1 Flashcards
When compared to subepithelial connective tissue grafts, free gingival grafts:
A. result in less scarring.
B. revascularize more rapidly.
C. are less predictable for root coverage.
D. provide superior color matching.
Answer: C
Rationale:
Free gingival grafts are primarily intended for increasing the zone of keratinized tissue. Root coverage, especially in wider areas of recession, is limited. Color match is inferior and scarring evident with free gingival grafts. Subepithelial connective tissue grafts, due to dual blood supply in the soft-tissue pouch, revascularize more rapidly.
The palatal roll technique for soft tissue augmentation around implants:
A. is only useful with small gingival defects.
B. can correct horizontal defects up to 5mm.
C. can be used to reconstruct the papilla.
D. should be performed one month prior to uncovering an implant.
Answer: A
Rationale:
A palatal roll procedure is accomplished at the time of uncovering an implant that has a small gingival defect that requires augmenting. It can only be used to aid with augmenting small horizontal and buccal width defects.
Reference:
Block M, Atlas of the Oral and Maxillofacial Surgery Clinics of North America, Vol 7 Number 2, Sept 1999, pg 109-116.
Soft Tissue Management in Implant Therapy in Peterson’s Principles of Oral and Maxillofacial Surgery, Miloro, M. et al., Editors, Second Edition, BC Decker Inc, 2004, pp. 205-221.
Connective tissue grafts are less predictable if performed at the time of: A. extraction. B. cortico-cancellous grafting. C. implant placement. D. implant uncovering.
Answer: B
Rationale:
Part of a connective tissue graft’s blood supply is obtained from the underlying of the periosteum. All surgical procedures interrupt this blood supply to some degree. The placement of a block graft, which involved the elevation of the periosteum off the native bone bed, has the highest potential to interfere with the blood supply and therefore has been found to have a higher complication rate with less predictability compared to the other listed procedures.
Reference:
Block M, Atlas of the Oral and Maxillofacial Surgery Clinics of North America, Vol 7 Number 2, Sept 1999, pp 95-107.
Soft Tissue Management in Implant Therapy in Peterson’s Principles of Oral and Maxillofacial Surgery, Miloro, M. et al., Editors, Second Edition, BC Decker Inc, 2004, pp. 209-221.
Following site development for implant placement by orthodontic separation of maxillary anterior teeth, what happens to the buccolingual width of the edentulous alveolus over time?
A. Less than 1% of the ridge resorbs over a period of 4 years
B. The ridge narrows by 34% over 5 years
C. More resorption occurs in adolescents than in adult patients
D. The ridge resorbs over 5 years whether or not fixtures are placed
Answer: A
Rationale:
A study by Spear, Mathews, and Kokich evaluated the long term width of the alveolar ridge after space had been opened for missing maxillary lateral incisors in adolescent orthodontic patients. The amount of bone loss was less than 1% over 4 years. Previous studies have shown that if maxillary anterior teeth are extracted, the alveolar ridge will narrow by 34% over a 5 year period.
Reference:
Spear FM, Mathews DM, Kokich VG. Interdisciplinary management of single-tooth implants. Semin Orthod. 1997; 3(1):45-72.
Kokich V: Maxillary lateral incisor implants: planning with the aid of orthodontics. J Oral Maxillofac Surg. 2004 Sep; 62(9 Suppl 2):48-56.
When conventional bone-added / socket lift osteotome technique is used, what raises the floor of the sinus?
A. The bur used to drill the pilot hole
B. The hydraulic pressure of the graft material
C The smallest osteotome
D The largest osteotome
Answer: B
Rationale:
In this sinus elevation technique, drills or osteotomes are used to reach the level of the sinus floor. An osteotome is used to fracture the sinus floor immediately prior to implant of graft placement. Graft material or the implant itself raises the sinus floor as the final step.
Reference:
Hahn J. Clinical uses of osteotomes. J Oral Implantol, 1999; 25:23-29.
Al-Maseeh J, Levin B, Symeonides E. The osteotome technique: a classification for technique approach and clinical case reports. Compen Contin Educ Dent. 2005; 26:551- 556.
Which of the following best characterizes the closed technique of creating a recipient site for a subepithelial connective tissue grafts?
A. It better preserves blood supply at the recipient site
B. It is preferred when abutment or root exposure is greater than 4mm apico-coronally
C. It allows for significant coronal advancement when vertical soft tissue augmentation is desired
D. The width of the recipient site should equal that of the exposed root or abutment surface
Answer: A Rationale:
\
Closed “pouch” technique for the preparation of a recipient site for a subepithelial
connective tissue graft. A, split thickness dissection (shaded area). B, Graft immobilization apically & coronally.
Since no releasing incision is created, the closed technique better preserves blood supply. The closed technique is preferred over the open technique when root or abutment exposure is LESS than 4mm apicocoronally. The open technique allows for significant coronal advancement; the closed technique does not. The width of the recipient site for the closed technique should be three times that of the exposed surface to be covered. The recipient site must be designed such that it can contribute adequate peripheral blood supply to sustain the graft. Dissection must extend well beyond the width of soft tissue being corrected.
Reference:
Miloro M et al, Peterson’s Principles of Oral and Maxillofacial Surgery. Pages 214-215, Second Edition, BC Decker, 2004.
Block M S et al, Atlas of the Oral and Maxillofacial Surgery Clinics of North America. Soft Tissue Esthetic Procedures for Teeth and Implants, Subepithelial Connective Tissue Grafting with Dental Implants. Pages 95-107, Volume Seven, Number Two, WB Saunders, 1999.
The optimal rate of distraction that is recommended while performing the alveolar distraction technique for implant site development is: A. 0.5 mm per day. B. 1.0 mm per day. C. 2.0 mm per day. D. 2.5 mm per day.
Answer: B
Rationale:
The rate of distraction is the distance the bone is lengthened each day. Various rates have been studied. A rate of less than 0.5 mm per day carries the risk of premature ossification, whereas a distraction rate of 2.0 mm per day is associated with increased fibroconnective tissue formation and decreased bone formation. A rate of 1 mm per day (usually done in at least two equal distraction movements per day) is considered optimal for bone formation.
Reference:
Batal H, Cottrell D. Alveolar distraction osteogenesis for implant site development. Oral Maxillofacial Surg Clin N Am 16 (2004) p.93.
Saulaić,N, MartÌn,M, Camacho, and GarcÌa, A Complications in Alveolar Distraction Osteogenesis: A Clinical Investigation
Journal of Oral and Maxillofacial Surgery, Volume 65, Issue 2, February 2007, Pages 267- 274
A flapless approach in the placement of dental implants has shown to:
A. have a positive effect on interdental papilla preservation.
B. have a failure rate of 10% below a flap approach.
C. be of greater benefit in the vertically atrophic maxilla.
D. minimize buccal fenestration apically.
Answer: A
Rationale:
The flapless technique preserves the interdental papilla though has not been shown to have a consistently predicable esthetic benefit as compared to a flap approach. The inability to directly visualize the alveolus can present problems with undetected fenestration and dehiscence.
Reference:
Parel SM and Schow SR: Early Clinical Experience With a New One-Piece Implant System in Single Tooth Sites, J Oral Maxillofac Surg 63:2-10, 2005
Becker W. Goldstein M. Becker BE. Sennerby L. Minimally invasive flapless implant surgery: a prospective multicenter study. Clinical Implant Dentistry & Related Research. 7 Suppl 1:S21-7, 2005.
The osteotome expansion technique for preparation of an implant osteotomy site:
A. requires a broad alveolar ridge to receive the implant.
B. cannot be used with soft bone.
C. compresses bone immediately adjacent to the implant.
D. requires sequential drill preparation prior to its use.
Answer: C
Rationale:
Osteotomes are ideal for the use in soft maxillary bone. This technique can be used to split or widen a narrow ridge to receive an implant. The osteotomes condense and laterally compress the soft bone at the osteotomy site. Only a small 1.5mm drill (pilot) needs to be used prior to use with an osteotome.
Reference:
Fonseca: Oral & Maxillofacial Surgery, Volume Number 7. Pages 111-114.
Misch, CE: Dental Implant Site Preservation and Development,Oral and Maxillofacial Surgery Clinics of North America Vol16, Issue 1, February 2004, pp 70-72
What is minimum amount of buccalñlingual bone width to allow placement of a 4mm diameter implant? A. 5mm B. 6mm C. 7mm D. 8mm
Answer: B
Rationale:
At least 1mm of buccal and 1mm of lingual bone are required; therefore a 6mm width for a 4mm diameter implant. With regards to the mesial distal width, 7mm is required. 4mm for the implant and 1mm of bone both along the mesial and distal surfaces with the additional knowledge that the periodontal ligaments of the adjacent teeth are 0.5mm.
Reference:
Manual Dental Implants: David P. Sarment, D.D. S., M.S., page 14.
Misch, CE, Dental Implant Prosthetics, Mosby, 2005, pp 354-5
Fonseca, et al. Oral and Maxillofacial Surgery: Reconstructive and Implant Surgery: (Vol 7). Pages 211-242.
The minimum distance that should be maintained between endosseous dental implants is how many millimeters? A. 1 B. 3 C. 5 D. 7
ANSWER: B
RATIONALE:
To maximize the chance for success, there must be adequate bone width to allow1 mm of bone on the lingual aspect and 0.5mm on the facial aspect of the implant. There should also be adequate space between the implants. The minimal distance between implants varies slightly among implant systems, but is generally accepted as 3mms. This minimal space is necessary to ensure bone viability between implants and to allow adequate oral hygiene once the restorative dentistry is complete.
Following one year of function, a healthy endosseous implant is expected to incur subsequent bone loss of how many millimeters per year? A. 0.1 B. 0.4 C. 0.8 D. 1.0
ANSWER: A
RATIONALE:
As described in the reference, in the first year of implant function, a loss of 0.8mm to 1.0 mm of bone can be expected without any subsequent clinical complications.
