W4 - Implantology Intro - Tulio

Question 1

Osteoinduction vs osteoconduction

Answer 1

• Osteoinduction: undifferentiated cells are stimulated to develop into bone forming cell lineage
• Osteoconductive surface: permits bone growth on surface

Question 2

2 types of osteogenesis

Answer 2

Intramembranous ossification

Endochondral ossification

Question 3

Describe intramembranous ossification

Answer 3

direct conversion of mesenchymal tissue into bone (bones of skull)

Question 4

Describe endochondral ossification

Answer 4

mesenchymal cells differentiate into cartilage and is later replaced by bone

Question 5

How does smoking affect implant healing (3)

Answer 5

Angiogensis reduced

Reduced nutrients

Reduced O2

Question 6

Are healed implants completely covered by hard tissues?

Answer 6

Not usually, only 60% covered by bone
40% is covered by fibrous tissue

Question 7

How can you measure quality of bone for implants?

Answer 7

CBCT

When drilling - is it soft? Resistance?

Question 8

Describe the 4 different time periods for implant loading

Answer 8

Depends on the quality of bone → if bad, wait longer for bone remodelling

Immediate loading

Same day - 1 week (if good bone)

Early loading

1 week - 2 months

Conventional loading

2-3 months

Immediate restoration

Within 1 week → if tooth not in occlusion

Question 9

If patient has significant medical history (ex diabetes) but it is well controlled, are implants contraindicated?

Answer 9

No, not contraindicated

BUT modify tx plan → ex. wait longer for healing

Question 10

Required distance between implant and neighbouring tooth

Answer 10

AT LEAST 1.5 mm

otherwise, no vasculature

Question 11

Should there be any mobility in implant?

Answer 11

No → no pdl = no micromovements

Essentially ankylosed

Could be loose crown component

or

failed implant

Question 12

How does amount of bone loss relate to strength of implant

Answer 12

More resorption = more vertical cantilever

• Implant not just replacing tooth, but also soft tissue
• Consider crown length to implant ratio
• Ex. dont use 6mm implant to replace 20mm crown

Question 13

What are the 3 different implant / abutment connections?

Answer 13

Question 14

How deep must the implant go? / How does mucosa level determine deepness?

Answer 14

Must go at least 4 mm from the top of the soft tissues

Ex. if thicker mucosa (4mm), can place implant at bone level

Question 15

Extraction consideration for immediate implant loading

Answer 15

Section the tooth to minimise socket widening / bone loss

Question 16

Why avoid class 1 cantilevers?

Answer 16

Too much force on implant

Question 17

What types of prostheses should be avoided with implants

Answer 17

Class 1 Levers

Distal cantilevers (esp molars)

If required, only recommend lateral incisor lever

Question 18

How does quality of bone impact implant abutment placement?

Answer 18

• When bone quality is high you can place abutment after 1 week
• If when you drill, bone is soft wait a few months for bone remodeling until placing abutment

Question 19

How long does it take for complete bone healing

Answer 19

+6 months

Question 20

What happens when you insert implant?

Answer 20

• Implant inserted
• Release of inflammatory cytokines
• Clot forms which is filled with fribrin
• Fibrin forms network to allow migration of cells toward implant surface (different implant materials react differently)
• Undifferentiated cells become osteoblast like cells and form first layer of highly mineralised cement and then bone on implant surface

Question 21

What do we use as material for implant screw?

Answer 21

Titanium alloy (not pure titanium)

Question 22

What systemic factors can affect healing process of implants?

Answer 22

• Diabetes
• Smoking

Question 23

What happens if fibrin clot is not in contact with surface of implant?

Answer 23

Bone won’t be formed on surface of implant- instead there will be fibro-osseointegration.

Question 24

What do bone cells come from?

Answer 24

Mesenchymal stromal cells / MSC

Question 25

What is immediate loading?

Answer 25

Placing abutment on the same day-1 week after implant placement

Question 26

Where is poorest bone quality?

Answer 26

Near maxillary tuberosity