Dental Implants in Health Flashcards by John Fixari

Which prosthetic is better than natural teeth?

Nothing!

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What is the “best” alternative to teeth?

Implants

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Osseointegration definition

Direct attachment/connection with vital osseous tissue (bone) to implant surface without CT

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What is an osseointegrated implant comparable to?

Ankylosed tooth

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T/F - 100% bone connection is possible

False - 60% is good enough

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How can you increase the amount of osseointegration?

Make a rough/porous surface (surface characteristics) - better for cancellous bone
Surgical manipulation of bone

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How can you surgically manipulate alveolar bone?

Anatomical location
Augmentation techniques (bone grafts)
Condensation

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How does the posterior maxilla compare to the anterior mandible

Post max = lots of trabecular (low density)

Ant man = lots of compact bone (more dense)

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How do we measure osseointegration?

It’s a histological finding

Based on bone:implant surface attachment

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What are components of reliable osseointegration

Biocompatability of the implant
Design of implant (we want it root-shaped)
Surface conditions of implant (rough > smooth)
Host bed (bone)
Loading conditions (healthier = quicker loading speed)

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What are the steps of implant placement?

1) Incision - cut soft tissue
2) Mucoperiosteal flap elevation (lift)
3) Prep bed in cortical/spongy bone (osteoctomy - drill bone)
4) Insert titanium device

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The highest success implants are placed where?

Root sulcus

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What can effect initial implant stability

Lateral displacement of bone tissue at cortical bone level
From bone quality
Surgical trauma

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How does trabecular bone help implant stability?

Necessary to keep bone vital by providing blood supply

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Surgical trauma effect

Initiates wound healing

We want the implant to ankylose with bone AND establish mucosal attachment

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Bone healing after 24 hours

Cortical bone resorption
Woven bone formation
Blood clots
Vasculature forms in newly formed granulation tissue

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Bone healing after 1 week

Have reparative macrophage/undifferentiated mesenchymal stem cells
Remodiling in apical trabecular bone region, at the threads of the screws

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Where is the most resorption/remodeling of bone?

At the tips of the threads of the screws

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Bone healing after 2 weeks

First detectable signs of new bone at the “furcation sites” of the implants

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Bone healing up to 6 weeks

Callus formation (slight shrinkage)
AND
lamellar compaction within woven bone

This temporarily decreases primary stability, but it can recover

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Bone healing after 6 weeks

Plateau effect of implant stability and enhanced bone formation around the implant

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Jumping distance definition

Distance that can be filled by new bone formation

-between the implant and surrounding alveolar bone

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What is the ideal tolerable jumping distance

20-40 um

Anything greater than 40 um will not heal well

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What is the accepted ealing period for osseointegration?

Study These Flashcards

Maxilla = 6 months
Mandible = 3 months

What are the 4 theories of loading

Immediate loading Early loading Late loading Progressive loading

Immediate loading

Load as soon as implants are placed

Early loading

Before 6 months

Late loading

Wait 6 months

Progressive loading

Start early, but with a smaller load and sequentially increase the load

What does it mean that bone can functionally adapt?

Responds to change in loading via remodeling of internal structure Helps achieve optimal biomechanical situaiton as long as forces aren't excessive

What type of bone do we want to integrate an implant into?

We want a balance of cortical and trabecular bone | Between 2 and 3 on that chart

How can we modify bone quality?

Different surgical techniques and instrumentation

What is the ideal surface characteristics of an implant?

Rough - TPS (Titanium Plasma spray) - SLA (sand-blasted, large grit, acid etched) - Coated: HA or TCP (tri-calcium phosphate) - these aren't used much - great initially, but coating may wear leading to gaps

Titanium-allow implant characteristics

Covered with titanium dioxide - increases biocompatibility Will increase in thickness over time Increased porosity leading to increased surface area which means better osseointegration Surface irregularity to increase osseointegration

What is the ideal location of implant placement?

Follow the Cingulum line

What happens if the implant is placed too buccally?

Screw will shoot through - look dark like an amalgam tattoo

What happens if the implant is placed too lingual?

Act as a cantilever - leading to tons of bone resorption and eventually failure

What can we do if there is insufficient bone for bone collar?

Use guided bone regeneration

What is the minimum thickness of alveolar bone needed to surround implant?

1mm

What is the minimum bone thickness needed between 2 implants?

3mm

What is the minimum bone thickness needed between and implant and a tooth?

4 mm

The coronal part of an implant should be placed where/

~5mm apical to the adjacent CEJ

T/F - Maximum parallelism between implants and teeth is mildly important

False - it is critical! - want only vertical occlusal forces along the long axis - Maximum of a 20' angle (but Kumar said 30')

What are the layers for trans-mucosal attachment?

Barrier epithelium | CT Zone

Barrier epithelium

2mm long | Scar tissue agter placing implant - thinner epithelium around the implant

CT Zone

1-1.5 mm high Fibrous Collagen fiber bundles are parallel to implant surface but do not attach to the implant

What are the components for the soft-tissue/mucosal component of osseointegration

Need trans-mucosal attachment Soft-tissue adjacent to implant surface Soft-tissue lateral to "adjacent zone"

Soft-tissue adjacent to implant surface

Lots of fibroblasts | Few blood vessels

Soft-tisse lateral to "adjacent zone"

Fewer fibroblasts than adjacent to implant surface Further away from implant surface Only blood vessel supply is via supraperiosteal blood vessels (none form PDL) Less blood for host/immune cells

What are the different Implant placement techniques?

2-stage implant placement | 1-stage implant placement

2-stage implant placement

Place fixture and cover with a soft-tissue flap | Load after healing

1-stage implant placement

Place fixture and add temporary abutment immediately with no cover Immediate loading can be done Only do this in patients with better prognosis

Micro-gap

Micro space between implant and abutment | Normally at the alveolar crest

Biologic width in dental implants

Exists around both unloaded and loaded implants | Should be 3mm

What are clinical parameters of Peri-implant health?

No mobility No bone loss ≥ 0.2mm in the first year - must use radiographic exam No pain, complaints, or infections Must be functionally and esthetically acceptable to both patient and doctor

What is the implant success rate after 5 and 10 years?

5 yrs = 94-98% | 10 yrs = 90-94%

What are the 3 techniques to evaluate implants?

Peri-implant probing Check for mobility Radiographs Do all 3 simultaneously

Resonance Frequency Analysis

A way to measure osseointegration | Resonsnce frequency of an object correlated to boundary constrains of a structure (aka how well its stuck in place)

Other factors to measure peri-implant health

Keratinized tissue or attached gingiva is required around implants Success rate of implants placed after grafted sites - very similar to sites with pristine bone

Dental Implants in Health Flashcards

(59 cards)