Implants_7th May_8am Flashcards
What is one stage and two stage implant surgery?
One stage is used with abutment screws (screw is visibly sticking out of gingiva)–>thus no need to do another surgery to re-expose
Two stage is used with cover screws (screw is buried under gingiva which is stitched up over the top), thus a second surgery is required to re-expose it (done in anterior region for aesthetics)
What do you have to consider in terms of implant diameter?
-Have to have bone all around implant to facilitate osteo integration
If there is only a thin amount of bone around base of sinus, what are the options to avoid piercing sinus?
- Shorter implant
- Sinus lift + bone augmentation
- Onlay/inlay graft
In which area do you never put implants and why?
Lower 6’s, this is where inferior alveolar nerve starts to curve.
Symphysis area: You will fracture the jaw
What is the minimum number of implants that you can do (and still make it worthwhile)?
If absolute worst 2 implants lower, 4 upper
More ideally 4 lower, 6 upper as better stability
Define osteointegration
Direction functional and structural connection between living bone and load bearing carrying implant, seem to have junctional epithelium
What is the difference periodontally between implant and natural tooth? What implications does this have?
Natural tooth has periodontal ligament, implant does not, works via osteointegration instead, therefore there is no feeling in the implant. Thus, advisable to put it against opposing arch natural tooth to get some feeling
Is a rough implant better or a smooth implant, why?
Rough: better osteointegration, allows shorter implants
T/F Denser bone causes better osteointegration
T (better to place implant into type i or type ii bone)
What should you consider when assessing your patient for suitability for implants?
MHx (undisturbed wound healing, jaw growth completed before implant insertion unless for special reasons e.g. ortho otherwise will cause infra-occlusion)
What are some factors you have to consider that may disturb wound healing?
- Diabetes
- Heavy smoking (>10)
- Radiotherapy patient (irradiated bone may cause vascular fibrosis and thrombosis)–>waiting time after therapy recommended
- Bleeding disorders (haemorrhage or drug induced anticoagulants)
What are some temporary contraindications to implant therapy?
- Insufficient bone volume
- Untreated periodontitis (infection will just result in peri-implantitis)
- Residual root (source of infecdtion)
- Local infection
What are some local risk factors for implant failure?
Erosive and bulbous disease: (autoimmune disease)
Xerostomia
Bruxism
What should you inform your patient for consent?
Treatment alternatives
Risks: damage to adjacent structures, immediate or post op complications (soft tissue diheisences, peri implantitis, fracture of implant)
Long term prognosis
Cost
*Implant treatment is lengthy and needs ongoing commitment
What radiographs should you always take for implants?
OPG (can show tilting of roots which may resorb if you put an implant through them)
What should you do for the evaluation stage of implants?
MHx + DHx
Indications + contra
Intra/extra oral exam, perio exam,
Existing pros assessment
Diagnostic impressions + casts
Radiographs
Photographs
Restorative dentist/ surgeon consult
Informed consent
Implant placement
What system is used to assess implant cases?
SAC
simple, advanced, complex
What is delayed, intermediate, early and immediate placement?
Delayed: Insufficient bone, need 6 months for bone to heal
Early placing: When enough bone at the end of 6-8 weeks to put implant in
Immediate: take tooth out and place implant immediately (risk of infection due to granular tissue especially if endo treated tooth)
(Other definitions fit somehwere along timeline not mentioned in lecdture)
What is a surgical guide for implants?
A guide with holes placed where you want the implants–>allwos you to drill in correct area
What is delayed, intermediate, early loading?
Delayed: After placement of implant, 3 months for bone to integrate into implant (so patinet has to wear plate for the 3 months before tooth can be added)
(Other definitions fit somewhere along timeline not mentioned in lecture)
What is the condition for doing early loading?
Restoration has to be put out of occlusion
Usually a temporary, and will need a permanent one later
What are steps for placing implant fixture into bone?
- Drill through gingiva into bone using surgical guide
- Raise flap
- Use implant bone drill to drill into bone, irrigate constantly with saline
