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BDS4 Implant Symposium > Restoration of Implants > Flashcards

Restoration of Implants Flashcards

1
Q

What is meant by prosthetically driven planning?

A

Top down approach
- Begin with end in mind
- Put implant in position where restoration would not be compromised

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2
Q

What are the phases of the implant journey?

A

Implant planning
Placement
Healing- pink firm and healthy
Impressions
Abutment selection
Provisionalisation- how long?
Loading
Definitive restorations- once maturation has occurred

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3
Q

What are the types of implant retained prostheses?

A

Removable prosthesis (like dentures)
-> Stud, bar, magnet retained

Fixed prosthesis -single or multi unit or full arch
-> Screw retained, cement retained

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4
Q

How does the denture retained by implant bar work?

A

3 implants splinted together
-> Denture clips on top

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5
Q

How do ball retained prostheses work with implants?

A

Implants placed with ball on top, clips onto female part on denture

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6
Q

How does the LOCATOR system work?

A
  • Silicone inserts on implant instead of denture clip over implants
  • Grip strength varies depending on colour
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7
Q

What can be done to make zirconia bridge frameworks looks aesthetic?

A

Cover with porcelain

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8
Q

What is used for a provisional in implants, what are the purposes of provisionals in his case?

A

Lab make temporary abutment and crown (peak material)

Allows maturation, shaping and healing- healthier proportions
-> Helps prevent shine through

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9
Q

What are the 2 techniques when taking impressions for definitive restoration with an implant?

A

Open tray- hole present to allow impression coping to go through (screwed into implant)

Closed tray- no need for hole in tray as coping gets stuck in impression material

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10
Q

What are the steps in the open tray technique?

A
  • Has coping- threaded post which screws into implant (can be done by hand/screw driver)
  • Impression tray is filled with rigid accurate elastomeric material like impregum is used
  • Only way coping can be removed is by unscrewing
  • Impression sets- unscrew coping and remove impression tray/material
  • Screw implant analogue onto impression coping- on pouring there is a direct transfer from where implant is in mouth onto cast
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11
Q

When is open tray technique preferred?

A

Good if space for fingers and screw drivers
-> anterior region

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12
Q

What are the benefits of open tray technique?

A

Color-coded components corresponds to prosthetic
connection

High precision impression

Clear-cut tactile response for accurate positioning

Guide screw can be tightened by hand or with the SCS screwdriver

Safer as screw retained

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13
Q

What are the steps in the closed tray technique?

A
  • Use different impression coping (T shaped), pressed down onto implant, material flows around, it gets stuck and is removed with impression material
  • 2 pieces- one part goes onto implant head, second part (red) pushed on top to secure
  • Parts click into place- will not be removed by accident
  • Impregum (polyether) used
  • When in lab- they will attach implant analogue
  • Put soft silicone mask to allow movement of gingivae
  • Pour as standard for any crown/bridge impression
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14
Q

What are the benefits of closed tray technique?

A

Color-coded components corresponds to prosthetic
connection

No additional preparation of tray

High precision impression

Clear-cut tactile response for accurate positioning

Preferred if less space- posteriorly

Cheaper

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15
Q

What are abutments used for?

A

Cn be used to correct angle implant is coming out at if not perfectly straight

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16
Q

What are the different types of abutments?

A

Come in range of sizes, shapes, materials (Ti, Zirconia, gold etc), colours

Can be standard or custom (crown prep-like)

17
Q

What is preferred screw or cement retained?

A

Screw

18
Q

What are the ADV of screw retained implant restorations?

A

More retrievable

Can be positioned for ideal aesthetics

Good retention even with <4mm abutment height

Better tissue response

19
Q

What are the DIS of screw retained implant restorations?

A

Must be passive- technique sensitive

Susceptible to porcelain fracture

Susceptible to screw fractures and loosening

Higher cost

Difficult access

Occlusal interferences possible

20
Q

What are the ADV of cement retained implant restorations?

A

Cement space acts as shock absorber

Easier access

Easier to fabricate

Lower cost

Better occlusal control

21
Q

What are the DIS of cement retained implant restorations?

A

More universal aesthetics- less custom

Unpredictable retrievability

> 5mm abutment height required for retention

Be careful not to get cement under soft tissue- risks periimplantitis

22
Q

What are the aesthetic challenges with implants?

A

Patient will want teeth to look as similar as possible

Survival of implants is great but appearance may be lacking

23
Q

What can lead to poor aesthetic in implants?

A

If implant is too deep/poor angulation and tissues are inflamed and not well keratinised or receded

If zenith too low
-> Long term provisional to remodel gingivae until it reaches desired height

24
Q

What is considered in the Pink Aesthetics score?

A
  1. Mesial papilla
  2. Distal papilla
  3. Soft tissue level- is graft required
  4. Soft tissue contour
  5. Alveolar process deficiency
  6. Soft tissue colour
  7. Soft tissue texture

Aiming for this to be stable long term

25
Q

What is the normal distance from alveolar bone to gingival margin?

A

3mm

26
Q

What is the normal distance interproximally from crest of alveolar bone to contact point? What is different about implants

A

5mm- if less than this then soft tissue fills space well

In implants it is more common to get black triangle- not as high of a soft tissue collar between IP bone and contact

27
Q

How can concavity in labial plate affect aesthetics of implant?

A

Depression in cervical region and incorrect height of zenith

28
Q

How do we achieve aesthetic results when 2 implants are placed to replace missing centrals?

A

2mm from head of implant to gingival margin

1.5mm away from adjacent teeth (causes crater to develop- if too near can cause recession) and 3mm between implants

If distance between IP contact is more than 3.5mm it is likely to cause black triangle
-> If slight it can be acceptable

29
Q

What are the common causes of compromised implant tissue sites?

A

Post extraction defects

Trauma

Hypodontia- bone never developed in first place (lack of hard and soft tissue)

Periodontal disease- significant amount of bone loss

Thin biotype- unstable soft tissues are more likely

30
Q

What are the determinants in aesthetic outcome for implants?

A
  • Bone volume and morphology
  • Space dimensions- for health and aesthetics
  • 3D implant position- optimal
  • Take account of biotype- if thin consider grafting at time of implant placement
  • Operator skill and experience
  • Biological limits- explain this to patients

BDS4 Implant Symposium (2 decks)

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