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Flashcards in Surgical aspects of implant planning Deck (15)
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1

Patient desires / expectations - priorities (4)

- Priorities – functional/fixed/aesthetic
- Smile line
- What is the patient like? Reasonable expectations, understanding/forgiving?
- Understand risks & timescale?

2

Patient desires / expectations - need to discuss (3)

Bridge
Denture
Gap
-don't assume implants are only option that may satisfy patient's expectations

3

Relevant medical history - relative contraindications (6)

Bisphosphonates --> ONJ and implant failure
-only absolute contraindication is regarded as IV bisphosphonates/ denosumab
-but oral bisphosphonate is considered high risk for elective surgery
Diabetes (poorly controlled) - 2-3% increased chance of implant failure
Immunosuppressants - affected healing response and ability to deal with bacteria
Steroids - worse healing
Bone disease - osteopetrosis/ Paget's
-dense bone difficult to drill in to and may overheat when drilling --> necrosis
Radiotherapy - could lead to osteoradionecrosis in that area (above 60-65 Gy)
Also other MH aspects related to general risks of surgery e.g. bleeding tendency

4

Smoking and implants (3)

20%-300% increase in failure risk
Healthy non-smoker - approx 3% failure (97% success)
Therefore, max risk is 9% failure (91% succeed)
Heavy smoking >15 cigarettes/ day
Not absolute contraindication to providing but IS absolute contraindication to providing on NHS
Variation in practitioner acceptance - no-smokers only vs less than 5/day vs less than 15/day

5

Extra-oral clinical examination (2)

a) Facial profile - skeletal pattern
b) Smile line

6

Intra-oral clinical examination (4)

c) Space requirements; horizontal and vertical
d) Access
e) Periodontal status
f) 3D assessment of available bone

7

Class III jaw shape

Mandible fairly square with flat front part
Can be an issue with implants - trying to put teeth too close together

8

Smile line - cervical line (3)

High - upper lip line is above cervical line
Medium - cervical line not exposed, but papillary line visible
Low - upper lip line covers papillary line

9

Space requirements - horizontal (3)

Minimum 3mm between implants
Minimum 1.5mm between implant and tooth
-implant needs to be close to vascularised tissue otherwise bone will necrode
Overall width minimum 7mm (width of a mirror handle)

10

Space requirements - vertical (4)

Screw-retained restoration - 5mm
Cement-retained restoration - 7.5mm
Minimum 15-17mm height for milled bar
Ideal 3mm from ACJ of adjacent teeth

11

Periodontal status (5)

Bleeding on probing
Pathological pocketing
Review previous BPE/ evidence of recession
-history of perio increase risk of peri-implantitis
-active disease contraindicates implant placement

12

3D bone dimensions (3)

Mesiodistal
-issues with ortho: space maintenance for missing laterals (but can torque teeth so roots diverge)
Buccolingual
-critical for whtether implant is feasible in anterior zone
Vertical

13

Assessing buccolingual dimension (3)

Palpate
Ridge map
Get CBCT to assess buccolingual dimension

14

Bone height (3)

IDN - 4mm safety margin (Renton), generally >2mm
Implant loaded over first 10mm length
Nobel Tapered Replace - 8mm+

15

Adjuvants to successful implants (3)

Stents:
-lab made pilot hole
-lab made no palatal contour
-CT guided surgery