MODULE 2 - Implants

Question 1

Osseointegration

Answer 1

PI Branemark, 1952. Titanium chambers embedded in bone that grew around it

Question 2

Implant Placement (Timing)

Answer 2

Drilling the implant into the extraction socket.
Immediate = 0-2 weeks
Immediate-delayed (Early) = 2 wks - 2 mos
Delayed = 2 mos (3 mos at U of T)

Question 3

Implant Loading (Timing)

Answer 3

Placement of an esthetic or functional restoration.
Immediate = 0-48 hrs
Early = 2 days - 12 weeks
Delayed/Traditional = 12+ weeks

Question 4

Surgical Options

Answer 4

Immediate function: esthetic crown placed immediately on implant during surgery
One-stage: implant and supra-gingival healing abutment placed during single surgery
Two-Stage: implant and sub-gingival cover screw placed, second surgery after gum heals to place healing abutment

Question 5

Implant Stability

Answer 5

Primary: initial mechanical stability of implant threads in intact bone. Decreases with time.
Secondary: delayed biological stability obtained by bony remodeling and osseointegration. Increases with time.
LOWEST STABILITY AT 4 WEEKS

Question 6

Implant Impressions

Answer 6

Open-Tray: coping removed as part of impression (taller so requires greater mouth opening)
Closed-Tray: coping stays on implant, re-placed into impression

Question 7

Engaging vs Non-Engaging Abutment

Answer 7

Single implant needs an engaging connector (conical/Tri-lobe) to prevent rotation
Multi-implant prosthesis uses non-engaging (circular) connector since it will naturally not rotate, and aligning all components perfectly with connector will add more trouble

Question 8

Systemic Risk Factors

Answer 8

Immunodeficiency/immunosuppression, bleeding disorders, cancer treatment, osteoporosis and bisphosphonate usage, diabetes, heavy smoking

Question 9

Smoking effects on implants

Answer 9

Failure rate twice that of non-smokers, more marginal bone loss, higher incidence of peri-implantitis, lower success for bone grafts

Question 10

Local Risk Factors

Answer 10

Oral hygiene, periodontal disease, mucosal diseases, parafunction

Question 11

Relative Contraindications

Answer 11

Bone volume, periodontitis, retained roots, local infection, drug/alcohol abuse, psychological disorders, young age

Question 12

Absolute Contraindications

Answer 12

ASA5 and 6, IV bisphosphonate use, cancer treatment, high dose immunosuppressive use, serious systemic disease, allergy (?), lack of compliance

Question 13

Papilla Regrowth (filled cervical embrasure)
Vertical and Horizontal Dimensions

Answer 13

Interproximal alveolar crest within 5mm of tooth contact point = 100% filled embrasure space
>5mm between contact point and AC = <50% filled embrasure space (black triangle)
Horizontal distance of 3-4mm between implant and tooth = 84% papilla regrowth. 1-2.5mm = 32% papilla regrowth

Question 14

Periodontal Biotype

Answer 14

Scalloped: thin gingiva, narrow KT, thin/scalloped bone, contact near incisal edge, recession reaction to injury
Flat: thick gingiva, wide KT, thick/flat bone, contact in mid-coronal area, pocketing reaction to injury

Question 15

Implant Platform Height

Answer 15

Esthetic region and thin biotype = at bone level
Esthetic region and thick biotype = 0.5mm supracrestal
Non-esthetic region (and implant length > 10mm) = 1mm supracrestal
Consider biologic width of 3mm between AC and esthetic crown

Question 16

Inter-Arch Space Requirement

Answer 16

8-12mm provides space for mucosa, abutment with adequate retention, and esthetic thickness of porcelain
6mm absolute minimum for PFM crown, but does not allow an esthetic emergence profile
4-5mm posterior full-metal screw-retained crown (no retentive abutment so can’t be cemented)

Question 17

Mesio-Distal Space

Answer 17

Comfort zone = 2+ mm space adjacent
Danger zone = 1-1.5mm space adjacent
NT to implant = 1.5-2mm space
Implant to implant = 3-4mm space
Total M-D space needed = 6-7mm

Question 18

Panoramic Radiograph

Answer 18

Initial evaluation of bone dimension, screening for pathology, rough determination of mental foramen and IAN canal position
Limitations: up to 25% magnification (measurement error of 3mm), poor resolution and no cross-section

Question 19

Periapical Radiograph

Answer 19

Preliminary analysis of M-D space, accurate horizontal measurements, higher quality and lower radiation exposure than panoramic, cost-effective & routinely used
Limitations: measurements only accurate when paralleling technique used, no cross-sections, small FOV

Question 20

CBCT

Answer 20

Provide a diagnostic edge and reduce unintended outcomes. Three-dimensional view of the site and detailed information on bone anatomy and quality

Question 21

Techniques for visualizing tooth on radiograph

Answer 21

Barium-impregnated resin denture tooth, gutta percha-embedded resin denture tooth, CaOH cement on surface of resin denture tooth, digital design

Question 22

Soft tissue stability & esthetics

Answer 22

Surgical technique, prosthetic protocol, phenotype, tooth shape, bone condition, position of osseous crest, implant position

Question 23

Confirmation of Osseointegration

Answer 23

Immobile, asymptomatic, intact bone-implant interface, restorable, <0.2mm annual bone loss

Question 24

Purpose of implant coping

Answer 24

To record position and timing (rotational position of connector) of implant and transfer it to cast

Question 25

Implant insertion checkpoints

Answer 25

Interproximal contacts, tissue pressure, complete seating (radiographically), occlusion, shade approval, final torque (35 Ncm)