Implant Success vs Survival Flashcards

1
Q

What is the purpose of implants?

A

Primary function is to act as an abutment for prosthetic device similar to natural tooth root scenario.

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2
Q

Why are dental implants used so often?

A

Dental implants are the most successful man made tooth replacement with success rates of 95 - 97%

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3
Q

What causes dental implant failures early on?

A

Poor osseointegration due to:

Poor bone quality

Patient’s medical health or parafunctional habits (eg bruxism)

Poor oral hygiene

Poor implant 3D position

Improper fabrication and choice of prosthesis.

Poor implant design

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4
Q

What causes late dental implant failures?

A

Occlusal overload (uncontrolled bruxism, poor occlusal design, or excessive load)

Peri-implantitis and poor oral health (Poor oral hygiene, Handicap, prosthetics prevent hygiene, poor maintenance)

Improper prosthetics design (lab error/misfit, defective components, fatigue/failure of implants)

Unknown

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5
Q

What are the problems with Alkbrektson’s classification of successful implants?

A

Suggests ideal implant health but:

Doesn’t reflect stable implants

Doesn’t reflect implants which have previously had bone loss but have stabilised

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6
Q

What defines survival rate of implants?

A

This is defined by an implant which is simply present after a certain amount of time.

It is regardless of disease presence

Function of the implant

Aesthetics of the implant

Patient satisfaction

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7
Q

How does satisfactory implant survival differ from implant success?

A

Satisfactory survival can still occur in less than ideal conditions, may need treatment to regain health and may need close long term maintenance.

Implant success results in ideal clinical conditions for a time period >12 months.

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8
Q

What are early, intermediate, and long term success considered for an implant to be deemed successful?

A

Early success 1 - 3 years

Intermediate success 3 - 7 years

Long term success >7 years

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9
Q

What are the clinical indices looked at when assessing whether implant is successful or surviving?

A

Perio index

Pain during function

Mobility grade 0 so implant has rigid fixation

Radiographic crestal bone loss after first year of function

Probing depths

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10
Q

What is success of an implant based on ICOI Pisa implant quality of health scale?

A

No pain/tenderness upon function

0 mobility

<2mm radiographic bone loss

No exudate history

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11
Q

What is satisfactory survival of an implant based on ICOI Pisa implant quality of health scale?

A

No pain on function

0 mobility

2 - 4mm radiographic bone loss

No exudates history

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12
Q

What is compromised survival of an implant based on ICOI Pisa implant quality of health scale?

A

May have sensitivity on function

No mobility

Radiographic bone loss >4mm (Less than 1/2 of implant body)

May have exudates history

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13
Q

What is failure of an implant based on ICOI Pisa implant quality of health scale?

A

Any of the following:

Pain on function

Mobility

Radiographic bone loss >1/2 of length

Uncontrolled exudate

No longer in mouth

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14
Q

What patient-related factors affect implant success rate?

A

Patient related factors: MHx, OH, Compliance with maintenance, Smoking, bruxism, Bone quality and quantity, Finances.

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15
Q

What implant related factors affect implant success rate?

A

Implant shape (Macroscopic/microscopic)

Implant surface

Implant material (Pure titanium, alloy, zirconia)

Implant system (Straumann, Nobel, Astra, Ankyloss, Neo-oss, etc)

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16
Q

What operator related factors affect implant survival rate?

A

Experience

Learning curve

Hours of study

Mentorship

Continued professional development

17
Q

What are the types of implant surfaces?

A

Smooth Sa <0.5 microns

Minimally rough Sa 0.5 - 1 microns

Moderately rough Sa = 1 - 2 microns

Rough Sa > 2 microns

18
Q

How is surface roughness looked at?

A

Macroscopically and microscopically

19
Q

How is an implant designed macroscopically to increase roughness?

A

Thread shape

thread depth

Thread width

Thread pitch

Thread helix angle

Crestal module

Rough or smooth neck

Microthreads: Machined surface

20
Q

What kinds of materials are used for dental implants?

A

Metals: 316L Stainless steel, Co-Cr alloys, titanium, and Ti6AI4V

Ceramics: Alumina, Zirconia, Carbon, Hydroxyapatite

Polymers: Ultra high molecular, weight polyethylene, polyurethane

21
Q

What implant properties are needed for a strong implant?

A

Strength

Ductile

Elastic modulus

Yield

Fatigue resistance

Corrosion resistance

Biocompatible and resistance to biodegradation

Correct metallurgy

22
Q

What are the types of titanium implants available for implants?

A

Grade I - IV pure titanium

Titanium alloys (eg roxolid)

23
Q

What are the features of pure titanium implants?

A

Soft and non allergenic

Different grades I - IV

Low elastic modulus and tensile strength

Strength and yield strength are lower than alloys

Strength is 1.5 x bone

24
Q

What is the advantage of using titanium alloys over pure titanium?

A

Titanium alloys increase corrosion resistance and microbial corrosion (Vn Cu Pd)

Increases strength decreases mass (When Al used)

25
Q

How do turned and rough surface implants differ in success rate?

A

No real difference observed between different implants.

26
Q

How does operator affect implant success rate?

A

There is a learning curve to creating implants

27
Q

How does skill improve over time?

A

250 procedures for an operator to improve skillset and become comfortable to undertake a new procedure

28
Q

How do you optimize inexperience?

A

Find hacks to accelerate early learning

Start developing new skills way in advance of plateauing on existing ones.

Don’t be afraid. It takes courage to jump from one curve to the next. Staying in comfort zone is easy but greatness happens when you escape from it