Wound Healing After Periodontal Treatment

Question 1

What happens to the alveolar ridge after extraction?

Answer 1

1. Ridge will change shape.
2. Buccal bone loss (5.2mm)
3. If bony wall was thin can be up to 7.5mm - this has a significant on the ability to place an implant on other restorations.
4. Narrowing of the band of attached gingiva
5. Coronal shifting of the MGJ
6. The 2 above are soft tissue changes that compromised the soft tissue health around an implant.

Question 2

When do bone loss changes tend to slow down after an extraction?

Answer 2

8 weeks - but some studies suggest longer.

Question 3

How does the resultant bone loss from an extraction implicate restorative treatment?

Answer 3

The restoration may appear bulbous due to bone loss
The gingival margin may be oddly placed
OH may be impaired
Ridge morphology and emergence profile of implant may be impaired

Question 4

Does an implant stop ridge resorption?

Answer 4

No.

Question 5

If an implant is placed too early what is the risk?

Answer 5

The risk of bone loss around the implant is greater.

As you haven’t allowed enough time to heal.

Question 6

What are the positioning requirements to an immediate or early implant?

Answer 6

1. Placed 2mm apical to ridge crest.
2. With 2-3mm of buccal bone over implant - i.e. relatively palatal.

Question 7

Where should implants NOT be placed?

Answer 7

1. NOT axially in the socket.
2. NOT filling the whole socket - unless there are thick tissues and placement is delayed.

Question 8

What may palatal implant placement after ridge remodelling or as an immediate implant compromise and why?

Answer 8

1. Palatal implant placement may compromise the aesthetic outcome of the restoration, as it may result in a lack of buccal bone support, leading to recession of the gingival margin and exposure of the implant.
2. Additionally, palatal placement may affect the stability of the implant, as it may not be fully integrated with the bone due to the lack of cortical bone support on the buccal aspect.

Question 9

To achieve bone stability for the implant and adequate thickness with good emergence profiles, what may be necessary?

Answer 9

1. Ridge augmentation procedures, such as bone grafting or guided bone regeneration (GBR), prior to implant placement.
2. This can help to ensure that the implant has a strong foundation and that the surrounding tissues are healthy and adequately supported.
3. Also helps hide buccal bone collapse.

Question 10

How can implant placement be restoratively driven?

Answer 10

By considering the:

1. Emergence profile of the crown.
2. Position of screw holes.
3. Emergence position of crowns.

Question 11

Define osseointegration.

Answer 11

A direct functional and structural connection between living bone and the surface of a load bearing implant.

Question 12

What is osseointegration dependent on?

Answer 12

1. Good primary stability at implant placement.
2. This achieved by ensuring the implant cannot move within the recipient site. Optimised by good surgical technique.
3. This is so good bone forms around the implant.

Question 13

What 5 things does the surgical trauma from osseointegration lead to?

Answer 13

Inflammation phase: Bleeding / coagulum formation

Granulation phase: Ingrowth of vessels and deposition of osteoid from osteoblasts

Development of provisional matrix

Callus phase: Irregular woven bone then parallel fibred bone

Maturation phase: Remodeling and modeling to form lamellar bone

Question 14

• How is a roughened implant surface achieved?

Answer 14

This can be achieved through a variety of methods, including:

1. etching
2. sandblasting
3. or acid treatment. 

The goal is to create a surface that is rough enough to promote osseointegration, but not so rough that it compromises the stability or longevity of the implant

Question 15

How rough is a roughened implant surface?

Answer 15

1um.

Question 16

What does a roughened implant surface help achieve?

Answer 16

1. Accelerates the integration process.
2. Resulting in earlier restoration of implant.

Question 17

How else can the osseointegration process accelerate?

Answer 17

Fluoride loading.

Question 18

What process only occurs with roughened and not machined implants?

Answer 18

Contact osteogenesis:

4 days: Initial blood clot and fibrin replaced by immature vascularized connective tissue

1 week: Immature connective tissue (CT), vascular structures, some woven bone formation, minimal inflammatory cells, some contact with implant surface – “contact osteogenesis” occurs only on rough, not machined, implants

2 weeks: Woven bone in all areas, some implant contact/integration, areas around implant providing initial stability, also remodeling

4 weeks: Fully mineralized bone in some areas

12 weeks: Mineralized bone with osteon structure present around implant; trabeculae and bone marrow present – lamellar bone formation

Question 19

What do histological studies with TiOblast implants show in comparison to machined implants?

Answer 19

“Human histological studies with TiOblast show a highly significant increase in bone-to-implant contact compared with a machined surface.”

Question 20

How to the levels of new bone, old bone, bone debris and soft tissue vary over a 6 week bone remodelling period?

Answer 20

1. New bone increases over the 6 weeks.
2. Old bone slowly decreses starting from week 2 same with bone debris.
3. This is because woven bone joins old bone and bone debris to form new bone.
4. Soft tissue varies across the first 4 weeks then stabilises: