Implant Surgery Flashcards
Name the 2 types of implant?
Tissue level - 1 stage surgical technique
Bone level - 2 stage surgical
What type of implant is the Straumann?
Bone level - no metal collar, more aesthetic cases
What does FEV stand for and what does it mean?
Finite element analysis
transfer of load to surrounding bone tested by mathematical model analysis.
what 4 factors can affect implant design?
Implant body shape (tapered)
Implant collar shape
Threads – shape, pitch, height (triangular compacting)
Grooves
why is the quantity and quality of bone important in implant design?
as we want to avoid stress of the bone around the neck of the implant leading to bone loss
what is the (long!) name of the commercially pure titanium?
How many grades are there?
What do the grades depend on?
titanium-6-aluminium-4-vanadium (Ti6Al4V) (Ti alloy)
4 grades
Amount of carbon and iron.
what is the properties of titanium-6-aluminium-4-vanadium (Ti6Al4V) (Ti alloy)?
very high-mechanical strength
reduces the titanium heat conduction and doubles resistance to corrosion
Better fracture resistance
what is roxolid?
15%zirconium
85% titanium
Higher tensile strength than titanium
Preserves bone
Greater flexibility with smaller implants
What material of implant are used today?
and name some properties?
pure ceramic
High-performance zirconia ceramic with higher fatigue strength than grade 4 titanium implants
what is the success rates of a zirconia implant?
excellent clinical performance with 97.5 % survival and success rates after three years.
what different forces are placed on an implant?
Compressive, tensile, shear forces
how much vertical force can be placed on a molar region and incisor region?
380-880N molar
less than 220N incisor
why is the lateral shearing forces so much less? What is the approximate force?
implants don’t deal with tensile forces
approx 20N
can only cantilever 1 unit
what is the crown: implant ratio
1:7
name 2 main reasons why implants may fail?
Biological factors – overloading, bruxism, bone insufficient quantity, less vascularity.
Mechanical factors – breakage of abutments, screw breakage, implant breakage.
what are the 4 different timings for implant placement?
Immediate – take tooth out and insert into socket same time. Good bone volume.
Immediate delayed – early soft tissue healing 4-8 weeks – then place implant in, may need bone grafting.
Delayed – partial bone healing – 3-4 months – better primary stability.
Elective – full bone healing > 4 months – edentulous arches. May have had full clearance long time ago.
what are the 4 types of bone
1 - most cortical bone
2 - cortical and some rabecular
3 - more trabecular
4 - nearly fully trabecular
do types 1 and 2 bone need threading?
yes - lots of cortical bone
do types 3 and 4 bone need threading?
No - can be easily compressed due to trabecular bone
Name 10 surgical technique tips for Straumann implants?
- Atraumatic soft tissue handling
- Serial round burs to flatten the implant sites
- Surgical stent for ideal position
- Always use cool saline irrigation for drills(<40oC), never room temp!
- Pilot drill to depth 500-800 rpm – 6mm to check alignment before you then drill down to 10-12mm length of implant.
- Twist drills to depth and width at slow speed
- Profile drills to create coronal flare
- Hand placed implant with copious irrigation
all threads within bone - Suture soft tissues
What are the different colours in the Straumann implant kit?
- Blue = rose head burs to prepare bone
- Blue drill = pilot drills 2.2mm wide
- Yellow = narrow platform implants, upto 2.8mm
- Red = standard upto 3.5
- Green = large 4.2mm
- Taps are to tap thread.
- Carrier used to pick up implant
- Closure screw stops material growing down inside of implant.
Is an implant hydrophobic or hydrophilic?
Implant comes in capsule surrounded with saline, nothing can be touched to oxidised surface only saline or blood no saliva!! Hydrophilic alloy!
what are the measurements of the depth gauges on the drill?
Depth gauges on drill = 6,8, 10,12, 14-16mm (rare to go this far!)
what screw is used for tissue implant?
healling screw
what is used to place a straumann implant?
torque rench
what screw is used for a bone implant?
closed screw
for tissue level implants, how long is the healing abutment left in place?
2-3 months
for bone level implants, how long is the healing abutment left in place?
2 stage - after 2 months, implant is exposed and taller healing abutment is placed.
what sutures may we use for implant?
resorbable
what xray would you take for angulation + how long after placement?
what is the follow up?
PA 1 week after
2yr follow up to look for crestal bone loss
what is a common sign from implants?
black triangle - loss of papilla
what is important in implant planning for aesthetics?
smile line
Name the 5 most common complications of implants?
- Wound breakdown – overtightened sutures, tissue necrosis.
- Infection – antiseptic mouthwash, only evidence of single dose 2g oral amoxicillin1hr before, none to prevent infection afterwards.
- Early loss - uncommon
- Mucositis – poor OH, lack of keratinised mucosa, is reversible! Inflammation!
- Peri-implantitis – non reversible! Bone loss around implant. Once threads are exposed surface isn’t smooth but easily harbours bacteria.
according to Buser et al and Cochran et al, what are the 4 criteria for success of implants?
- absence of clinically detectable implant mobility
- absence of pain or any subjective sensation
- absence of recurrent peri-implant infection
- absence of continuous radiolucency around the implant at the 12-week time point
what is the 8 + 10 year success of implants?
“the 8-year cumulative survival and success rates resulted in 96.7% and 93.3%, respectively.”
“the 10-year cumulative survival and success rates were 99.2% and 96.4%, respectively.”
what is the success of implants according to the meta analysis (2019 Long term survival)?
greater than 93%
what constitutes implant failure?
uncommon
early - maybe failure to osseointegrate, implant is lost.
late - mobile, no osseointegrate or peri implant bone loss.
what is acceptable peri implant bone loss?
some will occur in the first year:
greater than 1.0 mm in the first year
no greater than 0.2 mm a year after.
treatment for wound dihiscence?
CHX gel 2 xday
polyp around implants?
surgical removal and OHI
How much bone width is the minimum required to place a standard dental implant?
7mm
what is the width of standard implant?
4.4mm
What is the minimum distance between teeth that is sufficient to place a dental implant
7mm
When placing an immediate delayed implant, how many weeks do you wait after the tooth is extracted?
4-8 weeks soft tissue healing
When doing surgery for dental implants which of the following has the greatest impact on the outcome of surgery?
Using refrigerated saline to irrigate the drill –greatest impact too success is bone healing, don’t want to heat bone beyond 40 degrees.
When would you use tissue level implants rather than bone level implants?
When planning for a denture
