Principles of implant surgery

Question 1

What 6 things must you take into consideration when planning implant surgery?

Answer 1

1. Site anatomy - Via clinical examination and radiographs/cbct.
2. Site volume and shape
3. The size of the implant and spacing. What size should be used and where?
4. Emergence profile of the crown
5. Position of screw holes
6. Emergence position of crowns (nature of soft tissue)

Question 2

When would gingival grafting be necessary in implant surgery?

Answer 2

To optimise hard tissue aspect or the nature of soft tissue in the are where the implant supported restoration is going to exist.

Question 3

Give 3 provisional restorations use prior to implant surgery?

Answer 3

1. Existing dentures w/radio-paqye markers
2. Wax up and make an Essix device with denture or temporary teeth.
3. Maryland adhesive bridges, in composite.

Question 4

What does the use of digital dentistry allow prior to implant surgery?

Answer 4

1. Full mouth scan
2. A design can be made in silico (computer modelled) and transferred to intra oral try in.
3. This allows the patient to:

Question 5

How much bone should be around all aspects of each implant?

Answer 5

1-1.5mm

Question 6

When drilling bone what 2 things must be considered?

Answer 6

1. Avoiding vital structures.
2. Leave a 1-2mm buffer when drilling as the drill often cuts 1-2mm beyond the end of the implant.

Question 7

Why are wider screws considered for implants?

Answer 7

1. Increased wall thickness
2. Less chance of implant fracture.

Question 8

Why are shorter screws sometimes considered for implants?

Answer 8

1. Shorter screws just as strong as longer screws.
2. Shorter screws easier to remove if the implant fails.

Question 9

Why is sufficient keratinised tissue around the implant imperative for implant success?

Answer 9

1. If there is less keratinised tissue.
2. There is a higher risk of lingual plaque accumulation.
3. Higher risk of soft tissue recession.
4. As a result more inflammation and bleeding occurs.
5. Loss of attachment can occur resulting in the failure of an implant.

Question 10

If a patient lacks keratinised tissue around an provisional implant location what can be done?

Answer 10

1. Free gingival graft.
2. Tissue is taken from elsewhere in the mouth and attached.

Question 11

What must you tell and advise the patient preoperatively for implant surgery?

Answer 11

1. Information on the Current situation, All treatent options and the Nature of proposed treatment.

2 . Post operative advice/complications

3. Consent
4. Disinfection - Advise use of CHX mouthwash prior to implant surgery.

Question 12

What are incisions and raising flaps determined by in soft tissue access for implant surgery?

Answer 12

Surrounding and underlying anatomy:

Question 13

Define osteotomy.

Answer 13

An osteotomy isa surgical procedure that involves cutting bone (and sometimes adding bone tissue) to reshape or realign your bones

Question 14

What drilling techique is done during osteotomy during implant surgery and at what speed is the drill set at?

Answer 14

Incremental drilling.

1500-1800rpm

Question 15

The drill used in implant surgery can cause bone to overheat, what is done to counter this?

Answer 15

Cooling:

1. Copious sterile saline, pumped via drill unit.

Question 16

Ideally are single use or multi use drills used?

Answer 16

1. Single use drills gold standard.
2. Multi-use need to be audited

Question 17

What does primary stability of an implant mean?

Answer 17

Once the implant is placed, whether the implant is stable within the site.

Question 18

How much narrower is the final drill than the implant width in implant surgery?

Answer 18

0.3-0.5mm

Question 19

What is mechanical retention in implants determined by?

Answer 19

1. Density of the bone
   Varies between sites and patients - assess during preparation.
2. Surgical technique
   Underprepare site - drill slightly narrower than the implant that is placed there.
3. Implant design
   Thread pitch and implant macroshape.

Question 20

What is the degree of primary stability of an implant determined by?

Answer 20

This is how tight the implant has ben screwed into the recipent bone site.

Question 21

• What are the stages in original/conventional implant surgery?

Answer 21

1. Pre op planning
   
   2. Extractions (0.5-6 months for bone to heal)
   3. Stage 1 surgery- place and bury implants (3-6 month wait)
   4. Stage 2 surgery - exposre implants.
   5. Place healing abutment (1-2 month wait)
   6. Final abutment and impression.
   7. Temporary restoration (2-9 month wait)
   8. Definitive restoration
   9. Maintenance

Question 22

What are the 2 stages in the two-stage procedure in original/conventional implant surgery?

Answer 22

first stage:
- insert cover screws ()fingertight force or contra angle at 20 rpm 5 Ncm)
-suture back the muco-periosteal flaps
-an appropriate healing period is prescribed

second stage:
- healing abutments are istaleed for soft tissue healing
soft tissue is adapted and sutured back arounf the abutments

Question 23

What are the stages in single stage conventional implant surgery?

Answer 23

healing abutments are connected at the same time as the ficture installation.

Muco-periosteal flaps are sutured back around the healing abutments.

Question 24

hat are the 2 needs for implant placement?

Answer 24

• What are the 2 needs for implant placement?Surrounding bone and keratnised tissue.