Implants Flashcards
osseointegration
direct contact between living bone and a functionally loaded dental implant surface without interposed soft tissue at the light microscope level
what is the clinical manifestation of osseointegration?
absence of mobility
sinus augmentation (sinus lift)
surgical approach commonly used for the rehabilitation of the posterior edentulous maxilla with dental implants when there is insufficient bone height
indirect sinus lift (osteotome technique)
sinus grafting technique whereby the maxillary sinus floor is carefully infractured and the Schneiderian membrane is elevated through an osteotomy prepared and extended in the ridge with an osteotome
direct sinus lift (lateral window technique)
creation of access to max sinus through its lateral wall
the access to max sinus with direct sinus lift is used to elevate what?
Schneiderian membrane for the placement of graft material in inferior part of sinus space
≥10 mm from crest of ridge to floor of sinus
conventional implant procedure
6-9 mm from crest of ridge to floor of sinus
osteotome technique with sinus membrane displacement (during implant site preparation) and bone graft in combo with immediate implant placement
4-5 mm from crest of ridge to floor of sinus
lateral approach to sinus involving flap (Caldwell-Luc) with bone graft, with immediate or delayed implant placement
1-3 mm from crest of ridge to floor of sinus
lateral sinus approach with bone grafting material and delayed implant placement
hybrid implants
an implant prosthesis made by attaching denture teeth with heat-polymerized acrylic resin to cast metal substructure that is connected to several implants
biointegration (osseointegration)
bonding of living bone to the surface of an implant (ankylosis) which is independent of any mechanical interlocking mechanism
jaw shape-bone resorption patterns
- most of alveolar ridge is present
- moderate residual ridge resorption has occurred
- advanced residual rdige resorption and only basal bone remains
- some resorption of basal bone has started
- extreme resorption of basal bone has taken place
bone quality
- homogenous compact bone
- thick layer of compact bone surrounds a core of dense trabecular bone
- thin cortical bone with dense trabecular bone of favorable strength
- thin layer of cortical bone with low density trabecular bone
peri-implant mucositis
reversible inflammatory rxn of mucosa that surrounds an osseointegrated implant with no bone loss
peri-implantitis
inflammatory process affecting the hard and soft tissues around an implant that has results in
- PD >5mm with BoP (suppuration)
- progressive bone loss (greater than 0.2 mm/year after the first year it is loaded)
ailing implant
general term for implant affected by peri-implant mucositis, without bone loss
failing implant
general term for implant that is progressively losing its supporting bone anchorage (may exhibit increased PD, purulence, but is still clinically stable)
failed implant
dental implant that is mobile (has not achieved or has lost osseointegration) or that is symptomatic in spite of osseointegration
criteria for implant success
- immobile
- no peri-implant radiolucency
- <0.2mm bone loss after the 1st year of loading
- no pain, infection, neuropathies, paresthesia
- minimum 85% success at 5 years and minimum 80% success at 10 years
how is alveolar ridge deficiencies classified?
via Seibert classification
Seibert classification
system of 2 categories used to describe the form of a residual alveolar ridge
class 1 alveolar ridge defect
loss of tissue width in facial-lingual or buccal-lingual direction but there is adequate ridge height
class 2 alveolar ridge defect
loss of ridge height but there is adequate ridge width
class 3 alveolar ridge defect
loss of both ridge height and width
guided bone regeneration
surgical technique that increases and augments alveo.lar bone volume in areas designated for future implant placement or around previously placed implants
concept of guided bone regeneration
barrier to create a space into which cells originating from bone tissue can grow without migration or interference by faster proliferating cells of the flap connective or epithelium
what is considered the be the gold-standard material for bone grafting techniques?
autogenous bone
examples of bone necrosis
- bisphosphonate-related osteonecrosis of the jaw (BRONJ)
- osteoradionecrosis
- sequestration
bisphosphonate-related osteonecrosis of the jaw (BRONJ)
complication characterized by exposed necrotic bone in maxillofacial region that does not heal within eight weeks after diagnosis and proper care, in a patient under current or previous bisphosphonate tx for osteoporosis and hwo has not received radiation in the head and neck area
risk factors for bisphosphonate-related osteonecrosis of the jaw (BRONJ)
- route of administration (IV vs oral)
- duration of therapy
- type of bisphosphonate
osteoradionecrosis
death of most or all of bone cells due to irradiation
sequetration
necrotic bone that becomes separated from surrounding healthy bone and forms a sequestrum
…is a complication (sequela) of osteomyelitis and bisphosphonate-related osteonecrosis of the jaw (BRONJ)
sequestrum
island of non-vital bone that is separated from native healthy bone
sequestrectomy
removal of sequestrum by surgical means
one-stage surgery for implant placement
surgical protocol consisting of placing an endosseous root-form dental implant in bone and leaving it in contact with the oral environment during the healing process
two-stage surgery for implant placement
surgical procedure consisting of exposure of a submerged dental implant platform to the oral environment by the connection of an abutment which extrudes through the soft tissues
immediate implant placement
placement of dental implant at the time of tooth extraction into extraction socket
socket preservation
augmentation of residual alveolar socket at time of tooth extraction
…also known as socket augmentation and ridge preservation
rationale for socket preservation
an attempt to reduce dimensional changes of ridge, promote bone formation, minimize horizontal ridge resorption, and ultimately reduce or eliminate the need for further ridge augmentation
osseointegrated implants are ankylosed to surrounding bone without PDL which provides what?
mechanoreceptors shock-absorbing fxn and adaptation through remodeling
what is the most commonly used implant?
threaded root-form
common implant diameters
range from 3.3 to 5.0 mm
common lengths of implants
7-15 mm
piezoelectric bone surgery
surgical technique using an ultrasonica device operating at a modulated frequency that is designed to cut or grind bone but not damage adjacent soft tissues
anatomic considerations for implant in maxilla
- max sinus
- nasopalatine canal
- floor of nose and nasal spine
- greater palatine and pterygoid vessels
anatomic considerations for implant in mandible
- sublingual vessels
- mental n
- inferior alveolar n
- incisive branch of inferior alveolar n
- genial tubercles
in order to avoid the inferior alveolar n and mental foramen, how much space should be left to safely place an implant in the mandible?
2 mm between implant and coronal aspect of nerve
the heat generated during drilling site for implant placement must be less than what?
47 Celcius
what happens if the heat generated during drilling site for implant placement exceeds 47 degree Celcius?
irreversible necrosis of bone tissue after preparation of implant site
conditions that mandate implant removal?
- persistent pain on palpation, percussion or fxn
- horizontal and/or vertical mobility
- uncontrolled progressive bone loss
- uncontrolled purulent exudate
- more than 50% bone loss around implant
criteria for a successful outcome with implant placement
- implant is immobile and fxning
- no radiographic evidence of radiolucency
- vertical bone loss is less than 0.2 mm annually following the implant’s first year of service
- implant has an absence of persistent and/or irreversible signs of periimplantitis or pain
- patient and clinician are satisfied with treatment outcomes
connection between natural teeth and bone
bone, PDL, cementum with PDL insertion into bone and cementum
connection between implants and bone
osseointegration (bone grows to implant with ankylosis and no PDL)
junctional epithelium (epithelial attachment) of natural teeth
hemidesmosomes and basal lamina (basement membrane)
junctional epithelium (epithelial attachment) of implants
hemidesmosomes and basal lamina
connective tissue attachment (suprcrestal attached tissues) of natural teeth
collagen bundles (many groups) inserting into cementum
connective tissue attachment (suprcrestal attached tissues) of implants
no attachment of collagen to implant surface
probing depths in health of natural teeth
up to 3 mm
probing depths in health of implants
varies (up to 5 mm depending on implant placement and abutment length)
