implantology Flashcards
what % of all adults are edentulous
6
what % of all adults have had at leats 1 tooth extracted
74
in 2007, what % of paraesthesia relating to dental work was associated with implants
30
what can an implant be made of
- metal
- ceramic
what are the indications for implants
- replace single tooth
- replace multiple teeth - bridge
- full arch - denture
what are the advantages of implants
- function
- aesthetics
- quality of life improvement
why do implants improve function
gives a stable platform where restoration can rest
who do implants improve quality of life most for
edentulous pts
why does a pt need to be very motivated and compliant to have implants
lifetime of peri-implant care
what must a pt have (dentally) before being considered for dental implants
stable dentition - no caries or perio
how long must a pt be a non-smoker for to be considered for implants
3 months
why cant the pt take any form of nicotine before having implants placed
because of the affect on vasculature
how much more likely are implants to fail if the pt is a smoker
140%
why can the pt NOT have any bruxism or parafunctional habits if they want implants
any forces NOT directed down the long axis of the implant are detrimental to its health
how old must a girl be to have implants
at least 18
how old must a boy be to have implants
21
what is there potential for if a pt having implants placed has poorly controlled diabetes
poor wound healing/ poor outcome
what is the highest a pts HbA1c levels can be before not being eligible for implants
> 8
which medication is an absolute contraindication to implants
IV bisphosphonates
what must a pt taking a short course of oral bisphosphonates be warned of
less risk than IV but still risk of MRONJ/ failure of implant
why might psychiatric/ mental health issues be a contraindication to dental implants
may not be compliant with attendance for Tx and after care
what % of implants fail in smokers
10%
what should be done, from a legal standpoint, before placing dental implants in a smoker pt
have them sign disclaimer
what 7 types of pt can have implants on the NHS
- congenital missing/malformed teeth
- trauma
- surgical interventions
- congenital defects
- edentulous with repeated denture failure
- severe oral mucosa disorders
- no suitable anchorage in ortho
name 4 conditions that cause missing/ malformed teeth making a pt eligible for dental implants
- aggressive periodontitis
- hypodontia
- clefts
- amelogenesis imperfecta/ DI
what form of periodontitis would make a pt eligible for implants
immune based form of the disease
what type of trauma would more often make a pt eligible for dental implants
significant loss of dentoalveolar structure - not usually single teeth
give an example of a surgical intervention that would make a pt eligible for dental implants
head and neck cancer, cysts
what might make repeated full denture efforts fail resulting in the pt being eligible for dental implants
- atrophic mandible
- gag reflex
which implant system is used in tayside
straumann
name 4 implant systems
- straumann
- hoissen
- nobel biocare
- dentsply serona
what compatibility must an implant have
- biological
- biomechanical
- morphological
what is meant by biomechanical implant compatibility
physiological forces of mastication and speech
what is meant by morphological implant compatibility
dimensions that are easily applied to the oral cavity
why cant dental implants be magnitised?
need to be MRI safe and have image compatibility
what is osseointegration
direct structural and functional connection between living bone and the surface of load-carrying implant
what happens if the implant transmits excessive forces
osteoclastic bone resorption
what is the max load an implant cannot exceed
physiological norm
why should loading forces be directed axially in dental implants
the bone resists this the best
name 3 host factors that would affect osseointegration
- bone density
- bone volume and bone to implant surface area
- parafunctional habits
why does bone density matter in implants
withstanding stresses
why is a big implant surface area beneficial
the bigger the surface area the better it can withstand loading forces
why are parafunctional habits important when it comes to implants
can overload the implant with force
name 4 implant factors that affect osseointegration
- implant macro design
- chemical composition and biocompatibility
- surface Tx and coatings
- restorative crown
how can the restorative crown of an implant affect osseointegration
cantilever can cause torsional force
what is produced on the surface of the implant during osseointegration
titanium oxide
what physiological feature does an implant lack
PDL
why is it beneficial for the implant metal to be hydrophilic
integrates better
what 3 factors of the implant can be changed to improve osseointegration
- surface chemical composition
- hydrophilicity
- roughness of the implant
how can the surface of an implant be made more rough
- titanium plasma spraying
- grit blasting
- acid etching
- calcium phosphate spraying
what is the advantages of implant surface modification
- greater amount of bone-implant contact
- more rapid integration
- higher removal of torque values
what are 2 metals commonly used in dental implants
- titanium
- zirconium
why are titanium and zirconium commonly used in dental implants
only two metals that don’t inhibit that growth of osteoblasts
what is the name of a bone graft from the pt
antogenous bone
what is the name of a bone graft from another animal
xenograft material
what is the advantage of autogenous bone graft
heals faster
why does an autogenous bone graft heal faster than a xenograft material
already has the osteoblasts rather than having to recruit them
where would a xenograft material recruit osteoblasts from
the pts blood supply
how many grades of titanium are available for dental implants
4
how do the different grades of implant titanium differ
different amounts of carbon and iron
why is the level of titanium in dental implant alloys 50%?
reduces heat conduction and doubles resistance to corrosion
what are the 10 year survival statistics for dental implants
96-99% success
name 3 pt factors that you need to have before placing implants
- good OH
- good compliance
- well motivated pt
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
what is an implant pt at risk of if theyve had cancer of the head and neck
osteoradionecrosis
what dose of radiation can the are of the jaw before an implant pt is at increased risk of osteoradionecrosis
up to 50 greys
name 4 site related factors taken into account when placing implants
- perio status
- access for placement
- pathology near implant
- pervious surgery at site
what might affect access to place an implant
- TMD
- limited opening
- placing posterior implants
what pathology near an implant would be considrered before placing an implant
- perio
- cysts
- gingival pathology
- bone loss
why is bone loss important in placing implants
need adequate bone/soft tissue to heal implant
why might previous surgeries at the site of implant affect its placement
scarring at the site makes the mucosa very tough to advance
why is the mucosa being scarred/tough at the site of implant important
may not be able to advance/ achieve primary closure
what is an immediate implant?
implant placed immediately after XLA
what is a delayed immediate implant
implant placed 6-8 weeks after XLA
what is a delayed dental implant
implant placed anytime after 12 weeks after XLA
what does the number of implants increase
complexity of procedure
how is bone assessed before placing an implant
horizontally and vertically
what width of bone is needed to place an implant
7mm
what height of bone is needed to place an implant
8-10mm ideally
what type of mucosa is best for placing implants
thick biotype - keratinised
why is a thick biotype best for placing implants
can withstand the forces of cleaning and mastication
what is a thin biotype
lacking keratin
which vital structures do you have to be very careful placing an implant near to
- IAN
- max sinus
- mental foramen
- incisive foramen
why is the quality of papillae important in placing implants
very difficult to recreate if its lost
why might the papilla already be lost before placing an implant
bone loss
what might you want to do if the pt has recession but wants an implant
stabilise mucosa - treat recession then place implant
what will happen if you dont treat recession first before placing an implant
poor aesthetics
what makes up the aesthetic risk assessment for anterior implants
- facial support
- labial support
- upper lip length
- buccal corridor
- smile line
- maxillomandibular relationship
what type of occlusion is important to consider carefully before placing anterior composites
traumatic malocclusion
where is soft tissue of more importance when placing implants
posterior
what happens if there is no keratinised mucosa in the area of an implant
becomes painful for the pt to clean properly
what risk does no keratinised mucosa pose to implant placement
mucositis –> periimplantitis
what is an increased width of keratinised mucosa associated with?
lower alveolar bone loss and better soft tissue health
what thickness of keratinised tissue is beneficial to implant placement
> /= 2mm
what aesthetic risk does a thin biotype pose to implants
may see the metal shining through the mucosa
why does exposed threads of implants have poor prognosis
very difficult to clean
why are exposed threads of implants very difficult to clean
because theyve been etched/sand blasted the surface is very rough –> plaque retentive factor
what might recession or poor gingival health lead to in anterior implants
black triangle
how can black triangles be helping in implants
soft tissue grafts prior to implant placement
what is often characteristic to edentulous mandibles which can affect implant placement
knife edge ridge and undercuts
what name describes increased size of the maxillary antrum
pneumatisation
what should always be taken prior to implant placement
CBCT
what anatomical feature may cause alot of bleeding at the time of implant placement
feeder blood vessels
why does the quality of bone affect the initial stability of implant
friction fit
which bone classifications are there
1-4
where is class 1 bone found
anterior mandible
what does class 1 bone consist of
almost exclusively cortical bone with very little trabecular bone
how do type 2 and 3 bone differ from type 1
progressively more and more trabecular bone
what is class 4 bone
almost exclusively trabecular bone
where are class 3 and 4 bone found
mostly in maxilla
where are class 1 and 2 bone found
mandible
what classes of bone are good for implant placement
1 and 2
why are types 1 and 2 bone good for implant placement
give very good primary stability - good friction fit
why are types 3 and 4 bone not so great for implant placement
very spongy bone - instability
what can instability of an implant lead to
fibrous encapsulation
what does fibrous encapsulation of an implant lead to
failure
what may affect the stability of an implant within the first few weeks of placement
osteoclastic bone remodelling
when does an implant integrate and become more stable
once osteoblastic activity begins
how long does an implant in type 1-3 bone take to become stable
6 weeks
how long does an implant in type 4 bone take to become stable
12 weeks
what should guide the time taken before loading an implant
bone type and stability
why are photographs taken in implant placement
- resting line
- smile line
- position of midlines
- gingival recession /loss of papillae
- occlusion
why are radiographs taken in implant placement
assess :
- bone quality
- quality of adjacent teeth
- anatomical factors
what is a DPT taken for in implant placement
to assess antrum, IDB and height
what is the gold standard in implant placement
CBCT and radiographic stent planning software
what does stent planning software do
provides markers so we can see the ideal implant placement
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
what shape does the IDC usually have thats significant to implant placement
‘S’ shape that hooks back on itself
how can we assess exactly where the mental foramen is
- CBCT
- nabers probe
what minimum distance is required from the implant shoulder to the adjacent tooth at bone level
1.5mm
whats the average width of an implant
4.1mm
what is the minimum space required between two teeth to be able to place an implant
7.1mm
what is the minimum distance required between implant to implant shoulders
3mm
how much space is required by gap dimensions to place an implant
7.5mm
when is recountouring of bone often done
- excess bone
- knife edge ridges
- mandibular tori/exostosis
- undercuts
where can onlay grafts be taken from
- chin
- ramus
- illeac crest
what are the 2 types of implants
- bone level
- tissue level
how are tissue level implants placed
in 1 stage surgical technique
which type of of implant has a highly polished tranamucosal collar
tissue level
which part of the tissue level implant MUST be completely within the alveolar bone
‘endoosseous’ oxidised alloy
what type of implants are used under dentures
tissue level
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
which type of implant is always used in anterior teeth
bone level
which type of implant gives better aesthetic results
bone level
what is placed in the first stage of bone level implant surgery
endosseous part
what is placed in the second stage of bone level implant surgery
transmucosal part
what type of ceramic is used for implants
zirconia –> Y-TZP
what material advantage do ceramic implants have over titanium ones
higher fatigue strength
what is the survival rate of ceramic implants after 3 years
97.5%
what type of implant material is better for aesthetics
ceramic
what type of forces are dental implants best at dealing with
occlusal compressive forces
what type of forces do dental implants not deal with well
tensile or shear
what are tensile forces
tilting
what are rotating forces
rotating
how much compressive force can an implant deal with in the posterior teeth
380-880N
how much compressive force can an implant deal with in anterior teeth
<220N
why can anterior implants handle less compressive force than posterior teeth
the angulation of the implant
how much lateral/shearing force can implant handle
20N
how many units can you add onto a cantilever implant bridge and why
1 - because of the shearing and lateral forces
what should be the crown implant loading ratio
1.7
what two factors does implant failure relate to
- mechanical
- biological
give examples of biological factors that may cause implant failure
- bruxism
- poor vascularity of bone
- poor bone quality/quantity
name a mechanical factor that may lead to implant failure
breakage of abutment or implant
when are immediate implants advised
when good bone quality
which bone is often lost quickly after XLA
labial plate
what happens in the time between XLA and implant placement in an immediate delayed technique?
soft tissue healing only
what might be done in immediate delayed implant placement
bone graft
what advantage do delayed implants have
better primary stability as the implant has bone to go into
what time are elective implants placed after
> 4 months
when are elective implants often placed
edentulous arches
what is the average time frame between placing implants and loading them
8-12 weeks
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
how wide are pilot drills
2.2mm
what size are yellow twist drills
2.8mm
what size are red twist drills
3.5mm
what size are red twist drills
4.2mm
what are carries used for?
move the implant
what does the profile drill do
places coronal flare
what affinity to moisture does the implant surface have
hydrophilic
why are depth gauges used early on in implant placement
to be able to change the angulation is needed
what is the implant inserted using
torque wrench
what is placed after the first stage of implant surgery (if 1 stage procedure)
healing screw
what is placed after the first stage of implant surgery (if 2 stage procedure)
closure screw
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
why is the implant reviewed at 1 week post-placement
to check for wound breakdown/infection and to take PA to document angulation
what does the closure screw/healing abutment do
stop soft tissue healing over it
how long after implant placement in a 2 stage procedure will the implant be exposed and a taller healing abutment placed
2 months
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
how long is the implant followed up for
2 years
what are the radiographs taken at 1 and 2 years after implant placement looking for
crestal bone loss
name 5 implant complications
- wound breakdown
- infection
- early loss
- mucositis
- peri-implantitis
how might wound breakdown happen after implant placement
overtightened sutures
what do overtightened sutures after implant placement cause
oedema then breakdown/necrosis
how can you ensure tension free sutures after implant placement
periosteal release
what is the only evidence backed indication of antibiotic use in implant placement
1x 2g dose 1 hour before surgery of amoxicillin
what can early loss of implants be related to
overheating of bone at time of placement
what does mucositis relate to
- poor OH
- lack of keratinised tissue at site of implant
is mucositis reversible
yes
what is periimplantitis equivalent to
periodontitis for implants
when is the implant likely to fail inn periimplantitis
once threads exposed
what MUST cleaning instruments for implants be
plastic - not metal
what are the 10 year survival rates of implants
> 90%
what does failure to osseointegrate cause
- early failure
- implant lost completely
- mobility
what bone loss is normal for an implant a year after placement
1mm
what bone loss is normal for an implant 2 years after placement
0.2mm
what is wound dihisence
inflammatory response producing yellow sluth
what is the yellow sluth in wound dihisence made of
fibrin
what is the Tx of wound dihisence
topical chlorhexidine x2 day under recovered
