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Periodontics I > Overview of Implantology > Flashcards

Overview of Implantology Flashcards

1
Q

what is a dental implant

A

an artificial tooth root placed in the jaw to hold a replacement tooth or bridge

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2
Q

what are the 3 pieces that make up the dental implant

A
  • crown: extra gingival
  • abutment: transmucosal
  • implant body: endosseous portion
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3
Q

what are the types of implants

A
  • bone level vs tissue level
  • shapes and platform
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4
Q

describe bone level implants

A
  • connects at bone
  • allows customized and angled abutments
  • esthetic zone
  • allows two stage implant surgery
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5
Q

describe tissue level implants

A
  • connect at soft tissue level
  • smooth neck shapes the soft tissue
  • one stage implant surgery
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6
Q

describe the straight cylindrical implant

A
  • increased surface area
  • greater force transfer
  • most common design
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7
Q

describe the tapered conical implant

A
  • complex osteotomy sites
  • root proximity
  • bone concavity
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8
Q

what are the types of platform implants

A
  • narrow - standard - wide platform
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9
Q

what is the influence of microgap at two part implants

A
  • 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
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10
Q

what is platform swithcing

A

the concept of placing a narrower abutment on the wider implant to preserve alveolar bone levels at the crest of a dental implant

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11
Q

platform swithcing reduces:

A

per-implant bone resorption at the bone crest and maintains the supracrestal attachment

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12
Q

what does platform switching do - 3 things

A
  • 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
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13
Q

what do surface properties do

A

enhance cell adhesion to get better oseointegration

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14
Q

what are the surface characteristics

A
  • roughness ( macro and micro): texture and machined
  • subtractive: sandblast and acid- etch
  • additive: oxidation and coating
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15
Q

the roughness of an implant is measured by the:

A

Sa value -representing the mean height of peaks and pits of the surface

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16
Q

what are the 4 groups of roughness value

A
  • smooth: less than 0.5 micrometers
  • minimally rough: 0.5-1.0 micrometers
  • moderately rough: 2-3 micrometers
  • rough: greater than 2 micrometers
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17
Q

the rougher the implant, the ____ its Sa value

A

higher

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18
Q

the higher the Sa value, the _____ for bacterial adhesion

A

easier

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19
Q

the higher the Sa value, the traditional methods of removing biofilm become ___ effective

A

less

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20
Q

where can microbial adhesion occur

A

on any implant surface regardless of the degree of surface roughness

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21
Q

what is SFE

A

the interaction between the force of cohesion and the force of adhesion that determines whether or not wetting occurs

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22
Q

how is SFE obtained

A
  • sessile drop technique
  • different material, implant design with characteristics contribute to the SFE and cell/bacterial adhesion
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23
Q

a successful implant must present:

A

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

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24
Q

what are the landmarks to consider during implant placement

A
  • inferior alveolar canal/mental foramen
  • incisive foramen
  • maxillary sinus/nasal cavity
  • lingual undercut
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25
Q

what are the safety zones of the inferior alveolar canal and mental foramen

A
  • IAN: 2mm away
  • 3mm away from mental foramen
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26
Q

what are the ways to detect IAN/mental foramen and what is the accuracy of each

A
  • PA films: 75-46.8% accurate
  • pano: 94-49% accurate
  • CT scans: most accurate way to detect
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27
Q

when do you do direct sinus lifting vs indirect sinus lifting

A
  • direct: less than 4mm residual bone height
  • indirect: more than 4mm residual bone height
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28
Q

what are the sinus lift techniques

A
  • direct/lateral window technique
  • indirect/osteome technique/crestal approach/transalveolar approach
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29
Q

perforating the lingual plate during preparation of the implant site can result in:

A

extensive and life threatening bleeding

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30
Q

what are the bone requirements

A

osseointegration

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31
Q

what is osseointegration

A

a direct functional and structural connection between living bone and the implant surface

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32
Q

what is critical to successful osseointegration

A

the stability of the bone at the time of implant placement

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33
Q

what is the quantity and quality of bone referring to

A
  • quantity: related to the degree of bone loss or bone resorption present
  • quality: related to the degree of bone density present
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34
Q

describe type 1 bone

A
  • 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
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35
Q

describe type 2 bone

A
  • consistency of pine wood - D2
  • thick layer of compact bone surrounds a core of dense, trabecular bone
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36
Q

describe type 3 bone

A
  • consistency of balsa wood - D3
  • thin layer of corticla bone surrounds a core of dense trabecular bone
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37
Q

describe type 4 bone

A
  • consistency of styrofoam - D4
  • thin layer of cortical bone surrounds a core of low- density trabecular bone
  • commonly found in posterior maxilla
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38
Q

what are the concept of placement

A
  • prosthetically driven implant placement
  • hard tissue management
  • soft tissue management
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39
Q

need _____ between teeth and implant

A

1.5mm

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40
Q

need at least ___ between 2 adjacent implants

A

3mm

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41
Q

significantly greater BL resorption and gingival recession when the ridge width is less than:

A

2mm

42
Q

need at least _____ buccal bone thickness in the anterior region

A

2mm

43
Q

need at least ____ buccal bone and ____ lingual bone thickness in the posterior

A

1mm; 1mm

44
Q

need ____ bone apical from adjacent CEJ

A

3-4mm

45
Q

it is recemmended to place bone level implants:

A

subcrestally

46
Q

which dimensions does the ridge atrophy

A

horizontal and vertical

47
Q

what are the classes of Siebert Classification and describe each

A
  • Class 1: buccolingual loss of tissue (horizontal)
  • class II: apico-coronal loss of tissue (vertical)
  • class III: both loss of tissue
48
Q

what are the techniques for ridge augmentation for atrophic bony ridge

A
  • bone block technique vs particulate bone graft
  • guided bone regeneration (GBR)
  • sinus augmentation: direct/indirect
49
Q

what is guided bone regeneration

A

a surgical procedure that uses barrier membranes with bone grafts to augment atrophic bony ridge

50
Q

what is the healing time for ridge augmentation for atrophic bony ridge and what is it dependent on

A
  • longer healing time
  • 3-12 months before implant placement
  • dependent on the augmented volume, the graft material and individual healing ability
51
Q

what are the post op complications of ridge augmentation

A
  • membrane exposure
  • infection
  • sinus membrane perforation
52
Q

what are the dimensional changes 6 months post extraction

A
  • mean horizontal reduction in ridge width: 3.8mm
  • mean vertical reduction in ridge height: 1.24mm
53
Q

by performing ridge preservation:

A

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

54
Q

what soft tissues need to be managed

A
  • peri implant mucosa
  • transmucosal attachment
55
Q

what is the transmucosal attachment’s role

A

a mucosal seal should prevent bacterial products reaching the bone, ensuring the osteointegration

56
Q

the height of the peri-implant supracrestal soft tissue includes:

A

sulcular epithelium, JE, and supracrestal CT

57
Q

supracrestal tissue attachment is roughly ___

A

3mm

58
Q

soft tissue thickness greater than ____ is necessary to prevent peri implant soft tissue dehiscence

A

2mm

59
Q

a minimum of ____ of KT is necesarry to facilitate proper oral hygiene for peri implant health

A

2mm

60
Q

what are the ways soft issue can be managed and what is the goal of each

A
  • free gingival graft: to gain KT
  • connective tissue graft: to gain thickness
61
Q

describe the implant portion of the comparison between teeth and implatns

A
  • 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
62
Q

describe the tooth portion of the tooth vs implant comparison

A
  • 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
63
Q

epithelial cells are attached to peri implant fibers by:

A

hemidesmosomes

64
Q

describe collagen fibers around an implant

A

they do not insert into the implant but creates a cuff around the implant creating a mucosal seal

65
Q

per implant fibers forming a parallel cuff in a longitudinal direction prevents:

A

bacterial invasion

66
Q

peri implantitis lesion is dominated by:

A

plasma cells and lymphocytes but characterized by a larger proportion of polymorphonuclear leukocytes and macrophages

67
Q

area proportions, numbers and desnsities of ______ are higher in peri implantitis

A

plasma cells, macrophages and neutrophils

68
Q

describe the vascular supply to the gingiva

A
  • 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
69
Q

what is the definition of peri-implant health

A

absence of erythema, BOP, swelling and suppuration

70
Q

describe peri implant mucositis

A

an inflammation in absences of continguous marginal peri implant bone loss

71
Q

what is the clinical sign of inflammation in peri implant mucositis

A

BOP

72
Q

what are additional signs of peri implant mucositis

A

erythema, swelling and suppuration

73
Q

what is per implantitis

A

a pathological condition occurring in tissues around dental implants, characterized by inflammation in the peri implant mucosa and progressive loss of supporting bone

74
Q

what are the clinical signs of inflammation in peri implantitis

A

BOP and progressive bone loss identified on radiographs

75
Q

what is the prevalance for peri implant mucositis and peri implantitis at the subject level

A

43% and 22%

76
Q

what is the prevalence for peri implant mucositis and per implantitis at the implant level

A

29.5% and 9.3-22.1%

77
Q

what is the dx for peri implant diseases with baseline Xray or previous exam data

A
  • 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
78
Q

in the absence of previous exam data how do we dx peri implant disease

A
  • 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
79
Q

what are the factors in peri implant health

A
  • absence of inflammation
  • no BOP
  • bone level change less than 2mm
80
Q

what are the factors in peri implant mucositis

A
  • signs of inflammation
  • BOP and/or SoP
  • increased probing depth compared to baseline
  • bone level changes less than 2mm
81
Q

what are the factors in peri implantitis

A
  • signs of inflammation
  • BOP and/or SoP
  • increased PD compared to baseline or greater than or equal to 6mm
  • bone less greater than 3mm
82
Q

what are the peri implantitis risk factors/indicators

A
  • 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
83
Q

what are the peri implantitis risk modifiers

A
  • history of periodontal disease
  • smoking
  • DM
  • genetic factors
  • systemic condition
84
Q

bacterial colonization was initiated within _____ after implant placement

A

30 minutes

85
Q

the sequence of colonization on dental implants and biofilm formation is similar to:

A

that of teeth

86
Q

plaque leads to:

A

peri implant mucositis

87
Q

what is the histology of plaque causing peri implant mucositis

A

B and T cells infiltration at 21 days

88
Q

peri implant mucositis mirrors the progression of _____

A

gingivitis to periodontitis

89
Q

what are the microbial factors that are involved in the progression of health to disease

A
  • pioneer bacteria colonization
  • biofilm formation
  • congregation of early colonizers
  • acquisition of bridging bacteria
  • accumulation of keystone pathogens
  • dysbiosis and host immune response
90
Q

what are the changes seen from health to peri implant disease

A
  • increased plaque
  • increased inflammation
  • high GCF flow
  • gramu negative facultative anaerobes
91
Q

describe the microbiology of implants in fully edentulous patients

A
  • 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
92
Q

describe the microbiology of implants in partially edentulous patients

A
  • the microbiota is similar to remaining teeth
  • higher percentages of black pigmenting gram- negative anaerobes and capnocytophaga
93
Q

when do you treat perio disease in relation to implant placement

A

before

94
Q

what can be used for maintenance of implants

A
  • interproximal brushes
  • professional debridement
  • review of OH
  • deposit removal from implant/prosthesis surfaces
  • use of antimicrobials
  • reeval of maintenance interval
95
Q

scalers made of stainless steel and ultrasonic tips can:

A

roughen the implant surface creating scarring and pitting

96
Q

interproximal brushed can penetrate ____ into the gingival sulcus

A

3mm

97
Q

the use of scalers and currettes made of _____ are most favorable around the peri implant site

A

plastic or acrylic resin

98
Q

why are hard deposits on titanium not as hard to remove as those on natural tooth

A

the surface of titanium does not promote a tight bond for calculus

99
Q

prevent future complications by thorough:

A

dx and tx planning

100
Q
A

Periodontics I (13 decks)

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