Dental Implants and Their Placement - I

Question 1

What are examples of adjunctive therapy that needs to be completed prior to implant placement

Answer 1

Perio therapy
Endo therapy
Ortho therapy

Question 2

What should be taken into consideration when choosing between implant and FPD?

Answer 2

Prognosis of the restoration
Restoration needs for adjacent teeth
Pt age

Question 3

What are some characteristics that we look for when selecting a site for an implant?

Answer 3

Sufficient bone to surround the implant to provide adequate stability during healing
Adequate plaque control
Absence of inappropriate funcitonal loading during healing

Question 4

What can we use to evaluate bone support for an implant?

Answer 4

Pano and a complete set of PAs and BWs for most cases
Lateral tomograms with a template
Cone-beam CT

Question 5

How much bone should be on each side of the implant?

Answer 5

At least 1 mm

Question 6

T/F - in dense bone, longer and wider implants are needed

Answer 6

False - fewer and shorter implants are needed

Question 7

When are longer and wider implants useful?

Answer 7

Patients who grind or clench

Question 8

Where are wider implants useful?

Answer 8

Posterior sextants

Question 9

What is important for long-term success of an implant-supported prosthesis

Answer 9

Crown:Root ratio

Question 10

How much space is needed interocclusally from the shoulder of the implant to the occlusal surface of the opposing tooth

Answer 10

7mm

Question 11

How much space is needed between two adjacent implants?

Answer 11

at least 3mm

Question 12

How much space is needed between an implant and an adjacent tooth?

Answer 12

at least 2-3 mm

Question 13

Implant system choice should be based on what?

Answer 13

A system with well-documented long-term success
Easy to sue
Proven strength and accurate fitting
Screw design and root form
Titanium alloy with or without coating
Various micro and nanoporous surface properties

Question 14

What are some maxillary anatomic considerations for implants?

Answer 14

Incisive foramen
Greater palatine foramen
Floor of the nose
Floor of the maxillary sinus

Question 15

What are some mandibular anatomic considerations for implants?

Answer 15

Sublingual vessels
Mental nerve
Mandibular nerve
Incisive branch of mandibular nerve
Genial tubercles
Inferior alveolar nerve

Question 16

Immediate Implant Placement

Answer 16

The implant is placed immediately following the extraction of a tooth

Question 17

Immediate Implant Placement Advantages

Answer 17

Less surgeries
Less overall treatment time
Optimal use of available/existing bone

Question 18

Immediate Implant Placement Disadvantages

Answer 18

Site morphology may complicate optimal placement (we already have a hole there, which may not be what we need)
Tissue biotype may compromise optimal outcome
Potential lack of keratinized mucosa for flap adaptation
Adjunctive surgical treatment may be required
Technique-sensitive procedure

Question 19

T/F - Immediate Implant Placement may effect bone healing

Answer 19

False

Question 20

Early Implant Placement Advantages

Answer 20

Easier flap adaptation

Allows for the resolution of local pathology

Question 21

Early Implant Placement Disadvantages

Answer 21

Site morphology may complicate optimal placement
Longer treatment time
Varying amount of bone resorption at socket walls
Technique sensitive procedure

Question 22

Early Implant Placement technique

Answer 22

Soft tissue healing will be completed within 4-8 weeks
The mucosa may remain adherent via scar tissue to the underlying bone and CT
Only a small amount of new bone will form in the socket
GBR will be required around the implant at the time of placement

Question 23

For early and immediate implant placements, how much bone height do we need?

Answer 23

At least 3mm - anything less makes primary stability impossible

Question 24

How many socket walls must be intact to place an immediate or early implant?

Answer 24

at least 3 of 4

Question 25

How long do you need to wait for Delayed Implant Placement?

Answer 25

12-16 weeks | Substantial clinical and radiographic bone fill of the socket

Question 26

Delayed Implant Placement Advantages

Answer 26

Substantial bone sill of the socket that facilitates implant placement Mature soft tissues facilitate flap management

Question 27

Delayed Implant Placement Disadvantages

Answer 27

Increased treatment time Adjunctive surgical procedures may be required Varying amounts of resorption of the socket walls

Question 28

How long do you need to wait for Healed site implant placement?

Answer 28

>16 weeks

Question 29

Healed Site Implant Placement Advantages

Answer 29

Clinically healed ridge | Mature soft tissues, leading to easier flap management

Question 30

Healed Site Implant Placement Disadvantages

Answer 30

Increased treatment time Adjunctive surgical procedure may be required Large variation in available bone volume

Question 31

What are the Pros of Immediate/Early implant placement of a single-rooted tooth

Answer 31

Single Socket Easier extraction Adequate soft tissue/flap adaptation Generally, it is a manageable gap following immediate placement

Question 32

What are the Cons of Immediate/Early implant placement of a single-rooted tooth

Answer 32

Oval shape socket diameter Rotated tooth/tooth in malocclusion Anatomical landmarks Root length

Question 33

What are the Pros of Immediate/Early implant placement of a multi-rooted tooth

Answer 33

Intact large septum if roots are divergent | Non-esthetic zone

Question 34

What are the Cons of Immediate/Early implant placement on a multi-rooted tooth

Answer 34

More than one socket Lack of soft tissue for good flap adaptation Heavy occlusal forces Anatomic landmarks

Question 35

What do we need to be mindful of when placing an implant in an esthetic zone?

Answer 35

``` Soft and hard tissue biotypes Lip and smile ines Remaining dentition and perio support Emergence profile Mesial-distal and buccal-lingual/palatal dimensions Occlusion Anatomic landmarks ```

Question 36

One-staged surgical protocol

Answer 36

The mucosal flap can be adapted to the neck of the implant

Question 37

Two-staged surgical protocol

Answer 37

The mucosal flap is sutured on top of the implant obtaining primary wound closure