Implant lecture

Question 1

what are the basic parts of the implant

Answer 1

• implant body
• abutment
• crown

Question 2

why do we use titanium in implants

Answer 2

• excellent biocompatibility
• low weight/high strength
• excellent corrosion resistance
• contains a titacium oxide layer that promotes adhesion of osteogenic cells

Question 3

what is bone level

Answer 3

the interface of implant and abutment is at the bone

Question 4

what is tissue level

Answer 4

the interface of the implant and abutment is at the tissue

Question 5

what are the pros and cons of bone level

Answer 5

• better esthetics, no metal collar
  -can achieve primary closure if needed
• microenvironment allows bacteria to be present at bone level
• less cleansable
• harder to see residual cement

Question 6

what are the pros and cons of tissue level

Answer 6

• collar creates a biologic width
• bacteria is at tissue level, away from the bone
• metal collar may show through
• more cleansabke
• easier to see residual cement

Question 7

what are the types of prostheses

Answer 7

• single crowns
• FPDs
• implant supported RPDs
• overdnetures
• hybrid dentures

Question 8

what is implant retained prostheses

Answer 8

removable

Question 9

what is implant supported s=prostheses

Answer 9

fixed

Question 10

what is osseointegration

Answer 10

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

Question 11

what are the factors that determine successfull osseointegration

Answer 11

• biocompatibility of the implant surface
• macro and microscopic nature of the implant surface
• status of the implant sute (non infected bone, bone quality)
• surgical technique
• undisturbed healing
• long term loading and prosthetic design

Question 12

what are the patient factors that affect the implant success

Answer 12

• diabetes (controlled vs uncontrolled)
• osteoporosis and bisphosphonate use (not a contraindication though)
• smoking

Question 13

how does smoking affect implants

Answer 13

• increased failure of dental implants
• 84% vs 98%
• depends on use - heavy or light

Question 14

what is osseointegration clinically

Answer 14

• immobile
• clear sound to precussion
• no pain or infectino
• no paresthesia

Question 15

what is osseointegration radiographically

Answer 15

• no radiolucent peri-implant space
  -minimal bone loss- <1 mm remodeling, <0.1mm/year after the first year

Question 16

what is contact osteogenesis

Answer 16

bone first forms on the implant surface
- bone formation progresses from implant surface to existing bone
- rough surface implants

Question 17

what is distance osteogenesis

Answer 17

• bone forms on the surface of the existing bone
• bone formation progresses from the existing bone to implant surface
• smooth or machined surface implants

Question 18

what are the implant placement timing

Answer 18

• immediate: at the time of extraction
• delayed: 6-10 weeks after extraction
• late: 6 months or more after extraction

Question 19

describe the bone density and quality of Type D1, D2, D3 and D4

Answer 19

• D1: homogenous compact bone
• D2: thick layer of compact bone around a core of dense trabecular bone
• D3: thin layer of compact bone around dense trabecular bone
• D4: thin layer of cortical bone around a core of low density trabecular bone

Question 20

which implant timing has the lowest success rate

Answer 20

immediate

Question 21

what are the differences between periodontium of a tooth to a dental implant

Answer 21

• less vascularity
• no PDL
• fewer gingival fibers
• collagen fibers parallel the implant

Question 22

what does connective tissue do around an implant

Answer 22

• circular fibers form a cuff around the implant
• forms a hemodesmosome attachment to the implant and abutment
• forms a soft tissue seal

Question 23

describe the buccal surface of peri implant mucosa

Answer 23

• 3-4mm high on average
• core of connective tissue ( primarily collagen fibers, low cellular content)
• orthokeratinized epithelium

Question 24

describe the inner surface of peri implant mucosa

Answer 24

• thin barrier epithelium
• like JE
• connective tissue adhesion

Question 25

what are the vascular differences between real tooth and PDL

Answer 25

- no vascular supply from PDL - sources: alveolar bone (supraperiosteal vessels) , connective tissue

Question 26

what does less vascular supply mean about immune system

Answer 26

less vascular supply less immune system regulation

Question 27

what are the supracrestal attachment for implants and teeth

Answer 27

- implants: 3-4 mm. 1 mm epithelium, 2mm CT - teeth: 2 mm, 0.97mm epithelium , 1.07mm CT

Question 28

what are some other differences for teeth and implants

Answer 28

- teeth: 2.5mm PD, 1.1mm buccal mucosa thickness, taller papilla height, more papilla fill - implant: 2.9mm PD, 2.0mm buccal mucosa thickness, shorter papilla height, less papilla fill

Question 29

what are the types of implant faillures and describe each

Answer 29

- surgical: lack of osseointegration, improper placement, infection - mechanical: screw lossening, abutment fracture, implant fracture - esthetic: metal collar show through, smile line concerns, long crowns - biological: peri- implant mucositis and peri implantitis

Question 30

what are the parameters for peri implant health

Answer 30

- free of inflammation: no BOP, no suppuration, no erythema or edema - stable probing depths - no radiographic bone loss

Question 31

what are the symptoms of peri implant mucositis

Answer 31

- signs of inflammation such as BOP, erythema and edema - no radiographic bone loss

Question 32

is per implant mucositis reversible

Answer 32

yes if etiology is controlled

Question 33

what is the etiology of peri implant mucositis

Answer 33

plaque biofilm

Question 34

what is the prevalence of peri implant mucositis

Answer 34

43%

Question 35

what are the symptoms for peri implantitis

Answer 35

- signs of inflammation such as BOP, erythema, edema, and suppuration - radiographic bone loss - increased probing depth compared to time of restoration

Question 36

what is the etiology of peri implantitis

Answer 36

plaque biofilm

Question 37

what are the risk factors for peri implantitis

Answer 37

history of periodontitis, poor plaque control, no regular maintenance care after placement - data not conclusive for smoking and diabetes

Question 38

what is the prevalence for peri implantitis

Answer 38

22%

Question 39

what is the difference between peri mucositis and peri implantitis

Answer 39

peri implantits involves bone loss

Question 40

what if you have no previous radiographs or history

Answer 40

radiographic bone loss > or equal to 3mm - probing depths > or equal to 6mm - diagnostic for peri implantntis

Question 41

describe the remodeling phase

Answer 41

- 0.9-1.6mm bone loss in the frist year after placement - 0.1mm bone loss per year - clinically acceptable - not seen as much with platform switched implants

Question 42

what is the importance of keratinized mucosa

Answer 42

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

Question 43

what are the major risk factors for peri implantitis

Answer 43

- poor plaque control - lack of regular maintenance after placement

Question 44

how long to restore dental implants

Answer 44

12-16 weeks

Question 45

what is the maintenance schedule for implants

Answer 45

every 3 months - move to 6 months is OH is stable - based on risk factors and OH

Question 46

what are the treatment options for peri implant complication

Answer 46

- refer to specialist - nonsurgical therapy - debridement - surgical therapy: open flap debridement, osseous recontouring, bone grafting/guided tissue regeneration - explantation/removal of implant