Implants Flashcards
(26 cards)
Is bone continuous for osteointegration?
No. It is not continuous bone and has a proteoglycan layer at the interface about 20 nm thick.
For osseointegration, is there a connective tissue connection to the implant?
Yes, there can be.
For a natural tooth, what are the connections, tissues, biologic width, and probing depths?
Natural tooth:
Connection between bone, cementum, PDL
Connective tissue comprised of various fiber groups, and perpendicular attachment.
Biologic width = 2.04 mm
Probe depths =
For an implant, what are the connections, tissues, biologic width, and probing depths?
Implant:
Connection from osseointegration
Connective tissue comprised of fewer fiber groups, and parallel attachment.
Biologic width = 2.95 mm
Probe depths = 2.5 - 5.0 mm
What is the biologic width?
The width of periodontal ligament through the gingiva.
Should you probe implants?
Yes! This can be the most important diagnostic.
What are the two main ways to attach an implant?
Screw-retained or cemented.
Cemented can be difficult and cause perio-disease.
What is fibrointegration and is it good or bad?
Bad! This means the implant has failed. There were possibly micromovements at the beginning, so it is therefore a mobile implant.
Why does Titanium work so well as a biocompatible material?
The oxide layer! This layer is key. The TiO2 is a ceramic layer that is 3 - 5 nm thick and highly corrosion resistant.
Do you want a smooth or rough fixture?
Rough is best and provides better healing.
Roughness allows fibrin linkage and initial healing and bone integration. The cells spread out well.
The exposed top is smooth to allow cleaning.
Which is the most common method of “roughing” the fixture?
SLA is most common. “Sand-blasted, large grit, acid etched.”
Acid etched also exists (very rough) and machined (not rough enough).
Name 4 implant designs:
- Subperiosteal implant = not used anymore
- Transosseous implant = old design, stapled into mandible.
- Endosseus blade = old, if it fails there is major bone loss
- Endosseous Root form implant = popular today
Does gold integrate well for osseointegration?
Nope.
Why have a threaded fixture?
Implants aren’t self-tapping! The threads are there for surface area and to distribute forces.
What is the microgap?
A donut of inflammatory connective tissue infiltrate (neutrophils) that can result in bone loss.
Note: bone ALWAYS establishes below the microgap.
Where does bone establish around the fixture?
Below the microgap at the rough-smooth border or in relationship to the microgap.
Knowing that the microgap causes bone loss, what can be done?
Place the rough-smooth interface at a more apical gingival margin position…thus shifting the microgap higher.
Try to control the microgap
What is Type I Bone? How are the bone hardnesses classified?
Type I = hard, like granite (anterior mandible)
Type IV = least dense (posterior maxilla)
Implants in type IV are less successful, but they are improving.
What is a 2-stage implant?
Bone grafting is necessary and adds an additional step.
Is past periodontal disease always a disqualifier?
No. If the tooth had attachment loss or bone loss, there was no correlation to bone loss around an implant.
Poor compliance is the most significant factor of implant loss.
“implant survival was comparable to periodontally healthy individuals if the disease was treated/maintained “
Can the tooth that is to be replaced just be removed any which-way?
No, the buccal bone plate should be preserved, and should be about 2 mm thick.
Note that the immediate placement needs good bone!
Why not just always reflect the gingiva?
In theory, if the gingiva is not reflected, there is better blood supply maintained to the bone.
What is periimplant mucositis?
Chronic plaque-induced infection of the marginal periimplant soft tissues.
There is no resultant bone loss.
Pretty easy to treat early.
What is peri-implantitis?
Inflammation that results in progressive loss of supporting bone.
