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Perio II > Implant complications, Periimplantitis and Treatment > Flashcards

Implant complications, Periimplantitis and Treatment Flashcards

1
Q

implant tissue is divided into:

A

soft and hard tissues

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2
Q

soft tissue compartment is called:

A

peri implant mucosa

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3
Q

the hard tissue compartment forms a contact relationship with:

A

the implant surface to secure stability

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4
Q

what are the functions of the peri implant tissues

A
  • mucosa protects the underlying bone
  • bone supports the implant
  • therefore health of the peri implant mucosa is critical
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5
Q

describe the vascular supply in implants

A
  • supraperiosteal blood vessels
  • form capillaries to the CT papilla
  • vascular plexus of the PDL
  • lateral to the JE
  • runs coronally and terminates in supraalveolar portion of free gingiva
  • implants lack a PDL and PDL plexus
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6
Q

what is the location of the probe tip, distance from bony crest, probing depth, and bleeding of healthy gingiva

A
  • coronal to apical cells of JE
  • 1.1-1.2
  • 0.7
  • negative
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7
Q

what is the location of the probe tip, distance from bony crest, probing depth, and bleeding of implant

A
  • apical to apical cells of JE
  • 0.2
  • 2
  • positive
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8
Q

what is evaluated in dental implants

A
  • presence of plaque and calculus
  • clinical appearance of peri implant tissue
  • radiographic appearance of implant and peri implant structures
  • occlusal status, stability of prostheses and implants
  • probing depths and presence of exudate and/or bleeding on probing
  • patient comfort and function
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9
Q

successful and stable endosseous dental implants exhibit ___ mobility

A

no

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10
Q

if there is mobility: a _____ is recommended

A

radiographic evaluation

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11
Q

what is examined in the implant if there is mobility

A
  • abutment retaining screw
  • prosthetic abutment collar interface examined for looseness and breakage
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12
Q

what can occlusal overload cause

A

loosening of abutment screws, implant failure, and prosthetic failure

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13
Q

occlusion should be evaluated when?

A

at every maintenance appointment

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14
Q

what is the radiographic protocol for follow up after stable initial integration

A

variable

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15
Q

what is CBCT used for

A
  • standard of care
  • planning
  • assessment
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16
Q

what are the peri implant diseases

A

peri implant mucositis and peri implantitis

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17
Q

what is peri implant mucositis

A

an inflammation of the peri implant soft tissues and is characterized by edema, change in color (red or red-blue), bleeding and/or purulence on probing, with PD of greater than or equal to 4mm, and no evidence of radiographic peri implant bone loss

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18
Q

what are the general risk indicators for peri implant mucositis

A
  • cigarette smoking
  • radiation therapy
  • poorly controlled diabetes
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19
Q

cigarette smoking has been established as a risk factor for peri implant mucositis in:

A

3 years

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20
Q

what HBa1c makes diabetes a risk factor for peri implant mucositis and what happens

A
  • greater than 10.1
  • increased bleeding around implant
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21
Q

what are the major risk indicators for peri implant mucositis

A
  • oral hygiene
  • dose dependent relationship between oral hygiene assessed by plaque scores and peri implant mucositis
  • compliance/lack of compliance with supportive implant therapy
  • material and surface characteristics of implant components
  • accessibility of biofilm removal around implant supported prosthesis
  • location of the implant margins
  • dimensions of keratinized peri implant mucosa
  • excess cement
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22
Q

prevalence of peri implant mucositis with plaque was:

A

62.6%

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23
Q

what is the standard of care for management of peri implant mucosistis

A

mechanical biofilm control

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24
Q

peri implant mucositis in patients that are not adhering to supportive implant therapy is as high as:

A

48%

25
Q

patients that adhered to a strict maintenance protocol had a prevalence of peri implantitis in the range of:

A

20%

26
Q

in partially edentulous patients a lack of adherence to SIT within the overall patient sample was associated with onset of peri implantitis with an odds ratio of:

A

5.92

27
Q

what is considered in material and surface characteristics of implant components

A
  • evidence on the effect of implant surface roughness peri implant mucositis is limited
  • studies looking at highly machined implant abutments and bleeding on probing showed little difference
  • there was no difference in BOP between titanium and zirconium abutments either
28
Q

accessibility of biofilm removal around implant supported prosthesis plays an important role in:

A

the prevention and management of peri implant diseases

29
Q

the location of the implant margins has an impact on:

A

inflammation with supragingival margins being associated with decreased inflammation

30
Q

is grafting of keratinized mucosa necessary to maintain peri implant health

A

no

31
Q

what is excess cement associated with

A
  • clinical signs of peri implant mucositis
  • higher prevalence of peri implant mucositis in patients with cemented prostheses compared to screw retained prostheses
32
Q

what is peri implant mucositis

A

an inflammatory lesion of the peri implant mucosa in the absence of continuing marginal bone loss

33
Q

what is peri implant mucositis caused by

A

a disruption of host microbe homeostasis at the implant mucosa interface

34
Q

peri implant mucositis is a ____ condition at the _____

A

reversible; host biomarker level

35
Q

what are the factors associated with peri implant mucositis

A
  • biofilm accumulation
  • smoking
36
Q

what is an important preventive strategy for peri implant mucositis

A

regular supportive peri implant therapy

37
Q

what is the tissue response to microbial challenge at the 3 week mark

A

inflammatory lesions in the gingiva and peri implant mucosa
- similar location, size and apical extension

38
Q

what is the tissue response to microbial challenge at the 3 month observation

A
  • similiar composition to 3 week observation but different apical extension
  • peri implant mucosa extended further apically
39
Q

what is peri implantitis

A

a more advanced inflammatory disease that exhibits deep probing depths (greater than or equal to 5mm), BOP, and/or purulence, and radiographic evidence of peri implant bone loss beyond that typically associated with remodeling during healing

40
Q

peri implantitis is a ___ condition occurring in _______ chracterized by_______

A

pathological; tissues around dental implants; inflammation in the peri implant mucosa and progressive loss of supporting bone

41
Q

what are the clincal findings in peri implantitis

A
  • soft tissue inflammation
  • BOP
  • progressive bone loss as noted on the radiographs
42
Q

determination of prevalence of peri implantitis is complicated by:

A
  • methodology: diabetic vs non diabetic, compliance to maintenance, smoker vs non smoker
  • definition of peri implantitis
  • PD greater than or equal to 6mm, 2.5mm radiographic bone loss, BOP or suppuration
  • number of exposed threads afer 1 year or longer of occlusal loading
  • diversity of implant designs
43
Q

the prevalence of peri implant diseases showed that _____ of peri implant tissues had some form of inflammatory response and a prevalence of peri implantitis from _____-

A

90%; 28-51%

44
Q

patients with a hx of periodontitis exhibited ____ prevalence of peri implantitis vs ____ for those with a negative hx of periodontitis

A

38%;11%

45
Q

smoking increases the chance of peri implantitis by____ and mucositis by_____

A

31.6 or 3.8

46
Q

existing peri implant mucositis is a significant risk factor for development of:

A

peri implantitis

47
Q

what is the average prevalence of peri implantitis

A

28-51%

48
Q

what are the significant risk factors for peri implantitis

A
  • hx of periodontitis
  • poor OH
  • residual cement
  • smoking
  • genetics
  • diabetes
  • occlusal overload
  • residual PD of 5mm or greater with BOP
  • peri implant mucositis
  • existing peri implantitis
49
Q

personal hygiene must begin at_____ and modified with _______

A

the time of implant placement; use of oral hygiene aids to clean the peri implant region

50
Q

what do interproximal brushes do

A

penetrate up to 3mm into a ginvial sulcus and effectively clean a periimplant sulcus

51
Q

what must be examined during the maintenance visit

A
  • peri implant tissue margin
  • implant body
  • prosthetic abutment to implant collar connection and prosthesis
52
Q

what should be used when treating a failing implant

A
  • remove contaminated surface if present
  • citric acid/EDTA/tetracyline
  • ultrasonics
  • topical tetracycline
  • surgical repair if indicated
53
Q

what is done in surgical repair of implant

A
  • osseous grafting/GBR
  • remove implant from function
  • remove implant - more common now due to better explantation kits
54
Q

at the histologic level compared to periodontitis sites peri implantitis sites have:

A

larger inflammatory lesions

55
Q

surgical entry at peri implantitis sites often reveal a ______ pattern of bone loss

A

circumferential

56
Q

data identifying smoking and diabetes as potential risk factors/indicators for peri implantitis are:

A

inconclusive

57
Q

there is some limited evidence linking peri implantitis to other factors such as:

A
  • the post restorative presence of submucosal cement
  • lack of peri implant keratinized mucosa
  • positioning of implants that make it difficult to perform oral hygiene and maintenance
58
Q

evidence suggests that progressive crestal bone loss around implants in the absence of clinical signs of soft tissue inflammation is a:

A

rare event

Perio II (12 decks)

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