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BDS4 RESTORATIVE DENTISTRY > Implant Planning & Placement > Flashcards

Implant Planning & Placement Flashcards

1
Q

What is osseointegration?

A

Direct functional and structural connection between a load bearing dental implant & living (organised) bone

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2
Q

What are the 2 stages of osseointegration?

A

Primary osseointegration = implant anchored in bone due to frictional forces provided between osteotomy & dental implant design features

Secondary osseointegration = process of a functional connection between bone & a dental implant, living bone grows onto the surface of a dental implant

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3
Q

How does healing occur after implant insertion?

A
  • begins immediately after implant installation
  • granulation tissue in wound chamber (days)
  • immature [woven bone] (weeks)
  • Mature lamelar bone (months)
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4
Q

How does the supra-crestal soft tissue of a tooth present?

A
  • more fibroblasts
  • less collagen
  • collagen fibres orientated perpendicular to root surface
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5
Q

How does the supra-crestal soft tissue of an implant present?

A
  • more collagen
  • less fibroblasts
  • collagen fibres orientated parallel to implant crown
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6
Q

How does the sub-crestal soft tissue of a tooth present?

A
  • tooth anchored to bone by periodontal complex
  • capable of physiologic adaptation
  • resilient tissue attachment
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7
Q

How does the sub-crestal soft tissue of an implant present?

A
  • implant anchored to bone by direct functional contact
  • no physiologic adaptation present
  • rigid connection
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8
Q

What dental materials are used in dental implants?

A
  • titanium (Ti)
  • titanium zirconium (Ti-Zr)
  • ceramic implant (Y-TZP)
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9
Q

How do implants differ from teeth in function?

A
  • no proprioception from implant
  • no physiological adaptation
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10
Q

What type of titanium is used in implants?

A

Commercially pure TYPE 4 TITANIUM
- >85% to produce titanium dioxide

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11
Q

How do titanium-zirconium implants differ from titanium implants?

A

Increased strength compared to Ti
- good in narrow implant sites where less bone available

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12
Q

What determines implant design?

A
  • bone level/tissue level
  • tapered/parallel
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13
Q

When might tapered implants be advantageous?

A
  • provide increased primary stability in immediate placement [eg post XLA site]
  • may be used where there is root convergence apically
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14
Q

What determines length/diameter of implant selection?

A
  • site of implant
  • indication of implant
  • local anatomy
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15
Q

What is considered a ‘smooth’ implant?

A

0-0.5um

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16
Q

What is considered a ‘mild’ roughness implant?

A

0.5-1um

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17
Q

What is considered a ‘moderate’ roughness implant?

A

1-2um

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18
Q

What is considered a ‘rough’ implant?

A

> 2um

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19
Q

What surface treatment can be done to implants to roughen them?

A
  • sand blasting
  • acid etch
  • plasma spray
20
Q

What is the purpose of a dental implant?

A

Restore
- functionality
- aesthetics
- psychology

21
Q

What medications may affect the survival or success of a dental implant?

A
  • SSRIs
  • PPIs
  • bisphosphonates
  • steroids
22
Q

What medical conditions may contraindicate implant placement?

A
  • pts undergoing radiotherapy
  • poorly controlled diabetes
  • CV disease
23
Q

What social history findings may contraindicate implant placement?

A

Smoking
- increased risk of implant failure
- increased risk of peri-implantitis

24
Q

Why does smoking have a negative impact on implant healing?

A

Smoking affects
- vascularity
- fibroblast/osteoblast function
- PMN function

25
Q

What areas of dental history would you investigate when considering implant placement?

A
  • pt attendance
  • motivation
  • self performed plaque control
  • suitable for surgical procedure
  • presence of parafunctional habits
26
Q

Why should implants only be placed when patient growth has stopped?

A

If implants placed before growth complete:
- relative infra-occlusion
- suboptimal aesthetics
- occlusal disharmony
- implant fenestration

27
Q

What is defined as a high smile line?

A

> 2mm ST on show

28
Q

What is defined as a medium smile line?

A

<2mm of ST showing

29
Q

What is defined as a low smile line?

A

lip covers >25% of teeth

30
Q

What extra-oral findings may affect implant placement decisions?

A
  • presence of incisal cants
  • presence of gingival cants
  • width of aesthetic zone
31
Q

What are the different gingival phenotypes?

A
  • thick flat
  • thick scalloped
  • thin scalloped
32
Q

What issues are associated with implant placement when edentulous span is too wide?

A
  • challenge to fill place
  • issues with where to leave residual space
33
Q

What issues are associated with implant placement when edentulous span is too narrow?

A
  • risk of damage to adjacent teeth
  • risk of necrosis of bone between teeth & implants
  • will have significant effect of ST aesthetics
34
Q

How is available bone assessed for implant placement?

A

Assess
- volume
- orientation

35
Q

What relevant maxillary local anatomy may be relevant when considering implant placement?

A
  • maxillary sinus
  • nasal floor
  • naso palatine canal
  • infra-orbital nerve
36
Q

What relevant mandible local anatomy may be relevant when considering implant placement?

A
  • inferior alveolar canal
  • mental foramen
  • incisive canal
  • lingual perforating vessels
  • submandibular fossa
37
Q

What gingival phenotype has the best aesthetic results from implant placement?

A
  • thick biotype
  • rectangular teeth
38
Q

When looking at 3D implant positioning, what needs to be considered?

A

Mesio-distal positioning & orientation

Bucco-palatal positioning & orientation

Apico-coronal positioning

39
Q

What does 3D implant positioning depend on?

A
  • implant system being used
  • proposed gingival margin
  • local anatomy
  • prosthetic plan
40
Q

Why should implants be positioned a “safe” margin away from adjacent teeth?

A
  • lowers risk of damage to adjacent teeth
  • lower risk of bone necrosis and ST defect between implants and teeth
41
Q

What is the minimum mesio-distal distance required from other teeth/implants for implant placement?

A

1.5mm

42
Q

What is the required bone amount that should be present labially for implant placement?

A

> 1mm of bone labially

43
Q

What are the different placement protocol types that can be done during implant placement?

A
44
Q

What aids to implant planning are needed?

A
  • study models
  • diagnostic wax up
  • surgical template
  • essex
  • clinical photographs
  • CBCT
  • surgical guide
45
Q

How can implant placement be planned before committing to procedure?

A
  • diagnostic wax ups
  • combined with CBCT
46
Q
A

BDS4 RESTORATIVE DENTISTRY (9 decks)

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