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Perio Final > Dental Implants in Health > Flashcards

Dental Implants in Health Flashcards

1
Q

Which prosthetic is better than natural teeth?

A

Nothing!

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2
Q

What is the “best” alternative to teeth?

A

Implants

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3
Q

Osseointegration definition

A

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

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4
Q

What is an osseointegrated implant comparable to?

A

Ankylosed tooth

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5
Q

T/F - 100% bone connection is possible

A

False - 60% is good enough

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6
Q

How can you increase the amount of osseointegration?

A

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

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7
Q

How can you surgically manipulate alveolar bone?

A

Anatomical location
Augmentation techniques (bone grafts)
Condensation

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8
Q

How does the posterior maxilla compare to the anterior mandible

A

Post max = lots of trabecular (low density)

Ant man = lots of compact bone (more dense)

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9
Q

How do we measure osseointegration?

A

It’s a histological finding

Based on bone:implant surface attachment

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10
Q

What are components of reliable osseointegration

A

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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11
Q

What are the steps of implant placement?

A

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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12
Q

The highest success implants are placed where?

A

Root sulcus

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13
Q

What can effect initial implant stability

A

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

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14
Q

How does trabecular bone help implant stability?

A

Necessary to keep bone vital by providing blood supply

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15
Q

Surgical trauma effect

A

Initiates wound healing

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

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16
Q

Bone healing after 24 hours

A

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

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17
Q

Bone healing after 1 week

A

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

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18
Q

Where is the most resorption/remodeling of bone?

A

At the tips of the threads of the screws

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19
Q

Bone healing after 2 weeks

A

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

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20
Q

Bone healing up to 6 weeks

A

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

This temporarily decreases primary stability, but it can recover

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21
Q

Bone healing after 6 weeks

A

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

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22
Q

Jumping distance definition

A

Distance that can be filled by new bone formation

-between the implant and surrounding alveolar bone

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23
Q

What is the ideal tolerable jumping distance

A

20-40 um

Anything greater than 40 um will not heal well

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24
Q

What is the accepted ealing period for osseointegration?

A 
Maxilla = 6 months
Mandible = 3 months
25
Q

What are the 4 theories of loading

A

Immediate loading
Early loading
Late loading
Progressive loading

26
Q

Immediate loading

A

Load as soon as implants are placed

27
Q

Early loading

A

Before 6 months

28
Q

Late loading

A

Wait 6 months

29
Q

Progressive loading

A

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

30
Q

What does it mean that bone can functionally adapt?

A

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

31
Q

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

A

We want a balance of cortical and trabecular bone

Between 2 and 3 on that chart

32
Q

How can we modify bone quality?

A

Different surgical techniques and instrumentation

33
Q

What is the ideal surface characteristics of an implant?

A

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
34
Q

Titanium-allow implant characteristics

A

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

35
Q

What is the ideal location of implant placement?

A

Follow the Cingulum line

36
Q

What happens if the implant is placed too buccally?

A

Screw will shoot through - look dark like an amalgam tattoo

37
Q

What happens if the implant is placed too lingual?

A

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

38
Q

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

A

Use guided bone regeneration

39
Q

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

A

1mm

40
Q

What is the minimum bone thickness needed between 2 implants?

A

3mm

41
Q

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

A

4 mm

42
Q

The coronal part of an implant should be placed where/

A

~5mm apical to the adjacent CEJ

43
Q

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

A

False - it is critical!

  • want only vertical occlusal forces along the long axis
  • Maximum of a 20’ angle (but Kumar said 30’)
44
Q

What are the layers for trans-mucosal attachment?

A

Barrier epithelium

CT Zone

45
Q

Barrier epithelium

A

2mm long

Scar tissue agter placing implant - thinner epithelium around the implant

46
Q

CT Zone

A

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

47
Q

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

A

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

48
Q

Soft-tissue adjacent to implant surface

A

Lots of fibroblasts

Few blood vessels

49
Q

Soft-tisse lateral to “adjacent zone”

A

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

50
Q

What are the different Implant placement techniques?

A

2-stage implant placement

1-stage implant placement

51
Q

2-stage implant placement

A

Place fixture and cover with a soft-tissue flap

Load after healing

52
Q

1-stage implant placement

A

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

53
Q

Micro-gap

A

Micro space between implant and abutment

Normally at the alveolar crest

54
Q

Biologic width in dental implants

A

Exists around both unloaded and loaded implants

Should be 3mm

55
Q

What are clinical parameters of Peri-implant health?

A

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

56
Q

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

A

5 yrs = 94-98%

10 yrs = 90-94%

57
Q

What are the 3 techniques to evaluate implants?

A

Peri-implant probing
Check for mobility
Radiographs

Do all 3 simultaneously

58
Q

Resonance Frequency Analysis

A

A way to measure osseointegration

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

59
Q

Other factors to measure peri-implant health

A

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

Perio Final (7 decks)

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