Implant symposium

Question 1

What is osseo-integration?

Answer 1

A direct funcitonal and structural connection between a load bearing dental implant and living (organised) bone
Bony ingrowth into dental implant

Question 2

What is the definition of peri-implantitis?

Answer 2

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

Question 3

What is the definition of peri-implant mucositis?

Answer 3

REVERSIBLE inflammation affecting the peri-implant soft tissues/mucosa without any bone loss.

Question 4

Describe primary osseo-integration?

Answer 4

Implant anchored in bone due to frictional forces provided between osteotomy and dental implant design features

Question 5

Describe secondary osseo-integration

Answer 5

The process of a functional connection between bone and a dental implant. Living bone grows onto the surface of a dental implant.

Question 6

What is the difference between tooth and implant soft tissue attachment?

Answer 6

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

Question 7

What materials are used for dental implants?

Answer 7

Titanium - most common
Titanium zirconium
Ceramic implant

Question 8

What is the average length of implants?

Answer 8

8-10mm

Question 9

What is width of narrow implant and where are these used?

Answer 9

3mm - lateral incisors

Question 10

What is width of medium implants and where are these used?

Answer 10

4mm - canines, centrals, premolars

Question 11

What is the width of wide implants and where are they used?

Answer 11

5mm - molars

Question 12

Where are tapered implants more likely to be used?

Answer 12

In post-extraction sites
Where there is apical root convergence

Question 13

What is a tissue level implant and where is it more likely to be used?

Answer 13

Used posteriorly
Implant finishes ABOVE the bone - will have a shiny collar

Question 14

What are the benefits of a nano-roughened implant surface?

Answer 14

Osseo-integration is more successful with nano-roughened surface because new osteoblasts can grow into this and lock into it.

Question 15

What is a disadvantage of a nano-roughened implant surface?

Answer 15

Gives a better framework for bacteria to adhere to

Question 16

What are medical history HIGH LEVEL considerations for implants? (not contra-indications)

Answer 16

Radiotherapy
Poorly controlled diabetes
Cardiovascular disease
Medications
- SSRIs
- PPI’s
- Bisphosphonates

Question 17

Dental history considerations for implants?

Answer 17

• 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

Question 18

Specific risks of implant placement in patients who are not skeletally mature/ old enough?

Answer 18

Relative infra-occlusion
Sub-optimal aesthetics
Occlusal disharmony
Implant fenestration

Question 19

What are the notable maxillary anatomical sites to be aware of in implant placement?

Answer 19

Maxillary sinus
Nasal floor
Nasopalatine canal
Infra-orbital canal

Question 20

What are the notable mandibular anatomical sites to be aware of in implant placement?

Answer 20

Inferior alveolar canal
Mental foramen
Incisive canal
Lingual perforating vessels - part of sublingual artery - can pierce FOM and cause extensive bleeding
Submandibular fossa

Question 21

What are some contra-indications for implant placement?

Answer 21

Existing perio disease
Smoking - not complete contraindication but very bad
Osteoporosis

Question 22

Is a cement-retained or screw-retained implant more likely to have biological complications and why?

Answer 22

Cement-retained - more likely to have peri-implantitis if excess cement in soft tissues that causes issues.

Question 23

How far apart do 2 implants need to be from each other do avoid bony necrosis?

Answer 23

3mm apart

Question 24

What are some common causes of compromised tissue sites?

Answer 24

Post-extraction defects
Trauma
Hypodontia
Perio disease
Thin biotype

Question 25

What are the signs/ symptoms of peri-implantitis?

Answer 25

Pain - not always
Presence of BOP
Presence of suppuration
Increased pocket depth >5mm
Bone loss >2mm - sub-crestal bone loss

Question 26

Signs/ symptoms of peri implant mucositis?

Answer 26

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

Question 27

Define peri-implant health?

Answer 27

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

Question 28

What % of patients with implants have peri implant mucositis and peri-implantitis?

Answer 28

43% have peri implant mucositis

22% have peri-implantitis

Question 29

What should a patient considering implants be consented for before placement?

Answer 29

Need regular maintenance
Cost
Risk of failure
Risk of peri-implantitis/ mucositis

Question 30

Things that pre-dispose patients to peri-implant disease - aetiology?

Answer 30

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

Question 31

What is the role of the GDP in implants?

Answer 31

Regular routine appointments for implant patients
Patient preparation
Information resources
Referral information
After care and maintenance