Oral Surgery: Implants Flashcards
Indications for Implant
Replace missing tooth
Contraindications for Implant
- Uncontrolled Diabetes
- Immunocompromised Patients
- Volume and Height of Bone
- Bisphosphonate therapy
- Bruxism
- Smoking
- Hx of Head/neck radiation
- Cleft Palate
- Adolescents (not done growing 22-24 y.o.)
NOT OLD AGE
Implant Types
Subperiosteal: have failed over years
Transosteal
Endosteal
Subperiosteal Implants
Implant under periosteum
* NO true osteointegration
Poor Prognosis
Transosteal Implants
Only Mandibular Anterior
* Extraoral Approach
4 needed to support mandibular denture
Endosteal Implants
Placed in bone
* Largest category
Root form shape=most common today
Endosteal Implant Components
Implant Body
Abutment
Abutment Screw
Implant Crown
Implant Body
aka implant or fixture
* Axisymmetric (symmetric along long axis)
Procedures:
Sequentially enlarge the osteotomy
* reduce heat generated
* Pilot hole helps maintain axis w/free hand surgery
inserted into Tapped holes
* some implants are self tapping: cut threads into bone as its placed
Abutment
1 piece
=Abutment + Abutment screw
* No antirotation component
2 Piece:
* Abutment & Abutment screw are separate (more common)
* Antirotation component
Implant Crown
Screw Retained:
=screw through crown into implant
* Crown & abutment= 1piece
* Abutment screw is separate
Cement Retained:
=Abutment attached to implant separately ( w/cement)
Screw Retained Implant: pros vs cons
Pros:
* REtrievable
* Better for restoring restricted restorative space
Cons:
* Screw access hole: Decrease esthetics
* Not possible for angled implants
Cement Retained Implant: Pros vs Cons
Pros:
* Esthetics
Cons:
* Cement trapping=peri-implantitis
* Nonretrievable
* Needs more restorative space
1 vs 2-piece implants
Different from 1 & 2 piece abutments
1 piece:
= implant & abutment are attached together
* drilled into bone as 1 unit
* CANNOT correct angle b/w abutment and implant
2 piece:
=implant & abutment are separate
* implant is placed
* then abutment Is attached
* Then crown attached to abutment
Anti-rotation component
Prevents rotation of the abutment in the implant-> Provides stabilization
Different w/each brand
* Internal or External Helix
Implant surface
Rough surface: For bone integration
* No PDL for implants, Decreased ability to take heavy forces.
* restore w/light occlusion
Smooth surface: For soft tissue
* Gingival fibers orient next to implant
* Parallel to implant cuff
Socket Preservation
Maintains height & width of alveolar ridge
* re atraumatic Ext: Do not break buccal plate
Osseointegration vs Fibrousintegration
Osseointegration:
* direct histologic contact b/w bone & implant surface
Fibrousintegration:
* Presence of fibrous tissue layer b/w implant & bone
* Will be mobile=Failed osseointegration & implant placement
Primary vs Secondary Stability
Primary Stability:
* How the implant is when you first place it
* how locked in the threads are
Secondary Stability:
* Post-osseointegration
* long term healing of bone to thentitanium alloy
Bone quality: Type 1-4
Implant success rate goes from High to low as you increase bone type
Type 1: Anterior Mandible
* lots of Dense cortical bone
* not a lot of trabecular bone for vasculatiry
Best
Type 2: Posterior Mandible
* good mix of cortical & trabecular bone
Type 3: Anterior Maxilla
* Less cortical bone & More trabecular bone= Decrease stability
Type 4: Posterior Maxilla:
* worst type of bone
* not a lot of cortical bone
How far does an implant need to be placed from adjacent teeth?
1.5 mm
How far does an implant need to be placed from another implant?
3 mm
How far away does an implant need to be placed from IAN?
2 mm
How far away does an implant need to be placed from mental Nerve?
5 mm
Implants need to be placed 1mm away from…
Buccal plate
Lingual Plate
Inferior BOrder
Max Sinus
Nasal Cavity
1 vs 2 Stage Surgery
1 Stage:
* imlant and healing abutment are placed at same appt
* possible w/good primary stability
* Creates a good ST emergence profile
2 stage:
* implant is placed and capped w/a cover screw during osseointegratiion
* Open up and place abutment at next visit
Used if:
* Poor primary stability
* Graft placement is indicated
* Immunocompromised pt (Closing up decrease infection risk)
When is 2 stage surgery indicated over 1 stage surgery?
- Poor primary stability
- Graft placement is indicated
- Immunocompromised pt (Closing up decrease infection risk)
Implant Impression:
Once healing is complete, final impression is made so crown & abutment are properly oriented
Impression coping: transfer angulation and location of implant to master cast
* Open Tray: hold in tray for coping to pop out
* Closed tray: No hole in tray
Analog: Implant replica that is set into the cast
Surgical Stent
Used to help guide the implant drill as we deliver the implant
LAD
* Location
* Angulation
* Depth
What are the 4 characteristics of implant success?
- Immobile
- No peri-implant radiolucency
- Peri-implant bone loss < 0.2mm per year after 1st year
- No symptoms (pain, parasthesia, infection)
Implant Failure
associated with:
* Gram Negative anaerobic rods & filaments
Temp: 47 C for 1 min or 40 C for 7 mins to compromise osseointegration
If any 4 keys to implant success are present=failure
* mobility
* pain
* radiolucency *
peri-implant Bone loss
