MODULE 2 - Implants Flashcards
(25 cards)
Osseointegration
PI Branemark, 1952. Titanium chambers embedded in bone that grew around it
Implant Placement (Timing)
Drilling the implant into the extraction socket.
Immediate = 0-2 weeks
Immediate-delayed (Early) = 2 wks - 2 mos
Delayed = 2 mos (3 mos at U of T)
Implant Loading (Timing)
Placement of an esthetic or functional restoration.
Immediate = 0-48 hrs
Early = 2 days - 12 weeks
Delayed/Traditional = 12+ weeks
Surgical Options
Immediate function: esthetic crown placed immediately on implant during surgery
One-stage: implant and supra-gingival healing abutment placed during single surgery
Two-Stage: implant and sub-gingival cover screw placed, second surgery after gum heals to place healing abutment
Implant Stability
Primary: initial mechanical stability of implant threads in intact bone. Decreases with time.
Secondary: delayed biological stability obtained by bony remodeling and osseointegration. Increases with time.
LOWEST STABILITY AT 4 WEEKS
Implant Impressions
Open-Tray: coping removed as part of impression (taller so requires greater mouth opening)
Closed-Tray: coping stays on implant, re-placed into impression
Engaging vs Non-Engaging Abutment
Single implant needs an engaging connector (conical/Tri-lobe) to prevent rotation
Multi-implant prosthesis uses non-engaging (circular) connector since it will naturally not rotate, and aligning all components perfectly with connector will add more trouble
Systemic Risk Factors
Immunodeficiency/immunosuppression, bleeding disorders, cancer treatment, osteoporosis and bisphosphonate usage, diabetes, heavy smoking
Smoking effects on implants
Failure rate twice that of non-smokers, more marginal bone loss, higher incidence of peri-implantitis, lower success for bone grafts
Local Risk Factors
Oral hygiene, periodontal disease, mucosal diseases, parafunction
Relative Contraindications
Bone volume, periodontitis, retained roots, local infection, drug/alcohol abuse, psychological disorders, young age
Absolute Contraindications
ASA5 and 6, IV bisphosphonate use, cancer treatment, high dose immunosuppressive use, serious systemic disease, allergy (?), lack of compliance
Papilla Regrowth (filled cervical embrasure) Vertical and Horizontal Dimensions
Interproximal alveolar crest within 5mm of tooth contact point = 100% filled embrasure space
>5mm between contact point and AC = <50% filled embrasure space (black triangle)
Horizontal distance of 3-4mm between implant and tooth = 84% papilla regrowth. 1-2.5mm = 32% papilla regrowth
Periodontal Biotype
Scalloped: thin gingiva, narrow KT, thin/scalloped bone, contact near incisal edge, recession reaction to injury
Flat: thick gingiva, wide KT, thick/flat bone, contact in mid-coronal area, pocketing reaction to injury
Implant Platform Height
Esthetic region and thin biotype = at bone level
Esthetic region and thick biotype = 0.5mm supracrestal
Non-esthetic region (and implant length > 10mm) = 1mm supracrestal
Consider biologic width of 3mm between AC and esthetic crown
Inter-Arch Space Requirement
8-12mm provides space for mucosa, abutment with adequate retention, and esthetic thickness of porcelain
6mm absolute minimum for PFM crown, but does not allow an esthetic emergence profile
4-5mm posterior full-metal screw-retained crown (no retentive abutment so can’t be cemented)
Mesio-Distal Space
Comfort zone = 2+ mm space adjacent Danger zone = 1-1.5mm space adjacent NT to implant = 1.5-2mm space Implant to implant = 3-4mm space Total M-D space needed = 6-7mm
Panoramic Radiograph
Initial evaluation of bone dimension, screening for pathology, rough determination of mental foramen and IAN canal position
Limitations: up to 25% magnification (measurement error of 3mm), poor resolution and no cross-section
Periapical Radiograph
Preliminary analysis of M-D space, accurate horizontal measurements, higher quality and lower radiation exposure than panoramic, cost-effective & routinely used
Limitations: measurements only accurate when paralleling technique used, no cross-sections, small FOV
CBCT
Provide a diagnostic edge and reduce unintended outcomes. Three-dimensional view of the site and detailed information on bone anatomy and quality
Techniques for visualizing tooth on radiograph
Barium-impregnated resin denture tooth, gutta percha-embedded resin denture tooth, CaOH cement on surface of resin denture tooth, digital design
Soft tissue stability & esthetics
Surgical technique, prosthetic protocol, phenotype, tooth shape, bone condition, position of osseous crest, implant position
Confirmation of Osseointegration
Immobile, asymptomatic, intact bone-implant interface, restorable, <0.2mm annual bone loss
Purpose of implant coping
To record position and timing (rotational position of connector) of implant and transfer it to cast
