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module 8 > implantology > Flashcards

implantology Flashcards

1
Q

what % of all adults are edentulous

A

6

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2
Q

what % of all adults have had at leats 1 tooth extracted

A

74

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3
Q

in 2007, what % of paraesthesia relating to dental work was associated with implants

A

30

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4
Q

what can an implant be made of

A
  • metal
  • ceramic
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5
Q

what are the indications for implants

A
  • replace single tooth
  • replace multiple teeth - bridge
  • full arch - denture
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6
Q

what are the advantages of implants

A
  • function
  • aesthetics
  • quality of life improvement
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7
Q

why do implants improve function

A

gives a stable platform where restoration can rest

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8
Q

who do implants improve quality of life most for

A

edentulous pts

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9
Q

why does a pt need to be very motivated and compliant to have implants

A

lifetime of peri-implant care

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10
Q

what must a pt have (dentally) before being considered for dental implants

A

stable dentition - no caries or perio

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11
Q

how long must a pt be a non-smoker for to be considered for implants

A

3 months

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12
Q

why cant the pt take any form of nicotine before having implants placed

A

because of the affect on vasculature

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13
Q

how much more likely are implants to fail if the pt is a smoker

A

140%

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14
Q

why can the pt NOT have any bruxism or parafunctional habits if they want implants

A

any forces NOT directed down the long axis of the implant are detrimental to its health

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15
Q

how old must a girl be to have implants

A

at least 18

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16
Q

how old must a boy be to have implants

A

21

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17
Q

what is there potential for if a pt having implants placed has poorly controlled diabetes

A

poor wound healing/ poor outcome

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18
Q

what is the highest a pts HbA1c levels can be before not being eligible for implants

A

> 8

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19
Q

which medication is an absolute contraindication to implants

A

IV bisphosphonates

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20
Q

what must a pt taking a short course of oral bisphosphonates be warned of

A

less risk than IV but still risk of MRONJ/ failure of implant

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21
Q

why might psychiatric/ mental health issues be a contraindication to dental implants

A

may not be compliant with attendance for Tx and after care

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22
Q

what % of implants fail in smokers

A

10%

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23
Q

what should be done, from a legal standpoint, before placing dental implants in a smoker pt

A

have them sign disclaimer

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24
Q

what 7 types of pt can have implants on the NHS

A
  1. congenital missing/malformed teeth
  2. trauma
  3. surgical interventions
  4. congenital defects
  5. edentulous with repeated denture failure
  6. severe oral mucosa disorders
  7. no suitable anchorage in ortho
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25
Q

name 4 conditions that cause missing/ malformed teeth making a pt eligible for dental implants

A
  1. aggressive periodontitis
  2. hypodontia
  3. clefts
  4. amelogenesis imperfecta/ DI
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26
Q

what form of periodontitis would make a pt eligible for implants

A

immune based form of the disease

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27
Q

what type of trauma would more often make a pt eligible for dental implants

A

significant loss of dentoalveolar structure - not usually single teeth

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28
Q

give an example of a surgical intervention that would make a pt eligible for dental implants

A

head and neck cancer, cysts

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29
Q

what might make repeated full denture efforts fail resulting in the pt being eligible for dental implants

A
  • atrophic mandible
  • gag reflex
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30
Q

which implant system is used in tayside

A

straumann

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31
Q

name 4 implant systems

A
  • straumann
  • hoissen
  • nobel biocare
  • dentsply serona
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32
Q

what compatibility must an implant have

A
  • biological
  • biomechanical
  • morphological
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33
Q

what is meant by biomechanical implant compatibility

A

physiological forces of mastication and speech

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34
Q

what is meant by morphological implant compatibility

A

dimensions that are easily applied to the oral cavity

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35
Q

why cant dental implants be magnitised?

A

need to be MRI safe and have image compatibility

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36
Q

what is osseointegration

A

direct structural and functional connection between living bone and the surface of load-carrying implant

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37
Q

what happens if the implant transmits excessive forces

A

osteoclastic bone resorption

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38
Q

what is the max load an implant cannot exceed

A

physiological norm

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39
Q

why should loading forces be directed axially in dental implants

A

the bone resists this the best

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40
Q

name 3 host factors that would affect osseointegration

A
  • bone density
  • bone volume and bone to implant surface area
  • parafunctional habits
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41
Q

why does bone density matter in implants

A

withstanding stresses

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42
Q

why is a big implant surface area beneficial

A

the bigger the surface area the better it can withstand loading forces

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43
Q

why are parafunctional habits important when it comes to implants

A

can overload the implant with force

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44
Q

name 4 implant factors that affect osseointegration

A
  • implant macro design
  • chemical composition and biocompatibility
  • surface Tx and coatings
  • restorative crown
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45
Q

how can the restorative crown of an implant affect osseointegration

A

cantilever can cause torsional force

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46
Q

what is produced on the surface of the implant during osseointegration

A

titanium oxide

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47
Q

what physiological feature does an implant lack

A

PDL

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48
Q

why is it beneficial for the implant metal to be hydrophilic

A

integrates better

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49
Q

what 3 factors of the implant can be changed to improve osseointegration

A
  • surface chemical composition
  • hydrophilicity
  • roughness of the implant
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50
Q

how can the surface of an implant be made more rough

A
  • titanium plasma spraying
  • grit blasting
  • acid etching
  • calcium phosphate spraying
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51
Q

what is the advantages of implant surface modification

A
  • greater amount of bone-implant contact
  • more rapid integration
  • higher removal of torque values
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52
Q

what are 2 metals commonly used in dental implants

A
  • titanium
  • zirconium
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53
Q

why are titanium and zirconium commonly used in dental implants

A

only two metals that don’t inhibit that growth of osteoblasts

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54
Q

what is the name of a bone graft from the pt

A

antogenous bone

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55
Q

what is the name of a bone graft from another animal

A

xenograft material

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56
Q

what is the advantage of autogenous bone graft

A

heals faster

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57
Q

why does an autogenous bone graft heal faster than a xenograft material

A

already has the osteoblasts rather than having to recruit them

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58
Q

where would a xenograft material recruit osteoblasts from

A

the pts blood supply

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59
Q

how many grades of titanium are available for dental implants

A

4

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60
Q

how do the different grades of implant titanium differ

A

different amounts of carbon and iron

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61
Q

why is the level of titanium in dental implant alloys 50%?

A

reduces heat conduction and doubles resistance to corrosion

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62
Q

what are the 10 year survival statistics for dental implants

A

96-99% success

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63
Q

name 3 pt factors that you need to have before placing implants

A
  • good OH
  • good compliance
  • well motivated pt
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64
Q

what is the pt at risk of if they dont take time to take care of their implants

A
  • periimplantitis/ mucositis and then loss of implant
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65
Q

what is an implant pt at risk of if theyve had cancer of the head and neck

A

osteoradionecrosis

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66
Q

what dose of radiation can the are of the jaw before an implant pt is at increased risk of osteoradionecrosis

A

up to 50 greys

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67
Q

name 4 site related factors taken into account when placing implants

A
  • perio status
  • access for placement
  • pathology near implant
  • pervious surgery at site
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68
Q

what might affect access to place an implant

A
  • TMD
  • limited opening
  • placing posterior implants
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69
Q

what pathology near an implant would be considrered before placing an implant

A
  • perio
  • cysts
  • gingival pathology
  • bone loss
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70
Q

why is bone loss important in placing implants

A

need adequate bone/soft tissue to heal implant

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71
Q

why might previous surgeries at the site of implant affect its placement

A

scarring at the site makes the mucosa very tough to advance

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72
Q

why is the mucosa being scarred/tough at the site of implant important

A

may not be able to advance/ achieve primary closure

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73
Q

what is an immediate implant?

A

implant placed immediately after XLA

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74
Q

what is a delayed immediate implant

A

implant placed 6-8 weeks after XLA

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75
Q

what is a delayed dental implant

A

implant placed anytime after 12 weeks after XLA

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76
Q

what does the number of implants increase

A

complexity of procedure

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77
Q

how is bone assessed before placing an implant

A

horizontally and vertically

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78
Q

what width of bone is needed to place an implant

A

7mm

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79
Q

what height of bone is needed to place an implant

A

8-10mm ideally

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80
Q

what type of mucosa is best for placing implants

A

thick biotype - keratinised

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81
Q

why is a thick biotype best for placing implants

A

can withstand the forces of cleaning and mastication

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82
Q

what is a thin biotype

A

lacking keratin

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83
Q

which vital structures do you have to be very careful placing an implant near to

A
  • IAN
  • max sinus
  • mental foramen
  • incisive foramen
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84
Q

why is the quality of papillae important in placing implants

A

very difficult to recreate if its lost

85
Q

why might the papilla already be lost before placing an implant

A

bone loss

86
Q

what might you want to do if the pt has recession but wants an implant

A

stabilise mucosa - treat recession then place implant

87
Q

what will happen if you dont treat recession first before placing an implant

A

poor aesthetics

88
Q

what makes up the aesthetic risk assessment for anterior implants

A
  • facial support
  • labial support
  • upper lip length
  • buccal corridor
  • smile line
  • maxillomandibular relationship
89
Q

what type of occlusion is important to consider carefully before placing anterior composites

A

traumatic malocclusion

90
Q

where is soft tissue of more importance when placing implants

A

posterior

91
Q

what happens if there is no keratinised mucosa in the area of an implant

A

becomes painful for the pt to clean properly

92
Q

what risk does no keratinised mucosa pose to implant placement

A

mucositis –> periimplantitis

93
Q

what is an increased width of keratinised mucosa associated with?

A

lower alveolar bone loss and better soft tissue health

94
Q

what thickness of keratinised tissue is beneficial to implant placement

A

> /= 2mm

95
Q

what aesthetic risk does a thin biotype pose to implants

A

may see the metal shining through the mucosa

96
Q

why does exposed threads of implants have poor prognosis

A

very difficult to clean

97
Q

why are exposed threads of implants very difficult to clean

A

because theyve been etched/sand blasted the surface is very rough –> plaque retentive factor

98
Q

what might recession or poor gingival health lead to in anterior implants

A

black triangle

99
Q

how can black triangles be helping in implants

A

soft tissue grafts prior to implant placement

100
Q

what is often characteristic to edentulous mandibles which can affect implant placement

A

knife edge ridge and undercuts

101
Q

what name describes increased size of the maxillary antrum

A

pneumatisation

102
Q

what should always be taken prior to implant placement

A

CBCT

103
Q

what anatomical feature may cause alot of bleeding at the time of implant placement

A

feeder blood vessels

104
Q

why does the quality of bone affect the initial stability of implant

A

friction fit

105
Q

which bone classifications are there

A

1-4

106
Q

where is class 1 bone found

A

anterior mandible

107
Q

what does class 1 bone consist of

A

almost exclusively cortical bone with very little trabecular bone

108
Q

how do type 2 and 3 bone differ from type 1

A

progressively more and more trabecular bone

109
Q

what is class 4 bone

A

almost exclusively trabecular bone

110
Q

where are class 3 and 4 bone found

A

mostly in maxilla

111
Q

where are class 1 and 2 bone found

A

mandible

112
Q

what classes of bone are good for implant placement

A

1 and 2

113
Q

why are types 1 and 2 bone good for implant placement

A

give very good primary stability - good friction fit

114
Q

why are types 3 and 4 bone not so great for implant placement

A

very spongy bone - instability

115
Q

what can instability of an implant lead to

A

fibrous encapsulation

116
Q

what does fibrous encapsulation of an implant lead to

A

failure

117
Q

what may affect the stability of an implant within the first few weeks of placement

A

osteoclastic bone remodelling

118
Q

when does an implant integrate and become more stable

A

once osteoblastic activity begins

119
Q

how long does an implant in type 1-3 bone take to become stable

A

6 weeks

120
Q

how long does an implant in type 4 bone take to become stable

A

12 weeks

121
Q

what should guide the time taken before loading an implant

A

bone type and stability

122
Q

why are photographs taken in implant placement

A
  • resting line
  • smile line
  • position of midlines
  • gingival recession /loss of papillae
  • occlusion
123
Q

why are radiographs taken in implant placement

A

assess :
- bone quality
- quality of adjacent teeth
- anatomical factors

124
Q

what is a DPT taken for in implant placement

A

to assess antrum, IDB and height

125
Q

what is the gold standard in implant placement

A

CBCT and radiographic stent planning software

126
Q

what does stent planning software do

A

provides markers so we can see the ideal implant placement

127
Q

what does the “safety zone” take into account in implant placement in regards to the IDC and mental foramen

A

coronal aspect of the mental foramen is 2mm above the IDC and mental foramen

128
Q

what shape does the IDC usually have thats significant to implant placement

A

‘S’ shape that hooks back on itself

129
Q

how can we assess exactly where the mental foramen is

A
  • CBCT
  • nabers probe
130
Q

what minimum distance is required from the implant shoulder to the adjacent tooth at bone level

A

1.5mm

131
Q

whats the average width of an implant

A

4.1mm

132
Q

what is the minimum space required between two teeth to be able to place an implant

A

7.1mm

133
Q

what is the minimum distance required between implant to implant shoulders

A

3mm

134
Q

how much space is required by gap dimensions to place an implant

A

7.5mm

135
Q

when is recountouring of bone often done

A
  • excess bone
  • knife edge ridges
  • mandibular tori/exostosis
  • undercuts
136
Q

where can onlay grafts be taken from

A
  • chin
  • ramus
  • illeac crest
137
Q

what are the 2 types of implants

A
  • bone level
  • tissue level
138
Q

how are tissue level implants placed

A

in 1 stage surgical technique

139
Q

which type of of implant has a highly polished tranamucosal collar

A

tissue level

140
Q

which part of the tissue level implant MUST be completely within the alveolar bone

A

‘endoosseous’ oxidised alloy

141
Q

what type of implants are used under dentures

A

tissue level

142
Q

how are bone level implants placed

A
  • 2 stage surgery
    1. only place the endossesous part so its flush with the alveolus
    2. exposed to place transmucosal section
143
Q

which type of implant is always used in anterior teeth

A

bone level

144
Q

which type of implant gives better aesthetic results

A

bone level

145
Q

what is placed in the first stage of bone level implant surgery

A

endosseous part

146
Q

what is placed in the second stage of bone level implant surgery

A

transmucosal part

147
Q

what type of ceramic is used for implants

A

zirconia –> Y-TZP

148
Q

what material advantage do ceramic implants have over titanium ones

A

higher fatigue strength

149
Q

what is the survival rate of ceramic implants after 3 years

A

97.5%

150
Q

what type of implant material is better for aesthetics

A

ceramic

151
Q

what type of forces are dental implants best at dealing with

A

occlusal compressive forces

152
Q

what type of forces do dental implants not deal with well

A

tensile or shear

153
Q

what are tensile forces

A

tilting

154
Q

what are rotating forces

A

rotating

155
Q

how much compressive force can an implant deal with in the posterior teeth

A

380-880N

156
Q

how much compressive force can an implant deal with in anterior teeth

A

<220N

157
Q

why can anterior implants handle less compressive force than posterior teeth

A

the angulation of the implant

158
Q

how much lateral/shearing force can implant handle

A

20N

159
Q

how many units can you add onto a cantilever implant bridge and why

A

1 - because of the shearing and lateral forces

160
Q

what should be the crown implant loading ratio

A

1.7

161
Q

what two factors does implant failure relate to

A
  • mechanical
  • biological
162
Q

give examples of biological factors that may cause implant failure

A
  • bruxism
  • poor vascularity of bone
  • poor bone quality/quantity
163
Q

name a mechanical factor that may lead to implant failure

A

breakage of abutment or implant

164
Q

when are immediate implants advised

A

when good bone quality

165
Q

which bone is often lost quickly after XLA

A

labial plate

166
Q

what happens in the time between XLA and implant placement in an immediate delayed technique?

A

soft tissue healing only

167
Q

what might be done in immediate delayed implant placement

A

bone graft

168
Q

what advantage do delayed implants have

A

better primary stability as the implant has bone to go into

169
Q

what time are elective implants placed after

A

> 4 months

170
Q

when are elective implants often placed

A

edentulous arches

171
Q

what is the average time frame between placing implants and loading them

A

8-12 weeks

172
Q

what happens if room temperature saline is used during implant placement that means it HAS to be cooled

A

osteoblasts will die off because its not cold enough

173
Q

how wide are pilot drills

A

2.2mm

174
Q

what size are yellow twist drills

A

2.8mm

175
Q

what size are red twist drills

A

3.5mm

176
Q

what size are red twist drills

A

4.2mm

177
Q

what are carries used for?

A

move the implant

178
Q

what does the profile drill do

A

places coronal flare

179
Q

what affinity to moisture does the implant surface have

A

hydrophilic

180
Q

why are depth gauges used early on in implant placement

A

to be able to change the angulation is needed

181
Q

what is the implant inserted using

A

torque wrench

182
Q

what is placed after the first stage of implant surgery (if 1 stage procedure)

A

healing screw

183
Q

what is placed after the first stage of implant surgery (if 2 stage procedure)

A

closure screw

184
Q

how long will the healing abutment stay in place before the pt is seen by restorative team in a 1 stage implant procedure

A

2-3 months

185
Q

why is the implant reviewed at 1 week post-placement

A

to check for wound breakdown/infection and to take PA to document angulation

186
Q

what does the closure screw/healing abutment do

A

stop soft tissue healing over it

187
Q

how long after implant placement in a 2 stage procedure will the implant be exposed and a taller healing abutment placed

A

2 months

188
Q

what does the healing abutment do in a 2 stage procedure

A

helps the tissue form around the collar the way it would for a natural tooth

189
Q

how long is the implant followed up for

A

2 years

190
Q

what are the radiographs taken at 1 and 2 years after implant placement looking for

A

crestal bone loss

191
Q

name 5 implant complications

A
  • wound breakdown
  • infection
  • early loss
  • mucositis
  • peri-implantitis
192
Q

how might wound breakdown happen after implant placement

A

overtightened sutures

193
Q

what do overtightened sutures after implant placement cause

A

oedema then breakdown/necrosis

194
Q

how can you ensure tension free sutures after implant placement

A

periosteal release

195
Q

what is the only evidence backed indication of antibiotic use in implant placement

A

1x 2g dose 1 hour before surgery of amoxicillin

196
Q

what can early loss of implants be related to

A

overheating of bone at time of placement

197
Q

what does mucositis relate to

A
  • poor OH
  • lack of keratinised tissue at site of implant
198
Q

is mucositis reversible

A

yes

199
Q

what is periimplantitis equivalent to

A

periodontitis for implants

200
Q

when is the implant likely to fail inn periimplantitis

A

once threads exposed

201
Q

what MUST cleaning instruments for implants be

A

plastic - not metal

202
Q

what are the 10 year survival rates of implants

A

> 90%

203
Q

what does failure to osseointegrate cause

A
  • early failure
  • implant lost completely
  • mobility
204
Q

what bone loss is normal for an implant a year after placement

A

1mm

205
Q

what bone loss is normal for an implant 2 years after placement

A

0.2mm

206
Q

what is wound dihisence

A

inflammatory response producing yellow sluth

207
Q

what is the yellow sluth in wound dihisence made of

A

fibrin

208
Q

what is the Tx of wound dihisence

A

topical chlorhexidine x2 day under recovered

module 8 (9 decks)

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