Implant lecture Flashcards
what are the basic parts of the implant
- implant body
- abutment
- crown
why do we use titanium in implants
- excellent biocompatibility
- low weight/high strength
- excellent corrosion resistance
- contains a titacium oxide layer that promotes adhesion of osteogenic cells
what is bone level
the interface of implant and abutment is at the bone
what is tissue level
the interface of the implant and abutment is at the tissue
what are the pros and cons of bone level
- better esthetics, no metal collar
-can achieve primary closure if needed - microenvironment allows bacteria to be present at bone level
- less cleansable
- harder to see residual cement
what are the pros and cons of tissue level
- collar creates a biologic width
- bacteria is at tissue level, away from the bone
- metal collar may show through
- more cleansabke
- easier to see residual cement
what are the types of prostheses
- single crowns
- FPDs
- implant supported RPDs
- overdnetures
- hybrid dentures
what is implant retained prostheses
removable
what is implant supported s=prostheses
fixed
what is osseointegration
a stable implant relies on direct structural and functional connection between vital bone and the surface of an implant
what are the factors that determine successfull osseointegration
- biocompatibility of the implant surface
- macro and microscopic nature of the implant surface
- status of the implant sute (non infected bone, bone quality)
- surgical technique
- undisturbed healing
- long term loading and prosthetic design
what are the patient factors that affect the implant success
- diabetes (controlled vs uncontrolled)
- osteoporosis and bisphosphonate use (not a contraindication though)
- smoking
how does smoking affect implants
- increased failure of dental implants
- 84% vs 98%
- depends on use - heavy or light
what is osseointegration clinically
- immobile
- clear sound to precussion
- no pain or infectino
- no paresthesia
what is osseointegration radiographically
- no radiolucent peri-implant space
-minimal bone loss- <1 mm remodeling, <0.1mm/year after the first year
what is contact osteogenesis
bone first forms on the implant surface
- bone formation progresses from implant surface to existing bone
- rough surface implants
what is distance osteogenesis
- bone forms on the surface of the existing bone
- bone formation progresses from the existing bone to implant surface
- smooth or machined surface implants
what are the implant placement timing
- immediate: at the time of extraction
- delayed: 6-10 weeks after extraction
- late: 6 months or more after extraction
describe the bone density and quality of Type D1, D2, D3 and D4
- D1: homogenous compact bone
- D2: thick layer of compact bone around a core of dense trabecular bone
- D3: thin layer of compact bone around dense trabecular bone
- D4: thin layer of cortical bone around a core of low density trabecular bone
which implant timing has the lowest success rate
immediate
what are the differences between periodontium of a tooth to a dental implant
- less vascularity
- no PDL
- fewer gingival fibers
- collagen fibers parallel the implant
what does connective tissue do around an implant
- circular fibers form a cuff around the implant
- forms a hemodesmosome attachment to the implant and abutment
- forms a soft tissue seal
describe the buccal surface of peri implant mucosa
- 3-4mm high on average
- core of connective tissue ( primarily collagen fibers, low cellular content)
- orthokeratinized epithelium
describe the inner surface of peri implant mucosa
- thin barrier epithelium
- like JE
- connective tissue adhesion
what are the vascular differences between real tooth and PDL
- no vascular supply from PDL
- sources: alveolar bone (supraperiosteal vessels) , connective tissue
what does less vascular supply mean about immune system
less vascular supply less immune system regulation
what are the supracrestal attachment for implants and teeth
- implants: 3-4 mm. 1 mm epithelium, 2mm CT
- teeth: 2 mm, 0.97mm epithelium , 1.07mm CT
what are some other differences for teeth and implants
- teeth: 2.5mm PD, 1.1mm buccal mucosa thickness, taller papilla height, more papilla fill
- implant: 2.9mm PD, 2.0mm buccal mucosa thickness, shorter papilla height, less papilla fill
what are the types of implant faillures and describe each
- surgical: lack of osseointegration, improper placement, infection
- mechanical: screw lossening, abutment fracture, implant fracture
- esthetic: metal collar show through, smile line concerns, long crowns
- biological: peri- implant mucositis and peri implantitis
what are the parameters for peri implant health
- free of inflammation: no BOP, no suppuration, no erythema or edema
- stable probing depths
- no radiographic bone loss
what are the symptoms of peri implant mucositis
- signs of inflammation such as BOP, erythema and edema
- no radiographic bone loss
is per implant mucositis reversible
yes if etiology is controlled
what is the etiology of peri implant mucositis
plaque biofilm
what is the prevalence of peri implant mucositis
43%
what are the symptoms for peri implantitis
- signs of inflammation such as BOP, erythema, edema, and suppuration
- radiographic bone loss
- increased probing depth compared to time of restoration
what is the etiology of peri implantitis
plaque biofilm
what are the risk factors for peri implantitis
history of periodontitis, poor plaque control, no regular maintenance care after placement
- data not conclusive for smoking and diabetes
what is the prevalence for peri implantitis
22%
what is the difference between peri mucositis and peri implantitis
peri implantits involves bone loss
what if you have no previous radiographs or history
radiographic bone loss > or equal to 3mm
- probing depths > or equal to 6mm
- diagnostic for peri implantntis
describe the remodeling phase
- 0.9-1.6mm bone loss in the frist year after placement
- 0.1mm bone loss per year
- clinically acceptable
- not seen as much with platform switched implants
what is the importance of keratinized mucosa
keratinized tissue may improve patient comfort and benefit oral hygiene and plaque removal
what are the major risk factors for peri implantitis
- poor plaque control
- lack of regular maintenance after placement
how long to restore dental implants
12-16 weeks
what is the maintenance schedule for implants
every 3 months
- move to 6 months is OH is stable
- based on risk factors and OH
what are the treatment options for peri implant complication
- refer to specialist
- nonsurgical therapy - debridement
- surgical therapy: open flap debridement, osseous recontouring, bone grafting/guided tissue regeneration
- explantation/removal of implant
