PDL aspects Flashcards
Why is understanding periodontal health important in implantology?
It ensures proper soft and hard tissue management, reduces complications, and improves implant longevity.
What are the key differences between natural teeth and dental implants?
Natural teeth have a periodontal ligament, while implants lack it, affecting attachment, vascular supply, and disease progression.
What is supracrestal attachment (biologic width)?
The combined height of the junctional epithelium and connective tissue attachment around teeth or implants.
How does supracrestal attachment length differ between teeth and implants?
Around teeth: ~2.04 mm; around implants: ~4–4.5 mm (1.5x longer).
What happens if the biologic width is violated?
Bone resorption occurs to re-establish the protective distance between the bone and restorative margin.
Why is early crestal bone loss seen around dental implants?
Due to changes in the soft tissue-to-bone relationship, often from improper biologic width maintenance.
What are the characteristics of the inner connective tissue zone around implants?
Rich in fibers, resembles scar tissue, contains fibroblasts, and maintains the peri-implant seal.
What are the characteristics of the outer connective tissue zone around implants?
Contains fibers running in different directions, blood vessels, and cellular elements.
How do fibers around natural teeth differ from those around implants?
In teeth, fibers insert perpendicularly into cementum; in implants, fibers run parallel to the surface.
Why is connective tissue adhesion weaker around implants than natural teeth?
Lack of perpendicular fiber insertion and reduced mechanical resistance.
How does fiber orientation affect disease progression around implants?
Parallel fiber orientation and reduced vascularization make peri-implant tissues more susceptible to inflammation.
What are the clinical properties of soft tissue around natural teeth?
Firm, keratinized, and resistant to inflammation due to perpendicular fiber insertion.
What are the clinical properties of soft tissue around dental implants?
Less keratinized, parallel fiber orientation, and more prone to inflammation and disease.
How do soft tissue differences affect the inflammatory response?
Peri-implant tissues have a more pronounced inflammatory response due to reduced vascularization and fiber orientation.
How do soft tissue differences affect the healing process?
Implants have poorer vascular supply, leading to slower and less efficient healing compared to natural teeth.
How does biofilm form on dental implants?
Salivary proteins form a pellicle, followed by bacterial colonization and biofilm formation.
How does biofilm composition differ between implants and natural teeth?
Implants lack low molecular mucins found on enamel, leading to qualitative and quantitative differences in plaque formation.
What is unique about the microbial profile around dental implants?
Staphylococcus aureus has an affinity for titanium but is uncommon around natural teeth.
How does the host respond to bacterial challenge around implants?
Similar initial response to gingiva, but long-term inflammation is more pronounced in peri-implant tissues.
Why is the inflammatory infiltrate larger in peri-implant tissues?
Due to reduced vascularization and parallel fiber orientation, leading to greater apical extension of inflammation.
How does the healing response around dental implants differ from natural teeth?
Implants have poorer vascular supply, leading to slower healing and reliance on cortical bone vascularization.
What are the three sources of blood supply to bone in natural teeth?
Periodontal ligament, connective tissue above the periosteum, and within the bone.
Why is bone resorption common during the initial healing phase of implants?
Reflecting soft tissue flaps removes supra-periosteal blood supply, leaving poorly vascularized cortical bone.
How does the lack of periodontal ligament affect implant healing?
It reduces vascularization and adaptive capacity, leading to slower and less efficient healing.
What are the four classifications of peri-implant diseases and conditions?
Peri-implant health, peri-implant mucositis, peri-implantitis, and peri-implant soft/hard tissue deficiencies.
What are the clinical features of peri-implant health?
No inflammation, probing depth ≤5 mm, no bleeding on probing, and no bone loss beyond initial remodeling.
What is peri-implant mucositis?
Reversible inflammation of peri-implant soft tissues without bone loss.
What is peri-implantitis?
Inflammation of peri-implant tissues with progressive bone loss.
What causes peri-implant soft and hard tissue deficiencies?
Trauma, infection, poor surgical technique, or systemic factors like diabetes.
How is peri-implant health diagnosed clinically?
Absence of inflammation, probing depth ≤5 mm, no bleeding on probing, and no bone loss >2 mm.
What is measured during periodontal probing around natural teeth?
Clinical attachment level (CAL), pocket depth, and width of attached gingiva.
Why is probing depth greater around dental implants than natural teeth?
The probe tip penetrates deeper into the connective tissue, often reaching close to the bone crest.
How reliable is bleeding on probing for implants compared to natural teeth?
Less reliable for implants due to deeper probe penetration and parallel fiber orientation.
Why is gentle probing important for diagnosing peri-implant disease?
To avoid trauma and accurately assess inflammation without causing false bleeding.
What are the clinical signs of inflammatory lesions around implants?
Color alteration, swelling, thickness, and bleeding on probing.
How does the inflammatory response differ between peri-implant and gingival tissues?
Peri-implant tissues have a more pronounced response with greater apical extension of inflammation.
What is gingival crevicular fluid (GCF)?
A serum transudate in healthy gingiva that becomes an inflammatory exudate during inflammation.
What is peri-implant sulcular fluid (PISF/PICF)?
The fluid collected from the peri-implant sulcus, similar to GCF but with differences in composition.
What are the treatment options for peri-implant mucositis?
Non-surgical (mechanical debridement, antimicrobials) and surgical (flap surgery) approaches.
What are the treatment options for peri-implantitis?
Non-surgical (debridement, antibiotics) and surgical (bone grafting, guided bone regeneration).
