Eval and Maintenance

Question 1

Why do we do maintenance if longitudinal implant studies seem to suggest that it is not required?

Answer 1

Report success based on survival not progression of bone loss and attachment loss. This is different from longitudinal periodontal studies which monitor attachment loss over time.

Question 2

What are 2 main reasons for implant failure after loading?

Answer 2

1. Bacterial infection

2. Mechanical failure

Question 3

What is the key distinguisher between peri-implant mucocitis and periimplantitis?

Answer 3

Radiographic bone loss

Question 4

A lot of mechanical failure is related to what?

Answer 4

Occlusion

Question 5

Is there a biological width around implants?

Answer 5

Yes

Question 6

Why is there a deeper probing depth around implants versus regular teeth?

Answer 6

No PDL

Question 7

Is there more or less vascularization around an implant?

Answer 7

Less. Good because less inflammation, bad because less healing.

Question 8

Should probing depth be considered a parameter for implant health?

Answer 8

No

Question 9

Is bleeding on probing the same as for teeth and implants?

Answer 9

No

Question 10

When is probing depth and bleeding on probing useful for implant health determination?

Answer 10

When compared over time

Question 11

How is most diagnosis of implant health achieved?

Answer 11

Via X-rays

Question 12

What is the cardinal sign of implant failure

Answer 12

Mobility (could be fractured or just a loose abutment)

Question 13

What must make sure on radiograph with respect to threads?

Answer 13

Ensure bone is going in and out of threads

Question 14

What is the recommended interval for radiographic assessment of your implant success?

Answer 14

Day of fixture insertion 
Day of uncovering/abutment placement 
6-12 month intervals 
Annually for 1st 2 yrs 
Subsequent 2 yr intervals (if no complications)

Question 15

What is a primary cause of implant failure?

Answer 15

Abnormal/excessive forces, e.g. cantilevers or lateral forces

Question 16

What are 2 desires for implant occlusion?

Answer 16

Light centric contours, no excursive contacts

Question 17

What are 4 criteria for implant success?

Answer 17

1. No mobility
2. No perifixtural radiolucency
3. No more than 0.2mm bone loss annually after first year
4. No signs or symptoms (Pain, infection, neuropathy, or paresthesia)

Question 18

What is the only indication for using an instrument subgingivally around the implant?

Answer 18

Pathology or calculus

Question 19

What can be used for peri-implant mucocitis?

Answer 19

Local debridement, locally delivered antimicrobials

Question 20

Do implants require maintenance?

Answer 20

Yes (monitor them just like you monitor the health of natural teeth)

Question 21

What must not be used on a titanium implant?

Answer 21

Metal instruments

Question 22

What are the best monitoring method for implant health?

Answer 22

Radiographs

Question 23

What are the characteristics of peri-implant mucositis?

Answer 23

Probing depth more than 4mm
Inflammation
No suppuration
No radiographic bone loss
No mobility
(Like gingivitia)

Question 24

What are the characteristics of peri-implantitis?

Answer 24

Probing depth more than 4mm
Some or no suppuration
Radiographic bone loss present
Some or no mobility
(Like periodontitis)

Question 25

What should you watch for during implant maintenance?

Answer 25

Signs of ailing/failing implants

Question 26

What is the definition of "ailing"?

Answer 26

No mobility | May be treatable

Question 27

What is the definition of "failing"?

Answer 27

Not osseo-integrated Possible mobility May reverse torque Must be extracted

Question 28

What does radiographic bone loss around an implant indicate?

Answer 28

Peri-implantitis

Question 29

What does mobility of the implant indicate?

Answer 29

Failure

Question 30

Does plaque grow around implants?

Answer 30

Yes and in some cases it may be even more difficult to remove than calculus on teeth. Plaque index can be determined.

Question 31

Does probing depth matter for implants?

Answer 31

Maybe, maybe not. You may get deeper probing depths around an implant because the probe can go alongside connective tissue parallel to the implant

Question 32

Is bleeding on probing a sign of inflammation with implants?

Answer 32

Yes but it may also represent tissue wounding

Question 33

Are probing depth and bleeding on probing the same with implants as they are with teeth?

Answer 33

Not completely.

Question 34

Is probing depth related to long term SURVIVAL of implants?

Answer 34

No, according to the study cited in the lecture

Question 35

Should plastic probes be used around implants?

Answer 35

Yes

Question 36

What is a better indicator of implant attachment loss than probing depth?

Answer 36

Longitudinal measurements

Question 37

Do we need keratinized tissue around implants?

Answer 37

Lack of keratinized tissue does not lead to increased progression of peri-implantitis BUT it is preferable.

Question 38

Is bone loss right below the connection between the abutment and the implant in a two-stage abutment normal or a sign of pathology?

Answer 38

It is normal but it should not be too far below that connection.

Question 39

Besides bone loss, what can you tell from radiographs?

Answer 39

Assess screw/fixture fit/fractures In sudden onset failure, radiolucent changes may not be present If failure is gradual, will see radiolucent peri-fixtural space

Question 40

What are two examples of abnormal/excessive forces that may be primary cause of implant failure?

Answer 40

1. Cantilevers | 2. Lateral forces

Question 41

What are NOT recommended for professional cleaning of implants?

Answer 41

Metal hand scalers Metal ultrasonic scalers Interdental brush with metal core

Question 42

What are some ways to treat peri-implant mucositis?

Answer 42

1. Local debridement | 2. Locally delivered antimicrobials (Atridox or Arestin)

Question 43

What are some ways to treat peri-implantitis?

Answer 43

Do the equivalent of root planing on the implant