Dental Implants

Bone Physiology

  • Bone Classification:
    • D1: dense cortical bone.
    • D2: thick dense to porous cortical bone on crest and coarse trabecular bone within.
    • D3: thin, porous cortical bone on crest and fine trabecular bone within.
    • D4: fine trabecular bone.
    • D5: immature, nonmineralized bone.
  • Biomechanical Force.
  • Grafting and Regeneration

Osseointegration

  • Direct bone anchorage to an implant body.
  • Stages:
    • Stage 1: initial healing.
    • Stage 2: active remodeling.
    • Stage 3: fewer osteocytes and less bone remodeling.

Implant Interfaces

  • Implant/Bone Interface
    • Osseointegration.
    • Fibrous Encapsulation.
  • Implant/Soft Tissue Interface.

Types of Dental Implants

  • Subperiosteal
    • Definition.
    • Description.
  • Transosseous (Transosteal)
    • Definition.
    • Description.
  • Endosseous (Endosteal) Implant
    • Definition.
    • Description.

Patient Selection

  • Systemic Health.
  • Local Factors.

Evaluation for Implant Placement

  • Medical and psychological evaluation.
  • Comprehensive dental examination.
  • Assessment of patient expectations of outcomes.
  • Patient motivation and oral self-care abilities.
  • Habits or conditions placing the patient at risk for implant failure.
  • Preparation of diagnostic aids.

Post-Restorative Evaluation

  • Radiographic.
  • Occlusal evaluation.
  • Peri-implant probing.
  • Sufficiency of patient’s oral self-care.
  • Patient comfort.

Peri-Implant Preventive Care

  • Care of the Natural Teeth.
  • Implant Biofilm.
  • Planning the Disease Control Program
    • Relation to Treatment.
    • Types of Prostheses.
    • Monitoring Prostheses Fit.
  • Maintenance of Implant-Supported Restorations.
  • Antimicrobial Use
    • Toothpaste.
    • Mouthwash.
  • Fluoride Measures for Dental Caries Control.

Continuing Care

  • Basic Criteria for Implant Success.
  • Frequency of Appointments.

The Continuing Care Appointment

  • Health History Review, Vital Signs, and Intraoral/Extraoral Examination.
  • Selective Radiographs.
  • Periodontal Assessment.
  • Dental Biofilm Control.
  • Instrumentation.

Classification of Peri-Implant Disease

  • Peri-Implant Mucositis
    • Diagnostic Criteria.
    • Treatment.
  • Peri-Implantitis
    • Diagnostic Criteria.
    • Treatment.

Documentation

  • Consultation before implant treatment plan.
  • Examination.
  • Continuing care procedures.

Factors to Teach the Patient

  • How implants preserve surrounding bone.
  • How to care for implants.
  • Importance of daily self-care.
  • Role of biofilm in peri-implantitis.
  • Periodontitis increases risk of peri-implantitis.
  • Dedication necessary with implant therapy.
  • Necessity of ongoing maintenance care.
  • When to call the office to address potential or suspected problems around an implant.