Implant Dentistry

11 Lecture’s Summary
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“Not every end is the goal. The end of a melody is
not its goal, and yet if a melody hasn’t reached its
end, it hasn’t reached its goal.”
- Friedrich Nietzsche
 Oral Implantology

Maintenance: -

 Primary goal is to protect and maintain the tissue integration

 Good oral hygiene is a key element
 Criteria of Success: -
1- No Peri-Implantitis
2- No associated radiographic radiolucency
3- Marginal bone loss 1.0 - 1.5mm in the first year, then < 0.1mm annually thereafter
4- Tissue integration “bone and soft tissue”
5- Absence of mobility
6- No progressive soft tissue changes or bone loss
7- Stable clinical attachment level
8- Absence of bleeding upon probing
9- Absence of excessive probing depths
10- Absence of discomfort

 Hygiene Aids: -
o Only Plastic Scalers are used to avoid abrasion of the titanium
o The fluoride rinses can be used as long as they are made of neutral fluoride, the
acidulated types are contraindicated
o Chlorhexidine can be used during the Pre-surgical periods
 Maintenance and Recall: -
o Four Elements: -
1- Home-care regimen
2- Periodic recalls reinforcing regimen
3- Strict adherence to recall schedule and verification of function, comfort, and
esthetics
4- Lifetime maintenance commitment
o Clinical parameters of evaluation: -
1- Oral hygiene including plaque index
2- Implant stability (evaluate mobility)
3- Retrievability
 Failing implant may be masked if connected to a bridge prosthesis
 It’s Important to remove the Fixed Partial Denture to evaluate the implant
4- Peri-implant tissue health
5- Crevicular probing depths
 The most accurate way to detect Peri-Implant destruction
 A plastic Probe is used
6- Bleeding
7- Radiographic assessment
 It value is significant when: -
a. It’s impossible to probe the area due to constricted implant neck
b. To assess future mobility without FPD removal
c. To accurately determine the amount of bone loss in the absence of
increased crevicular depth
 Postoperative Radiographic Intervals: -
 One week after abutment insertion
 Immediately following fixed prosthesis insertion, then 6 months later
 Annually for the first 3 years, then every 2 years
8- Proper torque on screw joints
 Loosened screws are the most common problem
9- Occlusion
 Problems: -
o The best way to manage the hemorrhage during the bone preparation is to place the
implant “Applying Pressure”
o Failing or Failed Fixture

 Failing → The implant is going to Fail

 Clinical Signs: -
1- Progressive crestal bone loss
2- Soft tissue pocketing
3- Bleeding On Probing with possible purulence
4- Tenderness to percussion or torque
 Causes: -
1- Surgical compromises “bone overheating”
2- Lack of initial stability
3- Non-passive “Active” superstructures
4- Too rapid initial loading
5- Functional overload → That’s why Harmonious Occlusion is required
6- Improper Crown to Root Ratio
7- Inadequate screw joint closure
8- Infection
 Treatment
1- Removal of the fixture and placement of a wider fixture to provide
the initial stability
2- Removal of the prosthesis and abutments then irrigation of the area
with Chlorhexidine
3- Disinfection of the components and reinsertion
  Failed → The implant has already failed
 Clinical Signed: -
1- Mobility
2- Dull percussion sound
3- Peri-implant radiolucency
 Causes: -
1- Surgical compromises “bone overheating”
2- Lack of initial stability
3- Non-passive “Active” superstructures
4- Too rapid initial loading
5- Functional overload
6- Improper Crown to Root Ratio
7- Inadequate screw joint closure
8- Infection
 Treatment: -
1- Removal of the implant
2- The practitioner should wait for at least 6 months before the
insertion of another implant
3- If Bone graft is going to be used then the recipient area should be
healthy
 The fixture should be treated as a natural root
 Ex. In case of the presence of a peri-apical lesion the fixture can be
treated via Apicectomy

o Ailing Implants: - Are those implants showing radiographical bone loss without
inflammatory signs or mobility
 Should be monitored carefully to determine the causes of bone loss
 Maintenance and checkups at 3 - 4 month intervals
 Evaluation of the progression of the bone loss at 12 - 18 month frames

o Implantitis Vs. Periodontitis: -

 They share the same Clinical Signs, Causes and Treatment
o Soft Tissue Reactions: -
 Most common cause is the loose screws
 Poor oral hygiene can lead to Peri-implantitis which may result in progressive
bone loss
 Lack of attached Peri-abutment soft tissue
 Failing or Failed Implant
 Treatment: -
1- Removal of the offending screw, tightening the abutment and reinsertion of
the prosthesis
2- Reinforce oral hygiene
3- Soft-tissue autograft
4- Replacement of failed implant
o Fractured or loosened Screws
 The first complain is usually loose implant or discomfort
 Any procedure that requires contacting the implant “Ex. Impression” should be
Painless
 Over tightening of the screw will lead to loosening

In The End, Thanks to everyone who helped make these summaries as Successful as they are.

Especially Mohammed Al-Abbasi, Abdul-Rahman Al-Shalan and Poliana

Peace Out
The End