implant planning and placement Flashcards
What is osseointegration?
A direct functional and structural connection between a load bearing dental implant and living (organised) bone
What are the 2 stages of osseointegration?
Primary osseointegration - implant is anchored in bone due to frictional forces provided between osteotomy and dental implant design features
Secondary osseointegration - the process of a functional connection between bone and a dental implant. Living bone grows onto the surface of a dental implant
What are the differences between tooth supra-crestal soft tissue and implant supra-crestal soft tissue?
Tooth - more fibroblasts, less collagen and collagen fibers are orientated perpendicular to the root surface
Implant - more collagen, less fibroblasts, collagen fibers are orientated parallel to the implant crown
What are the differences between tooth sub-crestal tissue and implant sub-crestal tissue?
Tooth - anchored to bone by periodontal complex, capable of physiological adaptation and resilient tissue attachment
implant - anchored to bone by direct functional contact, no physiological adaption present, a rigid connection
What different materials can be used for implants?
Titanium - pure type 4 Ti
Titanium Zirconium (Ti-Zi)
Ceramic implant - yittra stabilised zirconia (Y-TZP)
When may a tapered implant design be used and why?
Where there is root convergence apically
May provide increased primary stability in immediate placement
What dictates the lengths and diameters of implants?
Site
Indication
Local anatomy
What size and diameter of implants have the best success rate?
Narrow diameter
Short (<10mm) implants
What are the different machine (turned) surface treatments of implants?
Smooth - 0-0.5um
Mild - 0.5-1um
Moderately - 1-2um
Rough - >2um
What different surface treatments can be applied to implants?
Sandblasting
Acid etch
Plasma spray
What is the purpose of an implant?
To replace missing teeth functionally, aesthetically and physiologically
Name 4 medical conditions/drugs that can affect implant success
Any from:
SSRIs - bruxism
PPIs
Bisphosphonates
Poorly controlled diabetes
Cardiovascular disease
Steroids
Radiotherapy
How does smoking dose affect implant success?
<10 daily is medium risk
>10 daily is high risk
What is important in DH during implant planning?
Patient attendance
Motivation
Previous treatment - is pt suitable for surgical procedure
Is the pt a bruxist
What are the risks of implant placement in someone who is not skeletally mature?
Relative infra-occlusion
Suboptimal aesthetics
Occlusal disharmony
Implant fenestration
What are the different gingival biotypes and how is this discerned?
Thick flat
Thick scalloped
Thin scalloped
Differentiated through probe visibility
What determines the presence of adjacent papilla in implants?
The distance from the bone crest to the adjacent contact point
What local anatomy in the maxilla is important during implant planning?
Maxillary sinus
Nasal floor
Naso-palatine canal
Infra-orbital nerve
What local anatomy in the mandible is important during implant planning?
Inferior alveolar canal
Mental foramen
Incisive canal
Lingual perforating vessels
Submandibular fossa
What positions do you need to consider for 3D implant positioning?
Mesio-distal positioning and orientation
Buccal-palatal positioning and orientation
Apico-coronal positioning
What does 3D implant positioning depend on?
Implant system being used
Proposed gingival margin
Local anatomy
Prosthetic plan (cement retained vs screw retained)
How much mesio-distal distance is needed between an implant and adjacent teeth and why is this?
Minimum of 1.5mm
Lowers risk of damage to adjacent teeth
Lowers risk of bone necrosis and soft tissue defects
How much buccal-palatal tissue is needed outside of the implant?
> 1mm of bone labially or >2mm hard/soft tissue
When should you consider guided bone regeneration (GBR)?
Dehiscence - bone defect towards the marginal bone
Fennestration - bony coverage of root surface is lost
If inadequate contour
What are the different types of placement protocol for implants?
Type 1 - immediate implant placement
Type 2 - early implant placement with soft tissue healing
Type 3 - early implant placement with partial bone healing
Type 4 - late implant placement in healed sites
What are the healing durations for the different implant placement protocols?
Type 2 - 4-6 weeks
Type 3 - 12-16 weeks
Type 4 - 6 months or more
Name 4 planning aids commonly used in implant planning?
Any from:
- study models
- diagnostic wax ups
- surgical template
- provisonal essex retainer
- clinical photographs
- CBCT
- surgical guide
Describe analogue implant planning
Diagnostic wax ups used to plan size and position of implants
Combine this with CBCT
Can be transferred to mouth to show the pt the aim of tx
When agreeable, converted to stone and surgical template is made
Describe digital implant planning
Software prosthetically and surgically plans implant placement
Allows identification of anatomical structures
Software highlights potential issues of spacing and orientation
Produces a surgical guide for implant placement
