fliecher Flashcards
clinical manifestations of ridge resorption
headaches improper speech diet painful oral sores fracture
physiologic impact of edentulism
frustration
depression
isolation
embaressment
as the bone loss progresses
- actions and consequences
additional denture adhesive is used
relining material
reshaping of dentures
multiple sets
complete loss of denture function
a common cause of denture related problems
alveolar ridge resorption
This is something that is completely avoidable today
• Yet, we still see patients that are completely edentulous in one or both arches
• We need to do a better job at explaining to our patients about the benefits of implants
total implant procedures per year in the USA
has increased exponentially each year
graph showed from 2011 - to 2021
o How would you treat this case if you didn’t have implants?
tx changes early on with implants
implants with ball clasps
- make a partial denture now with less material and it can be completely retentive and functional for the patient
Ball attachments
utalized to retain the denture
- will prevent resorption in area that they are placed
branemark implant
titanium and cylindrical
- screw shaped
supporting structure in tooth
periodontium
- alveolar bone
- PDL
- gingiva
supporting structure in implant
peri-implant tissue
- osseointegrated bone
- NO pdl
- gingiva
supporting structures (mucosal seal forms)
free gingival margin
gingival sulcus
free gingival groove
maxillary implants success rates in function from 1-4 years?
5-10 years?
1-4 = 95%
5-10 = 81%
mandibular implants success rates in function from 1-4 years?
5-10 years?
1-4 = 99%
5-10 = 91%
implant success based on
biocompatibilit bomechanics surgical protocol prosthetic protocol orla hygeine
broad breakdown of patient selection
medical eval
dental eval
psychological evaluation
medical eval
rule out disease
dental evaluation
cariies exam perio disease eval OHI eval bone level - quality - quantity
psychological eval
realisitic expectation
full understanding of procedures and complications
what to use to measure for adequate bone
pano / periapical rx
- clinical
- CBCT scan –tremendous amount of information and all of the information that we’re going to need, as far as the amount of bone that’s available
height width depth
tx plan decisions
type of implant design of prosthesis diagnosis extractions tissue augmentation
as little as ___ for healing after implant
6 weeks
- How important is the recall appointment to the long-term success of the dental implant and restoration, what is done during the appointment?
- Implant Recall Appointment
o Assessment and documentation Radiographic exam Mobility evaluation Osseointegration test? Soft tissue examination o Disease control instructions o Scaling and prophylaxis
assess what at recall at site
Soft Tissue Examination • Color • Texture • Shape • Bleeding • Exudate • Keratinization
probe implant?
yes - cant just tell by x-rays alone - have to look clinically
but NO metal ; use plastic or titanium instruments
Implants that get probed have no lower success rate, long-term, than implants that don’t
after healing how do we know when an implant is ready to be restored?
different stability test
- percussion
- torque and tactile
- resonance frequency analysis (RFA)
T/F size of osteomty slightly smaller than implant
true – helps with mechanical retention and stability
when does primary stability decrease?
around 2-3 weeks
have a decrease
- trauma from the surgery is causing initial bone to be lost on a microscopic level
• At the same time, get secondary stability increasing and bone placement at a much faster rate
• New bone formation takes place at a faster rate
• Also depends on the surface treatment of the implant itself
SLA active
getting stability sooner - but end result is same with same stability just occuring sooner with this
QUICKER RATE – and if quicker - less liklihood of problems occuring
reverse torque test
o Spin the implant into place clockwise
o After a period of time, will put a driver on the implant and will try to unscrew it
o If osseointegrated, won’t move
o If it isn’t, it will spin and come out
o Putting strain on the implant and may have osseointegration and cause it to lose it by doing the test
o For a long time, only test we had available
resonance frequency analysis (RFA)
basics?
include ISQ
uses a tuning fork
the stiffer the interface b/w the bone and implant - the higher the frequency
ISQ – implant stability quotient - has a NON-LINEAR correlation to micro stability – the scale is 1-100 ISQ
the more stable the implant the ISQ is
the higher frequency the ISQ quotient is
ISQ has a strong correlation to ?
measures?
micro mobility
RFA measures ressistance to lateral micro mobility
torque measures
resistance to shear forces
by measuring on two diff occasions?
you can verify not only the intial mechanical stability - but also determine the degree of osseointegration
insertion torque?
what influences it?
measures the rotational friction together with the force required to cut the bone
diameter of the implant will influence the torque
collar effect?
o Peak torque can give high values due to the “collar effect” when the implant collar is seated in cortical bone
ISQ graph and important marks
Micromobility decreases approximately 50% between 60 to 70 ISQ
• Between 60 and 70, have stability of a dental implant that can be restored
more reliable test than torque test
Stability Development Over Time
o As a result of osseointegration, initial mechanical stability is supplemented, and/or replaced by biological stability, and the final stability level for an implant is the sum of the two
o Stability does not generally remain constant after implant placement. For example, there is likely to be an initial decrease in stability, followed by an increase as the implant becomes biologically stable
low stability
medium
high?
in terms of ISQ
low is 60 and below
medium is 60-70
high is 70 and above
If we look at ISQ on day we place it and then 6-8 weeks later and assess the differences, get a pretty good idea of whether or not the implant has a high level of stability
o Implant failure will appear radiographically as
vertical bone loss
radiolucency around implant
what largely determines the patients potential abiblity to maintain home care
the design
prophy procedure
home care
- begins at first consultation
- stress professional monitring
- review homecare routine
tissue conditions peri- implant
stability
bone level (rx)
deposit removal
recall intervention
ultrasonics on implants?
o Conclusions: all ultrasonic scaling caused the production of titanium particles and caused damage to the SLA coating of the implant. Ultrasonic scalers should be used with great caution
He doesn’t like to use ultrasonics on implants
• Not a whole lot of evidence out there
Shows that pieces of the metal are coming off
No clear cut evidence that ultrasonics shouldn’t be used around a dental implant
cement on an implant is
a contributing factor to peri-implantitis and mucositis
if cement on implant can see this on radiograph
no - not all the time
have to raise a flap
dynamic 3D navigation and robotic assisted surgery
new techniques and no surgical guide used
dynamic 3D navigation
o No surgical guide used
o Shows your handpiece on the screen, live, so you can see exactly where your handpiece is
o Need to keep the bur cool to not cause the bone to necrose
With a surgical guide, the water is being blocked and the tip of the bur isn’t reached by the water
o Problem: surgeon isn’t looking at the patient, looking at the computer screen
robotic assisted surgey
o Advantage of this over 3d navigation
With 3d navigation, will get visual and audible cues, but nothing that will stop you from doing it incorrectly
This, will not allow you to go in at the wrong angle physically stop you
You still use the pedal, but the position in space is done by the robotic arm
If patient moves, it moves in real time no lag
o The issue: robotic arm is sensitive and finicky
Takes a while to be comfortable with it
basic of delayed implant placement
with soft tissue healing and only partial hard tissue / bone healing
immediate placement advantages
1 surgical procedure
reduced over all tx time
these are both potential advantages
immediate placement disadvantages
morphology of socket may lead to compromised implant positino
morphology of socket can compromise intital implant stabilit
lack of soft tissue volume for primar closure
increased risk of recession
complexitiy of procedure increases
flapless in immediate?
yeah maybe cause youll have the extraction socket to guide you
- up to individual
images needed for immediate
pano
periapical
CBCT
