Implant Complications + Maintainence Flashcards by Sana H

What are the different categories for implant complications?

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What is the difference between peri implant tissues compared to tissues around natural teeth?

Peri implant tissues lack developed blood supply

Different collagen structure and blood supply

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Peri implant tissue
Describe the structure of peri implant tissue

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Why can tissue end up collapsing over implant if crown is lost?

Collagen fibre bundles either circumferential or circular around abutment
or act as crest fibres moving out from Bone into surrounding mucosal tissue
This means it is held up by the crown and hence collapses when crown lost

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Bacterial colonisation

Only learn highlighted?

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What are the three different possibilities for peri implant tissues?

1) peri implant health
2) peri implant mucositis
3) peri implantitis

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Peri implant health

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Peri implant mucositis
What is it?
How prevalent?
Cause ?
What are the two Outcomes for peri implant mucositis?
Management?

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What are the signs and symptoms of peri implant mucositis

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Peri implant mucositis

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Do you need keratinised tissue around implant / abutment / restoration emergence?

2mm keratinised tissue
Without - more recession, more attachment loss

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What can further cause complications for impalnts?

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What are tissue deficiencies from implants often a complication of?
(What can cause Tissue deficiencies / remodelling / recession)

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Give two presentations of tissue deficiencies that can be seen

1) implant shines through tissue
2) Implant itself is exposed by recession

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Peri implantitis
Define
Prevalence
Cause
Reversible?
Outcomes
Management?

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Signs and symptoms of peri implantitis

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EFP Classification 2017

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EFP Classification 2017
What are the 3 classifications for peri implant status of an implant?

Peri-implant health
Peri-implant mucositis
Peri-implantitis

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EFP Classification 2017

What are the 2 requirements for diagnosis of peri implant health

No BOP
No bone loss beyond crestal bone level changes resulting from initial bone remodelling

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EFP Classification 2017

What are the 2 requirements for diagnosis of peri implant mucositis?

Bleeding on probing
No bone loss beyond crestal bone level changes resulting from initial bone remodelling

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EFP Classification 2017

What are the 3 requirements for diagnosis or peri implantitis?

Bleeding on probing
Bone loss beyond crestal bone level changes resulting from initial bone remodelling
Increased probing depths

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In the absence of previous examination data, a diagnosis of peri-implantitis can be based on the combination of:

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Peri implantitis

What are the clinical and radiographic features of peri implantitis?

How does bone loss present radiographically?

How common is peri implantitis

Risk of Peri implant mucositis and peri implantitis is higher when: - no maintenance - diabetes - wide implants - immediate placement

Does surface of implant effect risk of peri implantitis?

Yes Although rough surfaces eg TiOblast help to get good osseointegration, they can increase risk of peri implantitis as they may bacteria colonisation more likely and are harder to clean than smooth surfaces

Is peri implantitis due to mechanical or microbial issues? What is the difference between mechanical or biological/microbial issues? How has implant neck micro thread aimed to reduce mechanical load with implants?

See pages 32-35 Mechanical issues include - screw/cement /implant Passive / impassive fit (but cleanable) Adverse loading Occlusal Trauma Microbial issues/ biological failures - inflammation / bone loss: Inflammation in response to plaque accumulation at the tissue interface Implant design has been designed to reduce mechanical issues/mechanical load with implants and this includes : Internal connection reduces stress on bone HOWVEER KEY TO NOTE STILL SUFFER FROM PERI IMPLANTITIS THUS PERI IMPLANTITIS IS BIOLOGICAL ISSUE

Do teeth do better than fixed implants?

Although they have similar survival rates, implants may have more complications as they could suffer from soft tissue complications, screw loosening, suprastructure complications Impalnts are not fit and forget - they need to be monitored and maintained and looked after

Is smoking a risk factor for peri implantitis?

YES If you are currently smoking or even if you recently quit, still a risk factor for peri implantitis

1 - Does risk of implant failure in smokers remain the same as the years go on? 2 - Why or why not? 3 - Why is there a risk of implant failure for smokers after 5 years of having implant in? 4 - does the implant being placed in a grafted site affect implant failure?

1 - Risk of implant failure rates are highest in the year after implant is placed , risk reduces as years go on 2 - This is because smoking has an impact on healing and integration of implants - effects healing of bone around implant 3 - risk of peri implantitis post healing 4 - YES - smokers who had an implant placed into a grafted site - site that is NOT host bone - were more likely to have implant failure

Is previous periodontitis a risk factor for implant complications ?

Yes if pt had previous peridontitis then more likely to have peri implant mucositis, peri implantitis and implant failure More likely to lose implants

Make fc

Structure of dental implant

Internal connnection vs external connection

Implant / abutment interface as a risk Does the type of connection matter

Implant / abutment interface can be a risk factor NO - it does not matter if there is an external or internal connection - bacteria will still be able to get into implant/ these zones

Is how a prosthesis is retained a risk factor? How can cement vs screw retained increase risk of peri implantitis

Yes Excess cement can act as a plaque retentive factor and increases the risk

Other risk factors for peri implantitis

Poor plaque control Previous history of severe periodontitis Smoking Diabetes Absence of regular maintenance Cemented prosthesis instead of screw retained prosthesis Ill‐fitting/poorly designed fixed prosthesis - worse plaque control Previously grafted site Implant / abutment

Maintenance of Implants What is the aim of maintenance appointments? What determines the frequency and level of maintenance? How often are maintenance appointments for implants ?

Cumulative interceptive support therapy What treatment is advised For implants of pocket depths of less than 4mm and: - no plaque or bleeding? - plaque or bleeding?

1. Nothing 2. Scale and polish

Cumulative interceptive support therapy What treatment is advised for implants of pocket depth 4-5mm?

Antiseptics

Cumulative interceptive support therapy What treatment is advised for implants with pocket depth of more than 5mm and: -BOP, no bone loss - BOP, bone loss <3mm - BOP, bone loss >2mm

1. Antiseptics 2.antibiotics OR Resective/regenerative surgery 3. Resective/regenerative surgery

To clean implants what instruments should be used? What can be given in addition to cleaning ?

Hand instruments / ultrasonics With plastic, titanium or carbon fibre tips plastic causes the least damage

Why are steel tips not advised to be used to clean impalnts

They are too rough and can damage the surface

What other than scalars can be used to clean impalnts

Topical antimicrobials / disinfectants for mucositis Are they better than mechanical cleaning

We can use CHX (chlorhexidine) to reduce plaque scores and bleeding however they are not much better than mechanical cleaning

Adjunctive systemic and local antimicrobial therapy in the surgical treatment of peri implantitis Does the treatment outcome change based on surface of implant ?

Above treatment was more successful with a shiny surface compared to a rough surface

What is Implantoplasty? What is important to remember in implantoplasty?

Changing the shape of the implant surface using diamond and polishing burs (changing the implant surface - making smoother -reduced pocket depths ) Narrow impalnts that undergo implantoplasty are more likely to break under loading, whereas wider are not. So may not want to do this procedure on narrow impalnts taking heavy loads - especially posterior regions

What is the maintenance protocol for implants

Summary

What are Possible preventive strategies for implant complications

Before implant placement what should be done in terms of patient information and treatment

How should implant position be selected

To facilitate oral hygiene what should clinicians consider with keratinised tissue and the implant

If cement for the implant is used where should the restoration margins be placed and why

After implant has been placed