Planning and Placement

Question 1

What factors should be considered when pt wants implants?

Answer 1

Pt desires and expectations
Medical history
Past dental history
Social history

Question 2

What are key points to consider to pt expectations?

Answer 2

Are they aware of other options?
What are there priorities - aesthetics, function
Understand risks and timelines
Do have reasonable expectations

Question 3

What medical conditions could be contra-indication to implants placement?

Answer 3

Those of bisphosphonates
Daibetes
Immunosuppressants
Those on steroids
Those w/ bone disease
Those had radiotherapy 
Those increased bleeding tendency

Question 4

Why are those on bisphospohantes not suitable to have implants surgery

Answer 4

Increased risk MRONJ

Elective drilling = MRONJ

Question 5

Why are those with diabetes not suitable to have implants surgery?

Answer 5

Can influence healing post surgery

Increase risk of peri-implantitis

Question 6

Why are those on immune-suppressants not suitable to have implants?

Answer 6

Poor healing/ increased risk post-op infection

Question 7

Why are those w/ osteopetrosis not suitable for implants?

Answer 7

Increased bone dentistry - this creates poor blood supply = increased risk of failure

Question 8

Why are those w/ Paget’s not suitable for implants?

Answer 8

Bone can be dense or porous leading to high failure rates

Question 9

Why are those who have had radiotherapy not suitable for implants?

Answer 9

Increased risk of osteoradionecrosis

Not complete contraindication - need to look at dose and how received

Question 10

What is absolute contraindication to providing implants?

Answer 10

IV bisphosphonates/ denosumab (monoclonal antibody therapy)

Question 11

What should be considered in pt social hx?

Answer 11

Smoking - increased risk of failure

Absolute contraindication to providing on NHS

Question 12

What should be considered in exam to place implants?

Answer 12

EO - skeletal patterns, smile line

IO - space requirement, access, periodontal status, assessment bone

Question 13

Why is facial profile important to assess?

Answer 13

Skeletal pattern can affect support for prosthesis

Question 14

What expect to see in class III mandible?

Answer 14

Flat mandible anteriorly

Question 15

What expect to see in class II maxilla?

Answer 15

Long, thin arch

Question 16

Why is it important to assess smile line?

Answer 16

Assess aesthetic risk - is pt going to get unacceptable result

Question 17

Diff types smile line?

Answer 17

High - upper lip above cervical line
Medium - cervical line not exposed, papillary line visible
Low - can’t see dental papilla

Question 18

What is cervical line?

Answer 18

Connect necks of teeth - dots though gingiva zenith

Question 19

What is minimal distance required between implants?

Answer 19

3mm

Question 20

What is minimum distance between implant and tooth?

Answer 20

1.5mm

Question 21

What is minimum space needed for implant if natural tooth either side?

Answer 21

1.5mm either side implant
4mm for implants

Minimum 7mm space

Question 22

What happens if implant is placed with inadequate space?

Answer 22

Won’t have adequate blood supply - necrosis causing defect around implant

Question 23

How does blood supply differ for implant and natural tooth?

Answer 23

Tooth - blood supply from PDL

Implant - just from bone

Question 24

What is a crude way of assessing implant space?

Answer 24

Placing handle of mirror into gap - handle approx 7-8mm

Question 25

How much bone width is required bunco-lingual (to implant)

Answer 25

Want 1.5-2mm

More flexible - if bone thinner can augment

Question 26

What vertical bone height is needed for screw-retained implant?

Answer 26

5mm

Question 27

What vertical bone height is needed for cement-retained implant?

Answer 27

7.5mm

Question 28

Crude way of assessing access prior placing implant?

Answer 28

Two fingers between opposing dentition

Question 29

What should assess regarding periodontal status?

Answer 29

Pocket depths, calculus, active disease, oral hygiene, bleeding

Question 30

Why is it important to assess periodontal health?

Answer 30

Hx of periodontitis increase risk of peri-implantitis

Active disease contraindicate implant placement

Question 31

Is what planes should bone be assed?

Answer 31

Mesio-distal
Vertical
Buccolingual

Question 32

What is important to be aware of when assessing mesio-distal space?

Answer 32

Clinical and surgical space are different

Question 33

Difference between clinical and surgical space?

Answer 33

Clinic - physical gap between adjacent crowns

Surgical - bone available under gingiva

Question 34

What to be aware of root orientation?

Answer 34

If have convergent rooms - clinically looks like more space

If divergent - may have more surgical space than appears clinically

Question 35

Issue with crowned teeth?

Answer 35

May not be correct orientation - need to radiographically assess

Question 36

How to assess bunco-lingual space?

Answer 36

Palpate
Ridge map
CBCT

Question 37

Risks of inadequate bucco-lingual dimension?

Answer 37

Risks of exposure of threads w/o bone augmentation

Question 38

What are tx options if inadequate bucco-lingual dimension?

Answer 38

Bridge

Bone-augmentation

Question 39

What is ridge mapping?

Answer 39

Assess thickness of bone in mm
Older method of assessing bone chairside
Pt needs to be anaetised

Question 40

How measure bone height in maxilla?

Answer 40

Measure full height from alveolar crest to maxillary sinus

Question 41

What bone height is needed in maxilla for conventional implant?

Answer 41

8mm

Question 42

Limiting factor in height mandible?

Answer 42

Distance between alveolar crest and ID canal

Question 43

Safety margin to avoid ID damage?

Answer 43

4mm safety margin - generally >2mm

Question 44

What can increase success of implant placement?

Answer 44

Stents - guide drill along single path