Implant biology Flashcards
PDL natural vs implant
all fiber groups present in natural, none with implant
natural teeth PDL
*Periodontal fibers aIach from bone to root in multiple
directions
*Periodontal Ligament act as shock absorber
*Connective tissue fibers attach to teeth
implant PDL?
- Direct bone to implant contact (osseointegration)
- Ankylosis
- Peri-implant fibers parallel cuff, oriented longitudinal
Supracrestal tissue attachment components and measurements
implant epi cell attatchement
attatched via hemidesmosomes
parallel cuff
- Collagen fibers do not insert into the implant but creates a cuff around the implant
Difference in Blood Supply with implants
* Blood supply by?
* inflammatory response?
* Capillaries?
- Blood supply by terminal branches of large vessels
from periosteum. - More inflammatory response than gingival Bssues
- Fewer Capillaries
Teeth vs Implants
attatchment?
orientation of collagen fibers?
source of blood supply?
bio width?
bio width of implants
JE: 1.88mm
CT:1.05 mm
almost 3mm
JE length in implants
JE Length 1.3 to 1.8 mm (depends on the implant
design).
PDs may very based on implant design (and brand)
physiologic bone remodeling with implants
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
pathologic bone remoddeling with implants
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”
How much bone is adequate? MD demension
at least 1.5 mm between teeth and implant (Esposito, 1993)
- 3 mm between 2 adjacent implants
implant placement for anterior papilla
- 3-4 mm deeper than adjacent margin for papilla in anterior teeth
adequate bone in BL demension
As bone thickness approached 1.8 - 2 mm, bone loss decreased significantly and some evidence of bone gain was seen
BUCCO-LINGUAL demensions (Posteriors)
*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.
subcrestal placement
recommended to place implant beneath bony crest about .5mm
hides moderately rough surface from microbiota
Platform Switching
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
how does platform switching work
-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
The influence of Microgap at two-part
implants
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.
microgap and bone loss flow chart
Kera2nized Tissue and Implants
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
how can we increased the amount of KT
tissue grafts
