implantology Flashcards
1
Q
what % of all adults are edentulous
A
6
2
Q
what % of all adults have had at leats 1 tooth extracted
A
74
3
Q
in 2007, what % of paraesthesia relating to dental work was associated with implants
A
30
4
Q
what can an implant be made of
A
- metal
- ceramic
5
Q
what are the indications for implants
A
- replace single tooth
- replace multiple teeth - bridge
- full arch - denture
6
Q
what are the advantages of implants
A
- function
- aesthetics
- quality of life improvement
7
Q
why do implants improve function
A
gives a stable platform where restoration can rest
8
Q
who do implants improve quality of life most for
A
edentulous pts
9
Q
why does a pt need to be very motivated and compliant to have implants
A
lifetime of peri-implant care
10
Q
what must a pt have (dentally) before being considered for dental implants
A
stable dentition - no caries or perio
11
Q
how long must a pt be a non-smoker for to be considered for implants
A
3 months
12
Q
why cant the pt take any form of nicotine before having implants placed
A
because of the affect on vasculature
13
Q
how much more likely are implants to fail if the pt is a smoker
A
140%
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
15
Q
how old must a girl be to have implants
A
at least 18
16
Q
how old must a boy be to have implants
A
21
17
Q
what is there potential for if a pt having implants placed has poorly controlled diabetes
A
poor wound healing/ poor outcome
18
Q
what is the highest a pts HbA1c levels can be before not being eligible for implants
A
> 8
19
Q
which medication is an absolute contraindication to implants
A
IV bisphosphonates
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
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
22
Q
what % of implants fail in smokers
A
10%
23
Q
what should be done, from a legal standpoint, before placing dental implants in a smoker pt
A
have them sign disclaimer
24
Q
what 7 types of pt can have implants on the NHS
A
- congenital missing/malformed teeth
- trauma
- surgical interventions
- congenital defects
- edentulous with repeated denture failure
- severe oral mucosa disorders
- no suitable anchorage in ortho
25
name 4 conditions that cause missing/ malformed teeth making a pt eligible for dental implants
1. aggressive periodontitis
2. hypodontia
3. clefts
4. amelogenesis imperfecta/ DI
26
what form of periodontitis would make a pt eligible for implants
immune based form of the disease
27
what type of trauma would more often make a pt eligible for dental implants
significant loss of dentoalveolar structure - not usually single teeth
28
give an example of a surgical intervention that would make a pt eligible for dental implants
head and neck cancer, cysts
29
what might make repeated full denture efforts fail resulting in the pt being eligible for dental implants
- atrophic mandible
- gag reflex
30
which implant system is used in tayside
straumann
31
name 4 implant systems
- straumann
- hoissen
- nobel biocare
- dentsply serona
32
what compatibility must an implant have
- biological
- biomechanical
- morphological
33
what is meant by biomechanical implant compatibility
physiological forces of mastication and speech
34
what is meant by morphological implant compatibility
dimensions that are easily applied to the oral cavity
35
why cant dental implants be magnitised?
need to be MRI safe and have image compatibility
36
what is osseointegration
direct structural and functional connection between living bone and the surface of load-carrying implant
37
what happens if the implant transmits excessive forces
osteoclastic bone resorption
38
what is the max load an implant cannot exceed
physiological norm
39
why should loading forces be directed axially in dental implants
the bone resists this the best
40
name 3 host factors that would affect osseointegration
- bone density
- bone volume and bone to implant surface area
- parafunctional habits
41
why does bone density matter in implants
withstanding stresses
42
why is a big implant surface area beneficial
the bigger the surface area the better it can withstand loading forces
43
why are parafunctional habits important when it comes to implants
can overload the implant with force
44
name 4 implant factors that affect osseointegration
- implant macro design
- chemical composition and biocompatibility
- surface Tx and coatings
- restorative crown
45
how can the restorative crown of an implant affect osseointegration
cantilever can cause torsional force
46
what is produced on the surface of the implant during osseointegration
titanium oxide
47
what physiological feature does an implant lack
PDL
48
why is it beneficial for the implant metal to be hydrophilic
integrates better
49
what 3 factors of the implant can be changed to improve osseointegration
- surface chemical composition
- hydrophilicity
- roughness of the implant
50
how can the surface of an implant be made more rough
- titanium plasma spraying
- grit blasting
- acid etching
- calcium phosphate spraying
51
what is the advantages of implant surface modification
- greater amount of bone-implant contact
- more rapid integration
- higher removal of torque values
52
what are 2 metals commonly used in dental implants
- titanium
- zirconium
53
why are titanium and zirconium commonly used in dental implants
only two metals that don't inhibit that growth of osteoblasts
54
what is the name of a bone graft from the pt
antogenous bone
55
what is the name of a bone graft from another animal
xenograft material
56
what is the advantage of autogenous bone graft
heals faster
57
why does an autogenous bone graft heal faster than a xenograft material
already has the osteoblasts rather than having to recruit them
58
where would a xenograft material recruit osteoblasts from
the pts blood supply
59
how many grades of titanium are available for dental implants
4
60
how do the different grades of implant titanium differ
different amounts of carbon and iron
61
why is the level of titanium in dental implant alloys 50%?
reduces heat conduction and doubles resistance to corrosion
62
what are the 10 year survival statistics for dental implants
96-99% success
63
name 3 pt factors that you need to have before placing implants
- good OH
- good compliance
- well motivated pt
64
what is the pt at risk of if they dont take time to take care of their implants
- periimplantitis/ mucositis and then loss of implant
65
what is an implant pt at risk of if theyve had cancer of the head and neck
osteoradionecrosis
66
what dose of radiation can the are of the jaw before an implant pt is at increased risk of osteoradionecrosis
up to 50 greys
67
name 4 site related factors taken into account when placing implants
- perio status
- access for placement
- pathology near implant
- pervious surgery at site
68
what might affect access to place an implant
- TMD
- limited opening
- placing posterior implants
69
what pathology near an implant would be considrered before placing an implant
- perio
- cysts
- gingival pathology
- bone loss
70
why is bone loss important in placing implants
need adequate bone/soft tissue to heal implant
71
why might previous surgeries at the site of implant affect its placement
scarring at the site makes the mucosa very tough to advance
72
why is the mucosa being scarred/tough at the site of implant important
may not be able to advance/ achieve primary closure
73
what is an immediate implant?
implant placed immediately after XLA
74
what is a delayed immediate implant
implant placed 6-8 weeks after XLA
75
what is a delayed dental implant
implant placed anytime after 12 weeks after XLA
76
what does the number of implants increase
complexity of procedure
77
how is bone assessed before placing an implant
horizontally and vertically
78
what width of bone is needed to place an implant
7mm
79
what height of bone is needed to place an implant
8-10mm ideally
80
what type of mucosa is best for placing implants
thick biotype - keratinised
81
why is a thick biotype best for placing implants
can withstand the forces of cleaning and mastication
82
what is a thin biotype
lacking keratin
83
which vital structures do you have to be very careful placing an implant near to
- IAN
- max sinus
- mental foramen
- incisive foramen
84
why is the quality of papillae important in placing implants
very difficult to recreate if its lost
85
why might the papilla already be lost before placing an implant
bone loss
86
what might you want to do if the pt has recession but wants an implant
stabilise mucosa - treat recession then place implant
87
what will happen if you dont treat recession first before placing an implant
poor aesthetics
88
what makes up the aesthetic risk assessment for anterior implants
- facial support
- labial support
- upper lip length
- buccal corridor
- smile line
- maxillomandibular relationship
89
what type of occlusion is important to consider carefully before placing anterior composites
traumatic malocclusion
90
where is soft tissue of more importance when placing implants
posterior
91
what happens if there is no keratinised mucosa in the area of an implant
becomes painful for the pt to clean properly
92
what risk does no keratinised mucosa pose to implant placement
mucositis --> periimplantitis
93
what is an increased width of keratinised mucosa associated with?
lower alveolar bone loss and better soft tissue health
94
what thickness of keratinised tissue is beneficial to implant placement
>/= 2mm
95
what aesthetic risk does a thin biotype pose to implants
may see the metal shining through the mucosa
96
why does exposed threads of implants have poor prognosis
very difficult to clean
97
why are exposed threads of implants very difficult to clean
because theyve been etched/sand blasted the surface is very rough --> plaque retentive factor
98
what might recession or poor gingival health lead to in anterior implants
black triangle
99
how can black triangles be helping in implants
soft tissue grafts prior to implant placement
100
what is often characteristic to edentulous mandibles which can affect implant placement
knife edge ridge and undercuts
101
what name describes increased size of the maxillary antrum
pneumatisation
102
what should always be taken prior to implant placement
CBCT
103
what anatomical feature may cause alot of bleeding at the time of implant placement
feeder blood vessels
104
why does the quality of bone affect the initial stability of implant
friction fit
105
which bone classifications are there
1-4
106
where is class 1 bone found
anterior mandible
107
what does class 1 bone consist of
almost exclusively cortical bone with very little trabecular bone
108
how do type 2 and 3 bone differ from type 1
progressively more and more trabecular bone
109
what is class 4 bone
almost exclusively trabecular bone
110
where are class 3 and 4 bone found
mostly in maxilla
111
where are class 1 and 2 bone found
mandible
112
what classes of bone are good for implant placement
1 and 2
113
why are types 1 and 2 bone good for implant placement
give very good primary stability - good friction fit
114
why are types 3 and 4 bone not so great for implant placement
very spongy bone - instability
115
what can instability of an implant lead to
fibrous encapsulation
116
what does fibrous encapsulation of an implant lead to
failure
117
what may affect the stability of an implant within the first few weeks of placement
osteoclastic bone remodelling
118
when does an implant integrate and become more stable
once osteoblastic activity begins
119
how long does an implant in type 1-3 bone take to become stable
6 weeks
120
how long does an implant in type 4 bone take to become stable
12 weeks
121
what should guide the time taken before loading an implant
bone type and stability
122
why are photographs taken in implant placement
- resting line
- smile line
- position of midlines
- gingival recession /loss of papillae
- occlusion
123
why are radiographs taken in implant placement
assess :
- bone quality
- quality of adjacent teeth
- anatomical factors
124
what is a DPT taken for in implant placement
to assess antrum, IDB and height
125
what is the gold standard in implant placement
CBCT and radiographic stent planning software
126
what does stent planning software do
provides markers so we can see the ideal implant placement
127
what does the "safety zone" take into account in implant placement in regards to the IDC and mental foramen
coronal aspect of the mental foramen is 2mm above the IDC and mental foramen
128
what shape does the IDC usually have thats significant to implant placement
'S' shape that hooks back on itself
129
how can we assess exactly where the mental foramen is
- CBCT
- nabers probe
130
what minimum distance is required from the implant shoulder to the adjacent tooth at bone level
1.5mm
131
whats the average width of an implant
4.1mm
132
what is the minimum space required between two teeth to be able to place an implant
7.1mm
133
what is the minimum distance required between implant to implant shoulders
3mm
134
how much space is required by gap dimensions to place an implant
7.5mm
135
when is recountouring of bone often done
- excess bone
- knife edge ridges
- mandibular tori/exostosis
- undercuts
136
where can onlay grafts be taken from
- chin
- ramus
- illeac crest
137
what are the 2 types of implants
- bone level
- tissue level
138
how are tissue level implants placed
in 1 stage surgical technique
139
which type of of implant has a highly polished tranamucosal collar
tissue level
140
which part of the tissue level implant MUST be completely within the alveolar bone
'endoosseous' oxidised alloy
141
what type of implants are used under dentures
tissue level
142
how are bone level implants placed
- 2 stage surgery
1. only place the endossesous part so its flush with the alveolus
2. exposed to place transmucosal section
143
which type of implant is always used in anterior teeth
bone level
144
which type of implant gives better aesthetic results
bone level
145
what is placed in the first stage of bone level implant surgery
endosseous part
146
what is placed in the second stage of bone level implant surgery
transmucosal part
147
what type of ceramic is used for implants
zirconia --> Y-TZP
148
what material advantage do ceramic implants have over titanium ones
higher fatigue strength
149
what is the survival rate of ceramic implants after 3 years
97.5%
150
what type of implant material is better for aesthetics
ceramic
151
what type of forces are dental implants best at dealing with
occlusal compressive forces
152
what type of forces do dental implants not deal with well
tensile or shear
153
what are tensile forces
tilting
154
what are rotating forces
rotating
155
how much compressive force can an implant deal with in the posterior teeth
380-880N
156
how much compressive force can an implant deal with in anterior teeth
<220N
157
why can anterior implants handle less compressive force than posterior teeth
the angulation of the implant
158
how much lateral/shearing force can implant handle
20N
159
how many units can you add onto a cantilever implant bridge and why
1 - because of the shearing and lateral forces
160
what should be the crown implant loading ratio
1.7
161
what two factors does implant failure relate to
- mechanical
- biological
162
give examples of biological factors that may cause implant failure
- bruxism
- poor vascularity of bone
- poor bone quality/quantity
163
name a mechanical factor that may lead to implant failure
breakage of abutment or implant
164
when are immediate implants advised
when good bone quality
165
which bone is often lost quickly after XLA
labial plate
166
what happens in the time between XLA and implant placement in an immediate delayed technique?
soft tissue healing only
167
what might be done in immediate delayed implant placement
bone graft
168
what advantage do delayed implants have
better primary stability as the implant has bone to go into
169
what time are elective implants placed after
>4 months
170
when are elective implants often placed
edentulous arches
171
what is the average time frame between placing implants and loading them
8-12 weeks
172
what happens if room temperature saline is used during implant placement that means it HAS to be cooled
osteoblasts will die off because its not cold enough
173
how wide are pilot drills
2.2mm
174
what size are yellow twist drills
2.8mm
175
what size are red twist drills
3.5mm
176
what size are red twist drills
4.2mm
177
what are carries used for?
move the implant
178
what does the profile drill do
places coronal flare
179
what affinity to moisture does the implant surface have
hydrophilic
180
why are depth gauges used early on in implant placement
to be able to change the angulation is needed
181
what is the implant inserted using
torque wrench
182
what is placed after the first stage of implant surgery (if 1 stage procedure)
healing screw
183
what is placed after the first stage of implant surgery (if 2 stage procedure)
closure screw
184
how long will the healing abutment stay in place before the pt is seen by restorative team in a 1 stage implant procedure
2-3 months
185
why is the implant reviewed at 1 week post-placement
to check for wound breakdown/infection and to take PA to document angulation
186
what does the closure screw/healing abutment do
stop soft tissue healing over it
187
how long after implant placement in a 2 stage procedure will the implant be exposed and a taller healing abutment placed
2 months
188
what does the healing abutment do in a 2 stage procedure
helps the tissue form around the collar the way it would for a natural tooth
189
how long is the implant followed up for
2 years
190
what are the radiographs taken at 1 and 2 years after implant placement looking for
crestal bone loss
191
name 5 implant complications
- wound breakdown
- infection
- early loss
- mucositis
- peri-implantitis
192
how might wound breakdown happen after implant placement
overtightened sutures
193
what do overtightened sutures after implant placement cause
oedema then breakdown/necrosis
194
how can you ensure tension free sutures after implant placement
periosteal release
195
what is the only evidence backed indication of antibiotic use in implant placement
1x 2g dose 1 hour before surgery of amoxicillin
196
what can early loss of implants be related to
overheating of bone at time of placement
197
what does mucositis relate to
- poor OH
- lack of keratinised tissue at site of implant
198
is mucositis reversible
yes
199
what is periimplantitis equivalent to
periodontitis for implants
200
when is the implant likely to fail inn periimplantitis
once threads exposed
201
what MUST cleaning instruments for implants be
plastic - not metal
202
what are the 10 year survival rates of implants
>90%
203
what does failure to osseointegrate cause
- early failure
- implant lost completely
- mobility
204
what bone loss is normal for an implant a year after placement
1mm
205
what bone loss is normal for an implant 2 years after placement
0.2mm
206
what is wound dihisence
inflammatory response producing yellow sluth
207
what is the yellow sluth in wound dihisence made of
fibrin
208
what is the Tx of wound dihisence
topical chlorhexidine x2 day under recovered
