The Periodontium of Dental Implants Flashcards
What are the basic parts of an implant and their relation to teeth?
- Implant body
- Abutment
- Crown
Does implant anatomy have PDL?
NO
Why do we use titanium for implants?
- Excellent biocompatibility
- Low weight/high strength
- Excellent corrosion resistance
- Contains a titanium oxide layer that promotes adhesion of osteogenic cells
What does the titanium oxide layer of the titanium implant do?
promotes adhesion of osteogenic cells
What does the dental implant look like?
What is the bone level implants?
The interface of implant and abutment is at the bone
What is the tissue level implants?
The interface of the implant and abutment is at the tissue
What are the advantages of bone level implants
- Better esthetics, no metal collar
- Can achieve primary closure if needed
What are the disadvantages of bone level implants?
- Microenvironment allows bacteria to be present at bone level
- Less cleansable
- Harder to see residual cement
What are the disadvantages of tissue level implants?
- Metal collar may show through
What are the advantages of tissue level implants?
- Collar creates a “biologic width”
- Bacteria is at tissue level, away from the bone
- More cleansable
- Easier to see residual cement
What can dental implants be used for?
- replace one tooth
- replace multiple teeth
- replace all teeth
- support removable dentures
Implant retained denture =
removable
Implant supported denture =
fixed
What are the types of protheses that implants are used on?
Single crowns, FPDs, implant supported RPDs, overdentures, hybrid dentures
What is osseointegration?
A stable implant relies on direct structural and functional connection between vital bone and the surface of an implant
What are factors that determine successful osseointegration?
- 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
What medical history should you be aware of for implants?
- Diabetes (Controlled vs. Uncontrolled)
- Osteoporosis and bisphosphonate use (Not a contraindication to implant placement)
What social history should you be aware of for implants?
Smoking
* Increased failure of dental implants
* 84% vs 98% (without smoking)
* Depends on use – heavy or light
How will you know clinically if an implant is osseointegrated?
- Immobile
- Clear sound to percussion
- No pain or infection
- No paresthesia
How will you know radiographically if an implant is osseointegrated?
- No radiolucent peri-implant space
- Minimal bone loss; <1mm remodeling, <0.1mm/year after the first year
What should the bone loss be during remodeling after an implant?
less than 1.0 mm
What should bone loss be a year after an implant is placed?
less than 0.1mm/year
What is contact osetogenesis?
- Bone first forms on the implant surface
- Bone formation progresses from implant surface to existing bone
- Rough surface implants
What is distance osetogenesis?
- Bone forms on the surface of the existing bone
- Bone formation progresses from existing bone to implant surface
- Smooth or machined surface implants
What type of osteogenesis is rough surface implants?
contact osteogenesis
What type of osteogenesis is smooth or machined surface implants?
distance osteogenesis
When can you place an implant?
- Immediate; At the time of extraction
- Delayed; 6-10 weeks after extraction
- Late; 6 months or more after extraction
What is type D1 bone density/quality?
- Homogenous compact bone
What is type D2 bone density/quality?
- Thick layer of compact bone around a core of dense trabecular bone
What is type D3 bone density/quality?
- Thin layer of compact bone around dense trabecular bone
What is type D4 bone density/quality?
- Thin layer of cortical bone around a core of low-density trabecular bone
Which types of bone are more common in maxilla?
- D3
- D4
Which types of bone are more common in mandible?
- D1
- D2
What is primary stability?
implants have mechanical stability initially (just the implant sitting in the bone)
Over time, the primary stability ___________ but the secondary stability or biological stability __________
decreases
increases
Why do we wait to restore an implant with a crown?
You want to wait for the secondary/biological stabilty to increase before the mechanical stability decreases
What are the different types of implant loading?
- Immediate
- Early
- Conventional
What is immediate implant loading?
- Within 48 hours of placement
- Lower implant survival
- Parameters should be ideal
What is early implant loading?
- Prior to 3 months
What is conventional implant loading?
- After 3 months
-what we do at UMKC
What is the different between periodontium of a tooth versus a dental implant?
- Less vascularity
- No PDL
- Fewer gingival fibers
- Collagen fibers parallel the implant (fibers do not insert into cementum like a natural tooth)
What does the connective tissue look like around an implant?
- Circular fibers form a “cuff” around the implant
- Forms a hemidesmosome attachment to the implant and abutment
- Forms a “soft tissue seal”
What should the core of buccal surface peri-implant mucosa be?
- Core of connective tissue
–Primarily collagen fibers, very little fibroblasts
–High collagen fiber content, low cellular content
What is higher, the buccal surface of peri-implant mucosa or the buccal surface of gingiva on teeth?
buccal surface of peri-implant mucosa (3-4mm)
What type of epithelium is the buccal surface of peri-implant mucosa?
Orthokeratinized epithelium
What type of epithelium is the inner surface of the peri-implant mucosa?
- thin barrier epithelium (like junctional epithelium)
Is the dimension of supracrestal attachment of mucosa greater in teeth or implants?
implants (good thing!)
What is around implants?
mucosa
- not gingiva!
What are the vascular differences for an implant?
- No vascular supply from PDL
- Less vascular supply = less immune system regulation
What are the vascular sources for an implant?
- Sources: Alveolar bone (Supraperiosteal vessels) and Connective tissue
For implants what is the supracrestal attachment?
3-4mm
For teeth what is the supracrestal attachment?
2mm
How much epithelium and connective tissue for an implant?
- 1mm epithelium
- 2mm connective tissue
How much epithelium and connective tissue for a tooth?
- 0.97mm epithelium
- 1.07mm connective tissue
What is the difference between tooth and implant for the PD?
Tooth - 2.5 mm
Implant - 2.9 mm
What is the difference between tooth and implant for the buccal mucosa thickness?
Tooth - 1.1 mm
Implant - 2.0 mm
What is the difference between tooth and implant for the papilla?
Tooth - Tall papilla height and more fill
Implant - Short papilla height and less fill
What are the classifications of implant failures?
- Surgical
- Mechanical
- Esthetic
- Biological
What are surgical implant failures?
- lack of osseointegration
- improper placement
- infection
What are mechanical implant failures?
- screw loosening
- abutment fracture
- implant fracture
What are esthetic implant failures?
- metal collar show through
- smile line concerns
- long crowns
What are biological implant failures?
- Peri-implant mucositis
- Peri-implantitis
What does peri-implant health look like?
- Free of inflammation
—No BOP
—No suppuration
—No erythema or edema - Stable probing depths
- No radiographic bone loss following initial healing
What does peri-implant mucositis look like?
- Signs of inflammation
– BOP
– Erythema, edema - NO radiographic bone loss
- Reversible if etiology is controlled
- If not controlled, may develop peri implantitis
What is the etiology of peri-implant mucositis?
plaque biofilm
What is the prevalence of peri-implant mucositis?
43%
What is peri-implantitis?
- Signs of inflammation
–BOP
–Erythema, edema
–Suppuration - Radiographic bone loss
- Increasing probing depth compared to time of restoration
What is the etiology of peri-implantitis?
plaque biofilm
What are the risk factors for peri-implantitis?
- History of periodontitis
- poor plaque control
- no regular maintenance care after placement
(data not conclusive for smoking and diabetes)
What is the prevalence of peri-implantitis?
22%
What is the gingival comparison of peri-implant mucositis and peri-implantitis?
- Peri-implant mucositis = gingivitis
- Peri-implantitis (BONE LOSS) = periodontitis (BONE LOSS)
If no previous radiographs/history and patient has…
* Radiographic bone loss ≥ 3mm
* Probing depths ≥ 6mm
- Diagnostic for peri-implantitis
Not all bone loss is _____
pathologic
_______mm bone loss in the first year after placement
0.9-1.6
About ____mm bone loss per year
following the first year of implant
0.1
Not seen as much bone loss seen with ________ _______ implants
platform switched
Why do we want keratinized mucosa around implants?
keratinized tissue may improve patient comfort and benefit oral hygiene and plaque removal
What are the treatment options for implants without keratinized mucosa?
soft tissue graft to increase keratinized tissue
Major risk factors for peri-implantitis are…
- Poor plaque control
- Lack of regular maintenance after placement
Implants can’t get caries, but they can get…
bone loss
Implants may require oral hygiene aids if crowns are long, bulky, or difficult to clean such as…
- Interdental/Proxy Brushes
- Super Floss
What do you need to be careful with so you don’t damage the implant surface?
Avoid conventional scalers
- Use Ti scalers and plastic tips on your Cavitron/Ultrasonics
Don’t be afraid to ______ an implant
probe
What is the maintenance schedule for implants?
- 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
What is the maintenance schedule for patient’s based on?
- Risk factors
- Oral hygiene
- specific to each patient
What are treatment options for peri-implant complications?
- Refer to specialist
- Nonsurgical therapy
- Surgical therapy
What are the nonsurgical treatment options for peri-implant complications?
- Debridement (Ti curettes, PerioFlow)
What are the surgical treatment options for peri-implant complications?
- Open flap debridement
- Osseous recontouring
- Bone grafting/guided tissue regeneration
- Explantation/removal of implant
