Implants Flashcards
What is the success rate of implants?
95% at 3 years
90% at 10 years
What is the criteria of implant success?
-No implant mobility
-No perimplant radiolucency
-Minimal crestal bone loss (<0.2 mm /year)
-No pain, infection or discomfort
-Able to be restored prosthetically
What factors affect the success rate of implants?
-Diabetes: 90% 5 year survival rate with glycemic control, consider antibiotic prophylaxis and smoking cessation
-Osteoporosis: 130% increase in chance of failure in patients with thin cortical bone (vs thick)
-Bisphosphonates
-Smoking: 3 week holiday may be helpful, 11.3 vs 5% failure
-Age: Use cessation of growth standards, no upper limit as long as pt healthy
Describe situations of pediatric implant placement.
Group 1: Congenitally missing tooth (delay until all permanent teeth erupt, high risk of ankylosis
Group 2: Oligodontia (ectodermal dysplasia). Delay until able to maintain adequate hygiene (age 7), low risk of ankylosis due to abnormal alveolar growth
Group 3: Acquired anadontia (trauma, tumors). Minimal risk of ankylosis including grafted sites
Do you do implants on patients that have taken bisphosphonates?
-Minimal risk for osteoporosis patient w/o other risk factors, drug holiday controversial
-Contraindicated in patients taking due to malignant disease
What is the definition of osseointegration?
-Direct and highly differentiated connective tissue (free biologic bond between implant and bone at the light microscopic level)
What are the requirements for ossseointegration?
-Bicompatible implant material (titanium alloy most common, better than commercially pure titanium)
-Precise bone osteotomies, atraumatic surgery, primary stability
What are surface treatments?
-Increased surface area/bone contact, faster integration
-Ex: Titanium plasma spray, hydroxyapatite plasma spray, titanium oxide, acid-etch, grit blasted
What are the temp requirements with implant placement?
-<47 degrees C, use cold irrigation, sharp burs, low speed
Describe your clinical exam for an implant patient.
-Standard head and neck exam
-Occlusion (max/mand relationship, occlusal clearance)
-Bone height/width/quality
-Bony undercuts
-Pattern of bone loss
-Soft tissue thickness
-Amount of keratinized gingiva
-Condition of mucosa
-Proximity to sinus/nerves
Describe your radiographic exam on an implant patient.
Panorex: Know degree of magnification or use BB pan
-Lateral ceph for class II or III patients
-CBCT if surgical guide case
What are the minimum bone distances for implants?
-Buccal plate: 0.5 mm
-Lingual plate: 1 mm
-Nasal floor: 1 mm
-Inter-implant: 3 mm
-IAN: 2 mm
-Mental foramen: 5 mm due to anterior loop
-Implant-natural tooth: 1.5 mm
How long do you let implants integrate?
-Anterior mandible 3 mo
-Posterior mandible 4 mo
-Anterior maxilla 4-6 mo
-Posterior maxilla 6 mo
-Grafted bone 4-6 mo
How much torque do you need for an immediate loaded implant?
> 35 nCm
What is the ideal implant load/angulation?
-Ideal location centered under restoration
-Load along long axis of implant
-Maxilla slight angle towards buccal, mandible slight angle to lingual
-Occlusal forces directed upon long axis of opposing tooth
Describe cantilever distances in implants.
-AP spread: Cantilever to last tooth should be <2x AP spread
-<1.5x with 4 implants
-V shaped arch better than square shaped
What distance is used for anterior esthetics?
Distance below CEJ of adjacent tooth is 3 mm
How is an interdental papilla estimated?
Distance from contact point to crestal bone
-<5 mm papilla present 100%
-6 mm papilla present 56%
-7 mm papilla present 27%
Describe soft tissue augmentation?
Goal is to increased keratinized tissue
-Can be done prior to bone grafting, non-submerged implant placement or at 2nd stage
-Subepithelial CT graft, palatal roll, free gingival graft
What type of bone graft is puros?
Allogenic
What are materials that can be used in GTR?
-Resorbable: Collagen, acellular dermis, lamellar bone
-Non-resorbable: e PTFE (gore-tex). Can be Ti reinforced
What are the principals to distraction osteogenesis?
-5-7 days of latency
-Distract 1 mm/day
-Consolidate x3 months
What are requirements for zygomatic implants?
Can support hybrid prosthesis only
Full arch restoration requires additional 2-4 anterior maxillary implants
What is the all-on-4 technique?
-Maximize AP spread
-Angle posterior implants to avoid maxillary sinus/mental nerve
Hybrid prosthesis
How many implants required for a fixed PFM?
-6-8 implants. Need adequate bone/soft tissue. Need precise implant placement
What are the space requirements for hybrids and over-dentures?
-Hybrid: 15 mm of vertical space
-Overdenture: 12 mm space
What is peri-implantitis?
Mucosal inflammation with bone loss
Causes: Mechanical overload/bruxism
Bacteria similar to perio disease (gm negative anerobic P gingivalis, p intermedia)
What is the treatment for peri-implantitis?
Remove etiology
-Surgical exposure, debridement, removal of granulation tissue, decontamination (remove biofilm), GBR
