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Perio MT2 > Trauma from Occlusion: Dental Implants > Flashcards

Trauma from Occlusion: Dental Implants Flashcards

1
Q

What are the 2 types of trauma from occlusion?

A
  1. Tremendous amount of force

2. Support of tooth is compromised causing normal forces to be traumatic

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2
Q

What are some examples of tremendous amounts of forces leading to trauma from occlusion in dental implants

A
  1. Bruxing

2. High restorations

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3
Q

What is the relationship between force and physiologic limits of the tooth in regard to trauma from occlusion?

A

Trauma from occlusion occurs when the forces on the tooth are GREATER than the physiologic limits allowed by the tooth

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4
Q

Describe attachment of a natural tooth vs an implant

A
  • Natural Tooth: PDL attachment apparatus

- Dental Implant: Direct bone-implant surface mechanical binding (osseointegration) – NO PDL buffer zone, NO ‘give”

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5
Q

Describe the ability to adapt with a natural tooth vs a dental implant

A
  • Natural tooth: can “adapt” to heavy forces

- Implant: Continuous bone remodeling at bone-implant surface interface – no mobility during remodeling

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6
Q

Describe physiological vs pathological mobility in a tooth vs an implant

A

Tooth: Tooth mobility can be a physiological OR a pathological phenomenon
Implant: Implant mobility is ALWAYS pathological, never physiological

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7
Q

Can you tie an FPD between a tooth and an implant? Why or why not?

A

No! Because the tooth has a different level of mobility than the implant. This would lead to bone damage and/or fracture.
(you can tie b/t 2 implants tho)

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8
Q

What 3 structures are in contact in a natural tooth socket?

A

Bone, PDL, and cementum

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9
Q

Describe dental implant osseointegration

A

Direct contact between living bone and the implant surface

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10
Q

Where is the only place that you could find very very very minor movement of an implant in health

A

within trabecular bone – super tiny – if asked, say implants are immobile!!!

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11
Q

What are the 3 factors that determine osseointegration?

A
  1. Primary stability
  2. Healing at the interface
  3. Functional implant loading
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12
Q

Describe healing at the interface with dental implants, and max vs mand times

A
  • Bone formation and early remodeling occurs during healing at the interface following implantation
  • Max early remodeling = 3 mos
  • Mand early remodeling = 6 mos
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13
Q

What is primary stability of a dental implant and what does it depend on?

A
  • Primary stability is the stability of the implant at the time of the placement (mechanical interlocking mechanism b/t a screw and bone surface)
  • Depends on bone density and implant fixture design
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14
Q

What are the 3 types of functional loading of the implant?

A
  1. Immediate loading (at time of placement)
  2. Early loading (before conventional healing time, ~6wks)
  3. Late loading (following 3-6 mos, depending on location)
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15
Q

What are the 4 restorative designs of dental implants?

A
  1. Single tooth restoration
  2. Multiple unit fixed-type restoration (splinted)
  3. Full mouth fixed type implant supported restoration
  4. Full mouth removable type implant supported restoration
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16
Q

What are the 5 major consequences of having an implant in high occlusion?

A
  1. Porcelain fracture
  2. Implant to abutment (screw loosening or fracture)
  3. Implant fixture fracture
  4. Increasing mobility of adjacent teeth
  5. Eruption/malocclusion/intrusion, etc of adjacent teeth (observed following functional loading of the dental implant)
17
Q

Describe the effect of extraction on sensory nerves of the PDL

A

Sensory nerves to supply the PDL are GONE following extraction

18
Q

What happens to the inferior nerve following extraction?

A

Myelinated fiber content of the inferior nerve is reduced by 20%

19
Q

Where might an implant get some sensory information?

A

Presence and potential function of sensory nerve fibers in the BONE and PERI-IMPLANT environment

20
Q

Why does the implant have a small amount of proprioception?

A

There is a gradual increase in the FREE nerve endings close to the implant-bone interface during healing

21
Q

How do implants maintain mechanical sensation after the extraction has already occurred?

A

Mechanical sensation comes from existing mechanoreceptors within the periodontium.

22
Q

Describe sensory feedback pathways in periodontium

A

Sensory feedback thru receptors localized within pdl (viscoelasticity) and with bone (elasticity) are necessary for fine tuning jaw and limb motor control – needed for tactile sensibility and thickness discrimination

23
Q

How do “tactile sensibility” and “thickness discrimination” vary between natural teeth and implants?

A

Natural teeth: detection threshold of 20 um thickness and 1-2 g upon tooth loading
Implants: detection thresholds of 50-100 um thickness and 50-100 g upon loading (100% less efficient at detecting thickness and pressure)

24
Q

What are the 2 types of implant studies?

A
  1. Animal models

2. finite element analysis (FEA)

25
Q

What are the 3 types of forces on an implant?

A
  1. Static forces
  2. Functional forces
  3. Excessive forces
26
Q

What are static forces?

A

Constant forces applied as in orthodontic movement

27
Q

What are functional forces?

A

Expected intermittent multidirectional forces that would occur when a tooth/implant is in normal function

28
Q

What are excessive forces?

A

Forces that well exceed those of teeth/implants in function, such as cantilevered implants

29
Q

What are the restrictions between implants and orthodontics?

A

Cannot do ortho ON implants because need PDL in order to achieve orthodontic movements….will result in HYALINIZATION. Do ortho first!

30
Q

What 4 factors does loading time depend on for an implant?

A
  1. Primary stability of the implant
  2. Implant design (thread size)
  3. Restorative design
  4. Presence/absence of risk factors
31
Q

What are some risk factors that can effect loading time?

A

Diabetes, smoking, bone resorption

32
Q

Functional and well controlled loading may increase _____, but 100% bone-implant surface contact is _______.

A

Functional and well controlled loading may increase BONE TO IMPLANT CONTACT, but 100% bone-implant surface contact is NOT POSSIBLE

33
Q

Occlusal trauma is a _______ etiological factor for periodontal disease, but it can be a ______ etiological factor for peri-implant disease

A

Occlusal trauma in perio disease = Secondary factor

“ “ in peri-implant disease = PRIMARY factor

34
Q

What is the only direction of force that an implant can accept? What happens if this is not respected?

A

Axial (vertical) loading only….otherwise get peri-implant bone loss, bacterial ingress, infection and retrograde peri-implantitis

35
Q

What are the extra steps you must take if placing an implant in a patient who bruxes?

A
  1. Provide a mouthguard
  2. Use longer and wider dental implants
  3. Surround with thick bone for support
36
Q

What is the concept behind “all-on-4”

A

Hybrid dentures with 2 straight implants and 2 implants at an angle in the intermentalous region so that posterior teeth can be soundly cantilevered.

37
Q

What is the #1 requirement of “all-on-4” implants (and all implants really)

A

MUST PLACE IN GOOD QUALITY BONE – there will be bone resorption, huge amounts in particular with all-on-4.

38
Q

What are the 3 most common problems as far as the physical implant is concerned when there is high occlusion?

A
  1. Chipping
  2. Loosening
  3. Implant fracture

Perio MT2 (5 decks)

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