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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
Q

What is the dose dependant relationship based on for smoking

A

<10 per dy medium risk
>10 per day high risk

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26
Q

What does smoking efefct at a cellular level

A
  • vascularity
  • fibroblast/osteoblast function
  • PMN function
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27
Q

When should implants be placed in patients

A
  • all implants should be placed after cessation of growth
  • risk of placement of implants in px who are not skeletally mature
28
Q

What is the ideal age for implant placement

A

> 21YO

29
Q

What are the risks of placement of an implant in a px who is not skeletally mature

A
  • relative infra occlusion
  • suboptimal aesthetics
  • occlusal disharmony
  • implant fenestration
30
Q

What is the importance of smile lines in implant px

A
  • will impact on visability of implant and prosthesis
  • peri-implant soft tissues often difficult to mask
31
Q

What is a high risk smile line

A
  • > 2mm soft tissue showing
32
Q

What is a medium risk smile line

A

<2mm of soft tissue showing

33
Q

What is a low risk smile line

A
  • lip covers >25% of implant and prosthesis
34
Q

What do we want to look for in our extraoral examination

A
  • skeletal relationship
  • presence of incisal cants
  • presence of gingival cants
  • width of aesthetic zone
35
Q

What is the impact of skeletal relationship on implants

A
  • will impact positioning of prosthetic tooth and therefore implant 3d positiojn
  • may impact on occlusal forces on tooth and guidance
36
Q

What are the different gingival phenotypes

A
  • thick flat
  • thick scalloped
  • thin scalloped
37
Q

What would be the impact of a thin biotype in regards to implants

A
  • higher risk of shine through and recession
  • likely to give a bad aesthetic result
38
Q

What is the easiest way to assess gingival phenotype

A
  • put a probe into the sulcus - shine through?
39
Q

What is the importance of the distance of bone crest to contact point

A
  • 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
Q

What is a low risk bone crest to contact point measurement

A

<5mm to contact point

41
Q

What is a medium risk bone crest to contact point measurement

A

5.5-6.5mm to contact point

42
Q

What is a high risk bone crest to contact point measurement

A
  • =>7mm to contact point
43
Q

What is the impact of infection at implant site

A
  • 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
Q

What is the impact of the restorative status of adjacent teeth on implant placement

A
  • 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
Q

What is the impact of the width of edentulous span on implant placement

A
  • 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
Q

What is the problems with an edentulous span being too wide

A
  • challenge to fill the place
  • where should we leave the residual spaec
47
Q

What is the problem with the edentulous span being too narrow

A
  • risk of damage to adjacent teeth
  • risk of necrosis of bone between teeth and implants
  • will have significant effects on soft tissue aesthetics
48
Q

What is a low risk bone defect for implant placement

A
  • no bone deficiency
49
Q

What is medium risk bone defect for implant placement

A
  • horizontal bone deficiency
50
Q

What is a high risk bone deficiency

A
  • vertical bone deficiency
51
Q

What is relevant local anatomy in the maxilla

A
  • maxillary sinus
  • nasal floor
  • nasopalatine canal
  • infraorbital nerve
52
Q

What is relevant local anatomy in the mandible

A
  • inferior alveolar canal
  • mental foramen
  • incisive canal
  • lingual perforating vessels
  • submandibular fossa
53
Q

What is ‘prosthetically driven’ implant planning

A
  • think of where you want your prosthesis first and then work backwards
54
Q

What dimensions do we need to consider when placing implants

A
  • mesiodistal positioning and orientation
  • buccopalatal positioning and orientation
  • apico-coronal positioning
55
Q

What will the implant position depend on

A
  • implant system
  • proposed gingival margins
  • local anatomy
  • prosthetic plan cement vs screw
56
Q

What do we need to take into account when looking at the mesiodistal position/orietnation of the implant

A
  • 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
Q

What is the minimum width required between implant and tooth in the mesio distal direction

A

1.5mm

remember if 2 implants are adjacent to each other than you need them 3mm apart

58
Q

What do we need to consider when planning the bucco-palatal orientation

A
  • the positioning and angulation/orientation
  • depends on whether it is cement retained or screw retained restoration is planned
59
Q

How much bone/soft tissue do we need labial to the implant

A

aiming for >1mm of bone
or
>2mm hard tissue/soft tissue labial to implant

60
Q

When should you consider guided bone regeneration

A
  • dehiscence
  • fennestration
  • inadequate contour
61
Q

What is meant by fenestration when considering GBR

A
  • 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
Q

What is meant by dehiscence when considering GBR

A

splitting of the bone - basically implant doesnt have enough bone to cover it

63
Q

What is apicocoronal implant positioning planned relative to

A
  • 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
Q

Here is a summary table of the risks to consider for successful implant placement

A
65
Q

What are the different implant placement protocols

A
  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
Q

What aids do we need to plan

A
  • 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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