implants key points

Question 1

absolute contraindications - what should you do?

Answer 1

consider non-surgical tx alternatives or refer to specialist oral surgeon

Question 2

absolute contraindications

Answer 2

recent MI/CVA (<6m ago)
recent valvular prosthesis surgery (<6m ago)
prev irradiated bone in H+N area
IV bisphosphonates
ongoing chemo
high dose immunosuppressive therapy
allergies to implant materials
lack of compliance
incomplete growth

Question 3

relative general and medical contraindications

Answer 3

poor general health
uncontrolled DM
uncontrolled bleeding disorders/anti-thrombotic meds
immunocompromised
bone metabolism disorders
tobacco, drug, alcohol abuse
oral bisphosphonates
uncontrolled PDD
severe bruxist or parafct habits
pregnancy
psychoses

Question 4

smoking

Answer 4

not absolute contraindication but lowers survival and success rates

Question 5

why do you need at least 1.5mm each side of implant?

Answer 5

get circumference of bone loss which is <1.5mm

Question 6

periodontitis

Answer 6

not contraindicated in pts with history of periodontitis
3-4x risk of peri-implantitis
tx perio before implants

Question 7

what mucosa is ideal?

Answer 7

keratinised as forms a good seal around implant

non-keratinised harder to keep clean and more inflammation

Question 8

cement-retained

Answer 8

good aesthetics

cement removal
retrievability bad

Question 9

screw-retained

Answer 9

good retrievability and no cement complications

aesthetics

Question 10

tissue level implants

Answer 10

roughened surface with a smooth polished collar at top
+v good seal on gingivae
+ easier to clean - at level of gingivae so good access
- chance of metal shine through gingivae - compromised aesthetics
good for molar and premolar regions

Question 11

bone level tapered implants

Answer 11

implants placed at level of bone, no shiny polished collar
- less chance of metal show, better aesthetics
good for anteriors

Question 12

overall tx time

Answer 12

generally 3-4 months for straightforward case from placing implant until 1st aftercare appt

longer in hospital service

Question 13

risks

Answer 13

peri-implantitis
ST dehiscence (recession)
crown/abutment loosening or decementation of Rx
chipping or fracture of veneering ceramic, abutment or implant

Question 14

basic of procedure

Answer 14

flap
osteotomies
ratchet to place implant
healing cap
sutures
review 7-10days for review and suture removal