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23 Implants > 9/6 - Implant Surgery Basics, Flap Design, and Sutures > Flashcards

9/6 - Implant Surgery Basics, Flap Design, and Sutures Flashcards

1
Q

if patient is allergic to penicillin or amox what do you prescribe

A

clindamycin

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2
Q

what are the CHX gluconate prescriptions

A
  1. rinse for 5 minutes prior to initiating surgery
  2. rinse daily for 10 days after surgery
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3
Q

what NSAIDS prescribed

A

ibuprofen or tylenol

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4
Q

what are medical pre-op management

A

medical hx and consent forms

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5
Q

what are supportive pre op management

A

antimicrobial mouth rinse, antibiotic pre load, NSAID preload, sedation

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6
Q

what are technical pre-op management

A

specialized set up, instrumentation, flap design, implants, components

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7
Q

type of flap designs

A
  1. full thickness
  2. split thickness
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8
Q

rationale for flap design

A
  1. identificaiton of anatomical structures
  2. incision outline
  3. execution
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9
Q

aim for surgical flaps

A

to gain acess and move tissue from one place to another

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10
Q

basic principles of surgical flaps

A

visualization, prevent flap necrosis, dehiscene or tearing

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11
Q

how to prevent flap necrosis

A
  1. base > apex
  2. length < base
  3. axial blood supply included in teh base
  4. handling case with care
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12
Q

what flap makes incision into tissue until cortical plate and you reflect entire periosteum mucosa away from bone so goes TO THE BONE (bone itself exposed)

A

full thickness

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13
Q

what flap make incision where you release tissue in split thickness fashion TO PERIOSTEUM (periosteum stays intact w/ cortical bone)

A

partial thickness

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14
Q

without irrigation with sterile water or saline or a chilled irrigant, what do you risk

A

bone necrosis

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15
Q

drill speed for osteotomy

A

1000-1500 rpm MAX

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16
Q

hand position for bone prep drilling

A

straight in and out, no elliptical motion, no wrist movement

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17
Q

implant insertion torque and speed

A

<45 Ncm
15 rpm

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18
Q

abutment screw torque

A

25 Ncm

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19
Q

how to manage post surgically

A
  1. flap closure
  2. radiographs
  3. medicaitons
  4. instructions
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20
Q

what must flap primary closure be

A

water tight and tension free

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21
Q

what type of suture technique for flap closure

A

single interrupted

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22
Q

what are the types of multifilament sutures

A

non-absorbable: silk and polyester
absorbable: polygalactin and gut

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23
Q

what are the types of monofilament suturs

A

non-absorbable: polypropylene and nylon
absorbable: polyglecaprone

24
Q

what is the purpose of sutures

A
  1. provide mech support to wound until soft tissue can withstand functional forces
  2. approximation of wound edges for primary intention healing
  3. flap is position passively before suturings
  4. sutures should not pull the flap into position under tension
25
Q

how to make suturing minimally traumatic

A
  1. pass needle thru each side of incision separately
  2. pass needle thru mobile tissue
  3. suture every 5 mm
  4. smallest number of sutures for adequate support
  5. knot at needle insertion point
  6. no overly tight suture
26
Q

when suturing, do you pass needle thru immobile or mobile tissue first

A

mobile

27
Q

suture every ___ mm

A

5 mm

28
Q

should smaller or more amount of sutures provide adequate support

A

smaller

29
Q

knots should be place where? why?

A

at needle insertion point because they attract bacteria and may infect wound edges

30
Q

overly tight sutures may cause what

A

local tissue necrosis and scars

31
Q

what increases suture tension

A

wound edema and swelling

32
Q

pull suture thru tissue until ___ cm tail remains

A

1-2 cm

33
Q

the number of suture knots are determined by what

A

tensile strength and handling of suture material

34
Q

how many suture knots for silk

A

3/+

35
Q

how many suture knots for resorbable braided

A

4/+

36
Q

how many suture knots for monofilament

A

6/+

37
Q

what are complications related to improper suture

A
  1. hematoma, infection
  2. scar formation, stich marks
  3. wound dehiscence
  4. insufficient blood supply, edeme, altered healing
  5. systemic factors and habits
  6. implant failure
38
Q

too much tension on suture =

A

aggravated by post-surgical edema

39
Q

knots tied too loose =

A

wound opening

40
Q

inappropriate knot type or position =

A

knot away from edges

41
Q

sutures too close to edges =

A

dehiscence due to inflammation, swelling, decrease blood supply

42
Q

can patient who received implant take COX2 inhibitors

A

no

43
Q

osseointegration (w/ no grafting) for max anterior

A

4 month

44
Q

osseointegration (w/ no grafting) for max posterior

A

4-5 months

45
Q

osseointegration (w/ no grafting) for mand anterior

A

3-4 months

46
Q

osseointegration (w/ no grafting) for mand posterior

A

4 months

47
Q

during second stage uncovery procedure, should you anesthetize patient? what do you do after

A

yes duh - sound for implant head using perio probe

48
Q

do you hand torque healing abutment

A

YES YES YES

49
Q

implant insertion torque

A

<45 Ncm

50
Q

advantages of biopsy punches

A
  1. clean
  2. quick
  3. no sutture needed
  4. ok in non esthetic areas
51
Q

disadvantages of biopsy punches

A
  1. no direct eval of bone
  2. removal of keratinized tissue (and attached gingiva)
52
Q

how are electrosurg contraindicated

A
  1. production of heat
  2. loss of attached gingiva

good for natural teeth not implant sites

53
Q

how to test for ossointegration

A

radiograph, wiggle, tap, periotest, reverse torque

54
Q

do you knot at wound location?

A

NO

55
Q

entrance and exit of suture needle from wound should be how many mm? what angle of entrance?

A

2mm, 90 degrees

23 Implants (9 decks)

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