Overview of Implantology Flashcards
what is a dental implant
an artificial tooth root placed in the jaw to hold a replacement tooth or bridge
what are the 3 pieces that make up the dental implant
- crown: extra gingival
- abutment: transmucosal
- implant body: endosseous portion
what are the types of implants
- bone level vs tissue level
- shapes and platform
describe bone level implants
- connects at bone
- allows customized and angled abutments
- esthetic zone
- allows two stage implant surgery
describe tissue level implants
- connect at soft tissue level
- smooth neck shapes the soft tissue
- one stage implant surgery
describe the straight cylindrical implant
- increased surface area
- greater force transfer
- most common design
describe the tapered conical implant
- complex osteotomy sites
- root proximity
- bone concavity
what are the types of platform implants
- narrow - standard - wide platform
what is the influence of microgap at two part implants
- inflammatory cell infiltrate was consistently present at the level of the interface between the two components, the bone crest was consistently located 1-1.5mm apical to the microgap
- inflammatory infiltrate was due to bacterial contamination
what is platform swithcing
the concept of placing a narrower abutment on the wider implant to preserve alveolar bone levels at the crest of a dental implant
platform swithcing reduces:
per-implant bone resorption at the bone crest and maintains the supracrestal attachment
what does platform switching do - 3 things
- increases distance of implant- abutment junction from the crestal bone
- limits micro movements at the bone implant interface
- shifts the inflammatory cell infiltrate tinward and away from the adjacent crestal bone
what do surface properties do
enhance cell adhesion to get better oseointegration
what are the surface characteristics
- roughness ( macro and micro): texture and machined
- subtractive: sandblast and acid- etch
- additive: oxidation and coating
the roughness of an implant is measured by the:
Sa value -representing the mean height of peaks and pits of the surface
what are the 4 groups of roughness value
- smooth: less than 0.5 micrometers
- minimally rough: 0.5-1.0 micrometers
- moderately rough: 2-3 micrometers
- rough: greater than 2 micrometers
the rougher the implant, the ____ its Sa value
higher
the higher the Sa value, the _____ for bacterial adhesion
easier
the higher the Sa value, the traditional methods of removing biofilm become ___ effective
less
where can microbial adhesion occur
on any implant surface regardless of the degree of surface roughness
what is SFE
the interaction between the force of cohesion and the force of adhesion that determines whether or not wetting occurs
how is SFE obtained
- sessile drop technique
- different material, implant design with characteristics contribute to the SFE and cell/bacterial adhesion
a successful implant must present:
no mobility. no peri implant radiolucency, bone loss less than 0.2mm per year after the first year of loading, and no persistent pain, discomfort or infection
what are the landmarks to consider during implant placement
- inferior alveolar canal/mental foramen
- incisive foramen
- maxillary sinus/nasal cavity
- lingual undercut
what are the safety zones of the inferior alveolar canal and mental foramen
- IAN: 2mm away
- 3mm away from mental foramen
what are the ways to detect IAN/mental foramen and what is the accuracy of each
- PA films: 75-46.8% accurate
- pano: 94-49% accurate
- CT scans: most accurate way to detect
when do you do direct sinus lifting vs indirect sinus lifting
- direct: less than 4mm residual bone height
- indirect: more than 4mm residual bone height
what are the sinus lift techniques
- direct/lateral window technique
- indirect/osteome technique/crestal approach/transalveolar approach
perforating the lingual plate during preparation of the implant site can result in:
extensive and life threatening bleeding
what are the bone requirements
osseointegration
what is osseointegration
a direct functional and structural connection between living bone and the implant surface
what is critical to successful osseointegration
the stability of the bone at the time of implant placement
what is the quantity and quality of bone referring to
- quantity: related to the degree of bone loss or bone resorption present
- quality: related to the degree of bone density present
describe type 1 bone
- hard and dense like oak wood- D1
- less blood supply than other types- compact bone
- takes longer for an implant to integrate
- found in the mandible
describe type 2 bone
- consistency of pine wood - D2
- thick layer of compact bone surrounds a core of dense, trabecular bone
describe type 3 bone
- consistency of balsa wood - D3
- thin layer of corticla bone surrounds a core of dense trabecular bone
describe type 4 bone
- consistency of styrofoam - D4
- thin layer of cortical bone surrounds a core of low- density trabecular bone
- commonly found in posterior maxilla
what are the concept of placement
- prosthetically driven implant placement
- hard tissue management
- soft tissue management
need _____ between teeth and implant
1.5mm
need at least ___ between 2 adjacent implants
3mm
significantly greater BL resorption and gingival recession when the ridge width is less than:
2mm
need at least _____ buccal bone thickness in the anterior region
2mm
need at least ____ buccal bone and ____ lingual bone thickness in the posterior
1mm; 1mm
need ____ bone apical from adjacent CEJ
3-4mm
it is recemmended to place bone level implants:
subcrestally
which dimensions does the ridge atrophy
horizontal and vertical
what are the classes of Siebert Classification and describe each
- Class 1: buccolingual loss of tissue (horizontal)
- class II: apico-coronal loss of tissue (vertical)
- class III: both loss of tissue
what are the techniques for ridge augmentation for atrophic bony ridge
- bone block technique vs particulate bone graft
- guided bone regeneration (GBR)
- sinus augmentation: direct/indirect
what is guided bone regeneration
a surgical procedure that uses barrier membranes with bone grafts to augment atrophic bony ridge
what is the healing time for ridge augmentation for atrophic bony ridge and what is it dependent on
- longer healing time
- 3-12 months before implant placement
- dependent on the augmented volume, the graft material and individual healing ability
what are the post op complications of ridge augmentation
- membrane exposure
- infection
- sinus membrane perforation
what are the dimensional changes 6 months post extraction
- mean horizontal reduction in ridge width: 3.8mm
- mean vertical reduction in ridge height: 1.24mm
by performing ridge preservation:
maintain stable ridge volume to optimize functional and esthetic outcomes
- simplify treatment procedures following the ridge preservation
- ready for implant placement at 3-6 months
what soft tissues need to be managed
- peri implant mucosa
- transmucosal attachment
what is the transmucosal attachment’s role
a mucosal seal should prevent bacterial products reaching the bone, ensuring the osteointegration
the height of the peri-implant supracrestal soft tissue includes:
sulcular epithelium, JE, and supracrestal CT
supracrestal tissue attachment is roughly ___
3mm
soft tissue thickness greater than ____ is necessary to prevent peri implant soft tissue dehiscence
2mm
a minimum of ____ of KT is necesarry to facilitate proper oral hygiene for peri implant health
2mm
what are the ways soft issue can be managed and what is the goal of each
- free gingival graft: to gain KT
- connective tissue graft: to gain thickness
describe the implant portion of the comparison between teeth and implatns
- direct bone to implant contact (osseointegration)
- peri implant fibers form parallel cuff in an oriented longitudinal direction
- ankylosis, higher stress at the neck of the screw/implant
- blood supply by terminal branches of large vessels from periosteum, fewer capillaries
- stronger inflammatory response
describe the tooth portion of the tooth vs implant comparison
- periodontal fibers attach from bone to root in multiple directions
- connectiv tissue fibers attach to teeth
- perioodntal ligament act as shock absorber
- blood supply from PDL and periosteum
epithelial cells are attached to peri implant fibers by:
hemidesmosomes
describe collagen fibers around an implant
they do not insert into the implant but creates a cuff around the implant creating a mucosal seal
per implant fibers forming a parallel cuff in a longitudinal direction prevents:
bacterial invasion
peri implantitis lesion is dominated by:
plasma cells and lymphocytes but characterized by a larger proportion of polymorphonuclear leukocytes and macrophages
area proportions, numbers and desnsities of ______ are higher in peri implantitis
plasma cells, macrophages and neutrophils
describe the vascular supply to the gingiva
- supraperiosteal blood vessels
- form capillaries to the CT papilla
- vascular plexus of the PDL
- lateral to the JE
- runs coronally and terminates in supraalveolar portion of free gingiva
what is the definition of peri-implant health
absence of erythema, BOP, swelling and suppuration
describe peri implant mucositis
an inflammation in absences of continguous marginal peri implant bone loss
what is the clinical sign of inflammation in peri implant mucositis
BOP
what are additional signs of peri implant mucositis
erythema, swelling and suppuration
what is per implantitis
a pathological condition occurring in tissues around dental implants, characterized by inflammation in the peri implant mucosa and progressive loss of supporting bone
what are the clinical signs of inflammation in peri implantitis
BOP and progressive bone loss identified on radiographs
what is the prevalance for peri implant mucositis and peri implantitis at the subject level
43% and 22%
what is the prevalence for peri implant mucositis and per implantitis at the implant level
29.5% and 9.3-22.1%
what is the dx for peri implant diseases with baseline Xray or previous exam data
- presence of bleeding and/or suppuration on gentle probing
- increased probind depth compared to previous examinations
- presence of bone loss beyond crestal bone level changes resulting from initial bone remodeling - more than 2mm after the first year of function
in the absence of previous exam data how do we dx peri implant disease
- presence of bleeding and/or suppuration on gentle probing
- probing depths greater than 6mm
- bone levels greater than 3mm apical of the most coronal portion of the intraosseous part of the implant
what are the factors in peri implant health
- absence of inflammation
- no BOP
- bone level change less than 2mm
what are the factors in peri implant mucositis
- signs of inflammation
- BOP and/or SoP
- increased probing depth compared to baseline
- bone level changes less than 2mm
what are the factors in peri implantitis
- signs of inflammation
- BOP and/or SoP
- increased PD compared to baseline or greater than or equal to 6mm
- bone less greater than 3mm
what are the peri implantitis risk factors/indicators
- poor plaque control
- lack of regular maintenance
- tissue quality: thin phenotype, KT band, bone deficiency
- iatrogenic factors: malpositioning, poor design of emergence profile, inadequate abutment/implant seating
- excessive cement
- occlusal overload
- titanium particles: implant corrosion, micromovement
what are the peri implantitis risk modifiers
- history of periodontal disease
- smoking
- DM
- genetic factors
- systemic condition
bacterial colonization was initiated within _____ after implant placement
30 minutes
the sequence of colonization on dental implants and biofilm formation is similar to:
that of teeth
plaque leads to:
peri implant mucositis
what is the histology of plaque causing peri implant mucositis
B and T cells infiltration at 21 days
peri implant mucositis mirrors the progression of _____
gingivitis to periodontitis
what are the microbial factors that are involved in the progression of health to disease
- pioneer bacteria colonization
- biofilm formation
- congregation of early colonizers
- acquisition of bridging bacteria
- accumulation of keystone pathogens
- dysbiosis and host immune response
what are the changes seen from health to peri implant disease
- increased plaque
- increased inflammation
- high GCF flow
- gramu negative facultative anaerobes
describe the microbiology of implants in fully edentulous patients
- the microbiota is similar to the mucosal flora on the adjacent alveolar ridge
- over 80% were gram positive facultative cocci
- spirochetes were limited
- fusobacteria/black pigmenting gram negative anaerobes were found infrequently
describe the microbiology of implants in partially edentulous patients
- the microbiota is similar to remaining teeth
- higher percentages of black pigmenting gram- negative anaerobes and capnocytophaga
when do you treat perio disease in relation to implant placement
before
what can be used for maintenance of implants
- interproximal brushes
- professional debridement
- review of OH
- deposit removal from implant/prosthesis surfaces
- use of antimicrobials
- reeval of maintenance interval
scalers made of stainless steel and ultrasonic tips can:
roughen the implant surface creating scarring and pitting
interproximal brushed can penetrate ____ into the gingival sulcus
3mm
the use of scalers and currettes made of _____ are most favorable around the peri implant site
plastic or acrylic resin
why are hard deposits on titanium not as hard to remove as those on natural tooth
the surface of titanium does not promote a tight bond for calculus
prevent future complications by thorough:
dx and tx planning
