Implants Flashcards
What is a dental implant?
An artificial TOOTH ROOT that is surgically anchored into the jaw to hold a replacement tooth/teeth or denture in place.
Name 1 advantage of dental implants?
Do not rely on support from neighboring teeth.
What is the typical shape of an implant?
Screw shaped.
What is the relationship between the implant and bone?
Osseointegration: an implant has direct communication with the bone (no PDL).
What part of the bone does the implant sit in if placed properly?
The crest of the bone.
What is the abutment?
- Where the gum sits around the implant, termed the PERI IMPLANT MUCOSA.
4 components of an implant?
- Titanium dental implant.
- Abutment.
- Abutment screw.
- Restoration. (this could be cemented OR screwed on).
3 dental uses of implants?
- Restore a SINGLE tooth (implant crown).
- Restore MULTIPLE teeth (implant bridge).
- Secure a DENTURE FIRMLY (implant overdenture).
6 treatment plan Steps to the implant process?
- Plan & consent.
- Place implants.
- Uncover and connect abutments (usually 3-4 months later).
- Restorative procedures (ex. crown, implant overdenture).
- Restore.
- Monitor and maintain
How long after placement are implants usually uncovered?
3-4 months.
Relationship of dental implants and smoking?
- Increases failure rate of implants.
Chemoradiotherapy and implants?
- Radiation to the head and neck can increase chances of OSTEORADIONECROSIS after implant surgery.
Polypharmacy and implants?
Patient can have DRY MOUTH, thus peri-implant mucosa not in great condition which can INCREASE IMPLANT FAILURE.
Immunosuppression and implants?
- Poor healing between the bone and the implant.
7 Medical History things that can cause an issue with implants.
- Chemoradiotherapy.
- Polypharmacies.
- Immunosuppresion.
- MRONJ risks.
- Cardiac issues.
- Mental health issues.
- Diabetes.
- Thyroxine.
4 things that are known to increase implant failure?
- Smoking.
- Diabetes.
- Thyroxine (some evidence).
- Bruxism.
4 cases where implant treatment may be provided on the NHS?
- Patients with head and neck cancer.
- Severe hypodontia.
- Significant amount of trauma.
- Cleft palate patients.
9 risks associated with implant treatment?
- Minor surgical risks (bruising, swelling, pain).
- Major surgical risks (ex. burning bone, hitting adjacent teeth).
- Paraesthesia.
- Perforation into nasal cavity or maxillary antrum.
- Failure to integrate.
- Late failure.
- Bruxism and implants.
- Peri-implantitis.
- Failure or superstructures and components.
Alternatives to implants?
- No treatment.
- Bridges.
- Denture.
5 steps to implant planning (clinical steps).
- History/ examination.
- Radiographs.
- Other imaging CT/ CBCT.
- Surgical and radiographic templates.
- Ridge mapping (outdated technique).
What are surgical and radiographic templates made of?
- Can be made out of acrylic with holes drilled in to dictate where the implants will go.
How is ridge mapping done? Why is it done?
- Involves using a STUDY CAST and sticking PINS into the mucosa under LA.
- To see how THICK the mucosa is.
- OUTDATED TECHNIQUE.
What can be used to determine the length of mandible/maxilla bone available? What must be remembered when using radiographic views for this?
- 10mm gutta percha cones
- When using radiographs, must use MAGNIFICATION COEFFICIENTS to determine real life length.
Relationship of OPT size to real life size?
OPT 1.3x real life.
2 advantages of CBCT for implant planning?
- Allows accurate planning of the POSITION and ANGULATION that implant should go in at (prevent damage to maxillary sinus or ID canal).
- 3D PLANNING.
What information is used to make surgical and radiographic templates (4)?
- Radiographs.
- Scans.
- Existing prostheses.
- Casts.
How are surgical and radiographic templates used?
Can place template in the mouth during SURGERY and put the drill THROUGH THE EXISTING HOLES IN THE TEMPLATE to position the implants exactly as planned.
What are co axis implant?
Can change the angle of the implant (useful for incisors which are usually not vertical).
5 steps to SINGLE TOOTH implant placement.
- Raise flap.
- Drill bone with warm saline irrigating the entire time.
- Place implant.
- Place cover screw.
- Suture.
Why are cover screws placed?
To prevent bone from forming in the “hollow” part of the implant as this will later be used to place the RESTORATION.
What happens 3-4 months after the placement of an implant into bone?
OSSEOINTEGRATION of the implant to bone.
How is an implant uncovered?
Use a TISSUE PUNCH to remove the mucosa over the implant under LA.
9 prosthetic stages for single tooth implants?
- Uncover implant.
- Remove cover screw.
- Place abutment.
- Place coping and take a PUTTY WASH impression (coping would stay in impression when removed from mouth).
- Take an opposing arch impression.
- Take occlusion (ex. using wax wafer).
- Choose colour.
- Place a temporary restoration.
- Cast impression with a lab dummy (of the implant) in the impression.
What is a blunt triangle?
More blunt gingivae/ papilla around the implant, can COMPROMISE AESTHETICS.
1 advantage and 2 disadvantages of cement retained crown for implants?
- Advantage: no screw hole through the top of the restoration.
- Disadvantages: Can be difficult to remove, can get cement around the margins causing INFLAMMATION and BONE LOSS around the implant.
1 advantage and one disadvantage of screw retained restorations on implants?
- Advantage: if a patient chips a tooth/ breaks a bit of acrylic, the restoration can be unscrewed, fixed and re screwed.
- Disadvantage: must ensure the screw is not labial as that will compromise aesthetics.
What is a common system used for implant overdentures?
Locator abutments:
- Place an abutment with external and internal components on the implant.
- Place a stainless steel cap in the denture with a locator insert inside it.
3 different systems that can be used for implant retained dentures?
- Locator abutments.
- Ball abutments.
- Gold bar (with or without distal extensions).
- CAD-CAM titanium bar
What is a ball abutment implant retained denture?
- Ball part attached to the implant within the mouth.
- Cold cure a silver cap in the denture.
What is a gold bar implant retained denture?
- Gold bar connects the implants in the mouth.
- Little clips are placed in the denture and clip onto the bar in the denture.
1 advantage and 2 disadvantages of gold bar implant retained dentures?
- Advantages: Stops ANTERIOR ROTATION more than locators/ ball and socket.
- Disadvantages: more expensive, bar can be harder to clean underneath.
What are gold bar implant retained dentures starting to be superceeded by?
CAD-CAM titanium bars.
What does CAD-CAM stand for?
- Computer assisted design.
- Computer assisted manufacture.
2 advantages and 1 disadvantage of CAD CAM titanium bar implant retained dentures?
- Advantages: no solder joint (unlike gold) and titanium stronger than gold hence less likely to fracture, cheaper than gold.
- Disadvantages: difficult to clean underneath them.
4 common complications post implant treatment?
- peri implant mucositis.
- Peri implantitis.
- Loose/fractured components.
- Late implant failure.
Patient presents with broken parts of an implants (ex. screws in hand) or a broken down restoration (ex. worn away porcelain). What do you do?
Refer to someone else to restore and replace them.
What is the role of GDPs in implant patients? (3)
- Oral health advice.
- Triage and diagnosis (if possible) of a complication.
- Referral of the complication to an appropriately trained, indemnified and competent implant dentist.
5 things to maintain dental implants?
- Ensure patient is able to perform optimal plaque removal around the dental implants. Give OH instruction if necessary.
- Examine the peri-implant tissues for signs of inflammation, BOP and/or suppuration.
- Remove supra and submucosal plaque, calculus and excess residual cement.
- Perform radiographic examination only when clinically indicated.
- Assign risk level.
When should a radiograph of the implant be taken?
Ensure a BASELINE PERI APICAL radiograph of the implant (aligned using the long cone paralleling technique) is obtained ONE YEAR after superstructure connection.
How can probing depths for implants be measured?
- Measure baseline probing depths using fixed landmarks.
- BPE IS NOT APPROPRIATE for the assessment of dental implants.
What do implant recall appointment intervals depend on?
Depend on the RISK LEVEL you assign.
What is peri-implant mucositis?
Inflammation of the peri-implant mucosa with no evidence of crestal bone loss. The tissues will appear red, swollen and may bleed on probing.
What is the management (3) when there are signs of peri-implant mucositis?
- Exclude the presence of peri-implantitis by carrying out a RADIOGRAPHIC EXAMINATION to assess peri-implant bone levels compared with the baseline radiographs.
- Treat as for maintenance.
- Re-assess at a future visit to ensure that the inflammation has settled and a stable situation has been achieved.
What is peri-implantitis?
- Infection with suppuration and inflammation of the soft tissues surrounding an implant with clinically significant loss of peri-implant crestal bone after the adaptive phase.
- The tissues will appear red, swollen, may bleed on gentle probing and there will be suppuration.
How is peri-implantitis managed?
- Carry out a radiographic examination to evaluate peri-implant bone levels compared with the baseline radiograph.
- If clinically significant crestal bone loss is detected, refer back to the clinician who placed the implant.
- If this is not possible, treat as described in the maintenance section above, treat as for maintenance plus:
- Arrange a follow up after 1-2 months to assess the outcome of treatment. Where there is no improvement seek advice from secondary care.
- If the inflammation has settled and a stable situation has been achieved, arrange radiographic follow up in 6-12 months.
