What are 4 reasons for early implant failure which usually arise from failure of the initial integration to take place during biological healing phase?
- poor surgical technique
- inability to achieve primary fixation
- inadvertent implant loading
- infection and systemic conditions
What are 2 reasons for late implant failure?
- biological failures: caused by plaque-induced peri-implant diseases
- mechanical failures: caused by unfavourable loading conditions
What are the 4 approaches to implant monitoring and maintenance?
- reduction of risk factors
- patient education and motivation
- screening and surveillance
- instrumentation and intervention
What are 8 local risk factors for implant failures?
- radiotherapy
- smoking
- occlusal trauma
- parafunctional habits and bruxism
- poor soft tissue biotype
- poor bone quality and density
- endo/periapical lesions in adjacent teeth
- perio disease
What are 3 systemic conditions which contribute to implant failures?
- uncontrolled diabetes
- immunosuppression
- bisphosphonates
What are 6 general risk factors for implant failures?
- patient factors; smoking, systemic disease, meds etc
- host susceptibility; perio, plaque control, control of co-morbidities
- implant design; roughness of implant surface
- motivation; patient education
- prosthetic design; occlusal overload
- soft tissue quality and quantity; mechanically thick, keratinised, non-mobile mucosa
What are 3 reasons why smoking is a contraindication for implants?
- poor wound healing
- risk of peri-implant infection
- crestal bone loss
What advice should be given to smokers prior to implant placement?
- advise to stop smoking before implant placement
- placement can occur in smokers, but advice and careful monitoring is a must
Which flossing technique should be adopted for patients with implants?
cross-over flossing technique
In the first year of implant placement, what is the expected amount of bone loss?
<1.5mm
After the first year of implant placement, what is the expected amount of bone loss after this period?
0.2mm
The presence of peri-implant radiolucency or crestal bone loss is checked, what is used as the reference point for this?
implant shoulder
When estimating bone loss post implant placement, what is used to calculate the magnification factor?
distance between implant threads
When should radiographs be taken of an implant?
- at fit
- 1 year
- biannually
What is meant by biological width?
defined as the dimension of soft tissue which is attached to the portion of the tooth coronal to the crest of the alveolar bone
What is the biological width around implants?
2-3mm
2mm is the epithelial attachment
1mm is the supracrestal connective tissue attachment
Violations to the biological width may result in which 2 things?
- gingival inflammation only
- gingival recession with bone loss
Thin, fragile, highly scalloped gingiva is more at risk of what?
recession
Thin alveolar bone is more at risk of what?
horizontal bone loss
Thick alveolar bone is more at risk of what?
vertical bone loss
Probing of implants can be limited by which 3 factors?
- contour of prostheses
- depth of implant shoulder
- design of implant shoulder/abutments
What is the routine management of implants?
- presence of exudate, bleeding or swelling should be noted together with PPD measurements
- 6PPC if applicable annually
- removal of bacteria to improve peri-implant maintenance
Which testing can be used to check absence of mobility of implants?
a percussion test
Which 4 indices should be assessed regularly?
- plaque index
- bleeding on probing
- peri-implant probing depth
- presence of exudate, discharge, sinus or fistula
