Implant Complications Flashcards
definition of primary osseointegration
mechanical engagement of an implant with the surrounding bone after implant insertion
definition of secondary osseointegration
wheras bone regeneration and remodeling offers secondary oseointegration
poor initial stability - referencing bone quantity
bone quantity!
- the more bone thats present at an implant site, the better the possibility for success
poor initial stability - referencing bone quality
relates to the bone DENSITY
- type i – considered the least vasuclar and most homogenous (stronger cortical bone)
type IV – thin cortex and low density trabeculae
type 1, II, III, and IV bone quality
relates to density
I – least vascular and most homogenou
II- combination of cortical bone with a marrow cavity
III- predominantly composed of trabecular bone
IV- thin cortex and low density trabeculae
poor initial stability - referencing implant site (poor situation examples)
examples
- posterior maxilla with type IV bone
less than 1 mm buccal/lingual/ palatal to the implant width
anterior maxilla concavity
poor initial stability - referencing implant diameter
wider - usually more stable
ISQ scale?
ISQ has a non-linear correlation to micro mobility
micro mobility decreases >50% from 60-70 (stability is better closer to 70 +)
low stability i less than 60
higher is greater than 70
use of undersized drilling?
weak evidence that could enhance the primary implant stability in sites of poor bone density
osteotome technique affect?
weak evidence that in poor bone density could enhance the primary stability
flapless affect?
there is weak evidence suggesting that could enhance the primary stability
effect of surgical techniwue on the initial stability
poor / weak evidence when used undersized drilling, osteotome technique, or flapless technique
likely causes of implant exposure
thin cortical plate
un-even crestal ridge
too large implant
higher chance of implant fracture with?
AT THE TIME OF ONSERTION
small diameter nobel biocare trilobed have a higher incidence
more common area – anteiror mandible
causes of implant fracture during functino?
- inadequate fit of the superstructure
- material or design defect
- long-term metal fatigue
- occlusion, parafunctinoal habits
- location
- diameter
- bone resorption around the implant
general % of implant fracture
0.16-1.5%
main reasons (over arching) that an implant would fracture
- design and manufacturing defects
- non passive fit of the prosthetic framework
- physiologic or biomechanical overload
- others – localization
galvanic activity
iatrogenic implant placement of manipulation
implication of implant diameter
narrow platform – lower ISQ’s (less stable)
narrow platform – lower ISQ’s
regular and wide showed higher ISQ’s but no significant difference between the two
implication of implant length
13 mm and 10 mm when compared — in D1 bone – ISQ significantly higher for longer implant length
implants of 13 mm in length – ISQ value were higher in D3 bone than 10 mm
regular platform of 13 mm significantly higher ISQ values compared to 10 mm
over-arching themes to poor initial stability
- over size drilling
- under length drilling
- perforating cortical plate
- changing implant drilling direction
- wrong implant drilling system
initial stability in D1 bone vs D3
will always be different
D1 – higher
also drops off when using narrow platform
nerve injury prevelence in implant placement
0-11%
- referring to the inferior alveolar nerve
inferior alveilar nerve injury with implant placement
usually a reslt of poor planning
swelling may have been present around the nerve
poor surgical technique
retraction (like retractor placed against the nerve in mandibular pre-molar region) around mental nerve
with the use of CBCT – incidence of nerve injury should be decreased to a minimm
incidence of oro-antral communicatoin
11-56%
risk factors of oro-antral communication
thickness (thinness of sinus membrane)
presence of septa
sinus width – angle of medial and lateral walls at the crest
signficance between the membrane thickness and membrane perforation with oro-antral communicaton
the perforation rate was 41% when membrane thickness was LESS THAN 1.5 MM
perforation rate was 16.6% when membrane thickness i equal or greater than 1.5 mm
1.5 mm of membrane thickness?
PERFORATION RATE INCREASED RISK
41% VS 16.6%
BELOW AND ABOVE / EQUAL TO 1.5
oro-antral communication most commonly seen?
most common in first molar area
within the sinus area we see prevelance of
middle at 41%
posterior at 35%
anterior at 24%
orientation of sinus septum? / oro-antral communication link
medial-lateral orientation – HIGHER ON MEDIAL than lateral
panorex with oro-antral communication?
can cause up to 21% false diagnosis
sinus membrane perforation occurence can increase with?
in cases with SINUS SEPTUM there is a higher incidence of perforation
lower incidence if use two window technique
lower incidence with ultra-sonic
late complications - general
occur AFTER osseointeration
implant survival
exhibit characteristics that MAY lead to failure
implant failure
implant has LOST osseointegration
failing implant
has NOT FULFILLED the predetermine success criteria
peri-implantatis
LATE COMPLICATION (after osseointegration)
micro-organisms most commonly associated with implant failure are SPIROCHETES AND MOBILE FORMS OF GRAM-NEGATIVE ANAEROBES
- bone loss
- implant mobility
treatment of peri-implantitis
local debridement
surface decontamination
anti-infective therapy
surgical technique
removal
incidence of implant fracture
2.3%
related to
- improper treatment planning
- bruxism
- bone lost
