Management of dental implants.

Question 1

Fiber orientation on implant v natural teeth

Answer 1

Teeth
perpendicular attachment
Implant
parallel with no attachment to the implant
-So PD will be deeper

Question 2

What to monitor at Annual exam

Answer 2

 Oral hygiene
 Inflammation
 Bleeding
 Suppuration
 Probe depth

Question 3

Implant BOP and bone loss

Answer 3

Sensitivity of consistent BOP at
implants 60-100% for
progressive bone loss

Question 4

Periimplant mucositis

Answer 4

A disease in which
the presence of inflammation is confined to
the mucosa surrounding a dental implant
with no signs of loss of supporting bone.

Question 5

Perimplantitis

Answer 5

An inflammatory process
around an implant which includes both soft
tissue inflammation and loss of supporting
bone.

Question 6

Classification of Periimplantitis

Answer 6

early
moderate
advanced

Question 7

Early Peri-implantitis

Answer 7

PD ≥ 4 mm with bleeding and/or
suppuration and bone loss <25% of
implant length

Question 8

Moderate peri-implantitis

Answer 8

PD ≥ 6 mm with bleeding
and/or suppuration and bone loss 25-
50% of implant length

Question 9

Advanced Peri-implantitis

Answer 9

PD ≥ 8 mm with bleeding
and/or suppuration and bone loss >50%
of implant length

Question 10

AAP Threshold for Periimplantitis

Answer 10

Radiographic bone loss ≥ 2
mm beyond normal crestal
remodeling

Question 11

Peri-implant mucositis prevalence

Answer 11

 30.7% of implants

 63.4% of patients

Question 12

Peri-implantitis prevalence

Answer 12

 9.6% of implants

 18.8% of patients

Question 13

AAP recommended maintenance interval

Answer 13

6 month

Question 14

Plastic instruments and implant cleaning

Answer 14

 Majority of current evidence shows plastic
instruments are ineffective on implants
 Priority = plaque removal

Question 15

Types of implant complications

Answer 15

Prosthetic
spft tissue
hard tissue

Question 16

Prosthetic complications

Answer 16

Screw fractures
Loose screws/cement
Phonetic masticatory or esthetic problems
growth following placement

Question 17

Excess Cement

Answer 17

Excess cement found in
81% of implants with
peri-implantitis
 Excess cement found in
0% of healthy controls
 74% of cases returned
to health following
endoscopic cement
removal

Question 18

Ailing implant def

Answer 18

– Soft tissue complications only
 Complications without bone loss
 Can be non-responsive to therapy

Question 19

Failing implant

Answer 19

 Involves bone loss

 Clinical signs without mobility

Question 20

Failed Implant

Answer 20

Implant is clinically mobile

requires removal

Question 21

Early v late failure

Answer 21

– Early: failure to integrate

– Late: failure to maintain integration

Question 22

Soft Tissue Complications

Answer 22

 Mucositis
 Enlargement
 Loose abutment
 Insufficient
keratinized tissue

Question 23

First step in solving peri implant mucositis

Answer 23

Start with oral hygeine

Question 24

Nonsurgical tx for Peri implant mucositis

Answer 24

– Hand scalers
– Ultrasonic
– Subgingival
irrigation
– Superfloss

Question 25

Do you need CHX for tx

Answer 25

No studies show no difference v OH alone

Question 26

Mucogingival procedures

Answer 26

``` – Free soft tissue autograft – Subepithelial connective tissue graft – Acellular dermal matrix allograft  AlloDerm® – Mucograft® ```

Question 27

Goals of tx of peri implantitis

Answer 27

– Soft tissue health – Surface decontamination – Regeneration or resection

Question 28

Bony defect regen sequence

Answer 28

– Removal of prosthesis – Regeneration procedure with or without submerging implant

Question 29

Regen material for bony defects

Answer 29

– Similar to GBR | – Must involve implant decontamination

Question 30

Surface decon of implant

Answer 30

```  Citric acid  Tetracycline -both harmful to soft tissue Clindamycin preferred  Chlorhexidine ```

Question 31

Surface decon contact time

Answer 31

5 min then glycine powder air abrasion

Question 32

Tx of Peri-Implantitis |  Sequence

Answer 32

``` – Surface decontamination – Air powder abrasive / TCN / saline – EMD on implant surface – FDBA or Bio-Oss + PDGF – Absorbable collagen membrane – Connective tissue graft if lacking KT ```

Question 33

Two categories for failure

Answer 33

``` – Bacterial: similar flora to chronic periodontitis – Biomechanical  Poor bone quality  Load transmission  Parafunction  Prosthetic superstructure ```

Question 34

Methods of implant removal

Answer 34

```  Use of hand drivers  Trephines  Extraction forceps  Fingers?  Implant removal kit ```

Question 35

Dental readiness and implants

Answer 35

```  Class I - healthy, integrated, restored  Class II or III - ailing, requiring restoration, requiring maintenance  Class III - failing or failed  Record should be stamped on 603a ```