Miscellaneous

Question 1

What are the different types of implant placement techniques?

Answer 1

• Type 1=Immediate Placement
  
  • Place in fresh ext socket
    
    • Premolars=good
  • Most understand resorption patterns
    
    • 1st 3 months=BL
    • Be able to predict
    • Does NOT stop bone remodeling
• Type 2=Early Placement
  
  • 6-8 wks post ext
  • Ensures no pathology if tooth infection
  • allows primary healing & remodeling of tissues
• Type 3=Conventional/Delayed
  
  • 12-16 wks post ext
  • Allows complete bone remodeling
  • can be longer if (3-6 mos.)
    
    • Site preservation
    • Guided bone regeneration
      
      • Ridge augmentation
      • Sinus Augmentation

Question 2

Healing Stages:

Answer 2

• Stage 1
  
  • healing abutment
• Stage 2:
  
  • cover screw→ healing Abutment

Question 3

What are the different types of Loading for implants?

Answer 3

• Immediate Load
  
  • <1 wk after placement
• Early:
  
  • 1 wk - 2 months
• Conventional/Delayed
  
  • > 2 mos
  • Recommend fo:
    
    • poor 1° stability
    • compromised host
    • substantial bone augmentation
    • ⇣ implant dimensions

Question 4

Occlusal Forces

Answer 4

• Natural Teeth:
  
  • center of rotation: ½- ⅓ root length apical to crest
• Implants:
  
  • All forces→ alveolar crest
    
    • avg 0.1 mm bone loss/year
  • Axial forces=compressive→No BL
  • Lateral Forces=Shear forces→BONE LOSS
  • Shear forces due to:
    
    • Large. cusps
      
      • ideal=flat
    • Large Occlusal Table
      
      • idea: Table=Diameter
      • Reduce cusp height
      • maxillary: Reduce palatal contour of crown
      • mandibular: Reduce buccal contour of crown

Question 5

Placement Considerations: Number to remember

Answer 5

• 6mm Horizontal Bone
  
  • 1mm Buccal & Lingual Bone
  • 4 mm implant body
• Occlusal Clearance/VDO: 6-10 mm
• 5mm=Bone Height
• 4.5 mm: Gingival margin→ Platform
• 4 mm= Mental Foramen
• 3 mm: I;I
• 1.5 mm: I:T
• 2 mm= IAN
• 1 mm= Maxillary Sinus/Nasal Vestibule
• Esthetic ZONE
  
  • 4mm: Gingival Margin→ Implant Platform
  • Platform= 3mm deeper than CEJ
  • Buccal Part of implant is 1-2 mm palatal to adj tooth emergence profile
  • Interproximal Papilla: Depends on:
    
    • Presence of interproximal bone of adjacent tooth. Bone Defect=No papilla
      
      • Avg Height= 4.5 mm implant→tooth when 1.5 mm away
    • Distance b/w contact pt and bone crest
      
      • < 5mm= Full coverage
      • 6 mm= 56%
      • 7 mm= 27%

Question 6

Occlusal Forces: What Factors effect stress?

Answer 6

• Occlusal contact location
  
  • Overbulked→Cantilever→Shear Force
  • ideal=place in center of restoraiton
• Vertical Height (occlusal→ crest)
  
  • Longer crown→ ⇡Stress→ ⇡Shear Force
• Implant Diameter:
  
  • Wider Diameter→ ⇡ surface area of bone to implant contact→ ⇣ Stress (cantilever)
  • Narrow Diameter→ ⇡stress
  • Splinting
    
    • Implant to implant: ⇡ stress distribution (⇣ stress)
      
      • use in high stress areas
    • Implant to tooth: ⇡ stress at implant neck

Question 7

What is the criteria for a successful implant?

Answer 7

• Immobile
• No peri-implant radiolucency
• Mean avg Vertical Bone loss <0.1 mm after 1 year
• No pain, discomfort, paraesthesia, neuropathy, violate mandibular canal, sinus drainage
• Design allows satisfactory restoratoin
  
  • pt and dentist