perio - implant planning & placement

Question 1

osseointegration

Answer 1

direct functional & structural connection between load bearing dental implant & living bone

Question 2

primary v secondary osseointegration

Answer 2

primary - implant anchored in bone due to frictional forces provided between osteotomy & dental implant design features

secondary - process of functional connection between bone & dental implant, living bone grows onto surface of implant

Question 3

material used for implants

Answer 3

titanium - bioinert & high level of bone implant contact

titanium zirconia - strongest, good for narrow implant in canine site

ceramic (yttria stabilised) - good for thin gingival biotype / recession

Question 4

supra & sub crestal tissue in tooth

Answer 4

supra - more fibroblasts / less collagen / collagen fibres orientated PERPENDICULAR to root surface

sub - tooth anchored to bone via PDL / capable of physiological adaptation

Question 5

supra & sub crestal tissue in implant

Answer 5

supra - more collagen / less fibroblasts / collagen fibres orientated PARALLEL to implant crown

sub - implant anchored to bone via direct functional contact / no physiologic adaptation present i.e. NO PDL / rigid connection

this decrease in proprioception means when checking occlusion if implant is high crown can break as implant won’t move

Question 6

options for implant design

Answer 6

1. bone or tissue level
   bone - commonly used in aesthetic zone
   tissue - commonly used posteriorly
2. tapered or parallel
   tapered - may provide increased primary stability in immediate placement
   parallel - may be used when there is root convergence apically

Question 7

tooth restorability index

Answer 7

Dental Practicality Index from BSRD Toothwear Guidelines
takes into consideration each of the following restorative categories
1. structural integrity
2. periodontal state
3. endodontic state

Question 8

MH that could affect survival / success of implants

Answer 8

meds - SSRIs, PPIs, bisphosphonates, steroids
radiotherapy
uncontrolled diabetes
cardiovascular

Question 9

risks of placement of implants in patients who are not skeletally mature (4)

Answer 9

relative infra occlusion
suboptimal aesthetics
occlusal disharmony
implant fenestration

Question 10

gingival phenotype (3)

Answer 10

thick flat
thick scalloped
thin scalloped

Question 11

3D implant positioning

Answer 11

MD - 1.5mm minimum either side
BP - >1mm bone labially or >2mm HT/ST labial to implant
apico coronal -> 2mm
edentulous space -> >7mm

Question 12

what do we need when planning implants

Answer 12

study models
diagnostic wax up
surgical template
essix for provisional
clinical photos
CBCT
surgical guide

Question 13

common causes of compromised tissue sites

Answer 13

post xla defects
trauma
hypodontia
periodontal disease
thin gingival biotype