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23 Implants > 9/27 - Crown Fabrication, Screw vs. Cement Retained, Implant Occlusion > Flashcards

9/27 - Crown Fabrication, Screw vs. Cement Retained, Implant Occlusion Flashcards

1
Q

what mill do we use to create crowns

A

PM7

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2
Q

what program is used to design implant crowns

A

dental designer

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3
Q

what program is used to look at 3D model on phone

A

3shape communicate

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4
Q

how many mills can be created per puck

A

20 mills

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5
Q

what is the making of solid material into porous mass due to heat and compression

A

sintering

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6
Q

what are the different types of restorations

A

screw vs. cement

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7
Q

what is done during pre-treatment evaluation/diagnosis

A
  1. patient expectiaons
  2. systemic eval
  3. extra/intraoral photographs
  4. mounted diagnostic casts
  5. radiographs
  6. clinical/esthetic examination
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8
Q

when planning crown, what must you make decisions aout

A

adjacent teeth, ortho, implant position and number, prosthetic design, hard/soft tissue augmentation, provisionalization

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9
Q

distance from tooth to implant for crown

A

1.5-2mm

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10
Q

distance from implant to implant for crown

A

3 mm

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11
Q

distance of buccal bone for crown

A

> 1-1.5mm

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12
Q

what is bare minimum of interoccusal space needed for implant crown

A

> 5mm

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13
Q

what is a portion of dental implant that serves to support and/or retain a prosthesis

A

abument

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14
Q

types of implant/abutment junction

A

external hexagon and internal conical connection

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15
Q

what abutment junction has antirotations part on OUTSIDE of implant

A

external hexagon

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16
Q

what abutment junction has antirotational component INSIDE implant

A

internal conical connection

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17
Q

is there always a microgap beteween implant and abutment

A

yes

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18
Q

order of abutment junctions from most amount of microleakage to least

A

external hex> inernal trilobe> internal hexagon> internal-taper

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19
Q

what is the shifting of the microgap inwards called

A

platform switching

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20
Q

what is it called when abutment is smaller than implant platform

A

platform switching

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21
Q

what is thought to preserve crestal bone and interdental papilla by moving microgap inward

A

platform switching

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22
Q

advantages of external hex

A

*Ease of multiunit restorations
-Screw Fracture Retrievability
-Impression coping confirmation
Bar type overdentures, large cases nonparallel implants

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23
Q

advantages of internal conical

A

-Abutment/implant connection
-Bacterial Seal with Morse Taper
-Single unit less screw/abutment
loosening
-Prevents micro movement (lessened
bone remodeling around implant)

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24
Q

disadvantages of external hex

A

-Individual: Screw Loosening
*Plastic Deformation
-Bacterial Seal
-Screw fixture attachment

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25
Q

disadvantages of internal conical

A

-Screw fracture retrieval
-Thinning of implant wall in narrow body
-Radiographic confirmation

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26
Q

what screw strip easily? what do not?

A

easy strip = hex
not as easy = square

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27
Q

what are the standard square screww sizes

A

0.050”

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28
Q

what are the standard hex screw sizes

A

0.035”, 0.048”, 0.050”

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29
Q

advantages of gold screws

A
  1. galvanized pure gold deformed during screw tightening, increasing frictional resistance
  2. initial preload of gold screws is significantly higher compared with titanium screws
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30
Q

what is tension created in a screw when tightened

A

preload

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31
Q

what torque wrenches produce average torque values close to value of 35Ncm

A

toggle-type (friction-style) and beam-type (spring-style)

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32
Q

range of values and variability are GREATER with what style wrenches

A

toggle (friction)

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33
Q

mechanical torque-limiting devices should be checked and calibrated according to instructions how oten

A

annually

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34
Q

what torque style is better to start off with

A

spring style/beam

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35
Q

what style of torque

A

spring style/beam

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36
Q

what style of torque

A

toggle-type/friction

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37
Q

retighten screw how long after initial torque application

A

10 minues

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38
Q

what type of restoration has hole thru crown which gives access to abutment screw

A

screw-retained

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39
Q

where is hole on anterior teeth of screw retained

A

cingulum

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40
Q

where is hole on posterior teeth of screw retained

A

central fossa

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41
Q

what type of restoration has crown cemented onto abutment with no direct access to abutment screw

A

cement retained

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42
Q

where is hole on anterior teeth of cement retained

A

incisal edge or facial

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43
Q

where is hole on posterior teeth of cement retained

A

access exits functional cusp

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44
Q

advantages of screw retained restoration

A

primary: RETRIVABILITY
also limited restorative space (5mm) and no residual cement

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45
Q

disadvantages of screw retained restoration

A

esthetics and occlusal access hole

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46
Q

advantages of cement retained restoration

A

esthetics, no access hole, traditional C&B technique, passive fit, mitigate angulation issues

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47
Q

disadvantages of cement retained restoration

A

primary: RESIDUAL CEMENT
also: retrievability and space contraints (>/= 6mm)

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48
Q

what has a smaller biological width: natural tooth or implant

A

IMPLANT:

natural tooth = 2.04 mm
implant = 0.75 mm

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49
Q

is there a significant different bectween screw and cement restorations

A

no

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50
Q

if you choose to cement, must have how many mm space

A

6 mm

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51
Q

if you choose to cemement what must you do

A
  1. have 6 mm space
  2. choose radio-opaque cement (zinc phosphate and ZOE)
  3. control margin placement
  4. choose proper amount of cement
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52
Q

cement technique

A

put teflon inside crown and seat on abutment. inject PVS into crown. remove PVS and teflon and place cement. seat crown on PVS die and remove excess cement. seat andclean cement

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53
Q

how can you modify abutment

A

createion of vent hole to allow for excess cement to seep thru

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54
Q

main advantage of custom abutments

A

control of margin position
(avoid sub-gingival margins, prevent residual cement, optimize abutment design)

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55
Q

what types of custom abutment metal can be milled

A
  1. titanium
  2. gold-shaded
  3. zirconia
56
Q

does cement retained crown have occlusal access

A

no

57
Q

does cement/screw retained crown have occlusal access

A

yes! “screw-mented” so retrievable and has no risk of residual cement

58
Q

which is stronger: titanium or zirconia abutments

A

zirconia is 10x strnoger

59
Q

custom castable plastic pre-machined titaniu, gold alloy or chrome cobalt is almost exclusively used for what types of restoration

A

screw retained

60
Q

advantages of prefabricated abutments

A

inexpensive, may prepare

61
Q

disadvanages of prefabricated abutments

A

no control of margin placemen and HOC

62
Q

what abutments to select when provisional is used to sculpt tissue

A

no tissue displacement and support tissue

63
Q

implant should be placed how many mm apical to propsed CEJ

A

3-4 mm

64
Q

how long for custom abutment fabrication

A

1 week

65
Q

how long for abutment supported crown fabrication

A

2 weeks

66
Q

advantages of screw-mentable

A

Retrievable
Prevent residual cement
Milled=fit of custom abutment
Restorative materials
Monolithic zirconia / PFM / Gold

67
Q

disadvantages of screw-mentable

A

Extra steps
Access hole binding on driver-
lower torque
values delivered to
abutment screw
Cement interface-modes of
failure
Space constraints (need ≥ 6mm)

68
Q

difference between natural tooth and implant

A

Natural tooth: PDL, physiologic movement, decreased stress to bone, and proprioception

Implant: ankylosed, no physiologic movement, higher stress to bone, dull mechanoreception

69
Q

what has greater width: natural or implant

A

greater width = natural tooth
narrower width = implant

70
Q

natural tooth has a greater width and supportive cross-sectional shape, meaning what?

A

less stress to bone

71
Q

implant is narrower in width and has a round platform, meaning what?

A

greater stress to bone

72
Q

what is stimulation of sensory nerve terminals within tissues that give information concerning movements and the position of the body

A

proprioception

73
Q

for implants, does it require a lower or higher level of force to activate patient’s perception of force

A

HIGHER

74
Q

perception is from mechanoreceptors in periosteum as a result of what

A

result of bone deformation

75
Q

occlusal awareness of tooth:tooth

A

20 microns

76
Q

occlusal awareness of tooth:implant

A

48 microsn

77
Q

occlusal awareness of implant:implant

A

64 microsn

78
Q

occlusal awareness of tooth:implant overdenture

A

108 microns

79
Q

magnitude of bite force is dependent on what

A

age, sex, degree edentulism, bite location, and parafunction (bruxism/clenching)

80
Q

bite forces on molar, canine, premolar, and incisors

A

molar: 374-710N
canine/premolar: 424-583N
incisor: 150 N

81
Q

early signs of occlusal overload on natural tooth

A

hyperemia, cold sensitivity, and percussion

82
Q

what is present on natural tooth when occlusal overload is present

A

widened PDL, mobility, wear facets, stress lines, abfraction

83
Q

are there any early signs of occlusal overload present on implants?

A

no - asymptomatic typically

84
Q

what is present on an implant with occlusal overload

A

fatigue fracture, biomechanics failures, moat-shaped crestal bone loss, mobility

85
Q

is there a specific right or wrong way to approach implant occlusion

A

no (not yet anyways) - there havent been much studies

86
Q

distinctions for theories of implant occlusion are made according to what

A
  1. biomechanical design of implant
  2. # of implants
  3. design/fit of prosthesis
  4. opposing dentition
  5. supporting bone
  6. nature of bolus of food
87
Q

what does IPO stand for

A

implant protected occlusion

88
Q

describe IPO

A
  1. force along long axis of implant
  2. avoid non-axial loadings
  3. stable occlusion with narrow occlusal table
  4. reduce cusp height and inclines
  5. avoid splinting implants to natural dentition
  6. light contact in centric occlusion
89
Q

T/F: force is along the long axis of a prosthetically driven implant placement

A

true

90
Q

5% increase in torque for every ___ increase in implant angulation

A

10 degree

91
Q

how do you minimize the occlusal table

A
  1. limit width
  2. select appropriate diameter implant or multiple implants
  3. avoid cantilevers
  4. 15% increase in torque for every 1 mm increase in horizontal offset
92
Q

15% increase in torque for every ___mm increase in horizontal offset

A

1 mm

93
Q

what does it mean to limit vertical cantilevers

A

this results in more prosthetic issues (looks like its being supported only on one end)

94
Q

5% increase in torque for every ___ mm increase in vertical implant offset

A

1 mm

95
Q

do studies show a relationship between crown:implant ratio and marginal bone loss after functional loading?

A

NO

96
Q

what does it mean to minimize cusp height and inclines

A

reduce the lateral stress

97
Q

30% increase in torque for every ___ increase in cusp inclination

A

10 degree

98
Q

what does it mean to address parafunctional habits in regards to implant occlusion

A

eliminate premature contacts but expect increased risk for prosthetic complications

99
Q

should you avoid splinting implants to natural dentition? why?

A

YES! there are differences in physiologic movement where tooth has 10x the mobility causing intrusion of natural tooth

100
Q

if you have to use an implant split, what should you use

A

a rigid connector

101
Q

what occlusal scheme for implant occlusion

A

canine guidance

102
Q

what occlusal scheme if implant replaces canine

A

group function

103
Q

is there evidence that alteration of current occlusal concepts is necessary when restoring dental implants

A

no

104
Q

what should you strive for when looking at implant occlusion

A
  1. stable centric
  2. evenly distributed occlusal contacts
  3. no interferences during working/nonworking movements
  4. anterior guidance whenever possible
105
Q

what is “whether implant is still in mouth”

A

survival

106
Q

what is “clinical criteria to include mobility, radiographic assessment, ginigval and plaque indices”

A

success

107
Q

what are criteria for implant success

A
  1. immobile
  2. no radiographic PA radiolucency
  3. vertical bone loss less 1.5 mm during first year, then 0.2 mm anually after 1st year of implant
  4. absence of persistent or irreversible signs and symptoms
108
Q

for success, vertiical bone loss should be ___ during first year then ___ annually after 1st year of service of implant

A

1.5mm; 0.2mm

109
Q

success rate of ___% at end of 5 year observation, ___% at end of 10 year period

A

85%, 80%

110
Q

crestal bone loss may result from what

A

surgical trauma

111
Q

what is a primary indicator of need for early intervention if >1mm loss occurs after prosthesis placement

A

crestal bone loss

112
Q

do you need to see apex when takign radiograph of implant

A

not necessary

113
Q

describe implant radiograph

A

parallel orientation, clear threads, abutment: implant connection clear and crisp

114
Q

when to complete radiographs

A
  1. baseline - at restoration
  2. 6 months post-restoration
  3. 1 year post-restoration
  4. every 3 years (bare minimum) otherwise indicated due to clinical signs (but can do every year)
115
Q

why is keratinized tissue desiereable

A

cleansibility, comfort of cleaning aids, more manageable/predictable esthetically, more resistant to abrasion/recession

116
Q

describe probe depths of implants

A
  • deeper than natural teeth (2.5-5mm)
  • apply less pressure (fragile attachment apparatus)
  • less reliable
  • reveals tissue consistency, BOP, exudate
  • BOP - indicates inflammation
117
Q

BOP on an implant indicates what

A

inflammation

118
Q

what is apparant with implant health

A
  1. no pain, purulence, signs of inflammation
  2. pink, healthy tissues
  3. probe depths in range of 2.5-5mm without BOP
  4. normal crestal bone levels
  5. immobile
119
Q

what are peri-implant disease etiologies

A

plaque biofilm and lack of keratinized tissue

120
Q

what is inflammation confined to mucosa surrounding an implant with no signs of loss of supporting bone

A

per-implant mucositis

121
Q

what is inflammation around an implant which includes both soft tissue inflammation and loss of supporting bone

A

peri-implantitis

122
Q

what is an implant without mobility, but affected by bone loss and pocketing

A

ailing

123
Q

what is similar to ailing, but does not respond to therapy, worsening bone loss and pocketing despite therapeutic measures

A

failing

124
Q

what is a mobile implant and must be removed

A

failed

125
Q

is peri-implantitis slow or rapid progressing

A

rapid

126
Q

what bacteria in peri-implantitis

A

gram negative anaerobic flora

127
Q

what are risk factors for implants

A

smoking, poor oral hygiene, periodontitis

128
Q

what is done for implant maintenance

A

plaque index, soft tissue assessment, restoration evaluation, radiographic eval, and scaling and prophy or implant maintenance

129
Q

how is soft tissue assessment completed during implant maintenance

A
  1. palpation
  2. probing
  3. periodontal stability
  4. quality of tissue
130
Q

what should you evaluate when palpating during implant maintenance

A

evaluate for presence of inflammation, purulence

131
Q

how often to probe during implant maintenance

A

at leaset annually and more frequently in presence of inflammation or bone loss

132
Q

during implant maintenance, what should you look at during restoration evaluation

A

stable restoration (absence of movement and residual cement), proximal contact, and oclusion

133
Q

during implant maintenance, what should you look at during radiographic eval

A

assess bone levels and pathology

134
Q

the study spontaneous open contacts shows importance of what

A

retained or occlusal guard post treatment

135
Q

what are the specialized instruments used for implant maintenance

A

titanium scalers/probes
plastic scalers/probes

136
Q

should proshteses be removed and resinserted; including cleansing of abutments and prostheses during implant maintenance

A

yes

23 Implants (9 decks)

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