Implants Flashcards
Characteristics of ideal tooth replacement
Firm, does not destroy adjacent tooth preserve alveolar bone senate, easy to clean
What are mucosal inserts
Buttons in mucosa alone holding dentures in place. Not firm
Endodontic stabilizer
Historically, through apex of tooth into bone cause difficulty extracting
What is suprapeniostal implant
Raise flap and take impression and place cobalt chrome
Blade implant
Hard to retrieve
Trans mandibular implant
Difficult to retrieve
Definition of dental implant
Permucosal device
Bio compatible and biofunctional.
Placed within mucosa or on or within bone
Associated w oral cavity
To provide support forfixed or removable prosthesis
Definition of osteo integration
Time - dependent healing process
Finically asymptomatic rigid fixation
Of aloplastic materials
Is achieved and maintained in bone during loading
How are root form implants classified
By shape: cylindrical/tapered
Threaded/non-threaded (press fit)
Surface finish: polished/treated (acid etched, sand blasted)
Material: conventionally pure titanium, titanium alloy is stronger
Parts of implants
Implant body fixture
Abutment
Prosthetic
Vs
Single piece: harder to manage when fails
Surgical procedure of implants placement
Delayed loading
- Initial surgery
- Ossointegration period
- Abutment connection
- Final prosthetic restoration
If you need bone graft, wanna place safe
Immediate loading (for aesthetic zone)
temp crown on top of abutment
What happens when its not osseointegration but fibrous integration
Implant moves, poor long term success
Factors affecting success of osteo integration
Biocompatibility of material: commercially pure titanium, titanium alloy, zirconium, HA
Implant adaptation to prepared site
Atraumatic surgery: minimal tissue violence,
Undisturbed healing process
Successful implants have unbroken perimucosal seal between soft Tissue and implant abutment surface
Just long junctional epithelium,no PDL no sharpie fibres
Implant surface design
Pitch: threads per unit length
Increased pitch and depth allows for more contact area
Moderately rough surface with 1.5 micron improve contact area between bone and implant surface
Types of bone quality
Quality 1: homogenous compact bone, anterior lower jaw, less blood supply than rest of types, 5 months of OI, very dense that when you drill bone will over heat
Quality 2: thick layer of cortical bone surrounding dense trabecular, posterior lower jaw, 4 months of OI, bestest bone
Quality 3: thin cortical bone surrounding dense trabecular, in anterior upper jaw, 6 months OI
Quality 4: very think cortical bone w Low density trabecular bone, posterior upper jaw, 8 months OI
Surgical protocol
Atraumatic surgery: minimal tissue violence,
sharp instruments,
careful cooling (bone temp below 45 degrees),
use graded series of drills (tiny to big),
intermittent drilling,
moderate insertion torque cos strong torque result in stress and resorption
Biomechanics
Force and magnitude, fixed prosthesis more force, implant designs (distribute stress)
Complications of surgery
Failure of osteointegration: depends on location and bone quality
IDN posterior to mental foramen: required CBCT, DPT has magnification, take informed consent
Infection: peri-implantitis, active infection site, exposure of rough surface to oral fluids, manage with antibiotic therapy
Maxillary sinus: penetration usually not problem tight fit no communication, need to do sinus lift
Biological: lingual pouch, hit a vessel excessive bleeding
Aesthetic failure: if patient think ugly then is failure alr, lack of labial bone, inability to shade match, loss of papilla, recession
Fracture: excessive insertion torque, excessive cantilever, poor selection and design
Insertion wrong angulation: remove or bury, off axis loading, injury to adjacent teeth, unrestorability
Factors affecting survival: patient
Local: bone quality, bone quantity, periodontal health, anatomical structures, soft tissues
Systemic: immune suppression- diabetes, allotransplantation, poor healing, infection, drug exposure to bisphosphonates, previous radiotherapy
Habits: smokers, brutish, grinding, occupation, age (alveolarbone grows until 18, so later your bone grows over your implant gg)
Bone grafting types
Osteogenic: presence of viable osteoblasts and osteocytes in graft with direct healing and formation of new bone and blood vessels (autogenous marrrow)
Osteoconductive: inorganic material only, conducts path for osteoclasts to resort hydroxyapatite crystals and osteoblast from host bed to form new osteons (animal/cadevar)
Osteoinductive: organic portions of bone induces formation of new osteoblasts from osteoprogenitor cells (autogenous)
Autogenous, allogenous (human), xenogenous (animal), alloplastic (synthetic)
Must all be fixated in place if not disrupt angionenesis
What’s the easiest implant
Single tooth, adequate bone, space, soft tissue: upper premolar
What are some osteoactive agents
Osteoactive agents help support formation
Osteoinducers: rh BMP
Osteopromoters- TGF beta, PDGF, IGF, PRP (from blood into rich plasma)
Stem cells and tissue engineering, you need screws or titanium mesh
Where to take bone
Adjacent bone is best
Bone from drills
Mandibular Ramus, menton (incisive nerve), Coronoid
Maxillary tuberosity
Femur
New materials for bone graft
Regenerative material: PCL (poly caprolactone )
Sugars- heparin sulfate
MSC (mesenchymal stem cell derived) exosomes
Tissue engineered scaffolds
What are some newer advances in implantology
Computer aided surgery
Regenerative implants
Tissue engineering
