Implant symposium Flashcards
Includes perio
What is osseo-integration?
A direct funcitonal and structural connection between a load bearing dental implant and living (organised) bone
Bony ingrowth into dental implant
What is the definition of peri-implantitis?
A peri-implant biofilm-associated infection, characterised by inflammation of the peri-implant mucosa soft tissues and subsequent progressive bone loss of supporting peri-implant crestal bone.
Characterised by >2mm bone loss
Pocket depth >5mm
What is the definition of peri-implant mucositis?
REVERSIBLE inflammation affecting the peri-implant soft tissues/mucosa without any bone loss.
Describe primary osseo-integration?
Implant anchored in bone due to frictional forces provided between osteotomy and dental implant design features
Describe secondary osseo-integration
The process of a functional connection between bone and a dental implant. Living bone grows onto the surface of a dental implant.
What is the difference between tooth and implant soft tissue attachment?
Tooth - collagen fibres are orientated PERPENDICULAR to root surface.
Long junctional epithelium present
Implant - collagen fibres are orientated PARALLEL to implant crown
NO junctional epithelium
What materials are used for dental implants?
Titanium - most common
Titanium zirconium
Ceramic implant
What is the average length of implants?
8-10mm
What is width of narrow implant and where are these used?
3mm - lateral incisors
What is width of medium implants and where are these used?
4mm - canines, centrals, premolars
What is the width of wide implants and where are they used?
5mm - molars
Where are tapered implants more likely to be used?
In post-extraction sites
Where there is apical root convergence
What is a tissue level implant and where is it more likely to be used?
Used posteriorly
Implant finishes ABOVE the bone - will have a shiny collar
What are the benefits of a nano-roughened implant surface?
Osseo-integration is more successful with nano-roughened surface because new osteoblasts can grow into this and lock into it.
What is a disadvantage of a nano-roughened implant surface?
Gives a better framework for bacteria to adhere to
What are medical history HIGH LEVEL considerations for implants? (not contra-indications)
Radiotherapy
Poorly controlled diabetes
Cardiovascular disease
Medications
- SSRIs
- PPI’s
- Bisphosphonates
Dental history considerations for implants?
- Patient attendance – need to be regular attender. Need to be willing to attend in the short-term but also long-term maintenance.
- Motivation – need to have good OH
- Self performed plaque control
- Are they suitable for surgical procedure
- Presence of bruxism – parafunctional habit will break their implant
- Active periodontal disease - Contra-indication for implants
Specific risks of implant placement in patients who are not skeletally mature/ old enough?
Relative infra-occlusion
Sub-optimal aesthetics
Occlusal disharmony
Implant fenestration
What are the notable maxillary anatomical sites to be aware of in implant placement?
Maxillary sinus
Nasal floor
Nasopalatine canal
Infra-orbital canal
What are the notable mandibular anatomical sites to be aware of in implant placement?
Inferior alveolar canal
Mental foramen
Incisive canal
Lingual perforating vessels - part of sublingual artery - can pierce FOM and cause extensive bleeding
Submandibular fossa
What are some contra-indications for implant placement?
Existing perio disease
Smoking - not complete contraindication but very bad
Osteoporosis
Is a cement-retained or screw-retained implant more likely to have biological complications and why?
Cement-retained - more likely to have peri-implantitis if excess cement in soft tissues that causes issues.
How far apart do 2 implants need to be from each other do avoid bony necrosis?
3mm apart
What are some common causes of compromised tissue sites?
Post-extraction defects
Trauma
Hypodontia
Perio disease
Thin biotype
What are the signs/ symptoms of peri-implantitis?
Pain - not always
Presence of BOP
Presence of suppuration
Increased pocket depth >5mm
Bone loss >2mm - sub-crestal bone loss
Signs/ symptoms of peri implant mucositis?
Presence of BOP and or suppuration on probing
With/ without increased pocket depth from initial exam
Absence of bone loss beyond crestal bone level changes
Define peri-implant health?
Absence of clinical signs of inflammation
Absence of bleeding or suppuration on gentle probing
No increase in pocket depth compared to previous examinations
Absence of bone loss - sub-crestal
NOTE - can have a SINGLE point of bleeding on implant
What % of patients with implants have peri implant mucositis and peri-implantitis?
43% have peri implant mucositis
22% have peri-implantitis
What should a patient considering implants be consented for before placement?
Need regular maintenance
Cost
Risk of failure
Risk of peri-implantitis/ mucositis
Things that pre-dispose patients to peri-implant disease - aetiology?
History of severe perio
Poor plaque control
No regular supportive peri-implant care
Smoking
Diabetes
Local factors e.g. sub-mucosal cement
Poor operator placement
What is the role of the GDP in implants?
Regular routine appointments for implant patients
Patient preparation
Information resources
Referral information
After care and maintenance
