MDA Chapter 53 Dental Implants

What are the specialists involved with dental implants?

-Oral Surgeon
-Implantologist (General DDS with training)
-Dental Lab Technician

List the indications for dental implants?

-Increasing the support, stability, and patient satisfaction for a full lower denture
-Increasing the patients comfort in chewing
-Increasing the patients confidence in speaking and smiling
-Increasing the patients overall psychological health

List the contraindications for dental implants?

-Finances (bridge/ denture may be cheaper)
-Treatment can take up to nine months
-Risk of infection and other complications
-May loosen and require replacement
-Implant procedures may be challenging for some patients
-Bruxism causes some failures

What medical conditions make a patient a bad candidate for dental implants?

-Cardiovascular disease
-Respiratory disease
-Gastrointestinal disease
-Compromised immune system
-Chronic conditions that impede healing like diabetes, HIV, AIDS, suppressed immune system, chemotherapy treatment for cancer

List the types of specialists who may receive training in dental implants?

-Oral Surgeon and maxifacial surgeon
-Dental lab technician

What is the success rate for dental implants?

90% success

How long can dental implants last?

A Lifetime

Is the financial investment for an implant greater or less than for a fixed prosthesis?

greater for an implant (costs more)

How long can an implant procedure take to complete?

9 months

List what makes a patient an ideal patient for dental implants?

-Good health
-Adequate alveolar bone (jawbone that is healthy and strong)
-Have ample healing ability
-Committed to oral hygiene
-Regular dental visits

What evaluations must a patient undergo for Dental implants?

-Psychological Evaluation
attitude, ability to cooperate
-Dental Evaluation
condition of teeth, soft tissues, attached and unattached tissue, height/ width of edentulous alveolar bone ridge
-Medical Evaluation
existing medical conditions that could worsen

What is required from the patient before dental implant treatment begins?

Written Informed Consent
-background info on implants
-possible complications
-time frame
-home care
-follow-up appointments

A guide for placing implants into proper location made of clear acrylic that is sterilized before each use?

Stent/ Template

---Implants that are surgically placed into the bone.

Endosteal Implants, Osseointegrated implants

What are the three components of Endosteal Implants also called Osseointegrated implants?

-Titanium Implants
-Titanium Abutment Screw
-Abutment Post or Cylinder

---Surrounding the mouth


---Type of implant that is surgically embedded into the bone


---A permanent replacement of one tooth or multiple teeth with a fixture and an abutment that are anchored into the bone or surrounding structure for the purpose of supporting a denture, bridge, or single tooth.


---The process of introducing certain metals, such as titanium, into living bone and forming a biocompatible bond with living bone.


---Clear acrylic template positioned over the alveolar ridge to guide in the proper angulation and axis for drilling into the bone and placing the implant.


---Type of implant that includes a metal frame, which is surgically placed under the periosteum.


---Type of metal used for implants?


.---Type of implant in which the metal framework is surgically inserted through the inferior border of the mandible. this type of implant is used only on the mandible.


What is the benefit of Dental Implants?

Dental implants provide a natural looking and functional replacement for missing teeth that incorporates principles from fixed and removable prosthodontics with the use of bone anchored implants.

Do implants hold the artificial teeth in place as firmly as the root system holds the natural teeth?


What part of the dental implant is surgically embedded into the bone?


The implantation process involves several steps and can take anywhere from --- to complete.

3 to 9 months

Where are dental implant procedures preformed?

Most dental implant procedures are preformed in a dental office, but some may be preformed in a hospital

Are dental implants considered a standard of care?


A dental implant has a success rate of?

greater than 90%

What is essential for the long term effects of dental implants?

Effective home care and regular dental visits

How long can dental implants last?

as long as 20 years and sometimes a lifetime!

---An oral habit characterized by involuntary gnashing, grinding and clenching of teeth


maxillary healing after the insertion of the fixture takes about?

6 months

mandibular healing after the insertion of the fixture takes about?

3 months

maxillary healing after the insertion of the abutment takes about?

3 weeks

mandibular healing after the insertion of the abutment takes about?

1 week

What does the superstructure of a dental implant consist of?

Crown, Bridge, Denture

Dental implant patients can have a fixed or removable prosthesis dependent on?

existing oral conditions

What does the dentist determine during a psychological evaluation?

Patients attitude, ability to cooperate, overall outlook on procedure, realistic expectations and end results

What does the dentist examine before implant placement?

condition of teeth and soft tissues, areas of attached and unattached tissue, height and width of edentulous alveolar bone ridge.

What does a dental examination before implant placement provide a dentist with?

helps to determine the best type of implant for the patient and the location which would be best to place the implant at

What is the purpose of a medical history and evaluation before the implant procedure?

Asses any existing medical conditions that could worsen as a result of the stress of implant surgery

What is the purpose for taking both intraoral and extraoral radiographs during the planning phase and throughout the treatment of dental implants?

to evaluate and determine the height, width, and quality of bone in the area for the implant, as well as the exact positioning of the implant.
for locating anatomy and abnormalities as well

What types of radiographs should or may be taken for a dental implant procedure?

Periapical, Panoramic, Cephalometric, and Tomographic views

A --- is fabricated at the beginning of treatment to fabricate a surgical stent.

Diagnostic cast

A surgical stent is made from?

A clear acrylic resin

What is the purpose of a surgical stent?

It is used as a guide or template that is positioned over the alveolar ridge to guide the proper angulation and axis for drilling into the bone and placing the implant screws in their proper position in the bone

What must be done with the stent before it is positioned in the mouth?

it must be sterilized

Is verbal informed consent required before treatment for implants begins?

No! need written informed consent!!!

What should the written informed consent form include for dental implants?

-Background info on implants
-Complications of implant surgery
-Time frame
-Home Care
-Follow up appointments

What infection control conditions are required for dental implant patients?

Implant surgery must be completed under strict surgical sterile conditions with sterile instruments

Before Dental implant surgery the patients mouth should be rinsed with?

0.1% Chlorhexidine

What should be draped for dental implant surgery?

the head is draped and a sterile surgical drape is placed over the circumoral area leaving only the mouth exposed

It is recommended that the implant team consist of?

At least three people: the clinician, the surgical dental assistant and a nonsterile circulating dental assistant

Should the the clinician and the surgical dental assistant wear talcum powder sterile gloves while preforming dental implant surgery?

No! gloves must be talcum powder free and sterile

What type of packaging are implants delivered in?


List the different types of dental implants?

Endosteal, Subperiosteal, and Transosteal

Endosteal implants are also known as?

Osseointegrated implants

What is the most common type of implant placed?

Endosteal implants (Osseointegrated implants)

Endosteal implants are surgically placed where?

into the jaw bone

Each Endosteal implant holds?

one or more prosthetic teeth

Endosteal implants are generally used as an alternative for?

Patients with bridges or removable dentures

Implants and abutment screws are commonly made from --- because of its compatibility with bone and oral tissues.

the metal titanium

Titanium implants can be coated with ---- which rapidly osseointegrates the implant to the bone.

a ceramic substance called Hydroxyapatite

What three components make up an endosteal implant?

-Titanium implant
-Titanium abutment screw
-Abutment post or Cylinder

the --- of an endosteal implant is surgically embedded into the bone during stage 1 of surgery.

Titanium implant

the endosteal titanium implant portion consists of what forms?

a blade form, cylinder form or a screw form

the --- of an endosteal implant is screwed into the implant after osseointegration of the implant and during stage 2 of the surgery.

Titanium Abutment Screw

the --- of an endosteal implant attaches to the artifical tooth or denture.

abutment post or cylinder

---is the process by which living cells of the jawbone naturally grow around the implanted dental supports.




Osseointegrated implants are used to?

support, stabilize, and retain removable dentures, fixed bridges, and single tooth implants

How many appointments are required for Osseointegrated implants?


What does the first surgery for Osseointegrated implants all consist of?

-implant fixtures are placed within receptor sites in jawbone at predetermined locations.
-mucosa is sutured over fixtures
-1-2 week healing period
-existing prosthesis may be removed and relined to adapt to healed ridge
-3-6 month osseointegration period

How long does the osseointegration period take for dental implants?

3-6 months

What must be watched during the osseointegration period of dental implants?

must avoid trauma to the mucosa overlying the implant sites

What does the second surgery for Osseointegrated implants all consist of?

-Endosteal implant fixture is exposed
-abutment screw is connected to anchor
-tissues heal and surgery is complete

What does the third appointment for Osseointegrated implants all consist of?

-(the restorative phase)
-the final crown, bridge, partial denture, or full denture is made

The entire implant process usually takes about --- to reach completion.

3-9 months

Can a standard osseointegrated implant be done in two stages?


What are the different types of endosteal implants that are placed into the jawbone?


What is used to drill through the stent and into the soft tissue of the alveolar ridge?

Pilot drill (similar to a pesso bur)

What is the function of a pilot drill for use in dental implants?

creates a target point on the bone for the implant site

all drilling of the bone is accomplished with generous amounts of what solution?

sterile saline solution

what does the surgeon do after removing the surgical stent?

makes an incision at the implant site

after the surgical stent is removed and an incision is made at the implant site what is the next step?

the mucoperiosteal tissues are reflected

The alveolar crest should be at least -- wider that the implant being used.

2 mm

The implant is tapped into its final position with the?

Inserting Mallet

The sterile sealing screw also called the healing collar is placed into the implant cylinder with the?

Contra-angle screw driver

What is the goal of the restorative dentist during implant surgery?

to proved a temporary restoration during the 3-6 month osseointegration period. so patients can have a beautiful teeth and smile and continue normal functions without delay

when the surgical stent is repositioned in the mouth after the osseointegration period a sharp instrument such as a periodontal probe is lowered through the stents openings to make?

Bleeding points

What is used to remove the soft tissue over the implant site by peeling it back one layer at a time until the titanium sealing screw is located?

An electrosurgical loop

When the implant is uncovered and the sealing screw is removed what is used to clean the inside of the implants cylinder?

sterile cotton soaked in hydrogen peroxide

when the sealing screw is removed from the implants cylinder and the cylinder is cleaned what next is screwed into the implant?

the sealing screw is put in again also called the healing collar. but this attachment will now exted above the mucosa

before a permantent crown is fabricated for dental implants how long are the soft tissues given to heal?

10-14 days

A ---- implant is a metal frame that is placed under the periosteum and on top of the bone.

Subperiosteal implant

in contrast to a endosteal implant a subperiosteal implant is -- placed into the bone.


Subperiosteal implants are indicated for patients who?

do not have sufficient alveolar ridge remaining to support the endosteal-type implant.

Subperiosteal implants are used most frequently to?

support a mandibular complete denture

How many surgical procedures are required for a subperiosteal implant?

Two surgical procedures

What occurs during the 1st surgery that takes place for subperiosteal implants?

-alveolar ridge is exposed, impressions taken, tissue sutured back,impression sent to lab, metal posts and framework is made

What occurs during the 2nd surgery that takes place for subperiosteal implants?

-alveolar ridge is again exposed, metal frame is placed over ridge, tissue sutured into place

for a subperiosteal implant the metal framework lies?

on top of the jawbone and under the gum tissue (posts remain above gum tissue as anchors for the replacement teeth

the --- implant is inserted through the inferior border of the mandible and into the edentulous area.

Transosteal Implant

What is the most common type of Transosteal Implant?

-Transmandibular Staple Implant
-Fixed Mandibular Implant

When are Transosteal implants indicated?

When no other options exist such as in patients with severely resorbed ridges

---is redness and inflammation of the tissue around the implant caused by plaque.


Does plaque and calculus form on implants just as it does on natural teeth?

Yes! although because of the smoother surface on implants plaque is easier to remove then it is on natural teeth and so is calculus because it cannot become embedded in the titanium

List what devices are essential in plaque removal for implant patients?

-Single tufted tooth brush
-partial denture clasp brushes
-Interproximal brushes
-floss (thick,thin, fuzzy)
-Dental implant floss with a stiff curved end

What recall appointments are essential for the long term success of implants?

recall appointments for: examination, radiography, prophylaxis, removal of fixed components, replacement of components, and relines and remakes as recommended