Implant biology

Question 1

PDL natural vs implant

Answer 1

all fiber groups present in natural, none with implant

Question 2

natural teeth PDL

Answer 2

*Periodontal fibers aIach from bone to root in multiple
directions
*Periodontal Ligament act as shock absorber
*Connective tissue fibers attach to teeth

Question 3

implant PDL?

Answer 3

• Direct bone to implant contact (osseointegration)
• Ankylosis
• Peri-implant fibers parallel cuff, oriented longitudinal

Question 4

Supracrestal tissue attachment components and measurements

Answer 4

Question 5

implant epi cell attatchement

Answer 5

attatched via hemidesmosomes

Question 6

parallel cuff

Answer 6

• Collagen fibers do not insert into the implant but creates a cuff around the implant

Question 7

Difference in Blood Supply with implants
* Blood supply by?
* inflammatory response?
* Capillaries?

Answer 7

• Blood supply by terminal branches of large vessels
  from periosteum.
• More inflammatory response than gingival Bssues
• Fewer Capillaries

Question 8

Teeth vs Implants
attatchment?
orientation of collagen fibers?
source of blood supply?
bio width?

Answer 8

Question 9

bio width of implants

Answer 9

JE: 1.88mm
CT:1.05 mm
almost 3mm

Question 10

JE length in implants

Answer 10

JE Length 1.3 to 1.8 mm (depends on the implant
design).
PDs may very based on implant design (and brand)

Question 11

physiologic bone remodeling with implants

Answer 11

Once the implant is uncovered, vertical bone loss of 1.5 to 2 mm is evidenced apical to newly established implant-abutment interface.
After one year of Loading, up to 2 mm of bone loss is considered biologic bone remodeling and WNL

Question 12

pathologic bone remoddeling with implants

Answer 12

Baseline X-ray to evaluate progressive Bone Loss.
>= 2mm after the first of function is pathologic
>If you do not have a radiograph? PDs >= 6mm and BOP is pathologic
PERI IMPLANTITIS: characterized by inflammation in the peri-implant mucosa and progressive loss of supporting bone. Clinical sign of inflammation
is detected by bleeding on probings, while progressive bone loss is identified on radiographs”

Question 13

How much bone is adequate? MD demension

Answer 13

at least 1.5 mm between teeth and implant (Esposito, 1993)
- 3 mm between 2 adjacent implants

Question 14

implant placement for anterior papilla

Answer 14

• 3-4 mm deeper than adjacent margin for papilla in anterior teeth

Question 15

adequate bone in BL demension

Answer 15

As bone thickness approached 1.8 - 2 mm, bone loss decreased significantly and some evidence of bone gain was seen

Question 16

BUCCO-LINGUAL demensions (Posteriors)

Answer 16

*non linear correlation between buccal ridge width and the resorption
*2 mm threshold established to account for non linearity . Significantly greater resorption when the ridge width < 2 mm
* At least 1 mm buccal and lingual needed.

Question 17

subcrestal placement

Answer 17

recommended to place implant beneath bony crest about .5mm
hides moderately rough surface from microbiota

Question 18

Platform Switching

Answer 18

Concept of placing an abutment of a narrower diameter on the implant of a wider diameter to preserve alveolar bone levels at the crest of a dental implant

Question 19

how does platform switching work

Answer 19

-Shifts the inflammatory cell infiltrate inward and away from the adjacent crystal bone
-Maintains the supracrestal attachment
-Increases distance of implant-abutment junction from the crystal bone
-limits possible interface of bone with micromovements

Question 20

The influence of Microgap at two-part
implants

Answer 20

Inflammatory cell infiltrate was consistently present at the level of the interface between the two components, the bone crest was consistently located 1-1.5 mm apical of the microgap.
* Inflammatory Infiltrate was due to bacterial contamination
* Placement of two-part implants at different levels in relation to the bone crest resulted in different amounts of bone loss.

Question 21

microgap and bone loss flow chart

Answer 21

Question 22

Kera2nized Tissue and Implants

Answer 22

Implant sites with a band of <2 mm of KT were shown to be more prone to brushing discomfort, plaque accumulation, and peri-implant soft tissue inflammation when compared to implant sites with ≥2 mm of KT.

more keratinized tissue the better

Question 23

how can we increased the amount of KT

Answer 23

tissue grafts