explain albrektsson 1986 criteria for implant SUCCESS
- no mobility
- <0.2mm bone loss/year after 1 year of function
- no radiographic radiolucency
- no pain, paraesthesia, discomfort, or infection
what is the success of implants based on albrektsson criteria?
85% for first 5 years
80% for 10 years
how far should implants be between implants
(Tarnow 2000)
-implants should have 3mm distance
-if <3mm then they had x2 the bone loss (1mm vs 0.5mm)
-more MBL and less papilla fill
(Rodriguez-Ciurana 2009)
-platform-switched implants can have <3mm from adjacent implants
how far should implants be from teeth
-1.5mm
(Vela 2012)
-platform switched can have 1mm to tooth
is there a difference in bone and soft tissue around implants that are platform switched versus matched?
Canullo - no difference in soft tissue histologically in terms of inflammation and vasculature in platform switched versus platform matched implants
Atieh - 0.4mm more bone loss around platform matched, the degree of bone loss is inversely related to the amount of platform mismatch
how much platform switch do you need for it to make a difference
0.4mm (Atieh 2010)
what is the success of immediate loaded implants
97% implant survival (Del Fabbro 2019)
-higher in mandible than maxilla
-no difference in failure for the type of prosthesis
-immediate loading has long-term predictability and success rate
esthetic risk factors around implants
-thin tissues (horizontal thickness and vertical thickness)
-lack of KM
-thin facial bone
-dehiscence of the facial bone
-malposition of the implant
adv for early implant type 2
-x7 increase in soft tissue thickness (Chappuis)
-allows for:
-flap closure
-vascularity
-better esthetics
-reduced need for CTG
-resolution of infection
adv for early type 3 placement
-Partial bone healing allows for better implant stability
-soft tissue healing benefits
success of early implant compared to immediate or delayed
Bassir 2019:
No difference in risk of implant failure between the early and immediate or delayed
sig less MBL with early placement protocol compared to immediate
Chen and Buser 2014:
-survival rates are similar
-early implant more likely to have facial bony wall on CBCT compared to immediate
-case selection is important (Type 1 is successful with intact facial bone and grafting)
indications for immediate implant
1) intact facial bone wall >1mm thick
2) thick phenotype
3) no acute infection
4) sufficient volume of bone apical and palatal for correct 3D positioning and sufficient primary stability
implant positioning guidelines
1) implant-tooth distance of 1.5mm (or 1mm for platform switched; Vela)
2) 1.8mm of buccal bone (Spray)
3) 1mm of lingual bone
4) 3-4mm from the midfacial gingiva or the CEJ of the planned restoration
5) implant shoulder is 1mm palatal to the point of emergence at neighbouring teeth (Buser)
6) prosthetically driven
Indications for type 2 placement:
-thin or damaged facial bone wall
-sufficient bone volume apical and palatal for good stability and ideal prosthetic placement
Indications for type 3 placement:
insufficient bone available for type 1 or 2 placement and requires bone healing
comment on PES score for an implant
-mucosal discolouration
-mucosal loss of texture
-gingival margin discrepancy
-poor curvature of the gingival margin
-incomplete papilla fill
can also mention low smile line
comment on WES score for an implant
-form
-volume
-colour
-texture
-translucency
what is the reason for implant infra-occlusion and interprox contact loss
continued craniofacial growth and tooth eruption
what is the appropriate age for implants in the esthetic zone
-should be based on skeletal age and completion of growth rather than chronological age
-females usually complete growth earlier than males, but after the age of 20 the intergender differences is negligible and a majority of the growth is completed (Fudalej)
how do you determine the completion of skeletal growth
-hand write radiograph
-lateral ceph
what do you look at on a hand write radiograph
1) width of epiphysis is equal to diaphysis
2) ossification of sesamoid bone
3) capping of epiphysis of the middle phalanx of the 3rd finger
4) fusion of epiphysis and diaphysis
what do you look at on a lateral ceph for growth
look at the cervical vertebra and the shape indicates the phase of growth (transitions from trapezoid, to rectangle, to square)
loading protocols (Esposito)
-immediate: within 1 week
-early: 1 week to 2 months
-conventional: 2m
survival of implants in previously failed sites
-2nd attempt 83%
-3rd attempt 60%
Machtei
