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implant Flashcards

1
Q

What are the characteristics of the ideal tooth replacement? (5 characteristics)

A
  1. FIRM
  2. Does not destroy adjacent teeth
  3. Preserve alveolar bone
  4. Sensate
  5. Easy to clean
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2
Q

characteristics of ideal tooth replacement

A 
firm
does not destroy adjacent teeth 
preserve alveolar bone 
easy to clean
sensate
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3
Q

alternatives for tooth replacement

A

tissue supported dentures
tooth supported bridge
implant supported crown

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4
Q

what are the pros and cons of using tissue supported denture for tooth replacement

A

easy to clean

does not preserve alveolar bone

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5
Q

pros and cons of implant

A

pros:

  • achieve excellent aesthetics
  • does not involve preparation adjacent teeth
  • preserve residual bone

cons:

  • expensive
  • require surgery
  • technically complex
  • time consuming
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6
Q

condition needed for bone to be maintained

A

stress must be conducted to osteons/osteocytes

compressive stress will cause bone resorption

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7
Q

What are the historical types of dental implants? (6 types, acronym TrollMEMES)

A
  1. Transmandibular implant
  2. Mucosal insert
  3. Endodontic Implant (Stabilizer)
  4. Mini implant (temporary, transitional)
  5. Endosteal/Endosseous implant (Blade/root-form implant)
  6. Supraperiosteal implant
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8
Q

What are the pros of implants?

A
  1. Do not involve preparation of adjacent teeth
  2. Preserve residual bone
  3. Excellent aesthetics
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9
Q

what are the downsides of supraperiosteal implant

A

framework sits on top of periosteum, exerting pressure that causes bone resorption

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10
Q

What are the principles of implantation

A

Bone is the only tissue that regenerates

All other tissues repair with scar tissue except during fetal period

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11
Q

What are the conditions needed to allow bone to regenerate fully?

A

Needs to have certain stresses on the osteons and osteocytes to detect that the bone is being used if not the bone will atrophy
Thus, edentulous patients, bone resorb
Compressive stresses also cause bone resorption (force is too much, not physiologic, bone will resorb)

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12
Q

What are the historical types of dental implants? (6 types, acronym TrollMEMES)

A
  1. Transmandibular implant
  2. Mucosal insert
  3. Endodontic Implant (Stabilizer)
  4. Mini implant (temporary, transitional)
  5. Endosteal/Endosseous implant (Blade/root-form implant)
  6. Supraperiosteal implant
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13
Q

What is a mucosal insert implant

A

Tiny buttons in the denture, corresponding attachment button implanted ONLY in mucosa

  1. NOT FIRM, moves
  2. Does not maintain bone
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14
Q

What is an endodontic implant? (stabilizer)

A

After root canal treatment, place this implant through the root canal and apex into the bone- cause very difficult extraction
Purpose is to stabilise and preserve remaining natural teeth

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15
Q

What is a supraperiosteal implant?

A

Raise flap, take impression, cast CoCr framework that sits on top of periosteum, with tiny attachments that go through the mucosa to attach denture

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16
Q

What is a blade implant?

A

Use fissure bur to make groove, use mallet to knock implant into the bone

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17
Q

What is a transmandibular implant?

A

1 implant from mouth, 1 from chin through the mandible

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18
Q

What is the definition of a dental implant?

A

PERMUCOSAL device which is BIOCOMPATIBLE and BIOFUNCTIONAL and is placed within bone which retains prosthesis (fixed or removable)

Mad of various biomaterial (commonly titanium- gold standard)

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19
Q

Why use titanium in implants?

A

Osseointegration- serendipitous finding by Dr Branemark

  • Direct contact between bone and implant surface
  • Bone healed directly on titanium cylinder surface without intervening fibrous tissue
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20
Q

What is an alloplastic material?

A

Material not from the patient’s body (synthetic)

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21
Q

Definition of osseointegration?

A

(1) TIME DEPENDENT
(2) HEALING PROCESS
where by clinically asymptomatic
(3) RIGID FIXATION
of alloplastic materials is achieved, and maintained, in bone during
(4) FUNCTIONAL LOADING
(Zarb and Albrektson, 1991)

Basically ANKYLOSIS

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22
Q

What are the advantages of multicomponent implant compared to single piece implant?

A

greater retrievability in the situation of failure (e.g. if crown fractures, can just remove that part and replace, fixture is usually fine)

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23
Q

Why do people not use HA coatings on implants anymore?

A

Hydroxyapetite coating has been shown to break loose or even dissolve after a few years

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24
Q

Why are surface treated implants preferred to machine polished implants?

A

Roughened surface allows bone to grow in better, due to increased surface area of the titanium implant

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25
Q

Is the whole implant roughened to aid in osseointegration?

A

NO, transmucosal attachment has to be smooth to reduce plaque formation and biofilm adhesion

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26
Q

What are the parts of the implant?

A
  1. Implant body-fixture
  2. Abutment
  3. Prosthetic
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27
Q

What are the advantages of multicomponent implant compared to single piece implant?

A

greater retrievability in the situation of failure (e.g. if crown fractures, can just remove that part and replace)

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28
Q

easiest location to place implant and why

A

upper premolar

no nerve and sinus nearby

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29
Q

what are the downsides of mucosal insert implant (attachments used to retain denture)

A

not firm

does not preserve bone

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30
Q

what are the downsides of endodontic implant

A

make extraction difficult

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31
Q

what are the downsides of supraperiosteal implant

A

framework sits on top of periosteum, exerting pressure that causes bone resorption

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32
Q

what is a dental implant

A

permucosal device that is biocompatible and biofunctional that is placed within mucosa or on or within bone associated with the oral cavity to provide support for fixed or removable prosthesis

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33
Q

what is osseointegration

A

direct contact between bone and implant surface

time dependent healing process whereby clinically asymptomatic rigid fixation of alloplastic material is achieved and maintained in bone during functional loading

direct connection between living bone and load bearing endosseous implant at light microscopic level via direct bone apposition to implant surface

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34
Q

When do you use angulated abutments as opposed to straight axis abutments?

A

When there is some complication in the placement of the implant fixture in bone, where the angulation of the fixture is not corresponding to the intended prosthesis long axis. (Surgeon cock eye and drill wrongly)

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35
Q

What are the steps of the surgical procedure of implant placement? (4 main steps)

A
  1. Initial surgery
  2. Osseointegration period
  3. Abutment connection
  4. Final prosthetic restoration
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36
Q

benefits of threaded implant vs non threaded

A

threaded implant demonstrate maintenance of clear steady state bone response
enhances initial stability and increase surface contact

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37
Q

main benefit of multicomponent implant over single piece implant

A

retrievability

38
Q

What are 4 factors that influence osseointegration?

A
  1. Biocompatible material
  2. Implant adapted to prepared site
  3. Atraumatic surgery
  4. Undisturbed healing phase
39
Q

How would you describe the soft-tissue to implant interface of a SUCCESSFUL implant

A

Unbroken, perimucosal seal between soft tissue and implant abutment surface

40
Q

What are the similarities and differences in soft-tissue connection to implants and natural teeth

A

Similarity: epithelium attaches to surface of titanium and enamel through a basal lamina and formation of hemidesmosomes

Difference: natural tooth- sharpies fibers extend from bundle bone of lamina dura and insert into the cementum of tooth root surface. Implant- no sharpies fibers, no PDL, no cementum or fiber insertion. ONLY LONG JUNCTIONAL EPITHELIUM

41
Q

How does the difference in soft-tissue connection to implants affect the management and care of implants

A

Easy for periimplantitis to progress very quickly, because only long junctional epithelium is present

42
Q

What is pitch?

A

Number of threads per unit length. Increased pitch on top part of abutment to grip more of cortical bone, make implant more stable. Decreased pitch to allow cancellous bone to adapt to it

43
Q

What bone quality is usually found in the anterior lower jaw?

A

Quality I- HOMOGENOUS COMPACT BONE

44
Q

What bone quality is the most favourable for implant placement

A

Quality II, usually found in posterior lower jaw. Thick layer of cortical bone surrounding dense trabecular bone

45
Q

Why is quality I bone not the best for implant placement?

A

It is so dense, that when you drill, the bone may overheat

46
Q

Why is quality I bone not the best for implant placement?

A

It is so dense, that when you drill, the bone may overheat

47
Q

main benefit of multicomponent implant over single piece implant

A

retrievability

48
Q

location with greater success rate for osteointegration

A

interforamina area where bone is very thick and dnse

49
Q

What temperature must bone be kept below

A

45 degrees

50
Q

How do you ensure bone does not overheat?

A

Use NEW SHARP DRILLS
Use graded series of drills, do not just put in the biggest size and force it in
Proper drill geometry, and intermittent drilling

51
Q

What happens if your insertion torque is too high?

A

Result in stress concentrations around implant, microfractures, subsequent bone resorption

52
Q

What is one-stage surgical protocol for delayed loading?

A

Preferred method, sufficient insertion torque, implant is stable immediately

53
Q

When is immediate loading done?

A

Aesthetic anterior teeth

54
Q

What is two-stage surgical protocol for delayed loading?

A

Place in implant, close up, three months later you go back in
Put in bone graft also two-stage

55
Q

What are complications of off-axis loading

A

Bone resorption, or implant fracture

56
Q

What is success rate of osseointegration in type I bone?

A

97%. Highest success in type I (anterior mandible) Lowest success in posterior maxilla

57
Q

What is the course of action in failed osseointegration

A

Take out implant, let it heal and put in again

58
Q

What can you do to manage the complication of altered sensation and nerve injury?

A

Mandibular implants- risk of injury to IDN posterior to mental foramen

  1. Proper imaging- DPT has magnification, CBCT most accurate in measurement of distance
  2. Take measures to ensure magnification is correct
  3. Knowledge of anatomy and instruments
  4. Informed consent
59
Q

What are the various causes of infection and bone loss related to implant failure?

A
  1. Post-op infection, placement of foreign body into bone close to oral environment
  2. Perio disease (peri implantitis)
  3. Placement of bone graft/immediate implants into area of existing active infection
  4. Exposure of rough surface of implant to oral environment, rapid deterioration because of increased biofilm accumulation
60
Q

What are the maxillary sinus complications related to implants

A
  1. Penetration of sinus by implant- nothing happens unless percolation of oral fluid in max sinus
  2. Placement in thin maxillary bone without bone graft, implant can loosen and drift into sinus
  3. Sinus lift- tears in membrane leading to acute sinusitis
61
Q

What happens if implant is angulated wrongly

A
  1. Injury to adjacent teeth
  2. Lead to off axis loading
  3. Unrestorable- need to have procedure to remove it, or leave it and let it be buried
62
Q

What can cause fractures of implant/components?

A
  1. Excessive insertion torque during placement
  2. Excessive cantilever
  3. Poor implant selection and loading causes stress in excess of material property of titanium
63
Q

Aside from the IDN and maxillary sinus, what other anatomical structures can be perforated by implants?

A
  1. Lingual pouch (arteries)
  2. Nasal cavity
  3. posterior superior alveolar artery
  4. Pterygoid implants - pterygoid venous plexus
  5. Zygomatic implants- orbital floor and contents
64
Q

What happens if implant is angulated wrongly

A
  1. Injury to adjacent teeth
  2. Lead to off axis loading
  3. Unrestorable- need to have procedure to remove it, or leave it and let it be buried
65
Q

What are the factors affecting implant survival (SIMPP)

A 
Surgeon- skill, experience
Implant design, surface modification
Maintenance
Prosthodontic- loading of resto
Patient- local factors, systemic factors, habits
66
Q

What are the patient local factors that affect implant survival

A
  1. Bone quality- density
  2. Bone quantity- vertical, buccal lingual, length of time since tooth loss, infection/cyst
  3. Location- anatomical structures
  4. Soft tissue- more keratinised gingiva, easier to brush
  5. Oral hygiene, active perio disease
67
Q

What are the patient systemic factors that affect implant survival

A
  1. Immune suppression- diabetes, smokers, previous allotransplantation, immunosuppression therapy
  2. Previous drug exposure to bisphosphonates- MRONJ
  3. Previous radiation therapy (ORN)
68
Q

What are the patient habits that affect implant survival

A
  1. Smokers
  2. Bruxism
  3. Grinding/clenching
  4. Occupation- dangerous/active occupations (commando)
  5. Age - too young (below 18) alveolar bone still growing, infraoccluded implant
    too old- cannot cooperate, multiple medical problems
69
Q

what are the anatomic considerations when placing implant

A 
ridge relationship
inter arch clearance
attached tissue
inferior alveolar nerve
maxillary sinus
floor of nose
70
Q

complications of placing implant

A 
failure of osseointegration
altered sensation and nerve injury
infection and bone loss
maxillary sinus complications
aesthetic failure 
fracture of implant and components
perforation of anatomical structures
wrong implant angulaton
71
Q

what are the types of bone healing

A

osteogenesis
osteoconductive
osteoinductive

72
Q

what is osteogenesis bone healing

A

viable osteoblasts/osteocytes present, direct healing and formation of new bone and blood vessels

73
Q

what is osteoinductive bone healing

A

organic material induce differentiation of osteoblasts from osteoprogenitor cells

74
Q

what is osteoconductive bone healing

A

inorganic material provide scaffolding, conduct path for osteoclasts to resorb HA and osteoblasts to form new osteons

75
Q

what are the types of bone graft

A

autogenous
allogenous-human ie donor (provide scaffold for body to replace with own bone)
xenogenous
alloplastic (synthetic)

76
Q

why is it important for bone graft to be fixed in place

A

micro motions can disrupt angiogenesis. loss of blood supply cause bone graft to fail

77
Q

alternative techniques to graft bone for implant

A

fixation with bone screws or titanium mesh

alveolar sandwich osteotomy

distraction osteogenesis

78
Q

what are the osteoactive agents that can be used for bone graft

A

osteoinducers eg rhBMP but very expensive

osteoproomters

stem cells and tissue engineering

79
Q

what are the local sources of bone harvest

A 
maxillary tuberosity
maxilla 
mandible
ramus
menton
adjacent bone bone scrapings
bone from drills
80
Q

what are the regional sources of bone harvest

A 
calvarial parietal bone 
iliac crest
rib
free flap
tibial
81
Q

downsides of iliac crest anterior and posterior as a source for bone harvest

A

anterior: risk of peritonitis, retroabdominal hemorrhage, scar on side of hip
posterior: scar on backside

82
Q

what regional source of bone harvest can be harvested from under LA

A

Tibial (30cc of bone)

83
Q

how much vertical height can you gain with alveolar sandwich osteotomy vs alveolar distraction

A

alveolar sandwich osteotomy: up to 5mm

alveolar distraction: 12mm

84
Q

what are the types of sinus lift

A

internal lift (summer’s osteotome)

external lift

85
Q

what type of sinus lift is safer

A

external lift is safer as it allows for direct visualisation (but increased dissecting results in more swelling)

86
Q

what are the risks of sinus lift

A

membrane tear exposing bone graft to infection

acute maxillary sinusitis

spread of sinusitis to the cranial cavity

diseased maxillary sinus –risk of sinusitis

87
Q

what are the types of computer aided surgery

A

template based surgery

image guided surgery/navigational surgery

88
Q

soft tissue grafting techniques for implant

A

free gingiva graft
free subepithelial connective tissue graft
pedicled graft
acellular dermal or mucosal matrix

89
Q

what are regenerative implants

A

polycaprolactone (PCL) which is a 3D printed polymer with pores for osteoblasts to go inside

larger defects require PCL to be paired with BMP or platelet rich plasma to enhance healing

90
Q

what are some of the newer materials to generate bone for implant

A 
regenerative implants
PCL-TCP scaffold
sugars eg heparan sulfate act as ligand for different growth factors
msc exosomes
tissue engineered scaffolds

Oms (24 decks)

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