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.