Implant symposium Flashcards
• Describe dental implants and how these are used to replace teeth • Discuss case assessment • Describe the process of planning dental implant treatment • Awareness of factors impacting on complexity and feasibility of implant placement • Understanding of the relevant factors to consider when planning implant placement
what is osseointegration
Process by which clinically
asymptomatic rigid fixation of alloplastic materials is
achieved and maintained in bone during functional
loading
what are the 3 key factors of osseointegration
- Primary stability and lack of micromotion
- Implant surface
- Thread design
what are the 2 types of implant restorations
fixed restorations
removable prostheses
give 3 exmaples of fixed restorations
- Single crowns
- Cantilever bridges
- Fixed-fixed bridges
give an exmaple of a removable prosetheses
- Complete or partial implant overdentures
what is the difference between screw vs cement retained implants
Screw-retained
* Long axis of implant is important
* ‘prosthodontically driven
placement’
* Easier to remove for
maintenance
Cement retained
* Excess cement → risk of
periimplantitis
* risk of debond
what are the 3 components of screw implants
screw
screw-retained crown
implant
what are the 4 components of cement retained crowns
cement-retained crown
screw
abutment
implant
give 3 examples of individual abutments
- Locator-type abutments
- Magnets
- Ball-ended abutments
what are the 2 types of implant overdentures
- Individual abutments
- Bars with clips or sleeves
what are the 4 primary objectives of implant surgery
- Selection of appropriate implant type
* Diameter, length - Placement of implant(s) in appropriate position
* Prosthodontically-driven
* Primary stability - Implant must be completely within healthy bone
* Buccal and palatal at least 1mm thick
* Bone augmentation in cases of local deficiency - Implant should be surrounded by keratinised mucosa
3 secondary objectives of implant surgery
- Least number of surgical procedures
* Simultaneous grafting where possible - Reduction of healing time
* Active implant surfaces
* Autogenous bone chips → osteogenic potential - Reduction of pain/morbidity
* Avoid donor sites where possible
what is the SAC classification
Straightforward / Advanced / Complex
what 4 things should you consider when dteemrining the case complexiity using the SAC classifictaion
General
* e.g. smoking, patient expectations, periodontitis, oral health, growth completion
Aesthetic
* e.g. smile line, gingival biotype, soft tissue volume, patient demands
Surgical
* e.g. bone volume/extent of grafting required, local anatomy, risk of complications
Restorative
* e.g. occlusal factors, status of adjacent teeth, size of edentulous span
when assessing a patient for implants what factors must you consider
patient related factors
history
medical history
dental considerations
history/resence of periodontal disease
site-specififc
eligibility for NHS treatment
what doing a case assessment for implants what must you consider in terms of patient related factors
- Patient-level
- Dentition
- Site-specific
- Operator-related
- Within capability of operator – risk assessment/case complexity
what doing a case assessment for implants what must you consider in terms of history
- Patient age
- Patient concerns and expectations
- Motivation
- Smoking status
- Dental history – attendance/anxiety/previous experience
- Practicalities re: ability to attend multiple appointments and to undergo
treatment - Oral hygiene regime
- Social history
what doing a case assessment for implants what must you consider in terms of medical history
- Bleeding disorders e.g. genetic disorders/medications
- Bisphosphonates, biologics re: MRONJ risk
- Head and neck radiotherapy
- Uncontrolled systemic disease e.g recent MI/diabetes
- Immunodeficiency
- Dexterity e.g severe rheumatoid arthritis
what doing a case assessment for implants what must you consider in terms of dental considerations
Oral hygiene
History of TMD
Dental health stability
* Caries status
* Periodontal status
* Presence of infection
* Occlusion, tooth wear
* Bruxism
Feasibility of alternatives
Intra-oral access/mouth opening
what doing a case assessment for implants what must you consider in terms of history/presence of periodntal disease
- Increased risk of progressive peri-implant bone loss (peri-implantitis) in
periodontal patients - Need for regular periodontal maintenance therapy and OHI
- Increased complexity of long-term peri-implant treatment need
- Survival similar in chronic periodontitis
- Reduced short-term survival in some cases (previous ‘aggressive’
periodontitis)
what doing a case assessment for implants what must you consider in terms of site specificity
- Feasibility of alternatives
- Restorative status of neighboring
teeth - Space for the prosthetic tooth
- Interocclusal space
- Between adjacent teeth
- Between roots
- Span of the space
- Aesthetic demand
- Lip line
- Aesthetic zone
- Gingival biotype
- thick/thin
- Soft tissue defects
- contour and volume
- Shape of the crowns
- triangular/rectangular
when doing a case assessment for implants what must you consider in terms of eligibility for NHS treatment
- Developmental Disorder -Malformed, missing or ectopic teeth (e.g.
hypodontia, cleft palate, amelogenesis or dentinogenesis imperfecta) - Trauma -Teeth lost or of poor prognosis subsequent to trauma
- Head and neck cancer -Previous surgery and/or radiotherapy in
management of head and neck cancer - Severe denture intolerance - despite construction of technically acceptable
dentures e.g. edentulous patient with severe ridge resorption,
neuromuscular disorders complicating denture tolerance
what is the planning process for implants
- Study models +/- articulation
- Diagnostic wax up
- Vitality testing
- Plain film radiographs
2 prinicples of prosthetically driven planning
- Not planned according to the bone; but the location/form of the planned
restoration - Consider implant angulation
- Aim for screw retention
what are the 3 types of guyides for planning +/- surgery
tooth supported
mucosa supported
fully guided
what 5 things can you see on a plain film radiograph
Interradicular width
Endodontic pathology
Fractures
Caries
Bone levels (height)
in what 4 situations would a cone beam CT be indicated
- Exam and conventional films have failed to adequately demonstrate relevant anatomy
- Additional information will help minimise risk of damage to adjacent anatomy
- Clinically borderline situations
- Where implant positioning can be improved to optimize results e.g. use of
radiographic/surgical guides, computer assisted planning
Site-specific considerations
* More extensive augmentation procedures
* Sinus procedures
* ‘special techniques’ e.g. zygomatics/distraction osteogenesis
* Digital planning/placement EAO Consensus 2012
what 4 things should you interperet from the xray image
Bone volume, need for bone augmentation
* Proximity to local anatomy
* Proximity to adjacent teeth
* 1.5mm from adjacent tooth
* 3mm between adjacent implants (can get bone loss if implants are too close)
* Ability to place implant in a prosthetically driven position
* Can you put the implant where it needs to be for the planned prosthesis?
when is placement of the implant planned
according to the desired biological stage- no ideal time - patients heal at diff rates
what are the 4 key biological events you would want before placing thr implant
- Resolution of any infection
- Soft tissue healing, leading to increased soft tissue volume over the socket
- Bone healing, with bony infill of the socket
- Bone resorption and loss of buccal contour
what is type 1 (immediate) post-extraction implant placement
immediate placement at the time of extraction
what is type 2 (immediate-delayed) post-extraction implant placement
complete soft tissue covvergae (6-8/52)
what is type 3 (delayed) post-extraction implant placement
substantial boen fill of the socket (typically 12-16/52)
what is type 4 (delayed) post-extraction implant placement
completely healed site/ site where no teeth had formed (typically >16/52)
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