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23 Implants > 9/13 - Clinical Implant Provisionals, Implant Provisional Lab, Custom Tray Fabrication > Flashcards

9/13 - Clinical Implant Provisionals, Implant Provisional Lab, Custom Tray Fabrication Flashcards

1
Q

are implant provisionals implant-borne or tissue borne

A

implant borne

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2
Q

what are materials used for implant provisionals

A
  1. plastic of titanium temporary/provisional abutment
  2. acrylic (Jet or Trim)
  3. Bis-acryle (integrity)
  4. composite
  5. denture tooth
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3
Q

advantages of implant provisionals

A
  1. fixed
  2. tissue support
  3. identify implant and/or angulation problems
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4
Q

disadvantages of implant provisionals

A
  1. esthetic challenges (immediate/early)
  2. no removal during healing (immediate/early)
  3. implant vulnerability (immediate/early)
  4. no functional contribution (immediate/early)
  5. increased cost
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5
Q

what teeth do we provisionalize at creighton

A

anteriors

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6
Q

what are implant provisionals intended for

A
  1. post-surgical healing
  2. soft tissue development
  3. patient management
  4. predict prosthetic form/contour
  5. identify implant angulation problems
  6. evaluate questionable implants
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7
Q

when are implant provisionalization protocols IMMEDIATE

A

implants placed in function within 1 week of placement

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8
Q

when are implant provisionalization protocols EARLY

A

implant in function between 1 week and 2 months after placement

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9
Q

when are implant provisionalization protocols CONVENTIONAL/DELAYED

A

implant in function after 2 months healing

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10
Q

what situations are immediate implant provisionals used

A

in situations when:
- adequate primary stability
- no centric, eccentric, or protrusive contacts
- esethetic gain outweights risks associated w/ immediage loading protocols
- patient compliance w/ protocols

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11
Q

what is it called when the initial fixation of implant is sufficiently strong to withstand disloding forces

A

primary stability

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12
Q

what are examples of how primary stability is mechanical in nature

A
  1. osteotomy
  2. bone density
  3. implant geometry
  4. thread pattern
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13
Q

when is primary stability a MUST

A

in cases of immediate loading

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14
Q

as primary stability decreases, what happens to cumulative and secondary stability?

A

cumulative stability slightly decreases then maintains plateau

secondary stability increases

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15
Q

at creighton, when are implants considered progressive or delayed

A

after osteointegration

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16
Q

at what weeks is the implant most vulnerable to forces and must be avoid removal of provisional

A

2-4 weeks (15-21 days)

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17
Q

what can we do to test if implant is stable

A
  1. insertion/removal torque values
  2. periotest
  3. resonance frequence analysis (RFA) expressed as ISQ
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18
Q

what does RFA stand for

A

resonance frequency analysis

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19
Q

does denser bone have lower or higher insertion torque values

A

HIGHER

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20
Q

how does periotest work

A

a probe w/ accelerometer is placed on implant and calculates the contact time between the implant and probe

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21
Q

what does periotest correlate to

A
  1. micromovement
  2. variability
  3. lack of standardized values
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22
Q

what does RFA measure

A

interfacial integrity between implant and bone

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23
Q

what does RFA correlate with

A

implant bone contact and is expressed as ISQ

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24
Q

what does ISQ range from? what is the acceptable range? meaning what?

A

range from 1-100, acceptable is 55-85 meaning it has osseointegrated

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25
Q

what test provides variable results and interpretation of values

A

RFA

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26
Q

when are we unable to do implant provisional

A
  1. lack of primary stability
  2. parafunctional habits
  3. unable to eliminate centric/eccentric/protrusive contacts
  4. non-compliant patient
  5. non-esthetic zone
  6. esthetic gain does not outweigh risk of implant complications
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27
Q

when is prosthesis attached due to conventional loading

A

2 months post-implant placement (wait until implant osseointegrated)

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28
Q

when is conventional loading used

A
  1. sinus/ridge augmentation required
  2. compromised primary stability
  3. occlusal forces/parafunction
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29
Q

advantages of conventional loading

A
  1. ossointegrated implant
  2. tissue sculpting
  3. esthetics
  4. functional loading
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30
Q

disadvantages of conventional loading

A
  1. removable interim provisional
  2. lack tissue support during healing
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31
Q

can you add and subtract material on provisional to sculpt tissue

A

YES

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32
Q

what is the goal of soft tissue development

A

gingival symmetry with adjacent teeth

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33
Q

what is OPTIMAL corono-apical position of implant

A

3-4 mm apical to proposed CEJ

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34
Q

what corono-apical position of the implant is difficult to clean and manage deep sulcus?

A

> 5 mm apical to proposed CEJ

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35
Q

what corono-apical position of implant is unesthetic and results in short crown?

A

<3 mm apical to proposed CEJ

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36
Q

if you don’t have the option to do the optimal corono-apical position of implant and must choose between >5 mm or 3< mm, what should you choose?

A

better to do DEEPER (>5mm) than shallower

37
Q

what does blanching of soft tissue mean

A

soft tissue has too much pressure

38
Q

if tissue is constantly blanched, what is at risk

A

tissue necrosis

39
Q

after provisional insertion, how long should you wait to see if blanching goes away? what do you do if it does not come back after this time period?

A

rub for 5 minutes - if pink doesn’t come back, provisional needs to be repositioned

40
Q

what is evident around implant due to a highly polished provisional and appropriate emergence?

A

healthy tissue and hemidesmosomes

41
Q

which teeth are higher of the anteriors?

A

central and canines are a “step” higher than laterals

42
Q

how long does it take for tissue to mature

A

1-4 months

43
Q

what is injected around soft tissue cast to insure an accurate soft tissue profile

A

PVS

44
Q

can you place composite around PVS on soft tissue cast?

A

yes

45
Q

when creating pick-up impression/open tray impression, what stays on impression?

A

coping stays on impression

46
Q

are custom abutments custom made to patient

A

YES

47
Q

what is the main advantage of custom abutments

A

control of margin position

48
Q

how are you able to control margin position in custom abutments

A
  1. avoid sub-gingival margins
  2. prevent residual cement
  3. optimize abutment design
49
Q

what do you do on day of implant surgery

A
  1. deliver essix retainer
  2. index implants for provisional implant crown fabrication
  3. confirm shade
  4. complete records (note)
50
Q

how long do you wait between implant surgery and index before 2nd stage surgery/implant provisionals

A

4-6 months

51
Q

what implant piece is used to create impression

A

open-tray impression coping

52
Q

do you tighten open-tray impression coping with your hex drive or finger first?

A

finger first THEN drive

53
Q

how should impression PVS be placed around open-tray impression coping?

A

coping must be covered circumferentially and two teeth indexed on both sides

54
Q

what PVS is used for open-tray impression?why

A

clone bite or “O-bite” due to its greater rigidity and accuracy

55
Q

should you loosen the guide pin before removing the index

A

YES

56
Q

should you keep unscrewing the guide/survey pin until they become two separate pieces?

A

NO

57
Q

if you do not have an index, can you make an impression at the time of second stage and fabricate the provisional thereafter?

A

yes

58
Q

what implant piece do you place onto the open tray impression coping with the PVS

A

implant replica

59
Q

what should you used to widen the area on the stone cast so your impression coping fits thru

A

8 acrylic round bur

60
Q

when impression coping is placed thru stone model, what should you cover with it?

A

fast set plaster

61
Q

what do you place in the facial aspect of the stone? why

A

a hole/window to allowed for material injection

62
Q

where do you place base plate wax on impression/stone?

A

around junction of impression coping and implant replica

63
Q

what do you used to load and placeplaster

A

monoject syringe

64
Q

do you inject plaster thru the facial or bottom of the cast? what should you make sure you do

A

thru facial - make sure everything stays stable with no movement of index

65
Q

when must you adjust the cylinder on the implant?

A

if matrix does not seat

66
Q

what do you place inside the access channel?

A

gauze/cotton and rope wax

67
Q

what can be placed over metal to prevent dark show thru of metal

A

opacifier (if PMMA is thin)

68
Q

where do you add inlay wax? why?

A

add to gingival embrasure area to allow removal of provisional without breaking adjacent teeth

69
Q

where to place coe-sep

A

stone and not cylinder

70
Q

what can be placed around putty matrix and stone model with JET to prevent disloding when placing in warm water

A

rubber bands

71
Q

do you open an access thru the jet material with round bur? do you remove the cotton and provisional?

A

yes, yes

72
Q

do you add monomer or polymer to PMMA first

A

monomer

73
Q

where should you not spill on provisional cylinder?

A

on internal fit

74
Q

you should adjust contacts to prevent wrap around contacts. what should you not touch

A

contact area (incisal third)

75
Q

do you hand tighten or use hex drive to connect provisional to stone

A

hand tighten

76
Q

whenever placing a new abutment or healing screw, you should always irrigate implant fixture with what? why?

A

chlorhexidine using monoject syringe

this flushes saliva and bacteria out prior to seating abutment (high speed evac to remove excess)

77
Q

when placing the provisional into the patient, what should you use to fill the access chamber?

A

dental tape - cut excess so short 2-3 mm of cingulum or central fossa

78
Q

how much space is needed in provisional to place composite

A

2-3 mm

79
Q

do you need bonding agent when placing composite into provisional

A

NO! mechanical fit will keep it in place

80
Q

what are the materials that can be used for access hold filling?

A
  1. plumber’s tape/teflow + composite
  2. gutta percha + composite
  3. PVS material
  4. cotton pellets + composite
81
Q

why dont we usually use guta percha for access hole filling

A

because difficult to remove

82
Q

what dont we usually use PVS material for access hole filling

A

dark

83
Q

why don’t we usually use cotton pellets for access hole filling

A

pellets absorb saliva and become smelly over time

84
Q

implants provisionals must be what?

A
  1. esthetic
  2. smooth
  3. contoured appropriately to shape tissue
  4. used to communicate w/ lab
  5. temporary (finite lifespan to materials)
85
Q

how many thicknesses of baseplate wax over TEETH for custom tray

A

2 thicknesses

86
Q

how many thickness of baseplate wac over IMPLANT SITES for custom tray

A

3 thickness

87
Q

what do you place between baseplate wax and triad

A

foil

88
Q

where can handle be placed on custom tray for implants

A
  1. away from anterior implant site (need access to open tray impression coping pin)

OR

  1. on palate
89
Q

triad curing time for custom tray

A

intiial 2 min on stone
cure another 2 minute without wax and foil

23 Implants (9 decks)

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