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Bds3 - RMAOH PERIODONTOLOGY > Implant Complications + Maintainence > Flashcards

Implant Complications + Maintainence Flashcards

1
Q

What are the different categories for implant complications?

A
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2
Q

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

A

Peri implant tissues lack developed blood supply

Different collagen structure and blood supply

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3
Q

Peri implant tissue
Describe the structure of peri implant tissue

A
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4
Q

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

A

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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5
Q

Bacterial colonisation

A

Only learn highlighted?

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6
Q

What are the three different possibilities for peri implant tissues?

A

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

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7
Q

Peri implant health

A
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8
Q

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

A
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9
Q

What are the signs and symptoms of peri implant mucositis

A
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10
Q

Peri implant mucositis

A
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11
Q

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

A

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

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12
Q

What can further cause complications for impalnts?

A
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13
Q

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

A
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14
Q

Give two presentations of tissue deficiencies that can be seen

A

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

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15
Q

Peri implantitis
Define
Prevalence
Cause
Reversible?
Outcomes
Management?

A
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16
Q

Signs and symptoms of peri implantitis

A
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17
Q

EFP Classification 2017

A
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18
Q

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

A

Peri-implant health
Peri-implant mucositis
Peri-implantitis

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19
Q

EFP Classification 2017

What are the 2 requirements for diagnosis of peri implant health

A
  1. No BOP
  2. No bone loss beyond crestal bone level changes resulting from initial bone remodelling
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20
Q

EFP Classification 2017

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

A
  1. Bleeding on probing
  2. No bone loss beyond crestal bone level changes resulting from initial bone remodelling
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21
Q

EFP Classification 2017

What are the 3 requirements for diagnosis or peri implantitis?

A
  1. Bleeding on probing
  2. Bone loss beyond crestal bone level changes resulting from initial bone remodelling
  3. Increased probing depths
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22
Q

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

A
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23
Q

Peri implantitis

A
24
Q

What are the clinical and radiographic features of peri implantitis?

How does bone loss present radiographically?

A
25
Q

How common is peri implantitis

A

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

26
Q

Does surface of implant effect risk of peri implantitis?

A

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

27
Q

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?

A

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

28
Q

Do teeth do better than fixed implants?

A

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

29
Q

Is smoking a risk factor for peri implantitis?

A

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

30
Q

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?

A

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

31
Q

Is previous periodontitis a risk factor for implant complications ?

A

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

More likely to lose implants

32
Q

Make fc

A
33
Q
A
34
Q

Structure of dental implant

A
35
Q

Internal connnection vs external connection

A
36
Q

Implant / abutment interface as a risk

Does the type of connection matter

A

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

37
Q

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

A

Yes

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

38
Q

Other risk factors for peri implantitis

A

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

39
Q

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 ?

A
40
Q

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?

A
  1. Nothing
  2. Scale and polish
41
Q

Cumulative interceptive support therapy

What treatment is advised for implants of pocket depth 4-5mm?

A

Antiseptics

42
Q

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

A
  1. Antiseptics

2.antibiotics OR Resective/regenerative surgery

  1. Resective/regenerative surgery
43
Q

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

A

Hand instruments / ultrasonics
With plastic, titanium or carbon fibre tips

plastic causes the least damage

44
Q

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

A

They are too rough and can damage the surface

45
Q

What other than scalars can be used to clean impalnts

A
46
Q

Topical antimicrobials / disinfectants for mucositis

Are they better than mechanical cleaning

A

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

47
Q

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

A

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

48
Q

What is Implantoplasty?

What is important to remember in implantoplasty?

A

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

49
Q

What is the maintenance protocol for implants

A
50
Q

Summary

A
51
Q

What are Possible preventive strategies for implant complications

A
52
Q

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

A
53
Q

How should implant position be selected

A
54
Q

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

A
55
Q

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

A
56
Q

After implant has been placed

A

Bds3 - RMAOH PERIODONTOLOGY (21 decks)

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