Implantology Flashcards
the WHO in 2001 recognised edentulismm is a major public health problem that starts as impairment which eventually creates a
disability, turning in to a handicap
currently in the uk it is estimated that 6% of adults are edentulous and 74% have had
1 tooth removed
what are the complications of dental implants with poor compliance from patients
peri-implant mucositis
periimplantitis
the placement of implants incorrectly can result in
nerve damage
in 2007 what percentage of all nerve injuries was associated with implants
30%
10% in 1997
what is a dental implant
a prosthetic device of alloplastic material implanted into the oral tissues beneath the mucosa and/or periosteal layer and /or within the bone to provide retention and support for a fixed or a removeable prosthesis
what is alloplastic
any artificial material substituted for tissue grafts
what is an alloplastic implant
alloplastic implants are osteoconductive and can bridge wounds by osseointergration. after the initial insertion of an alloplastic implant, the implant acts as a guide and pathway for the continum of bone and tissue reproduction
what features of implants allow for bone and tissue reproduction
osteoconductive and osseointergration
what is xenograft
a tissue graft or organ transplant from a donor from a different species
why place implants
- replace single tooth
- implants as a bridge/cantilever
- placement of dentures when full arch missing
what are the advantages of placement of implants
- function
- aesthetics
- quality of life
what are the indications for implants
- committed to maintenance of periimplant health
- well maintained dentition free of caries and periodontally sound
- systemically well
- non-smoker
- not immunocompromised
- no bruxism or parafunctional habits
can you undertake implant treatment with patients with small amount of caries
you must not undertake treatment for with active disease
A big NO in the NHS is being a smoker and implants
you will not receive implants
how long do you have to be a non smoker for to qualify for implants
non smoker for minimal of three months
this includes nicotine vape
nicotine has a profound affect on the vasculature
a systematic review done by mustapha
showed that implants placed in smokers present with higher risk of failure compared to non smokers
by how much percentage do they fail
140.2%
how can you detect that a patient has been smoking
blood tests can detect nicotine metabolites
how many people will lose their implants if they smoke?
1/5 - 1/10 will loose implant if they smoke
why is it important the patient is not immunocompromised when undergoing implant treatment
so they can cope better with the physiological stress of the trauma of placing a dental implant
goes hand in hand with impaired wound healing
what affects do bruxism or parafunctional habits have implants
places excess force on implnts
why is age a contraindication for receiving dental implants
anyone younger than 18 is still growing, so you wouldn’t place implants in anyone who hasn’t completed growth
females ok after 18
some males continue growth at the TMJ in early 20’s
implants can get malpositioned with jaw growth
what are the medical health contraindications for implant placement
- poorly controlled diabetes (HBA1c greater than 8)
- bisphosphonate treatment
- psychiatric and mental health issues
- other conditions such as blood disorders, immunodeficiency
- alcohol/drug abuse/bone disorders and epilepsy
- taboacco use
why is poorly controlled diabetes HBA1C >8) a contraindication
greater risk of poor wound healing
poorly controlled diabetic patient need to be under 8 to be considered for treatment
which type of bisphosphonate treatment may allow patients to receive implants
I.V Bisphosphonates an absolute contraindication
Oral bisphosphonates less risk, but must be in discussion for the consent process
why might psychiatric and mental health issues contraindicate implant treatment
may not be compliant with attendance for treatment after care
who can get an implant on the NHS is governed by
the royal college of surgeons of england 2019
who are the priority groups who can get dental implants under the NHS
- patients with congenital, inherited disorders that have led to missing teeth, tooth loss or malformed teeth
- patients with traumatic vents leading to tooth loss
- patients with surgical interventions resulting in tooth and tissue loss
- patients with congenital or acquired conditions with extra-oral defects.
- patients who are edentulous in either one or both arches, where repeated conventional denture treatment options have been unsuccessful
- patients with severer oral mucosal disorders and severe xerostomia where conventional prosthetic treatment is not possible
- patients who do not have suitable existing teeth that can be used for anchorage for orthdontic treatment
patients with congenital, inherited disorders that led to missing teeth, tooth loss or malformed teeth include
- congenital hypodontia
- cleft lip and palate
- amelogenesis imperfecta
4.dentiniogenis imperfecta - aggressive periodontitis
what can affect repeated failure of conventional denture treatment
atrophic jaw
flat maxilla
profound gag reflex
what are the three parts to a strauman implant
crown
abutment
implant
what are the implant requirements
alloplastic material has to have a wide margin for safety
biocompatible
MRI safety
produce good image compatibility
what is osseointergration
a direct structural and functional connection between ordered living bone and the surface of a load-carrying implant
implants can transmit excessive forces to the bone, that physiologically would cause
osteoclastic bone resorption
which ever implant is placed, it is important that maximum loading does not exceed
physiological norms
loading should be done primarily
axial, long axis of the implant, which is what the bone resists the best
what type of forces does bone not like being transmitted
bones doesnt like forces transmitted in rotary or tilting position, cause that is not physiologically acceptable to the bone
factors affecting osseointergration include host and implant factors what are the host factors
- bone density: withstanding stresses of physiological loading
- bone volume and implant surface area: the bigger the area the more the bone can withstand
- parafunctional habits: overloading of implants caused by bruxism, which causes tortional movement
factors affecting osseointergration include host and implant factors what are the implant factors
- implant macro design
- chemical composition and biocompatibility
- surface treatment and coatings: can improve osseointergration
- implant tilting, prosthetic passive fit, crown height, occlusal table, loading time, cantilever (can cause tortional force)
what are the factors that increase osseointergration
- surface chemical composition
- roughness
- hydrophilicity
what two metals are used in implants
titanium and zircronium only two metals that do not inhibit the growth of osteoblasts
what is a sinus lift
when placing implants in the maxilla, when there is not sufficient bone volume, then more bone needs to be added to the site via sinus lift
where can get bone from to place a sinus lift
endogenous bone
from patient
xenograph - cow
how long should you wait for the bone to heal after placing a sinus lift
6 months
why does using bone from the patient themselves improve the recovery time for a sinus lift
patints own bone is populated with ostoblasts and bone morphogenic proteins
this allows bone to be produced straightaway rather than recruited from blood supply
According to the Royal College Guidelines which of the following patients would not be suitable for dental implants in the NHS?
A 85 year-old man with an atrophic mandible with COPD
A 69 year old woman with a profound gag reflex who has rheumatoid arthritis
A healthy 17 year old professional rugby player who knocked out tooth 11
A 23 year old patient who has a non-vital tooth 11 and wants an implant
A 45 year old patient who had teeth removed as part of his treatment for oropharyngeal cancer
A 23 year old patient who has a non-vital tooth 11 and wants an implant
tooth is non vital can still have alternTIVE TREATMENT
- RCT
Which is these conditions is a not a contraindication to dental implants on the NHS
A diabetic patient with HBA1c of 12
A patient with myeloma on intravenous bisphosphonates
A smoker who stopped 6 months ago and started using a nicotine containing vape
A patient with Sjogren’s syndrome
A patient with extreme bruxism
A patient with Sjogren’s syndrome
Which of the following materials has not been used as a dental implant?
Type 4 titanium alloy
Titanium/ zirconium alloy
Cobalt chromium
Iron
teeth
Iron
ideally you need about how many mm of bone width between the adjacent teeth
7mm
What factors are not considered important for osseointegration?
Biocompatibility
MRI safe
Bone volume
Surface modification
Angulation of implant
loading
MRI safe
what patient related factors determine whether a patient will receive dental implants
well motivated
excellent oral hygiene
very good compliance
what patient medication factors determine whether a patient will receive dental implants
medical fitness that affect poor wound healing
medication, anything that facilitates MRONJ, steroids (affect wound healing)
radiation treatment - risk of osteoradionecrosis
growth phase
what are the site related factors when placing an implant
- perio status
- access
- pathology near implant site
- perio patho
- gingival pathology
- previous surgery at site (scarring)
what are timings for when you place an implant
immediate implant - after extraction
delayed immediate implant - 6-8 weeks after extraction
delayed implant placement - 12 w - 6 m
what are anatomically bone requirements for an strauman implant
- bone volume horizontally and vertically present
- 7mm of width maximum
- 8-10 mm of length available
what is required for the anatomy of the soft tissue
keratinised mucosa
- withstands forces of cleaning and mastication
- thick biotype
- soft tissue quality
what anatomical structures do we have to be careful about when placing implants
maxillary sinus
incisive foreman
inferior alveolar canal
mental forman
what class bones are good for primary stability
class 1 and class 2 bone
found in the mandible - anterior
greater concentration of cortical bone
class 3 and 4 found in maxilla
when placing implants you may see that you have good stability, however stability is reduced after a few weeks why
this is as a result of the remodeling process, and you get osteoclastic activity
however after a set time the stability increases as you get osteoblastic activity leading to osseointergration
primary stability due to friction fit
instability = fibrous encapsulation = failure
A minimal distance of 1.5 mm from the implant shoulder to the adjacent tooth at bone level (mesial and distal) is required.
A minimal distance of 3 mm between two adjacent implant shoulders (mesiodistal) is required or 7 mm between the centre of each implant
two types of implants what are they
tissue level implant - 1 stage surgical technique
bone level implant 2 stage surgery- 1st stage
when would you opt to use a bone level implant instead of tissue level implant
when aesthetics is concerned
