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Module 6 - Removable Prosthodontics > Implants > Flashcards

Implants Flashcards

1
Q

What is a dental implant?

A

An artificial TOOTH ROOT that is surgically anchored into the jaw to hold a replacement tooth/teeth or denture in place.

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2
Q

Name 1 advantage of dental implants?

A

Do not rely on support from neighboring teeth.

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3
Q

What is the typical shape of an implant?

A

Screw shaped.

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4
Q

What is the relationship between the implant and bone?

A

Osseointegration: an implant has direct communication with the bone (no PDL).

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5
Q

What part of the bone does the implant sit in if placed properly?

A

The crest of the bone.

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6
Q

What is the abutment?

A
  • Where the gum sits around the implant, termed the PERI IMPLANT MUCOSA.
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7
Q

4 components of an implant?

A
  • Titanium dental implant.
  • Abutment.
  • Abutment screw.
  • Restoration. (this could be cemented OR screwed on).
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8
Q

3 dental uses of implants?

A
  1. Restore a SINGLE tooth (implant crown).
  2. Restore MULTIPLE teeth (implant bridge).
  3. Secure a DENTURE FIRMLY (implant overdenture).
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9
Q

6 treatment plan Steps to the implant process?

A
  1. Plan & consent.
  2. Place implants.
  3. Uncover and connect abutments (usually 3-4 months later).
  4. Restorative procedures (ex. crown, implant overdenture).
  5. Restore.
  6. Monitor and maintain
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10
Q

How long after placement are implants usually uncovered?

A

3-4 months.

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11
Q

Relationship of dental implants and smoking?

A
  • Increases failure rate of implants.
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12
Q

Chemoradiotherapy and implants?

A
  • Radiation to the head and neck can increase chances of OSTEORADIONECROSIS after implant surgery.
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13
Q

Polypharmacy and implants?

A

Patient can have DRY MOUTH, thus peri-implant mucosa not in great condition which can INCREASE IMPLANT FAILURE.

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14
Q

Immunosuppression and implants?

A
  • Poor healing between the bone and the implant.
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15
Q

7 Medical History things that can cause an issue with implants.

A
  • Chemoradiotherapy.
  • Polypharmacies.
  • Immunosuppresion.
  • MRONJ risks.
  • Cardiac issues.
  • Mental health issues.
  • Diabetes.
  • Thyroxine.
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16
Q

4 things that are known to increase implant failure?

A
  • Smoking.
  • Diabetes.
  • Thyroxine (some evidence).
  • Bruxism.
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17
Q

4 cases where implant treatment may be provided on the NHS?

A
  • Patients with head and neck cancer.
  • Severe hypodontia.
  • Significant amount of trauma.
  • Cleft palate patients.
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18
Q

9 risks associated with implant treatment?

A
  • 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.
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19
Q

Alternatives to implants?

A
  • No treatment.
  • Bridges.
  • Denture.
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20
Q

5 steps to implant planning (clinical steps).

A
  • History/ examination.
  • Radiographs.
  • Other imaging CT/ CBCT.
  • Surgical and radiographic templates.
  • Ridge mapping (outdated technique).
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21
Q

What are surgical and radiographic templates made of?

A
  • Can be made out of acrylic with holes drilled in to dictate where the implants will go.
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22
Q

How is ridge mapping done? Why is it done?

A
  • Involves using a STUDY CAST and sticking PINS into the mucosa under LA.
  • To see how THICK the mucosa is.
  • OUTDATED TECHNIQUE.
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23
Q

What can be used to determine the length of mandible/maxilla bone available? What must be remembered when using radiographic views for this?

A
  • 10mm gutta percha cones
  • When using radiographs, must use MAGNIFICATION COEFFICIENTS to determine real life length.
24
Q

Relationship of OPT size to real life size?

A

OPT 1.3x real life.

25
Q

2 advantages of CBCT for implant planning?

A
  • Allows accurate planning of the POSITION and ANGULATION that implant should go in at (prevent damage to maxillary sinus or ID canal).
  • 3D PLANNING.
26
Q

What information is used to make surgical and radiographic templates (4)?

A
  • Radiographs.
  • Scans.
  • Existing prostheses.
  • Casts.
27
Q

How are surgical and radiographic templates used?

A

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.

28
Q

What are co axis implant?

A

Can change the angle of the implant (useful for incisors which are usually not vertical).

29
Q

5 steps to SINGLE TOOTH implant placement.

A
  1. Raise flap.
  2. Drill bone with warm saline irrigating the entire time.
  3. Place implant.
  4. Place cover screw.
  5. Suture.
30
Q

Why are cover screws placed?

A

To prevent bone from forming in the “hollow” part of the implant as this will later be used to place the RESTORATION.

31
Q

What happens 3-4 months after the placement of an implant into bone?

A

OSSEOINTEGRATION of the implant to bone.

32
Q

How is an implant uncovered?

A

Use a TISSUE PUNCH to remove the mucosa over the implant under LA.

33
Q

9 prosthetic stages for single tooth implants?

A
  1. Uncover implant.
  2. Remove cover screw.
  3. Place abutment.
  4. Place coping and take a PUTTY WASH impression (coping would stay in impression when removed from mouth).
  5. Take an opposing arch impression.
  6. Take occlusion (ex. using wax wafer).
  7. Choose colour.
  8. Place a temporary restoration.
  9. Cast impression with a lab dummy (of the implant) in the impression.
34
Q

What is a blunt triangle?

A

More blunt gingivae/ papilla around the implant, can COMPROMISE AESTHETICS.

35
Q

1 advantage and 2 disadvantages of cement retained crown for implants?

A
  • 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.
36
Q

1 advantage and one disadvantage of screw retained restorations on implants?

A
  • 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.
37
Q

What is a common system used for implant overdentures?

A

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.

38
Q

3 different systems that can be used for implant retained dentures?

A
  • Locator abutments.
  • Ball abutments.
  • Gold bar (with or without distal extensions).
  • CAD-CAM titanium bar
39
Q

What is a ball abutment implant retained denture?

A
  • Ball part attached to the implant within the mouth.
  • Cold cure a silver cap in the denture.
40
Q

What is a gold bar implant retained denture?

A
  • Gold bar connects the implants in the mouth.
  • Little clips are placed in the denture and clip onto the bar in the denture.
41
Q

1 advantage and 2 disadvantages of gold bar implant retained dentures?

A
  • Advantages: Stops ANTERIOR ROTATION more than locators/ ball and socket.
  • Disadvantages: more expensive, bar can be harder to clean underneath.
42
Q

What are gold bar implant retained dentures starting to be superceeded by?

A

CAD-CAM titanium bars.

43
Q

What does CAD-CAM stand for?

A
  • Computer assisted design.
  • Computer assisted manufacture.
44
Q

2 advantages and 1 disadvantage of CAD CAM titanium bar implant retained dentures?

A
  • 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.
45
Q

4 common complications post implant treatment?

A
  • peri implant mucositis.
  • Peri implantitis.
  • Loose/fractured components.
  • Late implant failure.
46
Q

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?

A

Refer to someone else to restore and replace them.

47
Q

What is the role of GDPs in implant patients? (3)

A
  1. Oral health advice.
  2. Triage and diagnosis (if possible) of a complication.
  3. Referral of the complication to an appropriately trained, indemnified and competent implant dentist.
48
Q

5 things to maintain dental implants?

A
  1. Ensure patient is able to perform optimal plaque removal around the dental implants. Give OH instruction if necessary.
  2. Examine the peri-implant tissues for signs of inflammation, BOP and/or suppuration.
  3. Remove supra and submucosal plaque, calculus and excess residual cement.
  4. Perform radiographic examination only when clinically indicated.
  5. Assign risk level.
49
Q

When should a radiograph of the implant be taken?

A

Ensure a BASELINE PERI APICAL radiograph of the implant (aligned using the long cone paralleling technique) is obtained ONE YEAR after superstructure connection.

50
Q

How can probing depths for implants be measured?

A
  • Measure baseline probing depths using fixed landmarks.
  • BPE IS NOT APPROPRIATE for the assessment of dental implants.
51
Q

What do implant recall appointment intervals depend on?

A

Depend on the RISK LEVEL you assign.

52
Q

What is peri-implant mucositis?

A

Inflammation of the peri-implant mucosa with no evidence of crestal bone loss. The tissues will appear red, swollen and may bleed on probing.

53
Q

What is the management (3) when there are signs of peri-implant mucositis?

A
  1. Exclude the presence of peri-implantitis by carrying out a RADIOGRAPHIC EXAMINATION to assess peri-implant bone levels compared with the baseline radiographs.
  2. Treat as for maintenance.
  3. Re-assess at a future visit to ensure that the inflammation has settled and a stable situation has been achieved.
54
Q

What is peri-implantitis?

A
  • 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.
55
Q

How is peri-implantitis managed?

A
  1. 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.

Module 6 - Removable Prosthodontics (7 decks)

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