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Module 8 > Implantology > Flashcards

Implantology Flashcards

1
Q

Edentulism is a major public health problem that starts as an impairment which eventually creates a disability and leads to handicap. True or false?

A

True

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2
Q

What % of the population is estimated edentulous?

A

6%

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3
Q

What % of the population have had at least 1 tooth removed?

A

74%

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4
Q

What % of all nerve injuries caused by dental work were associated with implants?

A

30%

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5
Q

What are the risks of poor oral hygiene after having an implant placed?

A
  • Mucositis
  • Peri-implantitis
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6
Q

Give a definition of a dental implant.

A

A prosthetic device of alloplastic material implanted into the oral tissues beneath the mucosa and/ or periosteal layer, and/ or within the bone to provide retention and support for a fixed or a removable prosthesis​

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7
Q

What can implants replace?

A
  • Single crown
  • Multiple teeth (fixed bridge)
  • Full arch (denture)
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8
Q

What are advantages of placing implants?

A

Overall improvement of function, aesthetics and quality of life.

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9
Q

What are the indication for dental implants?

A
  • To replace a lost tooth or missing teeth
  • Well motivated/compliant patient (long term maintenance)
  • Well maintained dentition (caries free/periodontally sound)
  • Systemically well
  • Non-smoker (for minimum 3 months - including nicotine vapes)
  • Not immunocompromised
  • No bruxism or parafunctional habits
  • No impaired wound healing
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10
Q

How greater is the risk of a dental implant to fail in smokers compared to non-smokers?

A

140.2% higher risk - approx 10/20% will lose their implants if they smoke. Recent systematic reviews suggests higher than this.

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11
Q

There is a generic criteria for consideration of dental implants in NHS. State contra-indications that wouldnt fit this criteria.

A
  1. Age (not under 18)
  2. Medical History:
    - Poorly controlled diabetes (HBA1c > 8)
    - Bisphosphonate treatment
    - Psychiatric and mental health issues
    - Smoking
    - Poor dental health
    - Other conditions such as blood disorders, immunodeficiency, alcohol/drug abuse, bone disorders and epilepsy.
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12
Q

Who can get an implant on the NHS?

A

1 Patients with congenital, inherited conditions that have led to missing teeth, tooth loss or malformed teeth​.

2 Patients with traumatic events leading to tooth loss​.

  1. Patients with surgical interventions resulting in tooth and tissue loss, for example, head and neck cancer and non-malignant pathology​

4 Patients with congenital or acquired conditions with extra-oral defects of, for example, eyes or ears​

5 Patients who are edentulous in either one jaw or both in whom repeated conventional denture treatment options have been unsuccessful​

6 Patients with severe oral mucosal disorders and those with severe xerostomia where conventional prosthetic treatment is not possible and/or the provision of conventional treatment would be detrimental to the mucosal disorders​

7 Patients who do not have suitable existing teeth that can be used for anchorage to facilitate orthodontic treatment​

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13
Q

Name examples of congenital or inherited conditions that would qualify for a dental implant on NHS.

A
  • congenital hypodontia
  • cleft lip and palate
  • amelogenesis/dentinogenesis imperfecta
  • Aggressive periodontitis
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14
Q

Name different implant systems.

A
  • Straumann
  • Hiossen
  • Nobel Biocare
  • Dentsply Sirona
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15
Q

The material used for dental implants has to have a wide margin of safety. State some requirements needed for this alloplastic material.

A

Compatibility – biological, biomechanical and morphological​
MRI safety and image compatibility​

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16
Q

Excessive force on the implant stimulates osteoclastic activity around the bone, true or false?

A

True- forces on the implant must not exceed the normal masticatory forces.

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17
Q

Loading on dental implant should be directed primarily in what axis

A

Long axis- the bone resists this the best. The bone doesn’t like rotational or tilting positions as this isnt physiological acceptable to the bone.

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18
Q

Give a definition of osseointegration.

A

“A direct structural and functional connection between ordered living bone and the surface of a load-carrying implant”​

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19
Q

State host factors that would contribute to osseo-integration.

A

Bone density- bigger the more likely to withstand stress
Bone volume and bone implant surface area
Parafunctional habits

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20
Q

State implant factors that would contribute how well osseo-integration occurs.

A

Implants macro-design
Chemical composition and biocompatibility
Surface treatments and coating
Implant tilting, prosthetic passive fit, cantilever, crown height, occlusal table, loading time.

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21
Q

Name examples of properties on a dental implant that will improve osseo-integration.

A

-Surface chemical composition, biocompatibility, high corrosion resistance ​
- Hydrophilicity
- Increased roughness (macro-, micro-, and nano-sized topologies) - this is achieved by titanium plama spraying, grit blasting, acid etching, anodiation, calcium phosphate coating.

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22
Q

What are the advantages of surface modification?

A

Greater amounts of bone-to-implant contact
- Greater amount of integration which results in a higher removal torque value

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23
Q

What are the metals used in dental implants?

A
  1. Titanium (type 4)
  2. Zirconium
    These do not inhibit the growth of osteoblasts.
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24
Q

What is the advantage of using both xenograft and the patients on bone graft?

A

Xenograft: Acts as a scaffold, has a stabilising effect
Patients own bone graft: Populated with osteoblasts and bone morphogenic proteins - able to produce bone straight away therefore heals in a shorter time frame (4months).

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25
Q

Give examples of advantageous properties of titanium in dental implants.

A

Very- high mechanical strength
6% aluminium and 4% vanadium reduces to 50% the titanium heat conduction and doubles resistance to corrosion
Better fracture resistance

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26
Q

How successful are dental implants? State evidence based.

A

“the 8-year cumulative survival and success rates resulted in 96.7% and 93.3%, respectively.” ​
“the 10-year cumulative survival and success rates were 99.2% and 96.4%, respectively.”​

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27
Q

What is the ideal bone volume required for osseo-integration?

A

7mm width in between teeth and 1cm in height.

28
Q

What kind of factors would you look at on a patient assessment when considering an implant.

A

-Oral hygiene/compliance
- Medical factors: Medical fitness/ medications/ radiation treatment/ growth (if the pt is under 18)
- Site related factors: Periodontal status, access, pathology near implant site, previous surgeries at the site
- Surgical complexity: Timing of implant placement, simultaneous or staged graft procedures, number of implants.

29
Q

What anatomical factors would you consider when assessing a patient for an implant?

A
  1. Bone volume: horizontal and vertical
  2. Soft Tissue: Keratinized mucosa, soft tissue quality: thin/thick biotype?
  3. Site: Proximity to vital anatomical structures, maxillary sinus, IANB and mental foramen.
  4. Adjacent teeth: papillae, recession, interproximal attachment
  5. Aesthetics: facial support, labial support, upper lip length, buccal corridor, smile line, maxillomandibular relationship
30
Q

According to the study Chung et al (2006), was what associated with the absence of adequate amount of keratinized mucosa in dental implants, especially in molars.

A

Associated with higher plaque accumulation and gingival inflammation.

31
Q

According to Bouri et al (2008), what is increased width of keratinized mucosa (>2mm) around an implant associated with?

A

Associated with mean lower alveolar bone loss and improved indices of soft tissue health.

32
Q

Esposito et al. (2007) reported in their Cochrane systematic review that there is insufficient reliable evidence to provide recommendations on whether soft tissue correction or augmentation of the keratinized tissue amount around implants is beneficial for patients or not. ​True or False?

A

True

33
Q

What causes the “black triangle” appearance when placing implants.

A

When a tooth has been taken out, bone resorption occurs which means there is no bony structure for the papillae to sit on.

34
Q

How many mm minimum would you require for horizontal and vertical bone for implants?

A

Horizontal- at least 7mm
Vertical- 8-10mm

35
Q

How would you classify bone quality?

A

Class 1: Bone consists almost exclusively cortical bone (anterior mandible)
Class 2: Bone consists mostly of cortical but some trabecular
Class 3: Bone consists mostly of trabecular and some cortical bone.
Class 4: Bone consists almost exclusively of trabecular bone

36
Q

Does classfication 3 and 4 of bone quality tend to occur more in the maxilla or mandible?

A

Maxilla

37
Q

Why is it preferred to have Classification 1 and 2 when it comes to placing implants?

A

Tend to have better primary stability of implants.

38
Q

What is more likely to occur with Classification 3 and 4 with regards to placing the implant.

A

Class 3 and 4 tend to have instability which can lead to fibrous encapsulation which can ultimately lead to failure of the implant.

39
Q

What time difference is there for classification 4 in terms of time taken for implant to osseointegrate into bone and why is this?

A

Class 4 can take 12 weeks for stability whereas Class 1,2,3 takes around 6 weeks.
This is because have initial stability however remodelling phase where osteoclastic activity causes reshaping of the bone affecting the stability. The osteoblastic activity after this then causes stability of the implant.

40
Q

What is the gold standard radiograph used for dental implants?

A

CBCT.

41
Q

What is considered the “safety zone” when placing dental implants around the mental foramen region.

A

The ‘‘safety zone’’ also takes into account that the coronal aspect of the mental foramen is 2 mm above the inferior alveolar/mental nerve. ​

42
Q

What is the minimal distance required between the shoulder of a dental implant to the adjacent tooth?

A

A minimal distance of 1.5 mm from the implant shoulder to the adjacent tooth at bone level (mesial and distal) is required.​

43
Q

What is the minimal distance in mm between 2 adjacent implants.

A

A minimal distance of 3 mm between two adjacent implant shoulders (mesiodistal) is required or 7 mm between the centre of each implant​

44
Q

The gap width in between teeth must be how many mm wider than the implant shoulder?

A

The distance between adjacent teeth at bone level is approximately 1 mm (2 x 0.5 mm) more than the gap width. Hence, the gap width must be 2 mm wider than the implant shoulder​

45
Q

What are the 2 different types of implants?

A

Tissue level implant and bone level implants

46
Q

What type of implant would you put for a denture retained implant and would normally do this in 1 stage surgery?

A

Tissue level implant

47
Q

What type of implant would you use for anterior implant to give a better aesthetic result and normally complete this in 2 stages?

A

Bone level implant.

48
Q

The material used for dental implants was originally pure titanium however what has this now commonly changed to and what are the advantages of this.

A

Material: titanium-6-aluminium-4-vanadium
Has a very high mechanical strength
6% aluminium and 4% vanadium reduces to 50% titanium heat conduction and doubles resistance to corrosion
Better fracture resistance

49
Q

Overloading forces on the implant can lead to bone loss surrounding the implant, therefore what properties on the implant can help reduce the stress on the surrounding bone

A
  • Implant body shape (tapered favoured)
  • Implant collar shape (slight coronal flare)
  • Threads (shape, pitch, height, triangular compaction)
  • Grooves
50
Q

Describe Roxolid implant and its properties.

A

15% zirconium, 85% titanium
- Higher tensile strength
- Preserves bone
- Greater flexibility with smaller implants

51
Q

Implants are better at transfer loading from: Compressive, tensile or shearing forces?

A

Implants are better at dealing with compressive forces (occlusal forces). 380-880N in the molar region and 220N in the anterior region.

52
Q

When using an implant as a cantelever, how many units should this cantilever be?

A

1 unit (lateral forces are about 20N therefore cannot have excessive forces on this).

53
Q

What does immediate implant surgery mean?

A

When you extract a tooth you place the implant immediately - advisable when you have good quality bone.

54
Q

What is immediate delayed implant surgery?

A

Healing period of 4-6 weeks for soft tissue healing (not bone healing)

55
Q

What is the delayed technique for implant surgery?

A

When you get partial bony healing with a period of 3-4 months. Can be supplemented with bone graft.

56
Q

What is the elective technique for implant surgery?

A

Socket healed for more than 4 months, have full bony healing. Used in edentulous patients where full clearance is required.

57
Q

How long would you wait after an implant is placed before considering loading the dental implant?

A

8-12 weeks

58
Q

Describe the surgical technique for Straumann implants.

A
  1. Atraumatic soft tissue handling​
  2. Serial round burs to flatten the implant sites​
  3. surgical stent for ideal position​.
  4. always use cool saline irrigation for drills(<40oC)​
  5. Pilot drill to depth 500-800 rpm​ (approx 6mm down initially to check alignment)
  6. Twist drills to depth and width at slow speed ​
  7. Profile drills to create coronal flare​
  8. Hand placed implant with copious irrigation​
  9. all threads within bone​
  10. Suture soft tissues​
59
Q

For tissue level implants, how would the implant be managed after insertion?

A

the implant remains exposed with a healing abutment for 2-3 months before the restorative team commence treatment​

60
Q

For bone level implants, how would the implant be managed after insertion?

A

2 stage surgery so 2 months after implant insertion the implant is exposed and a taller healing abutment placed​

61
Q

What are some complications of placing implants?

A

Wound breakdown (over tightened sutures causing oedema and eventually necrosis)
Infection (no evidence to support antibiotics prior to surgery to prevent).
Early loss (uncommon)
Mucositis (lack of keratinized mucosa making it difficult to clean)
Peri-implantitis

62
Q

According to Buser and Cochran et al, what is the success criteria for a successful dental implant?

A
  1. Absence of clinically detectable implant mobility
  2. Absence of pain or any subjective sensation
  3. Absence of recurrent pei-implantitis
  4. Absence of continuous radiolucency around the implant at 12 week time point.
63
Q

What evidence based success rates do implants have?

A

According to Prof Derek Richards - meta analysis was 93.2% on average success rate with age being a significant factor.

64
Q

What is failure of an implant?

A

Early failure: Fail to osseo-integrate meaning the implant falls out or is mobile.
Late failure: Infection?

65
Q

What is considered to be acceptable peri-implant crestal bone loss?

A

First year: Shouldnt be greater than 1mm bone loss
Shouldn’t be greater than 0.2mm the year after.

Module 8 (8 decks)

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