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BDS4 Operative Dentistry > Implant Symposium - Placement > Flashcards

Implant Symposium - Placement Flashcards

1
Q

What is osseointegration

A
  • direct functional and structural connection between a load bearing dental implant and living organized bone
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2
Q

What are the 2 stages of osseointegration

A

primary
secondary

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3
Q

What is primary osseointegration

A
  • implant is anchored in bone due to frictional forces provided between osteotomy and dental implant design features
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4
Q

What is secondary osseointegration

A
  • porcess of a functional connection between bone and implant
  • living bone grows onto surface of a dental implant
  • produces an integrated surface
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5
Q

How does the tooth’s supracrestal soft tissues differ from an implants

A

Tooth
* more fibroblasts
* less collagen
* collagen fibres orientated perpendicular to root surface

Implant
* more collagen
* less fibroblasts
* collagen fibres orientated parallel to implant crown

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6
Q

How does the tooth’s subcrestal tissues differ from an implant

A

Tooth
* tooth anchored to bone by periodontal ligament complex (bone/PDL/cementum)
* capable of physiologic adaptation
* ‘resilient’ tissue attachment

Implant
* implant anchored to bone by direct functional contact
* no physiologic adaptation
* rigid connection

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7
Q

What are the materials that can be used for a dental implant

A
  • titanium
  • titanium-zirconia
  • ceramic implant
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8
Q

What makes Ti-Zr implants better than Ti implants

A

increased strength

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9
Q

What is the ceramic implant made out of

A

yittra stabilised zirconia

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10
Q

What is the advantage of a ceramic implant

A

non-metallic covered
dont get shine through

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11
Q

What are different features you may notice in implant design

A
  • polished collar/no polished collar
  • tissue level/bone level
  • parallel/tapered
  • width
  • length

different designs have no significant effect on implant survival or success

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12
Q

When may we want to use a bone level implant

A
  • aesthetic zone
  • provides more space to modify the profile
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13
Q

When may we want to use a tissue level implant

A
  • posteriorly
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14
Q

When may we use tapered

A
  • can provide increased primary stability in immediate placement (straight into socket - sockets are usually tapered)
  • tapered may also be preferred where there is root convergence apically
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15
Q

What is the different widths you can get for implants

A

3mm-4.5mm

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16
Q

Why may we select different lengths and diameters of implants

A
  • site
  • indication
  • local anatomy
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17
Q

What are the different implant surfaces we can get

A

can be machined/turned
roughness can be modified (smooth-rough)
surface tx can be done

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18
Q

What are the different surface treatments we can do to roughen the implant surface

A
  • sand blasting
  • acid etching
  • plasma spray
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19
Q

What is the benefit of a roughened surface

A
  • allows reparative osteocytes to grow into the implant to provide good connection
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20
Q

What are the primary aims of dental implant tx

A
  • replace missing teeth with aesthetic, functional and predictable restoration
  • low rate of omcplications during healing and maintenance
  • long term stability
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21
Q

What can we use to assess a px’s medical suitability for impants

A

ASA classification
haematological

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22
Q

What are the medications that may effect implant success

A
  • SSRIs
  • PPIs
  • bisphosphonates
  • steroids
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23
Q

What medical conditions may effect implant success

A
  • previous radiotherapy
  • poorly controlled diabetes
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24
Q

How does smoking effect implant success

A

increased risk of implant failure in patients who smoke
increased risk of perimplantitis in px who smoke
dose dependant relationship

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25
What is the dose dependant relationship based on for smoking
<10 per dy medium risk >10 per day high risk
26
What does smoking efefct at a cellular level
* vascularity * fibroblast/osteoblast function * PMN function
27
When should implants be placed in patients
* all implants should be placed after cessation of growth * risk of placement of implants in px who are not skeletally mature
28
What is the ideal age for implant placement
>21YO
29
What are the risks of placement of an implant in a px who is not skeletally mature
* relative infra occlusion * suboptimal aesthetics * occlusal disharmony * implant fenestration
30
What is the importance of smile lines in implant px
* will impact on visability of implant and prosthesis * peri-implant soft tissues often difficult to mask
31
What is a high risk smile line
* >2mm soft tissue showing
32
What is a medium risk smile line
<2mm of soft tissue showing
33
What is a low risk smile line
* lip covers >25% of implant and prosthesis
34
What do we want to look for in our extraoral examination
* skeletal relationship * presence of incisal cants * presence of gingival cants * width of aesthetic zone
35
What is the impact of skeletal relationship on implants
* will impact positioning of prosthetic tooth and therefore implant 3d positiojn * may impact on occlusal forces on tooth and guidance
36
What are the different gingival phenotypes
* thick flat * thick scalloped * thin scalloped
37
What would be the impact of a thin biotype in regards to implants
* higher risk of shine through and recession * likely to give a bad aesthetic result
38
What is the easiest way to assess gingival phenotype
* put a probe into the sulcus - shine through?
39
What is the importance of the distance of bone crest to contact point
* in a single tooth site, the distance between the bone crest to the adjacent contact point will determine the presence of the adjacent papilla * if inadequate, greater risk of presence of black triangles and an inadequate aesthetic result
40
What is a low risk bone crest to contact point measurement
<5mm to contact point
41
What is a medium risk bone crest to contact point measurement
5.5-6.5mm to contact point
42
What is a high risk bone crest to contact point measurement
* =>7mm to contact point
43
What is the impact of infection at implant site
* infection at proposed implant site will effect survival * acute infection higher risk than chronic * some may consider root treating a tooth prior to try and reduce infection size
44
What is the impact of the restorative status of adjacent teeth on implant placement
* risk of recession with subgingival restoration margins on adjacent teeth * risk of suboptimal aesthetics if trying to match a maxillary central incisor to a translucent, contralateral tooth with characterisation * may consider restoring adjacent tooth prior to placement
45
What is the impact of the width of edentulous span on implant placement
* depends on number of teeth missing * multiple adjacent missing teeth are more difficult to replace with an aesthetic restoration * space may be too wide or too narrow
46
What is the problems with an edentulous span being too wide
* challenge to fill the place * where should we leave the residual spaec
47
What is the problem with the edentulous span being too narrow
* risk of damage to adjacent teeth * risk of necrosis of bone between teeth and implants * will have significant effects on soft tissue aesthetics
48
What is a low risk bone defect for implant placement
* no bone deficiency
49
What is medium risk bone defect for implant placement
* horizontal bone deficiency
50
What is a high risk bone deficiency
* vertical bone deficiency
51
What is relevant local anatomy in the maxilla
* maxillary sinus * nasal floor * nasopalatine canal * infraorbital nerve
52
What is relevant local anatomy in the mandible
* inferior alveolar canal * mental foramen * incisive canal * lingual perforating vessels * submandibular fossa
53
What is 'prosthetically driven' implant planning
* think of where you want your prosthesis first and then work backwards
54
What dimensions do we need to consider when placing implants
* mesiodistal positioning and orientation * buccopalatal positioning and orientation * apico-coronal positioning
55
What will the implant position depend on
* implant system * proposed gingival margins * local anatomy * prosthetic plan cement vs screw
56
What do we need to take into account when looking at the mesiodistal position/orietnation of the implant
* implant should be a safe margin from adjacent teeth * this is to lower risk of damage to adjacent teeth as well as reducing the risk of bone necrosis and soft tissue defects in between the implants and teeth/other implants
57
What is the minimum width required between implant and tooth in the mesio distal direction
1.5mm remember if 2 implants are adjacent to each other than you need them 3mm apart
58
What do we need to consider when planning the bucco-palatal orientation
* the positioning and angulation/orientation * depends on whether it is cement retained or screw retained restoration is planned
59
How much bone/soft tissue do we need labial to the implant
aiming for >1mm of bone or >2mm hard tissue/soft tissue labial to implant
60
When should you consider guided bone regeneration
* dehiscence * fennestration * inadequate contour
61
What is meant by fenestration when considering GBR
* fenestration - this is an opening near the apex where the implant can be seen (http://glidewelldental.com/education/chairside-magazine/volume-16-issue-2/7-steps-for-treating-fenestrations-within-implant-sites)
62
What is meant by dehiscence when considering GBR
splitting of the bone - basically implant doesnt have enough bone to cover it
63
What is apicocoronal implant positioning planned relative to
* relative to proposed gingival margin position * depends on whether tissue or bone level implant used * usually want out implant placed around 2mm above the ACj
64
Here is a summary table of the risks to consider for successful implant placement
65
What are the different implant placement protocols
1. Immediate implant placement 2. Early implant placement with soft tissue healing (4-6 wks) 3. Early implant placement with partial bone healing (12-16 wks) 4. Late implant placement in healed sites (>6 months)
66
What aids do we need to plan
* study models * diagnostic wax up of ideal positions * surgical template * essex * clinical photos * CBCT * surgical guide

BDS4 Operative Dentistry (10 decks)

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