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
2
Q
What are the 3 pieces of a dental implant?
important
A
- Crown: extra-gingival
- Abutment: transmucosal
- Implant Body: endosseous portion
3
Q
What are the two types of levels of implants?
A
- bone level
- tissue level
4
Q
What are the features of bone level implants?
important
A
- Connects at bone
- Allows customized and angled abutments
- Esthetic zone
- Allows two-stage implant surgery
5
Q
What are the features of tissue level implants?
important
A
- Connect at soft tissue level
- Smooth neck shapes the soft tissue
- One-stage implant surgery
6
Q
What are the different shapes of implants?
A
- straight: cylindrical
- tapered: conical
7
Q
What are the features of straight: cylindrical implants?
A
- Increased Surface Area
- Greater Force Transfer
- Most Common Design
8
Q
What are the features of tapered: conical implants?
A
- Complex osteotomy sites
- Root proximity
- Bone concavity
9
Q
What are the types of platforms for implants?
A
Narrow—Standard—Wide platform
10
Q
What does a microgap on a two-part implant allow for?
A
- Inflammatory cell infiltrate was consistently present at the level of the interface between the two components, the bone crest was consistently located 1-1.5 mm apical of the microgap
- Inflammatory Infiltrate was due to bacterial contamination
11
Q
What is platform switching?
A
the concept of placing a narrower abutmenton the wider implantto preserve alveolar bone levelsat the crest of a dental implant
12
Q
_______________ reduces per-implant bone resorption at the bone crest and maintains the supracrestal attachment
important
A
Platform switching
13
Q
How does platform switching reduce peri-implant bone resorption?
important
A
- Increases distance of implant-abutment junction from the crestal bone
- Limits micro-movements at the bone implant interface
- Shifts the inflammatory cell infiltrate inward and away from the adjacent crestal bone
14
Q
What are implant surface properties?
A
- Surface characteristic and roughness
- Surface chemistry and surface free energy (SFE)
15
Q
What is the purpose of the surface properties of implants?
A
- enhance cell adhesion to get better osseointegration
16
Q
What are the different surface characteristics/roughness of implants?
A
- Roughness (Macro & Micro)
— Texture
— Machined - Subtractive
— Sandblast
— Acid-etch - Additive
— Oxidation
— Coating
17
Q
The roughness of an implant is measured by the…
A
Sa value
18
Q
What are the four groups of roughness value for implants?
don’t memorize the numbers just the concept
A
- Smooth (< 0.5 μm)
- Minimally rough (0.5-1.0 μm)
- Moderately rough (1.0-2.0 μm)
- Rough (> 2.0 μm)
19
Q
In general, the rougher the implant, the higher it’s Sa value (in um), the easier for…
A
- bacterial adhesion
This also means the traditional methods of removing biofilm is less effective.
20
Q
True/false
Microbial adhesion can occur on any implant surface, regardless of the degree of surface roughness.
important
A
true
21
Q
What is surface free energy (SFE)?
A
the interaction between the force of cohesion and the force of the adhesion that determines whether or not wetting occurs
22
Q
A successful implant must present…
A
- no mobility
- no peri-implant radiolucency
- bone loss less than 0.2 mm per year after the first year of loading
- no persistent pain, discomfort or infection
23
Q
What are the anatomical landmarks to consider during implant placement?
important
A
- Inferior Alveolar Canal/Mental Foramen
- Incisive Foramen
- Maxillary Sinus/Nasal Cavity
- Lingual undercut
24
Q
What is the safety zone for placing implants in the premolar/molar areas in the mandible?
important
A
Safety zone of 3mm from the mental foramen and 2mm from the IAN is recommended
25
The inferior alveolar canal and mental foramen need to be avoided in what area and why?
- Premolar and molar areas of the mandible
- nerve extends across the mandible mesially
26
What are the different ways to detect IAN/mental foramen?
* Periapical films: 75% to 46.8% accuracy
* Panoramic films: 94% to 49% accuracy
* CT scans : most accurate way to detect
27
What is the most accurate way to detect IAN/mental foramen?
| important
CT/CBCT scans
28
How do you know what type of sinus augmentation to do around the maxillary sinus/nasal cavity?
| important
- direct sinus lifting: less than 4 mm residual bone height
- indirect sinus lifting: more than 4 mm residual bone height
29
If there is less than 4mm residual bone height what type of sinus lift?
| important
direct
30
If there is more than 4mm residual bone height what type of sinus lift?
| important
indirect
31
Perforating the lingual plate (due to a lingual undercut) during preparation of the implant site can result in...
extensive and even life-threatening bleeding
32
How do you avoid perforating a lingual undercut?
Proper planning and consider reflection of the lingual flap to visualize the ridge
33
What is osseointegration?
A direct functional and structural connection between living bone and the implant surface
34
The __________ of the bone at the time of implant placement is critical to successful osseointegration
stability
35
What are the bone requirements in terms of quantity and quality?
* Quantity: related to the degree of bone loss or bone resorption present
* Quality: related to the degree of bone density present
36
What are the bone types in terms of quality?
| important
- Type 1: hard and dense like oak wood (D1)
- Type 2: consistency of pine wood (D2)
- Type 3: consistency of balsa wood (D3)
- Type 4: consistency of Styrofoam (D4)
37
What are the features of type 1 bone?
* Less blood supply than other types (compact bone)
* Takes longer for an implant to integrate
* Found in the mandible
| bad for implants
38
What are the features of type 2 bone?
* Thick layer of compact bone surrounds a core of dense, trabecular bone
| most ideal bone
39
What are the features of type 3 bone?
* Thin layer of cortical bone surrounds a core of dense trabecular bone
| also ideal
40
What are the features of type 4 bone?
* Thin layer of cortical bone surrounds a core of low density trabecular bone
* Commonly found in posterior maxilla
41
What is the best type of bone for implants?
D2 is best and then D3
42
What needs to be considered for placement of an implant?
- Prosthetically-driven implant placement
--- safety/function/value/esthetics
- Hard tissue management
- Soft tissue management
43
Mesiodistally, there needs to be at least ___ mm between teeth and implants
| important
1.5 mm
44
Mesiodistally, there needs to be at least ___ mm between 2 adjacent implants
| important
3 mm
45
What happens if you put implants too close together or too close to teeth?
- can't restore
- no access to clean
- bone loss
- peri-implantitis
46
Buccolingually, there is significantly greater resorption and gingival recession when the ridge width is less than ___ mm
| important
2 mm
47
Buccolingually, the anterior region needs at least ___ mm of buccal bone thickness
| important
2 mm
48
Buccolingually, the posterior region needs at least ___ mm of buccal bone and _____ mm lingual bone thickness
| important
1 mm
1 mm
49
Coronal-apically, there should be _____ mm from adjacent CEJ
| important
3-4 mm
50
Coronal-apically, it is recommended to place bone level implants...
| important
subcrestally
51
What directions can the ridge atrophy?
horizontal and vertical
52
What are the siebert classifications for ridge atrophy?
| important
* Class I: buccolingual loss of tissue (horizontal)
* Class II: apico-coronal loss of tissue (vertical)
* Class III: both loss of tissue
53
What are the types of ridge augmentation for atrophic bony ridge?
* Bone block technique vs particulate bone graft
* Guided Bone regeneration (GBR)
--- A surgical procedure that uses barrier membranes with bone grafts to augment atrophic bony ridge
* Sinus augmentation: direct/indirect
54
How long do you need to wait for healing after ridge augmentation
Longer healing time: 3-12 months to be ready for implant placement, depending on the augmented volume, the graft material and individual healing ability
55
What are the post operative complications for ridge augmentation?
membrane exposure, infection, sinus membrane perforation…etc
56
What are the "normal" dimensional changes 6 months post extraction?
| important
- mean horizontal reduction in ridge width: 3.8 mm
- mean vertical reduction in ridge height: 1.24 mm
57
What is the use of ridge preservation?
- maintain stable ridge volume to optimize functional and esthetic outcomes
- simplify treatment procedures following ridge preservation
--- ready for implant placement at 3-6 months
58
What is peri-implant mucosa?
The soft tissue surrounding dental implants
59
What is transmucosal attachment?
A mucosal seal should prevent bacterial products reaching the bone, ensuring the osteointegration
60
The height of the peri-implant supracrestal soft tissue (PST) includes...
- sulcular epithelium
- junctional epithelium
- supracrestal connective tissue
61
Supracrestal tissue attachment is roughly ____ mm
3 mm
- (JE 1.88 mm + CT 1.05 mm = 2.93 mm)
62
Soft tissue thickness greater than ___ mm is necessary to prevent peri-implant soft tissue dehiscence
2 mm
63
A minimum of ___ mm of KT is necessary to facilitate proper oral hygiene for peri-implant health
2 mm
64
What is the outcome of a free gingival graft?
- primarily gains KT
65
What is the outcome of a connective tissue graft?
- primarily gains thickness
66
What is the difference in soft tissue attachment in teeth versus implants?
| important
Teeth
* Periodontal fibers attach from bone to root in multiple directions
* Connective tissue fibers attach to teeth
* Periodontal ligament act as shock absorber
* Blood supply from PDL and periosteum
Implant
* 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
67
How are the fibers oriented around implants?
| important
Peri-implant fibers form parallel cuff in an oriented longitudinal direction
68
What has a naturally deeper probing depth: tooth or implant?
implant
69
Peri-implant fibers form __________ cuff in a
oriented longitudinal direction around an implant
| imporant
parallel
70
What are the features of the parallel cuff of peri-implant fibers?
| important
* Epithelial cells attached by hemidesmosomes
* Collagen fibers do not insert into the implant but creates a cuff around the implant creating a mucosal seal
* Prevents bacterial invasion
71
Similar to periodontitis, peri-implantitis lesion is dominated by what cells?
plasma cells and lymphocytes but characterized by a larger proportion of polymorphonuclear leukocytes and macrophages
72
Area proportions, numbers and densities of plasma cells, macrophages and neutrophils are higher in peri-implantitis or periodontitis?
peri-implantitis
73
What is the vascular supply in the gingiva?
- Supraperiosteal blood vessels
- Form capillaries to the CT papilla
**- Vascular plexus of the PDL**
- Lateral to the junctional epithelium
- Runs coronally and terminates in supraalveolar portion of free gingiva
74
What is the vascular supply for the implant?
- Lacks a PDL and PDL plexus
- Superficial CT almost devoid of vascular supply
75
What is peri-implant health?
| important
Absence of erythema, bleeding on probing, swelling and suppuration.
76
What is peri-implant mucositis?
| important
An inflammation in absences of continuous marginal periimplant bone loss. The clinical sign of inflammation is bleeding on probing. Additional signs may include erythema, swelling, and suppuration
77
What is peri-implantitis?
| important
A pathological condition occurring in tissues around dental implants, characterized by inflammation in the peri-implant mucosa and progressive loss of supporting bone. Clinical sign of inflammation is detected by bleeding on probings, while progressive bone loss is identified on radiographs
78
# % risk
_____ for peri-implant mucositis and ___ for peri-implantitis at subject level
43%
22%
79
# % risk
_______ for peri-implant mucositis and _______ for peri-implantitis at implant level.
29.5%
9.3%-22.1%
80
What are the signs of peri-implant health?
| important
- Absence of Inflammation
- No BoP
- Bone level change ≤ 2mm
81
What are the signs of peri-implant mucositis?
| important
- Signs of Inflammation
- BoP and/or SoP
- ↑PD compared to baseline
- Bone level change ≤ 2mm
82
What are the signs of peri-implantitis?
| important
- Signs of Inflammation
- BoP and/or SoP
- ↑PD compared to baseline or ≥6 mm
- Bone loss ≥3 mm
83
What are the risk factors for peri-implantitis?
| important
* **Poor plaque control**
* Lack of regular maintenance
* Tissue quality: thin phenotype, KT band, bone deficiency
* Iatrogenic factors: malpositioning, poor design of emergency profile, inadequate abutment/implant seating
* **Excessive cement**
* Occlusal overload
* Titanium particles: implant corrosion, micromovement
84
What are the risk modifiers for peri-implantitis?
| important
* **History of periodontal disease**
* Smoking
* DM
* **Genetic factors**
* systemic condition
85
What is the main summary of the risk factors for peri-implantitis?
MICROBE
HOST
DYSBIOSIS
86
Bacterial colonization was initiated within ____ min after implant placement
| important
30
87
The sequence of colonization on dental implants and biofilm formation is similar to that of _______
| important
teeth
88
__________ leads to peri-implant mucositis
Plaque
* Plaque accumulation and then reversed
* Histology demonstrated B & T cells infiltration at 21 days
89
Peri-implant mucositis may lead to ______________
peri-implantitis
90
What is the microbiology of implants in fully edentulous patients?
| important
* 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
91
What is the microbiology of implants in partially edentulous patients?
| important
* The microbiota is similar to remaining teeth
* Higher percentages of black-pigmenting Gram negative anaerobes and Capnocytophaga
92
Treat periodontal disease prior to...
| IMPORTANT
implant placement
93
Surface topography influences _________ formation
biofilm
94
How do you maintain implants?
- Provide guidelines for maintaining the long-term health of the dental implant
- Focus on both hard and soft tissue stability around the dental implant
- Work as a team— patient are co-therapists in the maintenance therapy
95
How does the patient clean around a dental implant?
- Interproximal brushes can effectively penetrate up to 3mm into a gingival sulcus and may effectively clean a peri-implant sulcus
- floss
96
What do you need to be careful of during professional debridement of implants?
Scalers made of stainless steel and ultrasonic tips can roughen the implant surfaces creating scarring and pitting
97
What should happen during a maintenance appointment for an implant?
* A thorough review of oral hygiene reinforcement and modifications
* Deposit removal from implant/prosthesis surfaces
* Appropriate use of antimicrobials
* Reevaluation of the present maintenance interval, with modification as dictated by the clinical presentation
98
The use of scalers and curettes made of ___________ are most favorable for use around the peri-implant site
plastic or acrylic resin
99
Hard deposits clinging to titanium are not as tenacious as those found on natural dentition; this is because...
the surface of titanium does not promote a tight bond for calculus
100
Focus of Implant dentistry has changed from obtaining osseointegration to...
the long term maintenance of peri-implant health both hard and soft tissues
101
Patients are __________ in the maintenance therapy
co-therapists
102
Future complications with implants can be prevented by...
thorough diagnosis and treatment planning
103
Convincing evidence that bacterial plaque not only leads to gingivitis and periodontitis but also can induce the development of...
peri-implantitis
