Implants Flashcards
What patient factors must be considered to enhance the functional and esthetic outcomes of immediate implants?
health of the patient
History to tooth failure
Esthetic evaluation
Periodontal biotype
What surgical factors must be considered to enhance the functional and esthetic outcomes of immediate implants?
Operator experience
Minimizing trauma during extraction
Removal of residual infection
Ability to achieve primary stability
Describe Immediate loading
Prosthesis connected to dental implant within 1 week after placement
-Restores immediate function to the patient
-Restores esthetics
-Preserves soft tissue architecture
-Dependent on initial stability of the implant
Describe Early loading
Prosthesis connected to dental implant between 1 week and 2 months after placement
-Patient does not have to deal with missing tooth for prolonged period of time
-Allows the clinician time to fabricate a restoration based on an impression/index performed at time of surgery
-Reduces the number of procedures performed on the patient in one session-reduced morbidity
Describe coventional loading
Prosthesis connected to dental implant >2 months after implant placement
-Osseointegration of implant is confirmed before restoration is placed
-Long history of success, predictable outcomes
How does immediate loading of a single implant affect implant survival rate, and marginal bone loss?
There is no significant difference for survival rate and marginal bone loss.
Survival rate
Immediate load: 96.8%
Conventional 97.9%
(1 year)
Marginal bone loss
Immediate load: 1.31mm
Conventional: 1.01mm
(5 years)
How does immediate loading of a single implant affect soft tissues surrounding the loaded implant, esthetics, and patient satisfaction?
Soft tissue - No significant differences
(mean recession almost identical)
Esthetics - no significant differences
(same Pink Esthetic and white esthetic score)
Patient satisfaction - no significant difference
What is the clinical performance and significance of complications and failures, when providing implant –supported reconstructions with either screw or cement retention?
There are no significant differences between the survival rates and failure rates of cement or screw retained abutments.
Possible complications for screw may include porcelain chipping at access hole.
Possible complication for cement may include excess cement causing biological complications
In what restorative situations may screw retained implant restorations be the treatment of choice and under what situations might cement retained implant restorations be the treatment of choice?
Screw retained:
-When retrievability is desirable
-When margins are submucosal (greater than 1.5 mm increases difficulty of removing cement) when the implant can be placed appropriately/prostheticaly driven
Cement retained:
-Esthetics
-Margins are supragingival
-When intact occlusal surface is desirable
inflammatory tissue pathology resulting from plaque accumulation and bacterial infiltration around implants
Peri-implant mucositis
Condition of inflamed peri-implant soft tissues, bone loss, and increased probing depth combined with exudation.
Peri-implantitis
Risk factors for Perio implant infections
- History of periodontitis
- Smoking
- Diabetes
What 4 elements of therapy have shown beneficial results in the treatment of peri-implantitis, based on systematic reviews?
- Oral hygiene instruction
- Non surgical debridement
- Smoking cessation
- Surgical therapy
4 Pre-op conditions are associated with peri-implant mucositis/peri-implantitis?
-Remaining periodontally involved teeth
-High plaque scores and biofilm
-History of smoking
-Poor oral hygiene recall
4 Post-op conditions are associated with peri-implant mucositis/peri-implantitis?
-Presence of active periodontitis
-Keratinized tissue band around the implant of 1mm or less
-Lack of structured oral hygiene recall program (spt)
-Smoking
Based on the best available evidence, does supportive periodontal therapy affect peri-mucositis/peri-implantitis, and how?
Yes, it does affect peri-mucositis and peri-implantitis, supported by the following evidence:
-High long-term survival and success rates of dental implants can be achieved in partially and completely edentulous patients adhering to regular SPT.
-SPT is associated with reduction in the incidence of peri-implant mucositits/peri-implantitis
-Patients with a history of periodontitis have a higher risk of peri-implant mucositis/peri-implantitis
-Active periodontal disease should be resolved prior to implant placement
What are the advantages and disadvantages of CAD/CAM abutments and frameworks for use in dental implant therapy?
Advantages:
Homogenous materials
Elimination conventional error
Rapid design
Comparable outcomes
Disadvantages:
Little documentation
Tooling/sintering misfit
Unreported bio implant
What are the suspected systemic risk factors for dental implants?
Systemic conditions:
-Periodontitis
-Smoking
-Mechanical design/materials
(prefab components)
-Technical design/materials
(Lab fabricated)
-Screw/cement/bruxism
What are the 4 suspected local risk factors for dental implants?
Local factors:
-interdental space
-tooth proximity
-tissue thickness/position
-bone quality
Have the survival rate of implant-supported prostheses and the incidence of complications changed since the year 2000? If yes, how?
-Studies prior to the year 2000 demonstrated lower five-year survival rate then do studies after the year 2000 this was statistically significant when considering implant supported fixed dental prostheses
-Prosthesis Survival, when considering implant-retained prostheses, has improved. Prior to 2000, cemented prostheses exhibited higher survival while more current studies show overall improvement in prosthetic performance with no significant difference between screw or cement retained
Is there a difference in 5-year implant survival associated with ceramic vs. metal abutments supporting single crowns?
Implant survival, overall = 96.9%
Implant survival, ceramic abutments = 95.8%
Implant survival, metal abutments = 96.9%
No difference between ceramic vs. metal
What are the anticipated outcomes when placing implants immediately following tooth extraction?
-Predictable implant survival
-Reduced overall treatment time
- Facial bone changes
-With immediate placement soft tissue recession is more variable
-Outcome influenced by skill of clinician
What are the esthetic risk factors with single tooth extraction and immediate implant placement in the anterior maxilla?
-soft tissue recession midfacially (thin facial plate, biotype)and proximally (contact position)
How might these be managed?
-Bone or soft tissue augmentation
-avoid immediate placement (ridge preservation)
Implant and prosthestic survival rates for maxilla and mandible
Implant:
Maxilla - 95-100%
Man - 98-100%
Prosthesis
Maxilla 87-100%
Man - 100%
How can you substantially lower the dose of a 3 dimensional image (CBCT)?
-Utilize appropriate exposure parameters
-Reduce the field of view (FOV) to the actual region of interest (ROI)
How should the decision to perform CBCT imaging for treatment Planning in Implant dentistry be made?
On individual patient needs after a thorough clinical examination and considered necessary.
List 2 indications for the use of guided surgical implant therapy
1.Aid in treatment planning when encountering complex anatomy
2. to perform minimally invasive surgery
When should you consider a staged approach to implant placement in the anterior maxilla?
When the hard and soft tissue in its current state would not support and esthetic outcome with primary stability at the time of implant placement
What types of surgical guides are available and how are these guides used to ensure that implants are placed according to the prosthetic plan?
-Soft tissue
-hard tissue (bone based or tooth)
-Externally anchored
-Static-rigid
-Dynamic-active guidance systems
What are the 7 limitations of surgical guides?
- patient limited opening
- implant position planning accuracy
- advanced techinque with learning curve
- limited surgical view
- Lack of water for cooling
- Cost
- Time
When would you consider a flapless surgery?
-When there is no need to visualize bone morphology and quantity at the surgical site (no undercuts, no nearby vital structures).
-When ample amount of bone is present. To reduce the risk of fenestration and dehiscence.
-a flapless surgery is advantageous when preserving tissue (bone) is critical.
How does flapless surgery influence marginal bone loss?
-Radiographic marginal bone loss ranges from 0.7 to 2.6 mm over 1 year.
-Only one study compared marginal bone loss between flapless and conventional surgery. This study found slightly less bone resorption in implants placed using flapless surgery (2.1 mm vs 2.8 mm).
How does flapless surgery influence soft tissue response?
Limited evidence available, only two studies and they do not include comparisons to conventional implant placement technique (with flap elevation). They did compare to before implant placement and found there were no significant changes probing depths, bleeding index, plaque index, and width of keratinized gingiva
What are the clinical characteristics of peri-implant mucositis
Inflammatory response that can include bleeding on probing,
Suppuration
No bone loss beyond normal remodeling
What are the clinical characteristics of peri-implan peri-implantitis?
Inflammatory response with an increase of probing depths >4mm
Crestal bone loss beyond normal remodeling
EXT Cellular and molecular - immediate
-Bleeding
-Clot formation: Coagulation cascade (extrinsic and intrinsic cascades) Factor VIII + Thrombin + Fibrin + platelets
-Hemostasis
-Fibrin clot provide a structural framework
EXT Cellular and molecular -
First week: Formation of granulation tissue, angiogenesis and epithelialization (granulation phase, inflammatory phase)
Release of inflammatory cells (polymorphonuclear leukocytes)
Release of macrophages: phagocytosis of microorganisms
The release of pro-inflammatory mediators/cytokines: TNF-Alpha, Il1-B, Il-6, Il-10 and whole slew of chemokines (CC)
Release of growth factors that promote cell migration, differentiation and angiogenesis:
BMP (BMP2, BMP4 and BMP7): Initial trigger for bone formation
TGF-Beta: Also a trigger for bone formation
VEGF-A (pro-angiogenesis factor)
Remnants of PDL cells, mesenchymal stem-cells migrate, proliferate, and differentiate into a variety of cell types, including fibroblasts, and later into osteoblasts, and osteoclasts.
Cellular migration, differentiation, proliferation
Angiogenesis starts and proceeds very quickly
Formation of the “provisional matrix” (granulation tissue)
Stabilization and organization of connective tissues by the formation and deposition of collagen
Epithelialization (starts by 1 weeks and complete in 3 weeks)
Early bone formation: progress from the apex and periphery and proceeded finally to the center and crest of the extraction socket.
EXT Cellular and molecular - 2-10 Weeks: Bone formation phase
-Osteoblast differentiation,
-Deposition of bone (woven bone): can be seen as early as 7 days at the bottom of the socket
-New bone formation: 2-3 weeks after extraction (immature bone)
-The bone deposited at the base and walls of the socket (woven bone)
-Epithelialization is complete (3 weeks)
-Bone growth: Starts 4-5 week, at 5 weeks 66% of the socket is filled, Bone fully formed in 8-10 weeks (composed of woven and lamellar bone)
EXT Cellular and molecular - >10 weeks: Remodeling and re-organization phase
Bone re-organization (in 3 months, you lose 50-60% of the original bone volume)
All stages of bone regeneration progress from the apex and periphery and proceeded finally to the center and crest of the extraction socket.
