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Oral surgery > Implantology > Flashcards

Implantology Flashcards

1
Q

Predictors for long term success of implants

A
  • Sufficient volume of healthy bone
  • Density of bone

Healthy bone to house adequate size and no. of implants
Failure of impants associated with bone with low mineral content

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2
Q

Main clinical manifestation of a successful implant

A
  • Absence of mobility
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3
Q

Main determinants of implant stability

A
  • Mechanical properties of the bone tissue at implant site
  • Implant engagement with bone tissue
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4
Q

Mechanical properties of the bone tissue at implant site dettermined by

A
  • Composition of bone at implant site
  • Stage of healing

Trabecular bone transformed into dense cortical bone near implant surface

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5
Q

Transformed into dense cortical bone near implant surface

A

Trabecular bone

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6
Q

Implant engagement with bone tissue dettermined by

A
  • Surgical technique
  • Design of implant
  • Osseointegration process
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7
Q

Successful healing of implant results in

A
  • Bone formation reinforcing interface zone
  • Forms bridges and direct contact between implant surface and surrounding bone
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8
Q

Unsuccessful healing of implant results in

A
  • Interface fibrous scar tissue
  • Caused by infection or mobility of implant after placement
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9
Q

A clinically stable implant shows a degree of mobility

A

True

This is on the microscale for example the application of a lateral load(bending)-implant is displaced and then returns to natural position

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10
Q

Types of load implants are subject to

A
  • Axial
  • Lateral
  • Rotational
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11
Q

Axial loads direction

A

Push in /pull out direction

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12
Q

Lateral loads direction

A

Any direction 360 degrees around implant

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13
Q

Rotational loads direction

A

Clockwise or counter clockwise

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14
Q

Primary implant stability

A

Contact between implant surface and surrounding bone at placement

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15
Q

Primary implant stability depends on

A
  • Bone
  • Surgical technique
  • Implant design
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16
Q

Implants

Biomechanical properties of bone dettermined by

A
  • Ratio of cortical to trabecular bone at implant site
17
Q

Cortical bone for implants

A
  • Outer layer of bone beneath periosteum
  • Densly packed mineralised lamallae
  • 10-20 stiffer than trabecular bone->better support
18
Q

Trabecular bone for implants

A
  • Porous structure
  • More soft tissue components than mineralised tissue
19
Q

Surgical technique effect on implant stability

A
  • Choice of drill diameters
  • Depth of preparation
  • Whether pretapering is used or not
  • 1 degree implant taper

Using thinner drill diameters, omitting pretaperinf and use of a tapered implant results in higher primary stability

20
Q

Secondary implant stability

A
  • Delayed bone response after implant placement
  • Change in cortical/trabecular bone ratio
  • Increasing degree of bone implant contact
  • 12-18 months
21
Q

Other endogenous and exogenous factors that influence implant healing and bone remodelling capacity

A
  • Patient general health
  • Use of drugs
  • Smoking
  • Irradiation
22
Q

Overload threshold is lower for

A

Implants with low stability than for one with high stability

23
Q

Bone healing response after implant placement

A
  1. Blood clot formation
  2. Fibrin network provides scaffold
  3. Mesenchymal cells in granulation tissue differentiate to preosteoblasts then osteoblasts to form bone

  1. Erythrocytes, leukocytes, thrombocytes
  2. Aids migrating cells involved in formation of new vessels, extracellular matrix and bone
24
Q

Stages of bone regeneration

A
  1. Immature woven bone replaced with mature lamellar bone
  2. Early bone formation after 3-4 months
  3. Remodelling process of repair-another 9-12 months

  1. Performed by bone metabolising units-osteoclasts and osteoblasts
25
Q

Can result in more rapid integration of implants

A
  • Rougher implant surface
  • More bone contacts at earlier stage
26
Q

Two types of implant integration

A
  • Contact osteogenesis
  • Distance osteogenesis
27
Q

Implant intergration by formation of bone directly to implant surface

A

Contact osteogenesis

28
Q

Bone formation from pre-existing bone surfaces towards implant surface

A

Distance osteogenesis

29
Q

Benifits of rougher implant surface

A
  • Initial blood clot better retained to implant surface
  • Clot acts as scaffold for migration of mesenchymal cells to interface
  • In smooth implants-shrinkage of blood clot after some time results in gap at implant interface
  • Better results in situations where bone grafting and immediate loading required
30
Q

The soft tissue barrier around an implant is important for

A
  • Implant stability and long term clinical function
  • Protects integrity of bone implant interface
31
Q

Morphology of soft tissue barrier around implant

A
  • Similar to gingiva around teeth
  • Sulcus epithelium
  • Contact epithelium followed by zone of connective tissue down to marginal bone

Difference between soft tissue barrier around implant and gingiva is direction of collagen fibres which run parallel with implant/abutment surface-perpendicualar fibres also present at teeth

32
Q

Expected bone loss during healing and first year of implant loading

A

0.5-1.5mm

Surface roughness and geometric features such as microthreads at neck of implant may reduce marginal bone loss

33
Q

Implant components

A
  • Implant fixture
  • Cover screw
  • Abutments
34
Q

Indications for implant treatment

A
  • Edentulism
  • Partial edentulism
  • Single tooth loss
35
Q

Contra-indications to implant treatment

A
  • Untreated periodontal disease
  • Periapical lesions in adjacent teeth
  • Untreated jaw bone infections or cysts
  • Terminal illness
  • Uncontrolled metabolic disease
  • Severe bleeding disorders
36
Q

Systemic risk factors of poor implant performance

A
  • Local bone quality
  • Bisphosphonate treatment in osteoporosis
  • Metabolic disease-diabetes
  • Smoking
  • Chemotherapy

Intravenous bisphophonate treatment may increase jaw osteomyelitis and necrosis as well as combination with corticosteroids
Smoking affects peripheral microcirculation and wound healing as well as bone quality

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