1. What does a dental implant simulates?
• a natural tooth root
2. what are dental implants used for?
• used to replace one tooth or multiple teeth for a partially or completely edentulous patient
3. what are the Types of dental implant systems?
- • Subperiosteal
- • transosseous
- • endosseous
4. what implants are the most widely used?
• Endosseous or “root form” implants (fully within bone)
5. subperiossteal implant?
• custom-fabricated framework of metal that rests over the bone of the mandible or maxilla, under the periosteum: complete arch or unilateral( left side of the mandible; on the right side, the framework is shown by dotted lines under the denture)
6. What is the material used to fabricate a subperiosteal implant?
• titanium or vitallium (cobalt-chromium-molybdenum)
7. What is the Placement Procedure:
- • 1. surgical flap [reflect mucosal tissues & expose bone]
- • 2. impression is made of the bony ridge
- • 3. metallic unit is cast and then placed in a second surgical step
8. Transosteal implant.?
• a dental implant that penetrates both cortical plates and passes through the full thickness of the alveolar bone. Also known as a mandibular staple implant or staple bone implant.
9. What is the material used to fabricate Transosteal implants?
• stainless steel, ceramic-coated materials, and titanium alloy
10. Parts of an endosseous implant?
11. Endosseous implants?
- • an implant placed within the bone to replace a single tooth or provide support for the replacement of complete or partial loss of teeth.
- • Successful tooth replacement is accomplished by osseointegration.
- • Immediate or 2 phase surgery.
12. Material used to fabricate endosseous implants?
• primarily plasma-sprayed titanium
13. Endosseous implants different types?
• (A,B) Blade types. (C) Cylinder type. (D, E) Screw types.
14. What does Implant/bone interface: Osseointegration refer?
- • to direct structural and functional union between the implant and healthy living bone.
- • Indicates successful placement of the implant.
- • No mobility evident.
15. What does Implant/bone: Fibrous encapsulation refer?
- (also called fibrous integration).
- Indicates failure of osseointegration.
- Mobility of the implant is evident.
16. What is Implant/soft tissue interface?
- • Biologic Seal (permucosal seal):must exist to prevent microorganisms and inflammation-producing agents from entering the tissues (the external environment of an implant is the oral cavity, with saliva, dental biofilm, and debris)
- • Soft tissue connection: sulcular epithelium is in contact with the implant surface. The attachment appears similar to the epithelial attachment of the junctional epithelium of a natural tooth. Hemidesmosomes and basal lamina have been identified. The epithelium resembles a long junctional epithelium. No connective tissue fibers (Sharpey’s fibers) can exist to hold the attachment as with a natural tooth.
17. What can Excessive lateral forces with inflammation can result in?
• Bone loss
18. What does Collaborative treatment planning mean?
• preliminary dental and dental hygiene treatment is completed to ensure a disease-free mouth prior to commencing the implant therapy. The restorative to coordinate the treatment sequence. A surgical guide is developed to facilitate proper alignment and placement of the implant according to the prosthetic treatment plan. The surgeon uses the surgical guide for precise positioning of the implant.
19. Who is involved in Collaborative Co-Therapy treatment planning?
• Dentist communicates with periodontist
20. What are Limiting factors during treatment that the patient should know?
- • –tissue damage during surgery due to overheating of the bone
- • –Infection
- • –premature biomechanical loading prior to Osseointegration = failure
- • –Bruxism and/or parafunction = splinting / fabrication of a bite appliance
- • –Excessive lateral forces with inflammation can result in bone loss
21. What is done is postrestorative evaluation?
- • Radiographic: bone level; no space between implant and abutment; and no space between abutment and prosthesis.
- • Peri-implant tissue health: no inflammation, no calculus or biofilm, no supporation.
- • Test for mobility: no movement.
- • Patient function and comfort
- • Sufficiency of patient’s oral self-care; feedback provided and additional instruction as needed with hands-on practice.
22. What is the key requirement for implant success?
• the disease control program for the tissue surrounding the implant. Meticulous daily personal hygiene is a necessity: repeated instruction may be needed
23. Planning the Disease Control Program?
- • Relation to treatment: supervision of a patient’s oral hygiene begins prior to the surgical phase for implant placement and carries on throughout the treatment phases.
- • Types of prostheses: implant-supported prostheses may be partial, complete, fixed, removable, or single-tooth replacements. Examples: overdenture, screw-retained restoration, and cemented restoration.
- • Monitoring prostheses fit: the to monitor the fit of the implant prosthesis on a regular basis by firmly wiggling the crown, bridge, or superstructure. Components that have become loose need treatment and are considered true emergencies in the dental practice.
24. What is the Selection of Biofilm-Removal Methods for implants?
- • Use implements, dentifrices, or other cleaning agents that will not scratch or abrade the titanium or other material. Each device is checked before recommended for use.
- • Toothbrushes: select toothbrush filaments that are smooth, soft, and end rounded to prevent damage to the titanium and the peri-implant tissue. Power toothbrushes with soft, end-rounded filaments can be applied effectively.
- • Dental floss: specialized spongy filament floss is available with a built-in threader, and commercial floss products include corded varieties.
- • Interdental care: use only smooth plastic-coated wires for interdental brushes. Synthetic yarn. Round, wooden toothpicks
25. During interdental care what should avoided?
• all metal core brushes
26. What is recommended for rinsing and irrigation?
- • Chemotherapy: antimicrobial = Chlorhexidine, 0.12%
- • Neutral sodium fluoride is recommended.
27. What is the basic criteria for implant success(healthy implant)?
• No pain / No discomfort / No mobility / No bone loss / No peri-implant radiolucency radiographically / No clinical signs of periimplantitis / tissue = firm in consistency with no edema / No bleeding / No increased pocket depths / No movement / No cracks, fractures, missing or nonsecured screws
28. What is the frequency of appointments after implant?
- • first series of appointments following placement of the implant(s) starts within a week and is scheduled weekly until healing is completed.
- • Maintenance appointments during the first year may be at 1- or 2-month intervals.
29. What is done in the maintained appointment?
- • Review of health history & vital signs
- –Comparisons with previous records
- • Intra-/extraoral examination & Selective radiographs
- • Periodontal assessment
- –Visual exam of Peri-implant tissue (changes in color, size, shape, and consistency)
- –Probing: smooth plastic probe with rounded end / Pressure-sensitive / Sweep probe gently around the circumference to determine bleeding tendency
- –BOP? = measure the depth of attachment / can be a warning signal
- –Mobility determination: failed implant = Mobility / close visual inspection for fluid at the gingival margin (can be a sign of an ailing implant)
- • Dental biofilm: tested with a disclosing agent. Look for biofilm accumulation patterns for patient instruction, and document.
- • Calculus:
- –mineralized deposits are usually not extensive, hard, or firmly attached
- –Semi-soft, partially mineralized deposits often are effectively removed with variations of floss implements
- • Review of personal dental biofilm control procedures:
- –bleeding points and/or probing depth increases are brought to the attention of the patient
- –address oral self-care problem areas
30. What type of curette is used for implant debridement?
- • Gold-tipped
- • titanium or vitreous carbon tipped instruments’
- • plastic scalers = limited effectiveness
- • polishing devices
- -Air polishing / rotary rubber cups
- -for plaque removal and smoothing of implant collars
- -Irrigation of the peri-implant sulcus with the antiseptic 10% povidone iodine
31. What is not recommended for implant debridement?
• Standard metal scalers or curettes
32. What is the instrumentation for biofilm removal?
• gauze strips, dental floss, or yarn wrapped around the abutment 360 degrees.
33. What is the instrumentation for Calculus removal?
• plastic / titanium / gold [must be monitored for wear] / Implant-specific ultrasonic tips / low power!!
34. Is stain removal necessary?
• No, unless it is necessary for esthetics, stain removal is not included routinely. When selective stain removal with a rubber cup is indicated, only a nonabrasive agent is used and applied gently. Tin oxide or nonabrasive toothpaste is suitable for a polishing agent.
35. Factors That Contribute to Implant Failure?
- •Systemic factors
- –medical history [not revealed?] / undiagnosed or uncontrolled diabetes / immunocompromised patient / poor vascularity / poor bone quality or quantity / unanticipated infection / cancer / osteoporosis
- •Surgical phase of treatment: traumatic insertion
- •Restorative phase of treatment: premature or excessive loading
- •Maintenance phase: patient neglect
36. Name two prominent contributing factors to breakdown of the peri-implant environment?
- • occlusal overload (biomechanical stress)
- • bacterial infection
37. What is the initial stage of peri-implant problems?
• Mucositis: reversible bacterial infection in the soft tissue similar to gingivitis. Mild color change with accompanying bleeding may be present.
38. What is the secondary stage of peri-implant problems?
• Periimplantitis: inflammation has reached the level of the bone. Edema or hemorrhage present in the surrounding tissues. Exudate may or may not be present. Increase in probing depth.
39. What is a Ailing implant?
- • Inflammation [but no mobility]
- • Incipient bone loss evident / Bone may appear normal radiographically
- • Review and reinforce patient’s oral self-care practice
- • Consultation with the surgeon
40. What is a Failing implant
- • Inflammation
- • maybe exudate
- • maybe mobility
- • Bone loss has occurred and continues
- • mmediate consult
41. What is a Failed implant?
- • evident mobility
- • Radiographic changes in bone level are apparent when comparing with prior films often showing a vertical bony defect.
- • Implant mobility coupled with radiographic evidence of bone destruction is conclusive indication of a failed implant.
- • Patient is referred immediately back to the surgeon for evaluation and removal of the failed implant.
42. What factors should we teach the patient?
- • Implant care
- • Role of biofilm in periimplantitis
- • Professional maintenance