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Dental Implants-short

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Kathleen Young

on 11 April 2017

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Transcript of Dental Implants-short

Care and Maintainece
Dental Implants
Pt With Plaque-induced gingivitis
• Patient education
• Periodontal instrumentation
• Elimination of plaque-retentive factors
• Correction of systemic factors
• one appointment
Patient with Slight Chronic Periodontitis
• all of the above…with education on periodontitis
• periodontal scaling and root planning areas of attachment loss
• possibly 2 appointments needed and ideally a reevaluation appointment
Patient with Moderate Chronic Periodontitis
• Same as above
• possible 4 quads of scaling and root planning w/ anesthetic
• up to 4 appointments needed with re-eval
• Retreat non-responsive areas
• customized care for pockets
• could use Arrestin
• possibly periodontal surgery
• 3mo recall
Patient with Severe Chronic Peridontitis
• Same as above
• with definite perio surgery indicated
• short 3mo recall
Each patient must be evaluated individually for
Oral hygiene
Periodontal health
Jaw relationships, tooth positions
Pt motivation
Amount of bone quantity and quality
General health
Age does not seem to be a factor on success or failure of implant
A child needs to be fully developed and stopped growing, because placement may restrict normal growth of the jaws
Who is a good candidate for an implant?
Pt must be in good health

If the following are present, could increase the occurrence of
early and late complications and failure

Uncontrolled diabetes (sometimes even controlled diabetes)
anti- coagulation medication
Chronic steroid therapy
High dose irradiation
Reduced immune defense (HIV, cancer requiring chemo)
Smoking and alcohol use, drug use, stress
Presence of untreated or unsuccessfully treated periodontal disease is a definite contraindication
Who is a good candidate for an implant?
Smaller bone volumes will necessitate osseous reconstruction

The minimal dimensions of implant site:
At least 6.6mm of bone is required in the facolingual direction and mesiodistal direction
height of jawbone needs to be 10mm
Diameter of implant ranges from 3 to 6mm
Who is a good candidate for an implant?

Can do bone grafts and bone augmentation surgeries, soft tissue augmentation

Panoramic radiographs are needed and possibly special 3-dimensional radiographs can be taken
Who is a good candidate for an implant?
The portion of the implant that is
surgically placed into living alveolar bone.

Can be screw-shaped, cylinder-shaped, or tapered screw-form

Plasma sprayed Titanium is the most popular
Implant fixture
Can be wide or narrow depending on what tooth they are replacing and how much bone is present
Acts as the root of the implant
• needs a period of 3 to 6 months to be fully
surrounded and supported by bone
Implant fixture
Can be wide or narrow depending on what tooth they are replacing
Implant fixture
The direct contact of a load carrying dental implant with living bone without any intervening connective tissue
Roughened surfaces are achieved by plasma spraying, acid etching, oxidizing or calcium-phosphate ceramics (hydroxyapatite)
Implant Components
Two stage (submerged protocol)
Implant is placed in bone and covered with cover screw
Flap is replaced and sutured
Pressure on implant should be avoided
Surgical Procedure
Two stage (submerged protocol)
Wait 3 months for mandible, 6 months for maxilla
After waiting period, submerged implants are exposed
Cover screws taken off and a healing abutment is placed
Gingiva is sutured tightly around protruding abutment
Surgical Procedure
One Stage (non-submerged protocol)
Implant is placed in bone with healing abutment already in place
Eliminates need for second surgery to uncover the implant
Still same waiting period

Generally it takes 9-12 months to arrive at the point of final restoration
Surgical Procedure
One Stage
Cover Screws
Right after extraction
Abutment post gets a crown

Natural tooth Dental Implant
The epithelium adapts to the abutment post, creating a biologic seal

The biological seal functions as a barrier between the implant and the oral cavity

A sulcus lined by sulcular epithelium surrounds the implant abutment post, as in a natural tooth
Peri-implant Tissues

Since there is no protective PDL, the peridontal pathogens can destroy bone much more rapidly than normal tooth

The connective tissue fiber bundles in the gingiva around an implant have been shown to be parallel to the implant or encircling the implant abutment
Peri-implant Tissues
No probing necessary if peri-implant tissue is healthy
Interpretation of probing is limited- some do not think probing is a valuable diagnostic tool for implants
Depths may be deeper than 3mm depending on type of abutment and post
Light probing should be used because of weak biological seal to abutment
A 3-month interval usually best for implants, but could be more frequent
Pt who has signs of inflammation around implants needs more frequent visits
Peri-Implant Probing
The PDL generally absorbs a lot of the forces placed on the tooth from chewing, dental appliances, etc.

Since no PDL in implant, need to keep occlusal forces to a minimum to avoid damage to surrounding alveolar bone

Collective forces placed on an implant are called “biomechanical forces”
Biomechanical forces
It is immobile when tested clinically

Make sure it is not a loose internal screw
An absence of gingival inflammation of peri-implant tissues
No discomfort or pain when the implant is in function
No increased bone loss or radiolucence around the dental implant on a radiograph
Radiographs should be taken once a year and compared to previous
Bone loss is less than 0.2mm annually
after the implant’s first year of service
An implant is considered successful when:
What it should look like
What it should not look like
A continual presence of plaque around implant can result in inflammation of soft tissues around implant

If this is allowed to progress, partial or total loss of osseointegration can occur

These pathological changes of the peri-implant tissues is called peri-implant disease
Peri-implant mucositis
– no loss of bone (plaque-induced gingivitis)
- loss of bone (chronic periodontitis in tissues surrounding implant)
Peri-implant Disease
Removable Prosthesis
This is one of the most important factors in the long-term success of the implant.

Meticulous self- care is of the utmost importance in preventing peri-implant disease

Some pts have had a long history of dental neglect

Our job to assist pt in maintaining implant by providing self-care education and home care tools
Implant Maintenance
Calculus on implant
Metal instruments can scratch the soft titanium

Debridement of Implants
Made of plastic
Special Implant Scalers
Debridement of Implants
One of the best aids a pt with implants can use
Super Floss
Wrench Shaped working ends
Cresent shape, Contra angle, Hoe
Made of Titanium
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