Implant Planning and Placement Flashcards

1
Q

What is a dental implant?

A

Screw that is placed into the maxilla or mandible, that replaces the root of a tooth.

Coronal restoration placed within the screw to replace the missing tooth.

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2
Q

What is osseointegreation?

A

A direct functional and structural connection between a load bearing dental implant and living organised bone

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3
Q

What are the two stages of osseointegration?

A

Primary osseointegration
- implant is anchored in bone due to frictional forces provided between osteotomy and dental implant design features

Secondary osseointegration
- The process of a functional connection between bone and a dental implant. Living bone grows onto the surface of a dental implant.

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4
Q

Describe the healing process following implant insertion?

A

Osteoclasts will remove the bone that is damaged during the placement of the implant

Then osteoblasts will create new bone during secondary healing in osseointegration.

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5
Q

What are the supra-crystal soft tissue differences between tooth and an implant?

A

Tooth- more fibroblasts, less collagen.
- Collagen fibres orientated perpendicular to root surface.

Implant- less fibroblasts, more collagen.
- collagen fibres orientated parallel to implant crown.

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6
Q

What are the sub-crystal differences between tooth and implant?

A

Tooth- anchored to bone via periodontal complex.
- capable of physiological adaptation
- Resilient tissue attachment.

Implant- anchored to bone by direct functional contact.
- No physiological adaptation
- Rigid connection.

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7
Q

What materials are used for dental implants?

A

Titanium- pure type 4 titanium, produces titanium dioxide.

Titanium Zirconia- increased strength compared to Ti

Ceramic- Yttrium stabilised Zirconia.

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8
Q

Under what circumstances with you want to use bone level and tissue level implants?

A

Bone level- aesthetic areas
Tissue level- used posteriorly

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9
Q

What might an implant’s surface be treated with before placement?

A

Sand blasting
Acid etch
Plasma spray

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10
Q

What are the advantages and disadvantages of implant surface treatments?

A

Advantages- good for osseointegration

Disadvantages- Peri-implantitis occurs, recession, microbes can accumulate on the surface of the implant.

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11
Q

What are the primary aims of a dental implant?

A

Replace missing teeth with aesthetic, functional and predictable restoration

Low rate of complications during healing and maintenance period

Long term stability

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12
Q

Describe the process of patient assessment for an implant?

A

C/O
HPC
Motivation
Medical history
Dental history
Social history
Age/skeletal maturity

Mouth level
- E/O and I/O

Site level

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13
Q

What aspects of the presenting complaint would you want to address?

A

Will implants address the patients presenting complaint?

What is the patient’s expectations?

Are they realistic?

Can you achieve them with implants?

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14
Q

What aspects of the patient’s medical history would you want to know?

A

ASA classification

Meications
- SSRI’s
-PPI’s
-Bisphosphonates
-Steroids

Radiotherapy

Poorly controlled diabetes

Cardiovascular disease

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15
Q

What aspects of social history would you want to know?

A

Are they a smoker?
- implants more like to fail and increased risk of peri-implantitis.
- More cigarettes you smoke, the more likely they are to fail.

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16
Q

Why are implants in a smoker more likely to fail?

A

Vascularity
Fibroblast/osteoblast function
PMN function

17
Q

What aspects of dental history would you want to know?

A

Regular attender?
Motivation
OH status
WHat treatment has the patient accepted in the past?
Bruxism?

18
Q

Does age matter with implant placement?

A

All implants should be placed after cessation of growth.

19
Q

What are the risks involved in placing an implant in a patient who is not skeletally mature?

A

Infra-occlusion- bone will continue to grow over the implant but the implant will stay fixed in place.

Suboptimal aesthetics

Occlusal disharmony

Implant fenestration

20
Q

Extra-orally, what would you want to examine?

A

Smile line
Skeletal relationship
Presence of incisal cants
Presence of gingival cants
Width of aesthetic zone

21
Q

What depicts a high, medium and low smile line?

A

High- greater than 2mm gingivae on show
Medium- less than 2mm gingivae on show
Low- lip covers greater than 25% of tooth.

22
Q

Intra-orally, what would you want to examine?

A

Gingival phenotype

Bone crest to contact point

Restorability of adjacent teeth

Infection at local site

Width of edentulous span

Anatomy of implant site

23
Q

What gingival phenotype is advantageous?

A

Thick and low scalloped.

It is not advisable to have a thin and high scalloped biotype because there is a high risk fo aesthetic failure.

24
Q

Why is bone crest height to contact point height so important?

A

it determines the presence of adjacent papilla.

25
Q

What bone crest to contact point distance is advantageous?

A

less than 5mm to contact point.

If it is greater than or equal to 7mm- this is not good.

26
Q

How might infection at the implant site influence the implant itself?

A

Will affect survival and success of dental implants.

Important to determine if the infection is acute or chronic.

27
Q

What aspects of the restorative status of adjacent teeth would you need to take into consideration?

A

Risk of recession with subgingival restoration margins on adjacent teeth

Risk of suboptimal aesthetics if trying to match a restored tooth with another restored tooth

28
Q

Why is width of edentulous space important to analyse?

A

Toot wide- challenge to fill the space, will leave spaces, not look aesthetic if you have to use larger teeth

Too narrow- risk of damage to adjacent teeth, risk of necrosis of bone between teeth and implants, aesthetic concerns.

29
Q

What aspects of the anatomy of implant site would you want to analyse?

A

Are the soft tissues intact?

Assessment of available bone-
- horizontal or vertical bone deficiency?

30
Q

What relevant anatomy in the maxilla would you need to be aware of for implant placement?

A

Maxillary sinus
Nasal flor
Nasopalatine canal
Infra-orbital nerve

31
Q

What mandibular anatomy would you need to be aware of for the placement of implants?

A

Inferior alveolar canal
Mental foramen
Incisive canal
Lingual perforating vessels
Submandibular fossa

32
Q

How much mesio-distal distance is required between the implant and adjacent teeth?

A

1.5mm on each side

This lowers the risk of damage to adjacent teeth
Lowers the risk of bone necrosis and soft tissue defect between implants and teeth

33
Q

What can be used to check for mesido-distal orientation?

A

Intra-operative radiographs

34
Q

How much bunco-palatal distance is required for an implant?

A

You want at least 2mm of buccal and palatal bone on either side of the implant.

35
Q

How is the pico-coronal element positioned?

A

Planned relative to the proposed gingival margin position
- 2mm apical to the ACJ.

36
Q

What aids are used for implant planning?

A

Study models
Diagnostic wax up
Surgical template
Essex (provisional)
Clinical photographs
CBCT
Surgical guide