periodontium of dental implants Flashcards
Basic parts of an implant
and their relation to teeth
implant body
abutment
crown
why titanium
- Excellent biocompatibility
- Low weight/high strength
- Excellent corrosion resistance
- Contains a titanium oxide layer that
promotes adhesion of osteogenic cells
The interface of implant and abutment is at the
bone
bone level
The interface of the implant and abutment is at
the tissue
tissue level
interface of implant can be either as
tissue or bone
adv/disadv of bone level
- 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
adv/disadv of tissue level
- 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
types of protheses
Single crowns, FPDs, implant
supported RPDs,
overdentures, hybrid
dentures (All on 4/All on X)
implant retained
removable
implant supported
fixed
A stable implant relies on direct structural and functional
connection between vital bone and the surface of an implant
osseointegration
Factors that determine successful
osseointegration:
-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
patient factors
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
osseointegration clinically:
- immobile
- clear sound to percussion
- no pain or infection
- no parethesia
osseointegration radiographically:
- no radiolucent peri-implant space
- minimal bone loss
<1mm remodeling
<0.1mm/year after the first year
Bone first forms on the implant surface
contact osteogenesis
Bone formation progresses from
implant surface to existing bone
contact osteogenesis
roughs surface implants
contact osteogenesis
Bone forms on the surface of the
existing bone
Distance Osteogenesis
Bone formation progresses from existing bone to implant surface
Distance Osteogenesis
Smooth or machined surface implants
Distance Osteogenesis
IMPLANT placement timing options
- immediate- time of extraction
- delayed- 6-10 weeks after ext
- late- 6 months or more after ext
type D1 (bone density and quality)
homogenous compact bone
type D2 (bone density and quality)
thick layer of compact bone around a core of dense trabecular bone
type D3 (bone density and quality)
thin layer of compact bone around dense trabecular bone
type 4 (bone density and quality)
thin layer of cortical bone around core of low-density trabecular bone
Initially, implants have mechanical stability
primary stability
Over time, the primary stability ______
but the secondary stability or biological
stability _____
decreased
increases
why dont wanna do implant tooth early
when mechanical and biological are good enough????idk
implant loading
immediate:
- Within 48 hours
of placement - Lower implant
survival - Parameters
should be ideal
implant loading
early
- Prior to 3
months
implant loading
conventional
after 3 months
Differences comparing the
periodontium of a tooth
to a dental implant
- less vascularity
- no PDL- relying on bone
- fewer gingival fibers
- collagen fibers parallel the implant (fibers do not insert into cementum like natural tooth)
(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”
“cuff”
hemidesmosome
peri-implant mucosa
buccal surface:
- 3-4mm high on avg
- core of connective tissue
-primarily collagen fibers, very lil fibroblasts
-high collagen fiber content, low cellular content
*orthokeratinized epithelium
buccal surface epithelium
orthokeratinized
peri-implant mucosa
inner surface:
- Thin barrier epithelium
- Like junctional epithelium
- Connective tissue adhesion
- Larger dimension of supracrestal attachment than teeth!
No vascular supply from PDL
so sources are
- Alveolar bone
- Supraperiosteal vessels
- Connective tissue
less vascular supply=
less immune system regulation
Supracrestal Attachment
for implants:
teeth:
3-4mm
1 mm epithelium
2 mm connective tissue
teeth: 2mm
* 0.97mm epithelium
* 1.07mm connective tissue
so more CT around implants!!*
implant:
*___mm PD
* ____mm buccal mucosa thickness
* Shorter papilla height, less papilla fill
2.9mm
2.0mm
implant failures classified
surgical
mechanical
esthetic
biological
(lack of osseointegration, improper placement, infection, etc)
surgical
(screw loosening, abutment fracture, implant fracture, etc)
mechanical fracture
(metal collar show through, smile line concerns, long crowns, etc)
esthetic
- Peri-implant mucositis
- Peri-implantitis
biological
Peri-Implant
Health
- free of inflammation
-no BOP
-np suppuration
-no erythema or edema - stable probing depths
- no radiographic bone loss following initial healing
Peri-Implant Mucositis
signs of inflammation
BOP erythema, edeme
Peri-Implant Mucositis no radiographic bone loss
reversible if etiology is controlled
-if not controlled, may develop peri-implantitis
Peri-Implant Mucositis
etiology: plaque biofilm
prevalence of implants to have this peri-implant mucositis:
43%
Peri-Implant Mucositis equivalent to ____ in normal tooth
gingivitis
Peri-Implantitis
start seening bone loss
Peri-Implantitis
signs of inflammation
BOP erythema, edema
Peri-Implantitis
radiographic bone loss
increasing probing depth, compared to time of restoration
Peri-Implantitis
etiology: plaque biofilm
and prevalence of this:
22%
risk factor of Peri-Implantitis
- History of periodontitis, poor plaque control, no
regular maintenance care after placement - Data is not conclusive for smoking and diabetes
difference between
healthy, peri-implant mucositis, peri-implantitis
BONE LOSS
- Peri-implant mucositis =
- Peri-implantitis =
gingivitis
periodontitis
What if you’ve never
seen the patient before?
If no previous radiographs/history:
* Radiographic bone loss
≥ 3mm
* Probing depths ≥ 6mm
=Diagnostic for peri-implantitis
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
0.9-1.6mm
0.1mm per year
platform switched implants
keratinized tissue may
improve patient comfort and benefit oral hygiene and plaque removal
treatment options:
soft tissue graft to increase keratinized tissue
Major risk factors for peri-implantitis:
poor plaque control
lack of regular maintenance after placement
Implants can’t get caries, but they can get
bone loss
May require oral hygiene aids if crowns are long, bulky, or difficult to
clean:
interdental/proxy brushes
super floss
Avoid conventional scalers, these can damage the implant surface
use this instead
- Use Ti scalers and plastic tips on your Cavitron/Ultrasonics
maintence schedule
- every 3 months for first year!
- move to every 6 months if implant is stable and OH is adequate
- continue every 3 months if OH is poor
- *should be based on patient
-risk factor
-oral hygiene
nonsurgical Treatment Options For PeriImplant Complications
debridement (Ti curettes, perioflow)
surgical therapy Treatment Options For PeriImplant Complications
- Open flap debridement
- Osseous recontouring
- Bone grafting/guided tissue
regeneration - Explantation/removal of implant
first thing you do for Treatment Options For PeriImplant Complications
refer to specialist
