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PERIO I > implantology > Flashcards

implantology Flashcards

1
Q

Dental implant

A

An artificial tooth root placed in the jaw to hold a replacement tooth or bridge

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2
Q

components of implants

A
  • Crown: extra-gingival
  • Abutment: transmucosal
  • Implant Body: endosseous portion
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3
Q

implant levels

A

Bone level vs Tissue level

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4
Q

Bone Level Implants
* Connect at?
* Allows?
* which zone?
* Allows what # stages?

A
  • Connect at bone
  • Allows customized and angled abutments
  • Esthetic zone
  • Allows two-stage implant surgery
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5
Q

Tissue Level Implants
* Connect at?
* shaping soft tissue?
* staged surgery?

A
  • Connect at soft tissue level
  • Smooth neck shapes the soft tissue
  • One-stage implant surgery
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6
Q

shapes of implants

A

cylindrical and tapered

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7
Q

cylindrical shaped implants

A
  • Increased Surface Area
  • Greater Force Transfer
  • Most Common Design
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8
Q

conical shaped implants

A
  • Complex osteotomy sites
  • Root proximity
  • Bone concavity
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9
Q

platform widths

A

std btwn 3.5-4.5mm

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10
Q

microgap

A
  • Inflammatory cell infiltrate was consistently present at the level of the interface between the two components, the bone crest was consistently located 1-1.5 mm
    apical of the microgap.
  • Inflammatory Infiltrate was due to bacterial contamination
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11
Q

platform switching

A

Platform switching is the concept of placing an narrower abutment on the wider implant to preserve
alveolar bone levels at the crest of a dental implant

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12
Q

how does platform switiching work

A

It reduces per-implant bone resorption at the bone crest and maintains the supracrestal attachment
* Increases distance of implant-abutment junction from the crestal bone
* Limits possible interface of bone with micro-movements
* Shifts the inflammatory cell infiltrate inward and away from the adjacent crestal bone

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13
Q

surface properties of implants

why would these be used?

A

Surface characteristic and roughness
Surface chemistry and surface free energy (SFE)

Enhance cell adhesion to get better osseointegration

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14
Q

ways to alter surface roughness

A

Roughness (Macro & Micro):
* Texture
* Machined

Substractive:
* Sandblast
* Acid-etch

Additive:
* Oxidation
* Coating

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15
Q

Smooth vs Rough Surfaces

A

moderately rough surfasces provided best osseointegration

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16
Q

issues with increasing roughness

A

the rougher the implant, the higher its’ Sa value
(in um), the easier for bacterial adhesion, the less efficacy of biofilm treatments

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17
Q

does microbial colonization always occur on implants based on roughness?

A

Microbial adhesion can occur on any implant surface,
regardless of the degree of surface roughness

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18
Q

Surface Chemistry And Surface Free Energy (SFE)

A
  • SFE is the interaction between the force of cohesion and the force of the adhesion that determines whether or not wetting occurs.
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19
Q

testing SFE

A
  • Sessile drop technique
  • Different material, implant design with characteristics contribute to the SFE and cell/ bacterial adhesion.
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20
Q

factors of cell and bac adhesion to implant

A
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21
Q

definition of successful implants

A

A successful implant must present no mobility, no peri-implant radiolucency, bone loss less than 0.2 mm per year after the first year of loading, and no persistent pain, discomfort or infection

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22
Q

Landmarks to consider during implant placement

A
  • Inferior Alveolar Canal/Mental Foramen
  • Incisive Foramen
  • Maxillary Sinus/Nasal Cavity
  • Lingual undercut
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23
Q

Inferior Alveolar Canal And Mental Foramen implamnt recomendations

A

Premolar and molar areas of the mandible
A loop of the nerve can be found to extend mesially.

Safety zone of 3mm from the mental foramen and
2mm from the IAN is recommended.

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24
Q

best way to detect IAN/ mental foramen

A

CT, worst is PA

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25
Q

Incisive Canal implant considerations

A

Size and location are Important, may even graft canal for more bone

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26
Q

Maxillary Sinus/Nasal Cavity for implants
direct vs indirect lifting

A

Sinus augmentation may be needed
Direct sinus lifting: less than 4mm residual bone height
Indirect sinus lifting: more than 4mm residual bone heigh

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27
Q

Lingual Undercut and implants

A
  • Perforating the lingual plate during preparation of the implant site can result in extensive and even life threatening bleeding.
  • Proper planning and considering reflect a lingual flap to visualize the ridge
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28
Q

osseointegration

A

A direct functional and structural connection
between living bone and the implant surface

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29
Q

requirements of successful osseointegration

A

The stability of the bone at the time of implant
placement is critical to the successful osseointegration

Quantity: related to the degree of bone loss or bone resorption present
* Quality: related to the degree of bone density present

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30
Q

classes of bone quantitiy for implants

A
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31
Q

classes of bone quality for implants

A

2 and 3 are best

32
Q

type 1 bone quality

A

Type 1: hard and dense like oak wood (D1)
* Less blood supply than other types (compact bone)
* Takes longer for an implant to integrate
* Found in the mandible

33
Q

type 2 bone quality

A

Type 2: consistency of pine wood (D2)
* Thick layer of compact bone surrounds a core of
dense, trabecular bone

34
Q

type 3 bone quality

A

Type 3: consistency of balsa wood (D3)
* Thin layer of cortical bone surrounds a core of
dense trabecular bone

35
Q

type 4 bone quality

A

Type 4: consistency of Styrofoam (D4)
* Thin layer of cortical bone surrounds a core of low
density trabecular bone
* Commonly found in posterior maxilla

36
Q

Concepts of implant Placement

A

Prosthetically-driven implant placement
Hard tissue management
Soft tissue management

37
Q

Prosthetically-driven Implant
Placement considerations

A

Safety/ Function/ Value/ Esthetics

38
Q

space req for implants in MD deminsion

A
  • At least 1.5 mm between teeth and implant
  • At least 3 mm between 2 adjacent implants
39
Q

results of lack of space btwn implants

A

can’t restore, no access to clean, bone loss, peri-implantitis

40
Q

BL deminsion implant considerations

A
  • Significantly greater resorption and gingival recession when the ridge width < 2 mm.
  • Anterior region: at least 2 mm of buccal bone thickness
  • Posterior region: at least 1mm buccal bone and 1mm lingual bone thickness is acceptable
41
Q

coronal apical deminsions for implants

A
  • 3-4mm from adjacent CEJ
  • It is recommended to place bone level implants subcrestally
42
Q

classes of ridge atrophy

hard tissue management

A
  • Ridge atrophies: horizontal and vertical
  • Siebert Classification:
  • Class I: buccolingual loss of tissue (horizontal)
  • Class II: apicocoronal loss of tissue (vertical)
  • Class III: both loss of tissue
43
Q

options for ridge augmentation for implant placement

A
  • Ridge augmentation for atrophic bony ridge
  • Bone block technique vs particulate bone graft
  • Guided Bone regeneration (GBR): A surgical procedure that uses barrier membranes with bone grafts to augment atrophic bony ridge
  • Sinus augmentation: direct/indirect
44
Q

complications of ridge augmentation:
healing?
postop?
tx time?

A
  • Longer healing time: 3-12 months to be ready for implant placement, depending on the augmented volume, the graft material and individual healing ability.
  • Post-op complications: membrane exposure, infection, sinus membrane perforation…etc.
  • Longer expected treatment time line
45
Q

Rationales for RIDGE PRESERVATION:
* Maintain? esthetics?
* Simplify?
* Ready for implant placement at?

A
  • Maintain stable ridge volume to optimize functional and esthetic outcomes (decreased atrophy)
  • Simplify treatment procedures following the ridge preservation
  • Ready for implant placement at 3-6 months
46
Q
  • Peri-implant mucosa
A
  • The soft tissue surrounding
    dental implants
47
Q
  • Transmucosal attachment of implants
A
  • A mucosal seal should prevent bacterial products reaching the bone, ensuring the osteointegration
48
Q

The height of the peri- implant supracrestal soft tissue (PST) includes:

A

sulcular epithelium, junctional epithelium and supracrestal connective tissue

49
Q

Supracrestal tissue attachment for implants

A

Supracrestal tissue attachment is roughly 3 mm
(JE 1.88 mm + CT 1.05 mm =2.93 mm)

50
Q

soft tissue thickness needed to prevent dihesence in implants

A
  • Soft tissue thickness greater than 2 mm is necessary to prevent peri- implant soft tissue dehiscence
51
Q
  • A minimum of ? mm of KT is necessary to facilitate
    proper oral hygiene for peri- implant health
A
  • A minimum of 2 mm of KT
    is necessary to facilitate
    proper oral hygiene for peri-
    implant health
52
Q

graft to gain KT?

A

free gingival graft

53
Q

graft to gain thickness?

A

conn tissue graft

54
Q

tooth vs implant perio support
* contact w bone?
* Peri-implant fibers?
* Ankylosis?
* Blood supply?
* inflammatory response?

A
  • Direct bone to implant contact (osseointegration)
  • Peri-implant fibers form parallel cuff in a oriented longitudinal direction
  • Ankylosis, higher stress at the neck of the screw/implant
  • Blood supply by terminal branches of large vessels from periosteum, fewer capillaries.
  • Stronger inflammatory response (in implant)
55
Q

peri implant fibers:
* Peri-implant fibers form?
* Epithelial cells attached by?
* Collagen fibers insertion?
* Prevents?

A
  • Peri-implant fibers form parallel cuff in a oriented longitudinal direction
  • Epithelial cells attached by hemidesmosomes
  • Collagen fibers do not insert into the implant but
    creates a cuff around the implant creating a mucosal seal
  • Prevents bacterial invasion
56
Q

inflammation in implants

A
  • Stronger inflammatory response
  • Similar to periodontitis, peri-implantitis lesion is
    dominated by plasma cells and lymphocytes but
    characterized by a larger proportion of PMNs and macrophages
  • Area proportions, numbers and densities of
    plasma cells, macrophages and neutrophils are
    higher in peri-implantitis
57
Q

Peri-implant health

A

Absence of erythema, bleeding on probing, swelling and suppuration

58
Q

Peri-implant mucositis

A

An inflammation in absences of continuous marginal peri- implant bone loss. The clinical sign of inflammation is bleeding on probing. Additional signs may include erythema, swelling, and suppuration.

59
Q

Peri-implantitis

A

A pathological condition occurring in tissues around dental implants, characterized by inflammation in the peri-implant mucosa and progressive loss of supporting bone. Clinical sign of inflammation is detected by bleeding on probings, while progressive bone loss is identified on radiographs

60
Q

Prevalence of peri-implant mucositis and implantitis

A
  • 43% for peri-implant mucositis and 22% for peri-implantitis at subject level
  • 29.5% for peri-implant mucositis and 9.3%-22.1% for peri-implantitis at implant level
61
Q

Diagnosis of implant conditions

with previous data available

A
  • Baseline X-ray or previous examination data is available
  • Presence of bleeding and/or suppuration on gentle probing.
  • Increased probing depth compared to previous examinations.
  • Presence of bone loss beyond crestal bone level changes resulting from initial bone remodeling ( ≥2 mm after the 1st year of function
62
Q

diagnosis implant conditions without previous data

A
  • In the absence of previous examination data :
  • Presence of bleeding and/or suppuration on gentle probing.
  • Probing depths ≥6 mm.
  • Bone levels ≥3 mm apical of the most coronal portion of the intraosseous part of the implant
63
Q

comparing implant health, mucositis and implantitis: inflam, BoP/SoP, bone, PD

A
64
Q

Peri-implantitis risk factors/Indicators
* plaque control?
* Lack of?
* Tissue quality?
* Iatrogenic factors:
* cement?
* Occlusa?
* Titanium?

A
  • Poor plaque control
  • Lack of regular maintenance
  • Tissue quality: thin phenotype, KT band, bone deficiency
  • Iatrogenic factors: malpositioning, poor design of emergency profile, inadequate abutment/implant seating
  • Excessive cement
  • Occlusal overload
  • Titanium particles: implant corrosion, micromovemen
65
Q

Peri-implantitis risk modifiers

A
  • History of periodontal disease
  • Smoking
  • DM
  • Genetic factors
  • systemic condition
66
Q

Microbiology of implant colonization

red complex?

A
  • Bacterial colonization was initiated within 30 min after implant placement.
  • The sequence of colonization on dental implants and biofilm formation is similar to that of teeth.
    Red complex: T. forsynthia, P.gingivalis, T. denticola
67
Q

progression thru peri implant dx’s

A
  • Plaque leads to peri-implant mucositis
  • Plaque accumulation and then reversed
  • Histology demonstrated B & T cells infiltration at 21 days
  • Peri-implant mucositis may lead to peri-implantitis
  • It mirrors the progression of gingivitis to periodontitis
68
Q

Implants in Fully Edentulous Patients microbio

A
  • The microbiota is similar to the mucosal flora on
    the adjacent alveolar ridge
  • Over 80% were Gram- positive facultative cocci
  • Spirochetes were limited
  • Fusobacteria/black- pigmenting Gram- negative anaerobes were found infrequently
69
Q

Implants in Partially Edentulous Patients microbio

A
  • The microbiota is similar to remaining teeth
  • Higher percentages of black-pigmenting Gram- negative anaerobes and Capnocytophaga
70
Q

perio dx tx when implant is planned?

A

tx before implant placed

71
Q

exposure of implant surface may lead to?

A
  • Surface topography influences biofilm formation
  • Exposure of the implant surface may lead to peri-implantitis due to colonization
72
Q

Maintenance of implants
* Provide?
* Focus on what tissues?
* Work as?

A
  • Provide guidelines for maintaining the long term
    health of the dental implant
  • Focus on both hard and soft tissue stability
    around the dental implant
  • Work as a team— patient are co-therapists in the
    maintenance therapy
73
Q

Maintenance oral hygiene mods

A

Oral Hygiene Modification

Interproximal brushes can effectively penetrate up to 3mm into a gingival sulcus and may effectively clean a
peri-implant sulcus

74
Q

professional debridment of implants

A

Scalers made of stainless steel and ultrasonic tips can roughen the implant surfaces creating scarring and pitting

75
Q

surgical management of failing implant

A

Implantoplasty and osseous surgery (regenerative surgery)

PERIO I (13 decks)

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