At what speed should insertion of an implant occur? 600-800 RPM Bisphosphonate considerations + For pts who have taken oral bisphosphonates <4 yearsand have nocormorbidities + Noalteration or delay in sx + For pts who have taken oral bisphosphonates <4 yearsand have taken corticosteroids or angiogenic meds + Drug holiday for 2 mo prior tosx and remain until osseous healing has occurred + For pts who have taken oral bisphosphonates > 4 years + Drug holiday for 2 mo prior tosx and remain until osseous healing has occurred; risks are stil be researched Bone healing stages 0 Phase 1 = inflammatory response (1st 48 hrs) 0 Phase 2 = regeneration (ANGIOGENESIS within 48-72 hrs, OSTEOGENESIS over 4-6 wks) 0 Phase 3 = remodeling (at 4 wks woven bone is being replaced by lamellar bone; max bone deposition at 3-4 months; steady state at 18 mo.) Bone level Standard- 4.1 Wide- 4.8 Narrow- 3.3 Bone quantity A and B only bone types with alveolar ridge presentBone quantity C only basal bone remains © A. most of alveolar ridge is present © B, moderate alveolar ridge resorption has occurred i © C. advanced alveolar ridge resorption has occurred Bone Quantity Types and only basal bone remains o D. some resorption of the basal bone has taken place o E. extreme resorption of the basal bone has taken place Bone types FAVORABLE for Types 2 and 3 implants * Open tray (implant and teeth are Choosing a tray for implant level NOT parallel) impression * Closed tray (implant and teeth are parallel) ; not enough height or width (will Class III ridge result in longer than normal crown and implant placed to far to one side to avoid thread exposure)Class Il ridge have width but no height (will result in longer than normal crown) Class | ridge enough height, not enough width (will result in implant placed too far to one side to avoid thread exposure) direct contact between bone and implant surfaces osseointegration Factors affecting implant loading + Cuspal inclination—for every 10 degree increase in cusp incline, there is a 30% increase in torque + Implant inclination—for every 10 degree increase in implant incline, there is a 5% increase in torque + Horizontal implant offset—for every 1mm increase in horizontal offset, there is a 15% increase in torque + Apical implant offset—for every Imm increase in vertical implant offset, there is 5% increase in torque Guidelines for implant placement: Height o Height: length of implant + 1-2mm + Maintain 2-3mm from vital structures * Consider actual drill length + Implants < 7mm in length are associated with higher failure rateGuidelines for implant placement: ridge width © Ridge width: diameter of implant + 2mm (or more) + Maintain at least 1-2mm thickness of bone around implant + Contributes to implant stability + Optimizes healing + Allows for ideal alignment and emergence profile (enhanced esthetics in anterior) heat generation when placing implants below 47 degrees C for 1 min or less How far from the IA canal must the implant be placed? 2mm How far from the mental foramen must the implant be placed? 5mm anterior to mental foramen How far from the nasal vestibule must the implant be placed? 1mmHow far from the PDL of adjacent 1mm teeth must the implant be placed? How far from the sinus floor must 1mm the implant be placed? How many mm should there 7mm between center of implant to center of implant (4mm implant)? How much distance do you need 5mm or less between the proximal contact and bone to preserve the papilla? How much horizontal space do you 6mm need?How much space must you have between 2 implants? 3mm How much vertical bone height must you have? 10mm of vertical bone If implant is placed with orientation that is not ideal, what type of restoration should be placed and why? screw retained because you will not be able to access cement to clean it during placement implant abutment junctions + Vertical: soft tissue implant w/polished collar; potential bone loss due to biologic width (bone remodeling depends on the location of the connection microgap) + Zero/horizontal: bone level implant; maintained marginal bone levels; healthy soft tissue; moves the abutment implant connection (micro-gap) from the cortical bone; adds to the biologic profile; improves load- stress distribution; increases CT mass implant conditions © Peri-implant mucositis: soft tissue inflammation (plaque induced) without alveolar bone loss; bleeding on probing +/- exudate 0 Peri-implantitis: soft tissue inflammation with marginal alveolar bone loss; bleeding on probing + marginal bone loss; must use radiograph to accurately monitor bone levels; 9-45% of implants+ Implant retained restorations o Cement retained * Cheaper, worse for soft tissue health, better occlusion, requires more restorative space, passive fit o Screw retained + More expensive, better for soft tissue, requires less space, more difficult fit implant success based on location anterior mn > anterior mx > post mn > post mx > grafted areas implant success variables *(1lenplant is not mobile + 2)No pertimplant RL on the radiograph +2) Vertical bone loss < 0.2mm annually following the 1st year (recommended changewith no more than 0Smmin the 1st year and (1mm annual) + (4) No passistent or irreversible signs and symptoms (pain, infections, neuropathies, paresthesia, violation of mandibular canal) + (6) Success rate of 85% aftr 5 years and 80% at 10 years minimum for *(6)lmplant design doesnt preclude placement of crown or prosthesis with an appearance that is satisfactory to thepatient and thedentist Loading Protocol * Conventional: > 2 mo. after implant placement + Early: > 1 week but < 2 mo. after implant placement + Immediate Maintenance interval 0 Post-sx monthly before restoration 0 3-6 mo after restoration o Alternate maintenance with periodontistMolar dimensions + Molar dimensions = 10-11 mm (MD) x 11 mm (FL) Narrow size 2-3.5mm OG space needed for cement 7mm retained OG space needed for screw- 5mm retained o Interproximal contact points and black spaces + If contact pt between adjacent teeth was w/in 5mm of the crestal bone, no black spaces were evident (100%) + If contact pt was w/in 6mm, a black space was evident 55% of the timePosterior biomechanics can have 1 implant diameter without horizontal cantilever primary stability stability gained at time of implant placement (goes away over time) Problems with drilling into denser + Greater heat is generated when drilling in denser bone + Greater and more extensive necrosis is possible + Dense bone requires additional intermediate drill bone diameters and/or dense bone drills + Higher implant failure rate reported for very dense and soft bone (Types 1 and 4) Rule of 7s 7mm M/D, 7mm vertical space, 7mm bone height secondary stability osteointegration (new bone formation at 5-6 weeks) *good indicator of long term stabilitySpacing between implant to 3mm implant spacing between implant to tooth 1.5mm Spacing Guidelines + Maintain 1.5-2mm from adjacent teeth/PDL and at least 3mm between implants + Maintains health of PDL/pulp + Maintains adequate crestal height for papillae + Improves emergence profile + Adequate access for oral hygiene (proxabrush) © Restorative space: apico-coronal + Implant collar height + abutment collar height + 4mm retention form + 2mm material thickness Standard Size 3.2-4.5mm Straumann sizes Standard- 4.8 Wide- 6.5 Narrow- 3.5success criteria regarding vertical bone loss ideally less than 0.5mm in the first year and 0.1mm annually (<0.2 mm annually after first year considered successful) two ways that bone adapts around distance osteogenesis and contact the implant osteogenesis Type 2 Bone thick layer of compact surrounding core of dense trabecular bone thin layer of cortical bone Type 3 Bone surrounding core of dense trabecular bone of favorable strength Type 4 Bone thin layer of cortical bone surrounding core of low density trabecular bone (osteoporotic)Type | Bone almost all jaw is composed of homogenous dense bone What gingival biotype of best for preservation of soft tissue? thick biotype What is the main issue if an implant is placed too lingually? hygiene (ridge lap crown) What is the threshold that we recognize occlusal forces for natural dentition and implants? teeth- 1gm implants- 5-10gm Where do you place an implant in relation to CE) for platform? 2mm apicalWhere do you place an implant in relation to CE} for shoulder margin? 3mm apical Where is force distributed most? (if you have excessive force through the implant where will bone loss occur?) around the neck of the implant because force is distributed most at highest third Why do we not connect implants to teeth? 1- tooth intrusion, 2- cement failure, 3- screw loosening Wide size 4.5-6mm