Rest: Implants

Question 1

Define osseointegration.

Answer 1

Direct functional and structural connection between load bearing dental implant and bone.
Primary - frictional forces.
Secondary - incorporation of bone and implant via cellular processes.

Question 2

Compare the differences between supra-crestal soft tissue of tooth and implant ?

Answer 2

Tooth - more fibroblasts, less collage, collagen fibres are orientated perpendicular to root surface.

Implant - more collagen, less fibroblasts, collagen fibres orientated parallel to implant crown.

Question 3

Compare the differences between sub-crestal tissue of tooth vs. implant.

Answer 3

Tooth - anchored to bone by PDL, capable of physiological adaptation, resistant tissue attachment.

Implant - anchored by direct functional contact, no physiological adaptation percent, rigid connection, no proprioception.

Question 4

What is the standard implant material ?

Answer 4

Titanium - bioinert.

Question 5

What is the benefits of roughened implant surface ?

Answer 5

Between mechanical retention and primary osseointegration.

Question 6

What is the problems with roughened implant surfaces ?

Answer 6

Risk of accumulation of biofilm.

Question 7

How does smoking increase rate of implant failure ?

Answer 7

Vascularity reduced, fibroblast and osteoblast function impaired, PMN function - all cause reduced healing.

Question 8

What are the risks associated with placement of implants in patients who are not skeletally mature ?

Answer 8

Relative infra-occlusion.
Suboptimal aesthetics.
Occlusal disharmony.
Implant fenestration.

Question 9

What is the preferred gingival phenotype ?

Answer 9

Thick scalloped.

Question 10

What are the oral factors which might influence success of an implant ?

Answer 10

Gingival phenotype.
Bone crest to contact point distance.
Degree of previous infection.
Restorative status of adjacent teeth.
Width of edentulous span.
Relevant local anatomy.
Available bone.

Question 11

IMPLANTS

How much bone should exist mesio-distally between an implant and roots of adjacent teeth ?

Answer 11

1.5mm.

Question 12

What relevant anatomy might influence your placement of implants in maxilla ?

Answer 12

Maxillary sinus, nasal floor, naso-palatine canal, infraorbital nerve.

Question 13

What relevant anatomy might influence your placement of implants in mandible ?

Answer 13

IAC, mental formane, incisive canal, sublingual artery, submandibular fossa.

Question 14

What special investigations do you require for implant planning ?

Answer 14

CBCT. Diagnostic wax ups. Study models. Surgical template. Clinical photographs.

Question 15

How much buccal bone should exist for implant placement ?

Answer 15

> 1mm bone or >2mm HT/ST labial.

Question 16

What is the risks of placing an implant too buccally ?

Answer 16

Fenestration. Dehiscence. Inadequate contour.

Question 17

Your patient smokes <10 cigarettes a day - are they high, medium or low risk of implant failure ?

Answer 17

Medium.

Question 18

Your patient smokes >10 cigarettes a day - are they high, medium or low risk of implant failure ?

Answer 18

High.

Question 19

What are the common causes of compromised tissue sites ?

Answer 19

Post-extraction defects.
Trauma.
Hypodontia.
Periodontal disease.
Thin biotype.

Question 20

What are the determinants of aesthetic outcomes for implants ?

Answer 20

Bone volume and morphology.
Space dimensions.
3D implant position.
Biotypes.
Operator skill and experience.