Implants

Question 1

What are the 2 stages of osteointegration?

Answer 1

Primary - implant anchored to bone due to frictional forces provided between osteotomy and implant design

Secondary - the process of a functional connection between bone and implant, bone grows onto the surface

Question 2

What is the function of an implant

Answer 2

To replace missing teeth, aesthetics and psychologically (and be predictable with low risk of complications and long term stability)

Question 3

What’s the difference in supracrestal tissues in tooth and implant?

Answer 3

In tooth collagen fibres are orientated perpendicular to the root surface, but are parallel in implant.
More collagen and less fibroblasts in implant

Question 4

What’s the difference in the subcrestal fibres between tooth and implant?

Answer 4

No PDL in implant

Question 5

Why might an implant have deep pockets (and still be regarded as healthy)?

Answer 5

Due to parallel orientation of collagen fibres

Question 6

What are the elements of implant design?

Answer 6

Tapered v parallel
Tissue level v bone level
Thickness
Height
Surface treatments eg roughness/ sandblasting ?

Question 7

What are the materials of implants?

Answer 7

Titanium (type 4)
Titanium zirconium
Ceramic

Question 8

What are some MH contraindications for implants?

Answer 8

Medical conditions which would render the patient unsuitable for prolonged course of treatment (ASA classification)
Meidcations - SSRIs, PPIs, Bisphosphonates, steroids
Radiotherapy
Poorly controlled diabetes
CV disease

Question 9

What are SH factors which would contraindicate implants?

Answer 9

Smoking - risk of implant failure
Affects vascularity and osteoblast function.

Question 10

What are DH factors which contraindicate implants?

Answer 10

Bruxism
Motivation/ attendance
Suitability for surgical procedures

Question 11

What is the effect of gingival phenotype on implant placement?

Answer 11

Gingival phenotype is measured by probe visibility
If thick - will heal more predictably and less resistant to recession

Question 12

What is the effect of the distance from bone crest to contact point?

Answer 12

If <5mm - no black triangles

Question 13

What 3 dimensions are implants planned in?

Answer 13

Mesiodistal
Buccopalatal
Apical coronal

Question 14

What is the ideal mesiodistal width of bone?

Answer 14

Minimum = 1.5mm
If 2 implants being placed - need double - 3mm apart

Question 15

What is the ideal bone remaining in a buccopalatal plane?

Answer 15

Aim for >2mm buccally

May need to consider graft

Question 16

What does the planning of the apical coronal positioning affect?

Answer 16

The gingival margin level
Should be 2mm from bone level implant

Question 17

What diagnostic aids are utilised in implant planning?

Answer 17

Study models
CBCT
Diagnostic wax up
Clinical photos
Surgical analogue/ guide
Essex retainer with Pontic

Question 18

What are the advantages of screw retained implant?

Answer 18

Easy to retrieve
Good retention
Better tissue response for provisional restoration

Question 19

What are the disadvantages of screw retained implant?

Answer 19

Expensive
Occlusal interferences possible
More susceptible to fracture

Question 20

What are the advantages of cement retained implants?

Answer 20

Cement acts as shock absorber
Better control of occlusal interferences
Less expensive

Question 21

What are the disadvantages of cement retained implants?

Answer 21

Retrievability is unpredictable
Requires >5mm retention height
More susceptible to peri implantitis

Question 22

What is the definition of peri implant health?

Answer 22

Absence of clinical signs of inflammation, bleeding, suppuration
No increased pocket depth (or >5mm)
Absence of bone loss beyond crestal bone level

Allows the presence of single bleeding spot

Question 23

What is the definition of peri mucositis?

Answer 23

Inflammatory lesion of the peri implant mucosa in the absence of marginal bone loss
Presence of bleeding/ suppuration without increased pocket depths

Question 24

What is peri implantitis?

Answer 24

The presence of inflammation of the peri implant tissues and associated alveolar bone loss
Bleeding/ suppuration
Increased pocket depths

Question 25

What is the success rate of treatment of peri implantitis?

Answer 25

50%

Question 26

What should be carried out at every exam for implants?

Answer 26

A 6PPC around the implant using a UNC 15 probe

Question 27

What are predisposing factors for peri implantitis?

Answer 27

History of severe periodontitis (should be stabilised for 6 months prior to implant placement)
Poor OH
No regular supportive perio care
Smoking
Diabetes
Submucous cement
Difficult access for cleaning

Question 28

What is the role of the GDP for implant patients?

Answer 28

Regular, routine and holistic care before and after implant placement
Patient preparation (clinical and emotional) before implant placement
Information resource for patients/ making a referral
Ongoing maintenance

Question 29

What is involved in consent for implants?

Answer 29

Why implants and other treatment options
Risk of leaving space
Nature of the procedure/ lengthy of treatment plan
Warn patient of the risk of peri implantitis, recession, screw fracture, crow/ porcelain chipping, need for replacement
Ensure patient is aware of need for supportive care and maintenance
Ongoing costs associated with implants