Implants In The Esthetic Zone Flashcards
No difference in survival rate of implants with regards to their anatomical location
Eckert and wollen
Henry and colleagues : multicenter study - success rate of ____ in anterior maxillary. However esthetic failure rate _____ in these areas
96%
9%
What do you need to understand when placing an implant in an esthetic zone
Biological principles
Anatomic principles
Surgical principles
Prosthetic principles
It has been suggested that implants should be placed only after the age of __ in females and ___ in males to avoid problems caused by further skeletal growth
15
18
_____ last to grow
______ skeletally mature faster than _____
Premaxilla
Females
Males
What does some evidence show with continuous vertical growth of the maxilla?
Continuous growth after age 18 - issue not totally resolved
What is necessary to evaluate growth plate fusion ?
Wrist x ray
Lateral cephalometric radiograph
Mandible
Pattern of bone growth may bring about _____ positioning of the implant in case it is placed _____
Increase in mandibular length is limited to the ______ _____ _____ to accommodate the permanent molars
Lingual
Early
Primary second molars
What is the most ideal anatomical lip line
Low
Alveolar ridge
Adequate width
Status of mucosa
Loss of architecture of gingival and its papilla due to loss of tooth — can lead to black triangle
What type of soft tissue is more prone to recession ?
Thin and scalloped gingival margin (compared to thick and flat gingival phenotype)
Soft tissue thickness (phenotype)
Thick is more ideal !
Keratinized tissue
Minimum of 2mm KT required for implant and or tooth
Mucogingival junction symmetry
Esthetics
Presence/absence of papilla/black triangle
Tissue shaping with provisionals
Which garber class is more ideal
Garber class I
Favorable horizontal and vertical levels of both soft tissue and bone are present
Garber class I
No vertical bone loss and slight 1-2 mm horizontal bone deficiency
Garber class 2
No vertical bone loss and horizontal bone loss greater than class II (2mm)
Garber class 3
No vertical bone loss but significant horizontal loss
Crater defect/depression
Garber class 4
Sites with extensive apicocoronal (vertical) bone loss present
A significant challenge to the surgeon
Garber class 5
4 main factors directly affect the esthetic outcome of implant supported restorations
Implant placement
Soft tissue management
Bone grafting considerations
Prosthetic considerations
Flap design for surgery
Conservative
Flap should be jagged
Only when necessary - can destroy blood supply
Implant placement
Implant position
Implant size
Too buccal position
Dehiscence and gingival recession
Too palatal position
Improper restoration, not hygienic, not ethic
Where must the centerline of the implant be located
At or near the center of the tooth it replaces
Buccal aspect of implant platform just touches imaginary line that touches the incisal edges of the adjacent teeth
Patients presenting with a thin gingival bio type
Palatoversion is desirable
Prevents showing of metal collar
Distance between implant-tooth
1.5 mm at least
Distance between implant -implant
3 mm at least
___ mm inter implant distance prevents overlap of horizontal bone loss (saucerization) between implants (maintains papilla)
3
In the case of max central incisor site, may be desirable to place the implant slightly to the _____ to mimic the natural asymmetry of the gingival contour often seen in these teeth
Distal
Most apical point of clinical crown. Generally distal. Lateral - exception and are in the center
Gingival zenith
Ideal apico-coronal position
3-4 mm apical to adjacent CEJ
Use gingival margin in case of recession
Allows for running room for emergence profile - easier to clean
What does implant size selection depend on
Dimension of the edentulous crest
Proximity of adjacent roots
Final restoration - molar vs mand central incisor, canine, max central incisors
Maintain at least 3 mm inter implant distance at the crest
Distance between the underlying interproximal alveolar crest heigh on the adjacent natural teeth and the final prosthetic contact point dictates the presence or absence of _______ ________
Interdental papilla
If the distance is more than _____, the complete papilla formation will be compromised. Often leads to _____ ____
5 mm
Black triangle
Average height interdental papilla between adjacent implants
3.4 mm
What can papillary height be influenced by
Spacing between implants
Placement of the contact point
Type 1 - immediate
Immediately after ext
Type 2- early
4-8 weeks later (soft tissue healed)
Type 3 - early delayed
12-16 weeks later (bone formation in clinical and Radiographic evaluation)
Type 4 - delayed
More than 16 weeks
Following tooth removal, a considerable amount of ____ _____ takes place in both ____-_____ or ______-_____ dimensions
Ridge collapse
Buccal -lingual
Apical-coronal
An average of ____ - _____ original height and width is expected to be lost after tooth ext with the greatest loss happening within the first ____ years
1/3rd
1/5th
2
Width loss without ridge preservation
30-35%
Width loss with ridge preservation is
15%
Buccal bone in esthetic zone is primarily made of ____ _____ ____. Function is to attach ____ _____. Following ext , most buccal bone is ____
Cortical bundle bone
PDL fibers
Lost
As the bone thickness in buccal are approached ____ to ____, bone loss decreased significantly, and some evidence of bone ____ was seen
1.8
2 mm
Gain
Implant angulation
Mimic adjacent teeth
Poor angulation can
Alter screw access hole - post = central fossa, ant = cingulum
Poor esthetic result
Difficult home care
Undesirable cantilevers
Optimal esthetic result is achieved only with ideal ____ _____ placement
3D implant
4 positional parameters contribute to the success of the restoration
Buccolingual
Mesiodistal
Apicocoronal position relative to implant platform
Angulation of implant
Prosthetic design factors
Cement vs screw retained
