual what size implant can you place?
4mm - you need 1mm in all directions surrounding the implant with sturdy bone
What amount of bone loss would you expect to see each year in an implant patient?
.2mm - The same as in non-implant patients
How early can an implant start failing?
As soon as it is placed?
What is a 1st stage implant?
The restoration is placed right away, there is no second stage surgery to uncover the implant
What is a 2nd stage implant?
The restoration goes on after tissue healing and you do a new incision to expose the implant subgingivally
If there is exudate and pus what does this mean?
Bleeding and pus is a failure of implant osseointegration
What is a primary failure to osseointegrate?
- What causes this? (4)
Immediate failure of implant
- Too much torque or pressure was exerted
- The bone was heated too high
- Patient was on bisphosphonates
- Or patient got an infection
What is a secondary failure?
- When would this occur?
The implant begins to osseointegrate with 2mm pockets at the follow up appointments but you see the patient at a later date (say a year) and it has 6mm pockets are present - This is peri-implantitis
If you have bone loss can your patient have peri-implant mucositis?
NO - Peri-implant mucositis is a precursor to implantitis which has bone loss
What percent of peri-implant mucositis progresses to implantitis?
90%
In studies of 6000 patients they found that implants placed _____mm or more apical to the CEJ of adjacent teeth got peri-implantitis
6mm or more
If the tooth next to the implant has gingivitis or perio is it at risk of peri-implantitis or no?
Yes
If you have a patient who comes in and they have gingivitis or plaque on their existing teeth is is advisable to start treatment for a graft or starting to place an implant?
NO
Peri-implantitis lesions are characterized by the presence of numerous ________ in the tissue surrounding the implant
Neutrophils
Is the bacteria found in patients with peri-implantitis the same or different than bacteria found in perio patients?
Different
Since bacteria is different in peri-implantitis patients than perio patients what does this mean for treatment?
A flap and full debridement is necessary
Anti-biotics for these patients will not work the same as perio patients
Occlusal trauma is a (primary / secondary) etiological factor for periodontal disease?
Secondary
Occlusal trauma is a (primary / secondary) etiological factor for peri-implantitis?
Primary
What is the ideal degree axis for an implant?
6 degrees or less from the axis
What is the max degree axis for an implant? (the most it can diverge from zero degrees)
20 degrees is the max
What are the classifications of peri-implantitis?
CLI - Slight horizontal bone loss with minimal peri-implant defects
CLII - Moderate horizontal bone loss with isolated vertical defects
CLIII - Moderate to advanced bone loss with broad circular bony defects
CLIV - Advanced horizontal bone loss with circumferential vertical loss, as well as loss of the oral/vestibular bony wall
How to treat a CLI peri-implantitis cases
Surgical reduction of pocket depth, clean the implant
How to treat a CLII peri-implantitis cases
- Surgical reduction of pocket depth, Repositioning more apical, Performing implantoplasty
- If ≥ 3 walls are affected restore using GTR technique
- If 1-2 walls are affected osteoclasts or bone leveling
How to treat CLIII and CLIV peri-implantitis cases
- The presence of vertical defects almost always requires GTR techniques
- Dr. Kumar says Explantation (Take that thing out)
What is the percentage of peri-implantitis reoccurrence?
100%
