Implant Complications and Maintenance Flashcards
What are the main complications of implants?
- Issues with tissue integration
- Implant issues
- Abutment issues
- Restoration issues
Are peri-implant tissues more or less vascularised than gingival tissues?
Less
As peri-implant tissue is less vascularised, what does this affect for the ability of the tissue?
Affects ability to react to bacteria and inflammation is decreased
Explain the features of the outer and inner zone of periimplant tissue
Outer zone = between bone and epithelium, multidirectional fibres, less collagen, more cells & vessels
Inner zone = contacts the implant zone, fibre -rich collagen, few cells & vessels, resembles scar tissue
What is peri-implant mucositis?
A reversible inflammation of peri-implant tissue, It can progress on to cause more destruction or can remain stable.
What are the signs and symptoms of peri-implant mucositis?
SIGNS:
Marginal tissue swelling
Bleeding on probing
Suppuration
Depper probing
SYMPTOMS:
Can be something that a patient is not aware of - patients need to be aware to clean properly around an implant to maintain it esp if they are a perio patient
Bleeding
Soft tissue tenderness
Halitosis
What is the main reason for using keratinsed tissue around an implant?
Regulating inflammation by making it easier to keep the implant clean.
When do tissue deficiencies occur when placing an implant?
Tissue deficiencies can occur if the impact is placed too far buccal.
Example - immediate implant placed incorrectly and then remodelling causes loss of buccal tissue
Occurs especially due to a thin biotype or trauma/infection
Worst outcome is the implant being exposed through the soft tissue, especially due to soft tissue recession
The shadow of the implant may also shine through the overlying soft tissues
What causes peri-implantitis?
Due to a host-response to the plaque as well as the rough implant surfaces being plaque retentive
Likely that the damage is not reversible if the implant surfaces get colonised with bacteria.
Leads to pain and recurrent infection and poor aesthetics
Ultimately implant failure
What are the 3 classifications for periodontitis around an implant?
HEALTH = no BOP and no bone loss beyond crestal bone level changes resulting from initial bone remodelling (seen from X rays before and after implant)
Mucositis = BOP but no bone loss
Peri-implantitis = BOP and bone loss
What is a big risk factor for peri-implantitis?
Smoking
Previous periodontitis
Leaving cement behind
Poor plaque control
What is a good recall time for maintaining implant patients with perio problems?
4-6 months
What are some of the principles to cleaning around implants?
- Ideally want to use cleaning instruments that are softer than the implant.
Do not use steel instruments to clean - use carbon, titanium or carbon fibre
- Dont want to compromise the implant and scratch it.
- Rough surface implants are harder to clean, hard to get between the threads if the implant is exposed.
- Anti-septics can be helpful
What is the maintenance protocol for implants?
Take medical history
Ask for complaints or problems
Extra and intra oral examination as usual
Assess the implant at the end, BOP, suppuration, probing depths, radiograph taken
Assess the restoration on top - is it loose, anything chipped
Cumulative therapy needed if something has complicated
What are good preventative strategies for preventing implant disease?
Pick the right patient
Pick the right size
Pick the right sized implant
Manage risk factors
Place at the right time to allow for shrinkage
Place in a restoratively driven manner
Design your restoration for hygiene in advance
Ensure systemic maintenance
