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Patient Care III > The Periodontium of Dental Implants > Flashcards

The Periodontium of Dental Implants Flashcards

1
Q

What are the basic parts of an implant and their relation to teeth?

A
  • Implant body
  • Abutment
  • Crown
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2
Q

Does implant anatomy have PDL?

A

NO

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3
Q

Why do we use titanium for implants?

A
  • Excellent biocompatibility
  • Low weight/high strength
  • Excellent corrosion resistance
  • Contains a titanium oxide layer that promotes adhesion of osteogenic cells
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4
Q

What does the titanium oxide layer of the titanium implant do?

A

promotes adhesion of osteogenic cells

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5
Q

What does the dental implant look like?

A
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6
Q

What is the bone level implants?

A

The interface of implant and abutment is at the bone

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7
Q

What is the tissue level implants?

A

The interface of the implant and abutment is at the tissue

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8
Q

What are the advantages of bone level implants

A
  • Better esthetics, no metal collar
  • Can achieve primary closure if needed
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9
Q

What are the disadvantages of bone level implants?

A
  • Microenvironment allows bacteria to be present at bone level
  • Less cleansable
  • Harder to see residual cement
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10
Q

What are the disadvantages of tissue level implants?

A
  • Metal collar may show through
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11
Q

What are the advantages of tissue level implants?

A
  • Collar creates a “biologic width”
  • Bacteria is at tissue level, away from the bone
  • More cleansable
  • Easier to see residual cement
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12
Q

What can dental implants be used for?

A
  • replace one tooth
  • replace multiple teeth
  • replace all teeth
  • support removable dentures
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13
Q

Implant retained denture =

A

removable

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14
Q

Implant supported denture =

A

fixed

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15
Q

What are the types of protheses that implants are used on?

A

Single crowns, FPDs, implant supported RPDs, overdentures, hybrid dentures

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16
Q

What is osseointegration?

A

A stable implant relies on direct structural and functional connection between vital bone and the surface of an implant

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17
Q

What are factors that determine successful osseointegration?

A
  • 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
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18
Q

What medical history should you be aware of for implants?

A
  • Diabetes (Controlled vs. Uncontrolled)
  • Osteoporosis and bisphosphonate use (Not a contraindication to implant placement)
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19
Q

What social history should you be aware of for implants?

A

Smoking
* Increased failure of dental implants
* 84% vs 98% (without smoking)
* Depends on use – heavy or light

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20
Q

How will you know clinically if an implant is osseointegrated?

A
  • Immobile
  • Clear sound to percussion
  • No pain or infection
  • No paresthesia
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21
Q

How will you know radiographically if an implant is osseointegrated?

A
  • No radiolucent peri-implant space
  • Minimal bone loss; <1mm remodeling, <0.1mm/year after the first year
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22
Q

What should the bone loss be during remodeling after an implant?

A

less than 1.0 mm

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23
Q

What should bone loss be a year after an implant is placed?

A

less than 0.1mm/year

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24
Q

What is contact osetogenesis?

A
  • Bone first forms on the implant surface
  • Bone formation progresses from implant surface to existing bone
  • Rough surface implants
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25
Q

What is distance osetogenesis?

A
  • Bone forms on the surface of the existing bone
  • Bone formation progresses from existing bone to implant surface
  • Smooth or machined surface implants
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26
Q

What type of osteogenesis is rough surface implants?

A

contact osteogenesis

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27
Q

What type of osteogenesis is smooth or machined surface implants?

A

distance osteogenesis

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28
Q

When can you place an implant?

A
  • Immediate; At the time of extraction
  • Delayed; 6-10 weeks after extraction
  • Late; 6 months or more after extraction
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29
Q

What is type D1 bone density/quality?

A
  • Homogenous compact bone
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30
Q

What is type D2 bone density/quality?

A
  • Thick layer of compact bone around a core of dense trabecular bone
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31
Q

What is type D3 bone density/quality?

A
  • Thin layer of compact bone around dense trabecular bone
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32
Q

What is type D4 bone density/quality?

A
  • Thin layer of cortical bone around a core of low-density trabecular bone
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33
Q

Which types of bone are more common in maxilla?

A
  • D3
  • D4
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34
Q

Which types of bone are more common in mandible?

A
  • D1
  • D2
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35
Q

What is primary stability?

A

implants have mechanical stability initially (just the implant sitting in the bone)

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36
Q

Over time, the primary stability ___________ but the secondary stability or biological stability __________

A

decreases
increases

37
Q

Why do we wait to restore an implant with a crown?

A

You want to wait for the secondary/biological stabilty to increase before the mechanical stability decreases

38
Q

What are the different types of implant loading?

A
  • Immediate
  • Early
  • Conventional
39
Q

What is immediate implant loading?

A
  • Within 48 hours of placement
  • Lower implant survival
  • Parameters should be ideal
40
Q

What is early implant loading?

A
  • Prior to 3 months
41
Q

What is conventional implant loading?

A
  • After 3 months

-what we do at UMKC

42
Q

What is the different between periodontium of a tooth versus a dental implant?

A
  • Less vascularity
  • No PDL
  • Fewer gingival fibers
  • Collagen fibers parallel the implant (fibers do not insert into cementum like a natural tooth)
43
Q

What does the connective tissue look like around an implant?

A
  • Circular fibers form a “cuff” around the implant
  • Forms a hemidesmosome attachment to the implant and abutment
  • Forms a “soft tissue seal”
44
Q

What should the core of buccal surface peri-implant mucosa be?

A
  • Core of connective tissue
    –Primarily collagen fibers, very little fibroblasts
    –High collagen fiber content, low cellular content
45
Q

What is higher, the buccal surface of peri-implant mucosa or the buccal surface of gingiva on teeth?

A

buccal surface of peri-implant mucosa (3-4mm)

46
Q

What type of epithelium is the buccal surface of peri-implant mucosa?

A

Orthokeratinized epithelium

47
Q

What type of epithelium is the inner surface of the peri-implant mucosa?

A
  • thin barrier epithelium (like junctional epithelium)
48
Q

Is the dimension of supracrestal attachment of mucosa greater in teeth or implants?

A

implants (good thing!)

49
Q

What is around implants?

A

mucosa

  • not gingiva!
50
Q

What are the vascular differences for an implant?

A
  • No vascular supply from PDL
  • Less vascular supply = less immune system regulation
51
Q

What are the vascular sources for an implant?

A
  • Sources: Alveolar bone (Supraperiosteal vessels) and Connective tissue
52
Q

For implants what is the supracrestal attachment?

A

3-4mm

53
Q

For teeth what is the supracrestal attachment?

A

2mm

54
Q

How much epithelium and connective tissue for an implant?

A
  • 1mm epithelium
  • 2mm connective tissue
55
Q

How much epithelium and connective tissue for a tooth?

A
  • 0.97mm epithelium
  • 1.07mm connective tissue
56
Q

What is the difference between tooth and implant for the PD?

A

Tooth - 2.5 mm
Implant - 2.9 mm

57
Q

What is the difference between tooth and implant for the buccal mucosa thickness?

A

Tooth - 1.1 mm
Implant - 2.0 mm

58
Q

What is the difference between tooth and implant for the papilla?

A

Tooth - Tall papilla height and more fill
Implant - Short papilla height and less fill

59
Q

What are the classifications of implant failures?

A
  • Surgical
  • Mechanical
  • Esthetic
  • Biological
60
Q

What are surgical implant failures?

A
  • lack of osseointegration
  • improper placement
  • infection
61
Q

What are mechanical implant failures?

A
  • screw loosening
  • abutment fracture
  • implant fracture
62
Q

What are esthetic implant failures?

A
  • metal collar show through
  • smile line concerns
  • long crowns
63
Q

What are biological implant failures?

A
  • Peri-implant mucositis
  • Peri-implantitis
64
Q

What does peri-implant health look like?

A
  • Free of inflammation
    —No BOP
    —No suppuration
    —No erythema or edema
  • Stable probing depths
  • No radiographic bone loss following initial healing
65
Q

What does peri-implant mucositis look like?

A
  • Signs of inflammation
    – BOP
    – Erythema, edema
  • NO radiographic bone loss
  • Reversible if etiology is controlled
  • If not controlled, may develop peri implantitis
66
Q

What is the etiology of peri-implant mucositis?

A

plaque biofilm

67
Q

What is the prevalence of peri-implant mucositis?

A

43%

68
Q

What is peri-implantitis?

A
  • Signs of inflammation
    –BOP
    –Erythema, edema
    –Suppuration
  • Radiographic bone loss
  • Increasing probing depth compared to time of restoration
69
Q

What is the etiology of peri-implantitis?

A

plaque biofilm

70
Q

What are the risk factors for peri-implantitis?

A
  • History of periodontitis
  • poor plaque control
  • no regular maintenance care after placement

(data not conclusive for smoking and diabetes)

71
Q

What is the prevalence of peri-implantitis?

A

22%

72
Q

What is the gingival comparison of peri-implant mucositis and peri-implantitis?

A
  • Peri-implant mucositis = gingivitis
  • Peri-implantitis (BONE LOSS) = periodontitis (BONE LOSS)
73
Q

If no previous radiographs/history and patient has…
* Radiographic bone loss ≥ 3mm
* Probing depths ≥ 6mm

A
  • Diagnostic for peri-implantitis
74
Q

Not all bone loss is _____

A

pathologic

75
Q

_______mm bone loss in the first year after placement

A

0.9-1.6

76
Q

About ____mm bone loss per year
following the first year of implant

A

0.1

77
Q

Not seen as much bone loss seen with ________ _______ implants

A

platform switched

78
Q

Why do we want keratinized mucosa around implants?

A

keratinized tissue may improve patient comfort and benefit oral hygiene and plaque removal

79
Q

What are the treatment options for implants without keratinized mucosa?

A

soft tissue graft to increase keratinized tissue

80
Q

Major risk factors for peri-implantitis are…

A
  • Poor plaque control
  • Lack of regular maintenance after placement
81
Q

Implants can’t get caries, but they can get…

A

bone loss

82
Q

Implants may require oral hygiene aids if crowns are long, bulky, or difficult to clean such as…

A
  • Interdental/Proxy Brushes
  • Super Floss
83
Q

What do you need to be careful with so you don’t damage the implant surface?

A

Avoid conventional scalers

  • Use Ti scalers and plastic tips on your Cavitron/Ultrasonics
84
Q

Don’t be afraid to ______ an implant

A

probe

85
Q

What is the maintenance schedule for implants?

A
  • Every 3 months for the first year
  • Move to every 6 months if implant is stable and OH is adequate
  • Continue every 3 months if OH is poor
86
Q

What is the maintenance schedule for patient’s based on?

A
  • Risk factors
  • Oral hygiene
  • specific to each patient
87
Q

What are treatment options for peri-implant complications?

A
  • Refer to specialist
  • Nonsurgical therapy
  • Surgical therapy
88
Q

What are the nonsurgical treatment options for peri-implant complications?

A
  • Debridement (Ti curettes, PerioFlow)
89
Q

What are the surgical treatment options for peri-implant complications?

A
  • Open flap debridement
  • Osseous recontouring
  • Bone grafting/guided tissue regeneration
  • Explantation/removal of implant

Patient Care III (25 decks)

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