Implant Success vs Survival Flashcards
What is the purpose of implants?
Primary function is to act as an abutment for prosthetic device similar to natural tooth root scenario.
Why are dental implants used so often?
Dental implants are the most successful man made tooth replacement with success rates of 95 - 97%
What causes dental implant failures early on?
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
What causes late dental implant failures?
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
What are the problems with Alkbrektson’s classification of successful implants?
Suggests ideal implant health but:
Doesn’t reflect stable implants
Doesn’t reflect implants which have previously had bone loss but have stabilised
What defines survival rate of implants?
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
How does satisfactory implant survival differ from implant success?
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.
What are early, intermediate, and long term success considered for an implant to be deemed successful?
Early success 1 - 3 years
Intermediate success 3 - 7 years
Long term success >7 years
What are the clinical indices looked at when assessing whether implant is successful or surviving?
Perio index
Pain during function
Mobility grade 0 so implant has rigid fixation
Radiographic crestal bone loss after first year of function
Probing depths
What is success of an implant based on ICOI Pisa implant quality of health scale?
No pain/tenderness upon function
0 mobility
<2mm radiographic bone loss
No exudate history
What is satisfactory survival of an implant based on ICOI Pisa implant quality of health scale?
No pain on function
0 mobility
2 - 4mm radiographic bone loss
No exudates history
What is compromised survival of an implant based on ICOI Pisa implant quality of health scale?
May have sensitivity on function
No mobility
Radiographic bone loss >4mm (Less than 1/2 of implant body)
May have exudates history
What is failure of an implant based on ICOI Pisa implant quality of health scale?
Any of the following:
Pain on function
Mobility
Radiographic bone loss >1/2 of length
Uncontrolled exudate
No longer in mouth
What patient-related factors affect implant success rate?
Patient related factors: MHx, OH, Compliance with maintenance, Smoking, bruxism, Bone quality and quantity, Finances.
What implant related factors affect implant success rate?
Implant shape (Macroscopic/microscopic)
Implant surface
Implant material (Pure titanium, alloy, zirconia)
Implant system (Straumann, Nobel, Astra, Ankyloss, Neo-oss, etc)
What operator related factors affect implant survival rate?
Experience
Learning curve
Hours of study
Mentorship
Continued professional development
What are the types of implant surfaces?
Smooth Sa <0.5 microns
Minimally rough Sa 0.5 - 1 microns
Moderately rough Sa = 1 - 2 microns
Rough Sa > 2 microns
How is surface roughness looked at?
Macroscopically and microscopically
How is an implant designed macroscopically to increase roughness?
Thread shape
thread depth
Thread width
Thread pitch
Thread helix angle
Crestal module
Rough or smooth neck
Microthreads: Machined surface
What kinds of materials are used for dental implants?
Metals: 316L Stainless steel, Co-Cr alloys, titanium, and Ti6AI4V
Ceramics: Alumina, Zirconia, Carbon, Hydroxyapatite
Polymers: Ultra high molecular, weight polyethylene, polyurethane
What implant properties are needed for a strong implant?
Strength
Ductile
Elastic modulus
Yield
Fatigue resistance
Corrosion resistance
Biocompatible and resistance to biodegradation
Correct metallurgy
What are the types of titanium implants available for implants?
Grade I - IV pure titanium
Titanium alloys (eg roxolid)
What are the features of pure titanium implants?
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
What is the advantage of using titanium alloys over pure titanium?
Titanium alloys increase corrosion resistance and microbial corrosion (Vn Cu Pd)
Increases strength decreases mass (When Al used)
How do turned and rough surface implants differ in success rate?
No real difference observed between different implants.
How does operator affect implant success rate?
There is a learning curve to creating implants
How does skill improve over time?
250 procedures for an operator to improve skillset and become comfortable to undertake a new procedure
How do you optimize inexperience?
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
