IMPLANTS Flashcards
What are 4 reasons for early implant failure which usually arise from failure of the initial integration to take place during biological healing phase?
- poor surgical technique
- inability to achieve primary fixation
- inadvertent implant loading
- infection and systemic conditions
What are 2 reasons for late implant failure?
- biological failures: caused by plaque-induced peri-implant diseases
- mechanical failures: caused by unfavourable loading conditions
What are the 4 approaches to implant monitoring and maintenance?
- reduction of risk factors
- patient education and motivation
- screening and surveillance
- instrumentation and intervention
What are 8 local risk factors for implant failures?
- radiotherapy
- smoking
- occlusal trauma
- parafunctional habits and bruxism
- poor soft tissue biotype
- poor bone quality and density
- endo/periapical lesions in adjacent teeth
- perio disease
What are 3 systemic conditions which contribute to implant failures?
- uncontrolled diabetes
- immunosuppression
- bisphosphonates
What are 6 general risk factors for implant failures?
- patient factors; smoking, systemic disease, meds etc
- host susceptibility; perio, plaque control, control of co-morbidities
- implant design; roughness of implant surface
- motivation; patient education
- prosthetic design; occlusal overload
- soft tissue quality and quantity; mechanically thick, keratinised, non-mobile mucosa
What are 3 reasons why smoking is a contraindication for implants?
- poor wound healing
- risk of peri-implant infection
- crestal bone loss
What advice should be given to smokers prior to implant placement?
- advise to stop smoking before implant placement
- placement can occur in smokers, but advice and careful monitoring is a must
Which flossing technique should be adopted for patients with implants?
cross-over flossing technique
In the first year of implant placement, what is the expected amount of bone loss?
<1.5mm
After the first year of implant placement, what is the expected amount of bone loss after this period?
0.2mm
The presence of peri-implant radiolucency or crestal bone loss is checked, what is used as the reference point for this?
implant shoulder
When estimating bone loss post implant placement, what is used to calculate the magnification factor?
distance between implant threads
When should radiographs be taken of an implant?
- at fit
- 1 year
- biannually
What is meant by biological width?
defined as the dimension of soft tissue which is attached to the portion of the tooth coronal to the crest of the alveolar bone
What is the biological width around implants?
2-3mm
2mm is the epithelial attachment
1mm is the supracrestal connective tissue attachment
Violations to the biological width may result in which 2 things?
- gingival inflammation only
- gingival recession with bone loss
Thin, fragile, highly scalloped gingiva is more at risk of what?
recession
Thin alveolar bone is more at risk of what?
horizontal bone loss
Thick alveolar bone is more at risk of what?
vertical bone loss
Probing of implants can be limited by which 3 factors?
- contour of prostheses
- depth of implant shoulder
- design of implant shoulder/abutments
What is the routine management of implants?
- presence of exudate, bleeding or swelling should be noted together with PPD measurements
- 6PPC if applicable annually
- removal of bacteria to improve peri-implant maintenance
Which testing can be used to check absence of mobility of implants?
a percussion test
Which 4 indices should be assessed regularly?
- plaque index
- bleeding on probing
- peri-implant probing depth
- presence of exudate, discharge, sinus or fistula
What should be done as part of supportive implant maintenance? (8)
- 3-12 monthly intervals for exams
- BoP, PPD, plaque, suppuration, mobility
- check crestal bone levels
- OHI, smoking cessation
- check stability of pre-existing health conditions
- check occlusal trauma
- check removable prostheses
- educate/re-inforce implant care
Which instruments are not recommended due to scratching the titanium?
steel instruments
Which instruments are not recommended due to being bulky and known to shed particles not bio-compatible?
- teflon
- plastic
Which bacteria is mostly responsible for the failure of implants?
gram negative anaerobes
When is an implant considered a failure?
- lost
- mobile
- bone loss greater than 1.5 in first year and greater than 0.2 in the following years
Which factor plays the most important role in the failure of implants?
bacterial infections
What are 7 factors in the onset and development of peri-implantitis?
- excessive mechanical stress
- poor design of the implant
- diabetes
- osteoporosis
- long term use of steroids
- radiotherapy
- smoking
What is the following the definition of?
a reversible inflammatory change of the peri-implant soft tissues without bone loss
peri-implant mucositis
What is the following the definition of?
an inflammatory process around osseointegrated implants in function affecting the mucosa and resulting in the loss of supporting bone around the implant
peri-implantitis
Why are implants more susceptible to infection?
the connective tissue attachment in implants has fewer fibre bundles and their orientation tends to run parallel to the implant surface, resulting in less overall protection from invading pathogens
What are 6 signs and symptoms of peri-implantitis?
- radiological evidence of vertical destruction of the crestal bone, the defect is usually saucer shaped and there is osseointegration of the apical part of the fixture
- vertical bone destruction associated with the formation of a peri-implant pocket
- increasing probing depths
- bleeding and suppuration on probing
- possible swelling of the peri-implant tissues and hyperplasia
- pain is an unusual feature, if present, is associated with an acute infection
What are 6 signs and symptoms of peri-implant mucositis?
- swelling
- bleeding
- discharge or suppuration
- pain or tenderness
- increased pocket depths
- no evidence of bone loss
What is cement associated peri-implantitis?
cement is a biofilm retentive factor and once bacteria attaches to it, they are resistant to anti-microbial agents and host defences, cement cannot be removed any more than 1.5mm thus causing plaque retention
What are 7 clinical markers that are used to determine the presence and severity of inflammation around an implant?
- plaque and calculus accumulation
- inflammation of the peri-implant tissues
- increase in PPD
- bleeding on probing
- suppuration from the peri-implant tissues
- mobility
- radiographic changes
Why do implants have deeper probing depths when compared to natural teeth?
no attachment of the junctional epithelium around implant so therefore less resistance, pockets of 2-4mm in health
What are 5 risks that are vital for therapists to monitor?
- smoking cessation
- diabetes control
- patient education
- plaque control
- monitoring health of implant
