Overview of Implantology / Peri-implant diseases and conditions Flashcards
What 4 landmarks should we
consider during implant placement?
- Inferior Alveolar Canal/Mental Foramen
- Incisive Foramen
- Maxillary Sinus/Nasal Cavity
- Lingual undercut
•premolar and molar areas of the mandible.
• a loop of the nerve can be found to
extend mesially.
Mental foramen:
How many mm away from mental foramen should you be w implant?
3mm
How many mm away from IAN should you be w implant?
2 mm
What is the most accurate way to detect the IAN and mental foramen?
CBCT
•Important to avoid perforaMng the lingual plate
during preparaMon of the implant site since
perforaMons can result in extensive and even life-
threatening bleeding (Bruggenkate et al, 1993)
•Reflec*ng a lingual flap in order to visualize the
ridge is a safe way of performing surgery
Lingual undercut
_____: related to the degree of bone loss or
bone resorption present
Quantity:
_____: related to the degree of bone loss or
bone resorption present
Quantity:
_____:: related to the degree of bone density
present
Quality
Type ____ bone: hard and dense like oak wood
•less blood supply than other types (compact bone)
•takes longer for an implant to integrate
•found in the mandible
Type 1
Type _____ bone: thick layer of compact bone
surrounds a core of dense, trabecular bone
consistency of pine wood
Type II
Type ___ bone: thin layer of corMcal bone
surrounds a core of dense trabecular bone
consistency of balsa wood
Type III
Type ____ bone: thin layer of corMcal bone
consistency of Styrofoam
surrounds a core of low density trabecular bone
commonly found in posterior maxilla
Type IV
What roughness or smoothness is desired for implants to enhance osseointegration?
Moderately rough
What is the Sa value in micrometers for a moderately rough implant surface?
1-2 micrometers
_______ Implants:
•connecMon at sol Mssue level
•smooth neck that shapes the sol Mssue
•come in different sizes depending on where we are
placing it: WN (wide neck) or RN (regular neck)
•used for one-stage implant surgery
Tissue Level
______ Implants:
•connection at bone
•allows for different customized and angled abutments,
which is important if it is a compromised case or in the
aesthetic zone
•allows for two-stage implant surgery
Bone Level
What brand of implant is used at uMKC for tissue level implants generally?
Straumann
Implants –2 Piece system –Very popular system –Extensive Research –Good customer care -No tissue level implants -No 1 piece
Nobel Biocare™
\_\_\_\_\_\_ Implants –1 or 2 Piece implant –Very popular system –Extensive Research –Good customer care
Straumann™
____ implant shape
• Increased Surface Area
• Greater Force Transfer
• Most Common Design
Straight - Cylindrical
____ implant shape
• Osteotomy more complex to correct
• Preferred with root proximity or limited
bony envelope due to narrower
Tapered - Conical
____ stage implant placement
•An implant is placed with a transmucosal healing abutment
(it “sMcks out” the sol Mssue aler the surgery)
•Hard and sol tissues heal around the entire fixture.
•Upon completion of osseointegration, the restorative phase
can begin.
One stage
___ stage implant placement
•The implant is “buried” under the sol tissues
•In this case we do not use an healing abutment but a
cover screw.
•Preferred in case of big bone augmentations and
when the primary stability is not optimal
•Wound Protection
•Will require a 2nd surgery in 3-4 months to uncover
the implant.
•A 2nd chance to correct any sol Mssue deficiencies.
Two stage
What are the 4 simple steps of surgical implant placement
–Flap reflection after anesthesia –Osteotomy preparation (Sequential drilling with drill bits of increasing size) –Implant placement with adequate torque –Suturing
_____: measurement of the resistance that the implant
encounters during its advancement in the apical direction by means of a rotating
movement on its axis. (Ncm)
Insertion torque:
MESIO-DISTAL
• - at least ____ mm between teeth and
implant
1.5
____ mm for papilla in anterior teeth
3-4mm
___ mm between 2 adjacent implants
3 mm
BUCCO-LINGUAL (anterior zone)
- As bone thickness approached ____ - ____mm,
bone loss decreased significantly and some
evidence of bone gain was seen
1.8 - 2 mm
IN posterior, how many mm is needed BL bone for implant?
1 buccal 1 lingual so 2 mm total
Concept of placing an abutment of a
narrower diameter on the implant of a wider
diameter to preserve alveolar bone levels at
the crest of a dental implant
- It reduces per-implant bone resorption at the one crest:
- Shils the inflammatory cell infiltrate inward and way from the adjacent crestal bone
- Maintains the supracrestal attachment
- Increases distance of implant-abutment junction from the crestal bone
- limits possible interface of bone with micro-movements
Platform switching
Siebert ridge atrophy classification
buccolingual loss of tissue
Class I (
Siebert ridge atrophy classification
(apicocoronal loss of tissue)
Class II (apicocoronal loss of tissue)
Siebert ridge atrophy classification
both loss of tissue
Class III
is a surgical procedure that uses barrier
membranes with bone grafts to augment
atrophic bony ridge
GBR (Guided Bone Regeneration)
What mm are considered short implants?
6-7mm
Is crown to root ratio valid for implants?
Nope
How many mm is lost on average horizontally post extraction?
3.8 mm
How many mm is lost on average vertically post extraction?
1.24 mm
Peri-implant fibers _____ cuff,
oriented _______
parallel cuff; oriented longitudinal
Epithelial cells attached
by ______ to implants
hemidesmosomes
Collagen fibers do not insert into the implant but creates a \_\_\_\_ around the implant (but they still create a sealing)
cuff
Blood supply by terminal
branches of large vessels
from ______ for implants
periosteum.
More or less inflammatory response in implants
than gingival tissues
More
Are there fewer or more capillaries around an implant?
Fewer
ALer one year of loading, up to ___ mm of
bone loss can be considered physiologic
bone remodeling and WNL
1.9 mm
“An inflammation in absences of continuous marginal peri-
implant bone loss. The clinical sign of inflammation is
bleeding on probing. Additional signs may include erythema,
swelling, and suppuration.”
Peri implant mucositis
What is the main sign of peri implant mucositis?
Bleeding on probing
“Is 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”
Peri implantitis
What are the main signs of peri implantitis?
BOP with progressive loss of bone
• Presence of bleeding and/or suppura0on on gentle probing.
• Increased probing depth compared to previous examina:ons.
• Presence of bone loss beyond crestal bone level changes resul:ng from ini:al bone remodeling
( ≥2 mm a=er the first Y of func:on) —> Ideally you would like to have a BASELINE XRAY
Peri implantitis
I n t h e a b s e n c e o f p r e v i o u s e x a m i n a t i o n d a t a :
• Presence of bleeding and/or suppura:on on gentle probing.
• Probing depths of ≥6 mm.
•Bone levels ≥3 mm apical of the most coronal por:on of the intraosseous part of the implant.
Peri implantitis
• Absence of inflammation • No BOP • Bone loss ≤ 2mm.
Peri implant health
Signs of inflammation • BOP and/ or SOP • > PD compared to baseline • Bone loss ≤ 2mm.
Peri implant mucositis
• Signs of inflammation • BOP and/or SOP • > PD compared to baseline (≥ 6mm) • Progressive bone loss (≥ 3 mm)
Peri implantitis
Similar to periodontitis, peri-implantitis lesion is dominated
by ____ and ______
plasma cells and lymphocytes
Similar to periodontitis, peri-implantitis lesion is dominated
by plasma cells and lymphocytes but characterized by a
larger proportion of _____ and ______
polymorphonuclear leukocytes and
macrophages
Area proportions, numbers and densities of plasma cells,
macrophages and neutrophils are higher or lower in peri-implantitis
Higher
What is the main etiological factor of peri implantitis?
Plaque
What is a risk factor that has strong evidence to be more at risk for peri implantitis?
Previous periodontal disease
Implant sites with a band of
2
Does a rough or smooth surface catch and hold onto more bacteria?
Rough
Do you place implant or treat perio disease first?
Treat perio disease first
