Implant Planning & Placement

Question 1

What is osseointegration?

Answer 1

Direct functional and structural connection between a load bearing dental implant & living (organised) bone

Question 2

What are the 2 stages of osseointegration?

Answer 2

Primary osseointegration = implant anchored in bone due to frictional forces provided between osteotomy & dental implant design features

Secondary osseointegration = process of a functional connection between bone & a dental implant, living bone grows onto the surface of a dental implant

Question 3

How does healing occur after implant insertion?

Answer 3

• begins immediately after implant installation
• granulation tissue in wound chamber (days)
• immature [woven bone] (weeks)
• Mature lamelar bone (months)

Question 4

How does the supra-crestal soft tissue of a tooth present?

Answer 4

• more fibroblasts
• less collagen
• collagen fibres orientated perpendicular to root surface

Question 5

How does the supra-crestal soft tissue of an implant present?

Answer 5

• more collagen
• less fibroblasts
• collagen fibres orientated parallel to implant crown

Question 6

How does the sub-crestal soft tissue of a tooth present?

Answer 6

• tooth anchored to bone by periodontal complex
• capable of physiologic adaptation
• resilient tissue attachment

Question 7

How does the sub-crestal soft tissue of an implant present?

Answer 7

• implant anchored to bone by direct functional contact
• no physiologic adaptation present
• rigid connection

Question 8

What dental materials are used in dental implants?

Answer 8

• titanium (Ti)
• titanium zirconium (Ti-Zr)
• ceramic implant (Y-TZP)

Question 9

How do implants differ from teeth in function?

Answer 9

• no proprioception from implant
• no physiological adaptation

Question 10

What type of titanium is used in implants?

Answer 10

Commercially pure TYPE 4 TITANIUM
- >85% to produce titanium dioxide

Question 11

How do titanium-zirconium implants differ from titanium implants?

Answer 11

Increased strength compared to Ti
- good in narrow implant sites where less bone available

Question 12

What determines implant design?

Answer 12

• bone level/tissue level
• tapered/parallel

Question 13

When might tapered implants be advantageous?

Answer 13

• provide increased primary stability in immediate placement [eg post XLA site]
• may be used where there is root convergence apically

Question 14

What determines length/diameter of implant selection?

Answer 14

• site of implant
• indication of implant
• local anatomy

Question 15

What is considered a ‘smooth’ implant?

Answer 15

0-0.5um

Question 16

What is considered a ‘mild’ roughness implant?

Answer 16

0.5-1um

Question 17

What is considered a ‘moderate’ roughness implant?

Answer 17

1-2um

Question 18

What is considered a ‘rough’ implant?

Answer 18

> 2um

Question 19

What surface treatment can be done to implants to roughen them?

Answer 19

• sand blasting
• acid etch
• plasma spray

Question 20

What is the purpose of a dental implant?

Answer 20

Restore
- functionality
- aesthetics
- psychology

Question 21

What medications may affect the survival or success of a dental implant?

Answer 21

• SSRIs
• PPIs
• bisphosphonates
• steroids

Question 22

What medical conditions may contraindicate implant placement?

Answer 22

• pts undergoing radiotherapy
• poorly controlled diabetes
• CV disease

Question 23

What social history findings may contraindicate implant placement?

Answer 23

Smoking
- increased risk of implant failure
- increased risk of peri-implantitis

Question 24

Why does smoking have a negative impact on implant healing?

Answer 24

Smoking affects
- vascularity
- fibroblast/osteoblast function
- PMN function

Question 25

What areas of dental history would you investigate when considering implant placement?

Answer 25

- pt attendance - motivation - self performed plaque control - suitable for surgical procedure - presence of parafunctional habits

Question 26

Why should implants only be placed when patient growth has stopped?

Answer 26

If implants placed before growth complete: - relative infra-occlusion - suboptimal aesthetics - occlusal disharmony - implant fenestration

Question 27

What is defined as a high smile line?

Answer 27

>2mm ST on show

Question 28

What is defined as a medium smile line?

Answer 28

<2mm of ST showing

Question 29

What is defined as a low smile line?

Answer 29

lip covers >25% of teeth

Question 30

What extra-oral findings may affect implant placement decisions?

Answer 30

- presence of incisal cants - presence of gingival cants - width of aesthetic zone

Question 31

What are the different gingival phenotypes?

Answer 31

- thick flat - thick scalloped - thin scalloped

Question 32

What issues are associated with implant placement when edentulous span is too wide?

Answer 32

- challenge to fill place - issues with where to leave residual space

Question 33

What issues are associated with implant placement when edentulous span is too narrow?

Answer 33

- risk of damage to adjacent teeth - risk of necrosis of bone between teeth & implants - will have significant effect of ST aesthetics

Question 34

How is available bone assessed for implant placement?

Answer 34

Assess - volume - orientation

Question 35

What relevant maxillary local anatomy may be relevant when considering implant placement?

Answer 35

- maxillary sinus - nasal floor - naso palatine canal - infra-orbital nerve

Question 36

What relevant mandible local anatomy may be relevant when considering implant placement?

Answer 36

- inferior alveolar canal - mental foramen - incisive canal - lingual perforating vessels - submandibular fossa

Question 37

What gingival phenotype has the best aesthetic results from implant placement?

Answer 37

- thick biotype - rectangular teeth

Question 38

When looking at 3D implant positioning, what needs to be considered?

Answer 38

Mesio-distal positioning & orientation Bucco-palatal positioning & orientation Apico-coronal positioning

Question 39

What does 3D implant positioning depend on?

Answer 39

- implant system being used - proposed gingival margin - local anatomy - prosthetic plan

Question 40

Why should implants be positioned a "safe" margin away from adjacent teeth?

Answer 40

- lowers risk of damage to adjacent teeth - lower risk of bone necrosis and ST defect between implants and teeth

Question 41

What is the minimum mesio-distal distance required from other teeth/implants for implant placement?

Answer 41

1.5mm

Question 42

What is the required bone amount that should be present labially for implant placement?

Answer 42

>1mm of bone labially

Question 43

What are the different placement protocol types that can be done during implant placement?

Answer 43

Question 44

What aids to implant planning are needed?

Answer 44

- study models - diagnostic wax up - surgical template - essex - clinical photographs - CBCT - surgical guide

Question 45

How can implant placement be planned before committing to procedure?

Answer 45

- diagnostic wax ups - combined with CBCT