Week 12: Dental Implants

What is a dental implant?

a nonbiologic device surgically inserted into the jawbone

What are the parts of a dental implant?

crown, abutment, implant fixture/body

Describe a cement retained implant

screw in abutment to connect to body, the crown is cemented to the abutment

usually anterior teeth

Describe a screw retained implant

crown and abutment are fixed together, the screw goes all the way thru the crown, abutment, and body

usually posterior teeth

What are the parts of a screw retained implant?

body, abutment, prosthesis, and screw

What shape can the body of a implant have?

parallel or tapered

smooth or rough

What are implant-supported prosthesis?

implant bridge

2 implants acting as abutment and middle is the missing tooth

What does a denture implant look like?

What is a crossbar implant?

used for dentures, partial snaps on

lower anteriors

Define osseointegration

direct contact of bone with the implant surface --> another word is ankylose

functionally stable attachment between bone and implant without any CT

bone grows and attaches to threads of the implant

How does healthy mucosal tissues around implants compare to periodontal tissue?

more collagen and less vascular to periodontal tissue

CT resembles scar tissue

they are more susceptible to inflammation and inflammatory cells

What does the implant treatment sequence look like?

1. Presurgical workup - pt should have no dental disease

2. CBCT Scan

3. Tooth extraction (3-6 month healing)

4. Stage 1 surgery: placement of implant (3-6 month healing)

5. Stage 2 surgery: uncovering implant (several days healing)

6. Restorative process - attaching abutment and crown

Describe the clinical characteristics of peri-implant health

No BOP

No inflammation

No suppuration/exudate

Gingival margin follows crestal bone --> bone should be covering the threads

Normal or reduced bone level --> look at baseline after implant is placed to compare

Define remodeling

osteoclast and blast work in harmony

clast makes bone resorb causing some slightly lower levels

Describe the clinical characteristics of peri-mucositis

inflam of gingival soft tissue

BOP

Clinical signs of inflammation

Increase of probing depths (overtime—compare to baseline)

Peri-Implant Crevicular Fluid (PICF)

Increase of cytokins in PICF

What is peri-mucositis caused by?

plaque

reversible

Describe the clinical characteristics of peri-implantitis

inflam of gingival soft tissue and loss of crestal bone

BOP

Suppuration/exudate

Radiographic Bone Loss

Increase of cytokins in PICF

**refer to perio

What is peri-implantitis caused by? (4)

Plaque/calculus

Excess Cement

Genetic Factors

Iatrogenic Factors (from provider)

irreversible

What are the genetic factors that cause peri-implantitis?

cytokine secretion

gene polymorphisms

protein production

What are the iatrogenic factors that cause peri-implantitis?

Malpositioned implant body

Over countered implant crown

Poor restoration-abutment seating

What are the the 2 main causes of peri-implantitis? (risk factors)

history or periodontitis

poor plaque control and no regular maintence

What are some other risk factors that cause peri-implantitis? (may need more research)

1. smoking

2. systemic conditions

3. reduced keratinized mucosa

4. occlusal overload

5. titanium particles --> caused by incorrect instrumentation

What are the hard and soft tissue deficiencies that can cause peri-implantitis? (slide images)

Diminished Alveolar Ridge

Extraction trauma

Endodontic Infections/periapical peri-Implantitis

Thin Buccal Plate

Tooth/Root Position

Maxillary Sinuses

What is retrograde peri-implantitis?

overheating of the implant body when it is placed, causing infection

What is periapical endodontic lesions?

pre existing infection in bone was not cleared up and implant was placed regardless

How does an implant become mobile?

1. Usually related to peri-implantitis

2. Loose abutment/fractured abutment

3. Rupture of cement seal on cemented restorations (fistula)

4. Loosening of internal screw

How can a provider ensure a successful maintenance of implants?

1. correct instruments used

2. maintenance protocol

3. standard of clinical practice

What are the factors of an implant that will make it successful?

1. quality of soft tissue

2. inflam response

3. implant position

4. mode of retention

(we don't have control)

How can a patient ensure a successful maintenance of implants?

1. level of compliance

2. level of self care

3. management of risk factors

Who makes up the dental implant team?

patient

surgeon

restorative team (us)

What is the standard of care for dental implant maintenance?

Mechanical plaque control with manual or powered toothbrushes

Professionally administered plaque control procedures

- Oral hygiene instructions

- Mechanical debridement

- Hand or powered instruments with or without polishing tools

What is code 6081?

Scaling and debridement in the presence of inflammation or mucositis of a single implant, including cleaning of the implant surfaces, without flap entry and closure

not performed in conjunction with D1110, D4910, or D4346

only used when treating one implant

How do we probe around an implant?

plastic probe, light pressure

Should be avoided during the initial healing and integration phase (3-6 months (can get baseline readings tho)

What info does probing around an implant provide?

Provides baseline information

BOP

Suppuration

Probing depth

Radiographic bone loss

Implant mobility

Is probing depth as meaningful as it is with natural teeth?

no, longer abutment then greater PD

to interpret probe readings, there must be baseline data

What instruments should we use to remove deposits around an implant?

Plastic instruments (not recommended anymore)

Gold-tipped titanium instruments

Graphite-reinforced nylon scalers

Titanium instruments

Ultrasonic instruments (plastic tips)

Air Polishing with Glycine powder

What is the recall like for implants?

3-6 month professional removal of plaque/biofilm

3 months for periodontally involved patient with dental implants (frequent)

What should you avoid using on implants?

APF fluorides --> .02% NaF recommended

abrasive polishers --> use tin oxide or nonabrasive

What are some adjuncts for cleaning dental implants?

Toothbrushes (ETB)

Interspace brushes (Tuft End)

Power Brushes

Interdental brushes

Rubber tips

Dental floss

Oral Irrigation/Water flossers

Antimicrobial Agents

What is a good rinse to use for peri-mucositits?

CHX rinse

What is a good air polisher for implants?

Glycine powder Hu-Friedy EMS Air-Flow® Perio powder

What are the best adjuncts for implants?

power brushes

water flossers

oral irrigation

What is a dental hygienist measuring and assessing around an implant to determine its health?

BOP

Inflammation (color, contour, consistency)

Suppuration

Probing and Relative

Attachment Loss

Radiographs

Periodontal risk assessment