implants

Question 1

describe osseointegration

Answer 1

Direct connection between bone and implant without interposed soft tissue layers. If you cut the bone surface It will grow towards it.

Question 2

describe barrier epithelium around implants

Answer 2

terminates about 2mm apical to soft tissue margin
Hemidesmosomal attachment
Basal lamina

Question 3

what is the purpose of connective tissue?

Answer 3

Seals from intra oral environment
Protects implant-bone surface
Resists bacterial irritants
Resists mechanical trauma

Question 4

what are the 9 steps to implant maintenance

Answer 4

1. risk assessment
2. visual inspection
3. assess access cavity
4. OH
5. probing depth
6. BOP
7. suppuration
8. access for probing/cleaning
9. mobility

Question 5

describe probing in terms of implants

Answer 5

Non exposed surface- metal probe Measurements more sensitive to force variation as no ligaments and close to bone
Can cause speration of junctional epithelium
5 days after attachment heals
Successful: 3-5mm
Avoided after first 3 months

Question 6

describe peri-implant mucositis

Answer 6

Reversible inflammatory reaction in soft tissue surrounding implant 
No radiographic signs 
Erythema 
Odema 
Bleeding

Question 7

describe peri-implantitis

Answer 7

Inflammatory reaction with loss of supporting bone in the tissues surrounding an implant
Bleeding and pus on probing
Deep pockets and possible exposure of threads
Possible swelling of tissues
Rarely pain
Radiographic evidence of vertical destruction of crestal bone
360o loss of bone in saucer shape

Question 8

how would you treat implant disease with PD <3mm with no BOP or plaque

Answer 8

No therapy required
Length of recall appointment may be increased
Radiographs taken every year

Question 9

how would you treat implant disease with PD <3mm with BOP and plaque

Answer 9

Mechanical debridement (nonmetallic curettes)
Polishing (rubber cup and nonabrasive polishing paste)
Re-instruct oral hygiene 
Motivated to initiate and continue maintenance

Question 10

how would you treat implant disease with PD 4-5mm

Answer 10

Antiseptic cleansing
Chemical plaque control
Mouth rinse 10ml (0.1-0.2%) for 30s x 3-4wks
Local CHX gel (0.2%) x 3-4wks

Question 11

how would you treat implant disease with PD >5mm with BOP and no bone loss

Answer 11

same as 4-5mm PD

Question 12

how would you treat implant disease with PD >5mm with BOP and bone loss <2mm

Answer 12

Systemic or local antibiotic therapy
Ornidazole (1,000mg o.d.) x 10 days, or Metronidazole (250mg t.d.s.) x 10 days, or Amoxicillin (250-500mg t.d.s.) and metronidazole (200mg t.d.s.) x 10 days
Application of antibiotics using controlled release devices for 10 days e.g tetracycline fibres and minocycline microspheres.

Question 13

how would you treat implant disease with PD >5mm with BOP and bone loss >2mm

Answer 13

Resective or regenerative surgery
Surgical therapy in conjunction with systemic antibiotics and implant surface debridement.
Regeneration: barrier membrane technique alone or in combination with autogenous grafts or bone substitutes considered.

Question 14

explain mechanical debridement of implants

Answer 14

Prevent early phase plaque formation 
Remove existing plaque 
Maintaining the surface integrity of the transmucosal regenerated surfaces can increase plaque accumulation 
Specific prophy paste, cups and brushes 
Implant hand instruments

Question 15

what are the similarities between peri-implantits and periodontitis?

Answer 15

Implants susceptible to bacterial plaque accumulation and calculus formation
Bacterial plaque accumulation provokes inflammatory response in peri-implant mucosa
Leads to loss of soft tissue seal, pocket formation and bone loss

Question 16

what are the differences between peri-implantitis and periodontitis?

Answer 16

Due to lack of connective fibre insertion and decreased vascular supply around implants there may be greater susceptibility to plaque induced inflammation.
Subgingival calculus is rare
Calculus on implants is easier to remove.