Implants Flashcards
What are the 2 stages of osteointegration?
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
What is the function of an implant
To replace missing teeth, aesthetics and psychologically (and be predictable with low risk of complications and long term stability)
What’s the difference in supracrestal tissues in tooth and implant?
In tooth collagen fibres are orientated perpendicular to the root surface, but are parallel in implant.
More collagen and less fibroblasts in implant
What’s the difference in the subcrestal fibres between tooth and implant?
No PDL in implant
Why might an implant have deep pockets (and still be regarded as healthy)?
Due to parallel orientation of collagen fibres
What are the elements of implant design?
Tapered v parallel
Tissue level v bone level
Thickness
Height
Surface treatments eg roughness/ sandblasting ?
What are the materials of implants?
Titanium (type 4)
Titanium zirconium
Ceramic
What are some MH contraindications for implants?
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
What are SH factors which would contraindicate implants?
Smoking - risk of implant failure
Affects vascularity and osteoblast function.
What are DH factors which contraindicate implants?
Bruxism
Motivation/ attendance
Suitability for surgical procedures
What is the effect of gingival phenotype on implant placement?
Gingival phenotype is measured by probe visibility
If thick - will heal more predictably and less resistant to recession
What is the effect of the distance from bone crest to contact point?
If <5mm - no black triangles
What 3 dimensions are implants planned in?
Mesiodistal
Buccopalatal
Apical coronal
What is the ideal mesiodistal width of bone?
Minimum = 1.5mm
If 2 implants being placed - need double - 3mm apart
What is the ideal bone remaining in a buccopalatal plane?
Aim for >2mm buccally
May need to consider graft
What does the planning of the apical coronal positioning affect?
The gingival margin level
Should be 2mm from bone level implant
What diagnostic aids are utilised in implant planning?
Study models
CBCT
Diagnostic wax up
Clinical photos
Surgical analogue/ guide
Essex retainer with Pontic
What are the advantages of screw retained implant?
Easy to retrieve
Good retention
Better tissue response for provisional restoration
What are the disadvantages of screw retained implant?
Expensive
Occlusal interferences possible
More susceptible to fracture
What are the advantages of cement retained implants?
Cement acts as shock absorber
Better control of occlusal interferences
Less expensive
What are the disadvantages of cement retained implants?
Retrievability is unpredictable
Requires >5mm retention height
More susceptible to peri implantitis
What is the definition of peri implant health?
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
What is the definition of peri mucositis?
Inflammatory lesion of the peri implant mucosa in the absence of marginal bone loss
Presence of bleeding/ suppuration without increased pocket depths
What is peri implantitis?
The presence of inflammation of the peri implant tissues and associated alveolar bone loss
Bleeding/ suppuration
Increased pocket depths
What is the success rate of treatment of peri implantitis?
50%
What should be carried out at every exam for implants?
A 6PPC around the implant using a UNC 15 probe
What are predisposing factors for peri implantitis?
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
What is the role of the GDP for implant patients?
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
What is involved in consent for implants?
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
