1. replace single tooth 2. implants as a bridge/cantilever 3. placement of dentures when full arch missing

Implantology Flashcards by Rohmat Ali

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

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currently in the uk it is estimated that 6% of adults are edentulous and 74% have had

1 tooth removed

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what are the complications of dental implants with poor compliance from patients

peri-implant mucositis

periimplantitis

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the placement of implants incorrectly can result in

nerve damage

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in 2007 what percentage of all nerve injuries was associated with implants

30%

10% in 1997

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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

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what is alloplastic

any artificial material substituted for tissue grafts

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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

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what features of implants allow for bone and tissue reproduction

osteoconductive and osseointergration

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what is xenograft

a tissue graft or organ transplant from a donor from a different species

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why place implants

replace single tooth
implants as a bridge/cantilever
placement of dentures when full arch missing

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what are the advantages of placement of implants

function
aesthetics
quality of life

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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

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can you undertake implant treatment with patients with small amount of caries

you must not undertake treatment for with active disease

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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

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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%

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how can you detect that a patient has been smoking

blood tests can detect nicotine metabolites

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how many people will lose their implants if they smoke?

1/5 - 1/10 will loose implant if they smoke

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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

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what affects do bruxism or parafunctional habits have implants

places excess force on implnts

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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

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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

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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

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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

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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

1. patients with congenital, inherited disorders that have led to missing teeth, tooth loss or malformed teeth 2. patients with traumatic vents leading to tooth loss 3. patients with surgical interventions resulting in tooth and tissue loss 4. patients with congenital or acquired conditions with extra-oral defects. 5. patients who are edentulous in either one or both arches, where repeated conventional denture treatment options have been unsuccessful 6. patients with severer oral mucosal disorders and severe xerostomia where conventional prosthetic treatment is not possible 7. 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

1. congenital hypodontia 2. cleft lip and palate 3. amelogenesis imperfecta 4.dentiniogenis imperfecta 5. 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

1. bone density: withstanding stresses of physiological loading 2. bone volume and implant surface area: the bigger the area the more the bone can withstand 3. 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

1. implant macro design 2. chemical composition and biocompatibility 3. surface treatment and coatings: can improve osseointergration 4. implant tilting, prosthetic passive fit, crown height, occlusal table, loading time, cantilever (can cause tortional force)

what are the factors that increase osseointergration

1. surface chemical composition 2. roughness 3. 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

1. perio status 2. access 3. pathology near implant site - perio patho - gingival pathology 4. 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

1. bone volume horizontally and vertically present 2. 7mm of width maximum 3. 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