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PATIENT CARE III EXAM 2 > periodontium of dental implants > Flashcards

periodontium of dental implants Flashcards

1
Q

Basic parts of an implant
and their relation to teeth

A

implant body
abutment
crown

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2
Q

why titanium

A
  • Excellent biocompatibility
  • Low weight/high strength
  • Excellent corrosion resistance
  • Contains a titanium oxide layer that
    promotes adhesion of osteogenic cells
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3
Q

The interface of implant and abutment is at the
bone

A

bone level

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4
Q

The interface of the implant and abutment is at
the tissue

A

tissue level

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5
Q

interface of implant can be either as

A

tissue or bone

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6
Q

adv/disadv of bone level

A
  • Better esthetics, no
    metal collar
  • Can achieve primary
    closure if needed
  • Microenvironment
    allows of bacteria to be
    present at bone level
  • Less cleansable
  • Harder to see residual
    cement
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7
Q

adv/disadv of tissue level

A
  • Collar creates a
    “biologic width”
  • Bacteria is at tissue
    level, away from the
    bone
  • Metal collar may show
    through
  • More cleansable
  • Easier to see residual
    cement
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8
Q

types of protheses

A

Single crowns, FPDs, implant
supported RPDs,
overdentures, hybrid
dentures (All on 4/All on X)

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9
Q

implant retained

A

removable

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10
Q

implant supported

A

fixed

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11
Q

A stable implant relies on direct structural and functional
connection between vital bone and the surface of an implant

A

osseointegration

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12
Q

Factors that determine successful
osseointegration:

A

-Biocompatibility of the implant surface
-Macro and microscopic nature of the implant surface
-Status of the implant site (non infected bone, bone quality)
-Surgical technique
-Undisturbed healing
-Long term loading and prosthetic design

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13
Q

patient factors

A

medical history
1. diabetes
controlled vs. uncontrolled
2. osteoporosis and bisphosphonate use
not a contraindication to implant placement

social history
1. smoking
-increased failure of dental implants
84% vs 98%
-depends on use- heavy or light

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14
Q

osseointegration clinically:

A
  1. immobile
  2. clear sound to percussion
  3. no pain or infection
  4. no parethesia
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15
Q

osseointegration radiographically:

A
  1. no radiolucent peri-implant space
  2. minimal bone loss
    <1mm remodeling
    <0.1mm/year after the first year
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16
Q

Bone first forms on the implant surface

A

contact osteogenesis

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17
Q

Bone formation progresses from
implant surface to existing bone

A

contact osteogenesis

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18
Q

roughs surface implants

A

contact osteogenesis

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19
Q

Bone forms on the surface of the
existing bone

A

Distance Osteogenesis

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20
Q

Bone formation progresses from existing bone to implant surface

A

Distance Osteogenesis

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21
Q

Smooth or machined surface implants

A

Distance Osteogenesis

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22
Q

IMPLANT placement timing options

A
  1. immediate- time of extraction
  2. delayed- 6-10 weeks after ext
  3. late- 6 months or more after ext
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23
Q

type D1 (bone density and quality)

A

homogenous compact bone

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24
Q

type D2 (bone density and quality)

A

thick layer of compact bone around a core of dense trabecular bone

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25
Q

type D3 (bone density and quality)

A

thin layer of compact bone around dense trabecular bone

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26
Q

type 4 (bone density and quality)

A

thin layer of cortical bone around core of low-density trabecular bone

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27
Q

Initially, implants have mechanical stability

A

primary stability

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28
Q

Over time, the primary stability ______
but the secondary stability or biological
stability _____

A

decreased

increases

29
Q

why dont wanna do implant tooth early

A

when mechanical and biological are good enough????idk

30
Q

implant loading
immediate:

A
  • Within 48 hours
    of placement
  • Lower implant
    survival
  • Parameters
    should be ideal
31
Q

implant loading
early

A
  • Prior to 3
    months
32
Q

implant loading
conventional

A

after 3 months

33
Q

Differences comparing the
periodontium of a tooth
to a dental implant

A
  1. less vascularity
  2. no PDL- relying on bone
  3. fewer gingival fibers
  4. collagen fibers parallel the implant (fibers do not insert into cementum like natural tooth)
34
Q

(peri-implant tissues)
Connective tissue:
* Circular fibers form a _____
around the implant
* Forms a _______
attachment to the implant
and abutment
* Forms a “soft tissue seal”

A

“cuff”
hemidesmosome

35
Q

peri-implant mucosa
buccal surface:

A
  1. 3-4mm high on avg
  2. core of connective tissue
    -primarily collagen fibers, very lil fibroblasts
    -high collagen fiber content, low cellular content
    *orthokeratinized epithelium
36
Q

buccal surface epithelium

A

orthokeratinized

37
Q

peri-implant mucosa
inner surface:

A
  • Thin barrier epithelium
  • Like junctional epithelium
  • Connective tissue adhesion
  • Larger dimension of supracrestal attachment than teeth!
38
Q

No vascular supply from PDL
so sources are

A
  • Alveolar bone
  • Supraperiosteal vessels
  • Connective tissue
39
Q

less vascular supply=

A

less immune system regulation

40
Q

Supracrestal Attachment

for implants:
teeth:

A

3-4mm
1 mm epithelium
2 mm connective tissue

teeth: 2mm
* 0.97mm epithelium
* 1.07mm connective tissue
so more CT around implants!!*

41
Q

implant:
*___mm PD
* ____mm buccal mucosa thickness
* Shorter papilla height, less papilla fill

A

2.9mm
2.0mm

42
Q

implant failures classified

A

surgical
mechanical
esthetic
biological

43
Q

(lack of osseointegration, improper placement, infection, etc)

A

surgical

44
Q

(screw loosening, abutment fracture, implant fracture, etc)

A

mechanical fracture

45
Q

(metal collar show through, smile line concerns, long crowns, etc)

A

esthetic

46
Q
  • Peri-implant mucositis
  • Peri-implantitis
A

biological

47
Q

Peri-Implant
Health

A
  1. free of inflammation
    -no BOP
    -np suppuration
    -no erythema or edema
  2. stable probing depths
  3. no radiographic bone loss following initial healing
48
Q

Peri-Implant Mucositis
signs of inflammation

A

BOP erythema, edeme

49
Q

Peri-Implant Mucositis no radiographic bone loss

A

reversible if etiology is controlled
-if not controlled, may develop peri-implantitis

50
Q

Peri-Implant Mucositis
etiology: plaque biofilm
prevalence of implants to have this peri-implant mucositis:

A

43%

51
Q

Peri-Implant Mucositis equivalent to ____ in normal tooth

A

gingivitis

52
Q

Peri-Implantitis

A

start seening bone loss

53
Q

Peri-Implantitis
signs of inflammation

A

BOP erythema, edema

54
Q

Peri-Implantitis
radiographic bone loss

A

increasing probing depth, compared to time of restoration

55
Q

Peri-Implantitis
etiology: plaque biofilm
and prevalence of this:

A

22%

56
Q

risk factor of Peri-Implantitis

A
  • History of periodontitis, poor plaque control, no
    regular maintenance care after placement
  • Data is not conclusive for smoking and diabetes
57
Q

difference between
healthy, peri-implant mucositis, peri-implantitis

A

BONE LOSS

58
Q
  • Peri-implant mucositis =
  • Peri-implantitis =
A

gingivitis
periodontitis

59
Q

What if you’ve never
seen the patient before?

A

If no previous radiographs/history:
* Radiographic bone loss
≥ 3mm
* Probing depths ≥ 6mm

=Diagnostic for peri-implantitis

60
Q

not all bone
loss may be pathologic.
remodeling phase=
_____mm bone loss in first year

about ____mmbone loss per year following

not as seen as much with _____implants

A

0.9-1.6mm
0.1mm per year

platform switched implants

61
Q

keratinized tissue may
improve patient comfort and benefit oral hygiene and plaque removal

treatment options:

A

soft tissue graft to increase keratinized tissue

62
Q

Major risk factors for peri-implantitis:

A

poor plaque control
lack of regular maintenance after placement

63
Q

Implants can’t get caries, but they can get

A

bone loss

64
Q

May require oral hygiene aids if crowns are long, bulky, or difficult to
clean:

A

interdental/proxy brushes
super floss

65
Q

Avoid conventional scalers, these can damage the implant surface
use this instead

A
  • Use Ti scalers and plastic tips on your Cavitron/Ultrasonics
66
Q

maintence schedule

A
  1. every 3 months for first year!
  2. move to every 6 months if implant is stable and OH is adequate
  3. continue every 3 months if OH is poor
  4. *should be based on patient
    -risk factor
    -oral hygiene
67
Q

nonsurgical Treatment Options For PeriImplant Complications

A

debridement (Ti curettes, perioflow)

68
Q

surgical therapy Treatment Options For PeriImplant Complications

A
  • Open flap debridement
  • Osseous recontouring
  • Bone grafting/guided tissue
    regeneration
  • Explantation/removal of implant
69
Q

first thing you do for Treatment Options For PeriImplant Complications

A

refer to specialist

PATIENT CARE III EXAM 2 (10 decks)

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