2/27 - grafting

Question 1

complications of block graft

Answer 1

dehiscence

fracture of the graft

fracture of mandible

Question 2

distraction osteogenesis

Answer 2

making bone longer

Question 3

guided bone regeneration

Answer 3

bone formation only

want bone formation before soft tssue

Question 4

collagen membrane is resorbable?

Answer 4

yes

vs titanium

Question 5

clinical handeling better in

Answer 5

resorbable ones

- bioresorbable

Question 6

sinus augmentation

before - what do need to check

Answer 6

history of sinusitis
post nasal ldrip
sinus pathology
CBCT evaluation of the sinus

Question 7

residual height of bone over 5 with sinus lift?

Answer 7

1. simultaneous
2. external sinus life
   6-9months healing
   implant placement

Question 8

residual height of bone over 5 with sinus lift?

Answer 8

1. simultaneous
2. external sinus life
   6-9months healing
   implant placement

Question 9

pedicle graft ideal for

Answer 9

soft tissue height augmentation

idel in cases of decreased vascularity of the recipient site

in cases where bone and soft tissue grafting is planned

Question 10

shallow plat

vs deep

Answer 10

artery closer or farther from CEJ of the teeth

Question 11

bone grafts are always

Answer 11

prosthetically driven

Question 12

bone graft healing

Answer 12

non vascularized bone grafts heal through a sequence of events

bone grafts initially undergo partial necrosis - osteocyte dath

followed by an inflammatory stage - existing bone is replaced with new bone by osteoblasts brught n by invading vessels

creeping substitution – the slow process of vessel invasion and bony replacement

Question 13

creeping substitution

Answer 13

the slow process of vessel invasion and bony replacement

Question 14

revascularization in cancellous graft

Answer 14

rapidly and completely due to its open architecture that allows easy invasion of blood vessels

Question 15

revascularization in cortical graft

Answer 15

slowly and incompletely due to its dense lamellar structure

vessels must penetrate along haversan and volkmans canals

Question 16

inlay vs onlay graft

Answer 16

interposition (inlay) grafts maintained volume and persevered significantly better than onlay grafts
- onlay only get blood from underneath

Question 17

embriological origin of grafts

Answer 17

those from calvarial and facial sites have SUPERIOR VOLUMETRIC maintenance and survivial over the grafts from rib, tibia, or iliac crest

Question 18

wolf’s law

Answer 18

normal skeletal bone has the ability to adapt to the physical stresses through the process of remodeling

Question 19

rigid fixation

Answer 19

results in PRIMARY BONE HEALING
- effects of this on bone grafts are results in bone graft survivial, greater bony union, increase d primary bone healing and rapid revascularization by virtue of graft IMMOBILITY

Question 20

recipient site factors

Answer 20

grafts placed in an avascular bed do NOT survive well, other factors at the recipient site include prior irriadiation, infection, and tissue scaring

Question 21

best grafts are __ and __ because

Answer 21

cancellous for apid revacularixation and cortical to resist resorption

Question 22

example of block grafts

Answer 22

chin
ramus
body
hip
calvarium

Question 23

keys to the graft

Answer 23

● You want rigid fixation
● Want good adaption to the graft
● PASSIVE TISSUE CLOSURE
● AND FOR TO SIX MONTH healing

Question 24

complications of block grafts

Answer 24

dehiscence
failure of the graft
fracture of the mandible

Question 25

basic characteristics of barrier membrane

Answer 25

``` biocompatibility cell oclussion tissue integration spacce making and space maintenance clinical handeling limited suceptibilty to complications ```

Question 26

membranes that space making and space maintenance

Answer 26

capacity to resist collapse under in vivo conditions and therefore to create and maintain sufficient volume during the healing process COLLAGEN AND TITANIUM REINFORCED

Question 27

NON resorbable membrane

Answer 27

expanded PTFE polytetrafluoroethylene rigidity achieved with fluorinated ethylene propylene

Question 28

complications in GBR

Answer 28

class I - class IV

Question 29

class I complication in GBR

Answer 29

small exposure less than 3 mm without purulent discharge

Question 30

class II complication in GBR

Answer 30

large exposure more than 3 mm without purulent discharge

Question 31

class III complication in GBR

Answer 31

membrane exposure with purulent discharge

Question 32

class IV complication in GBR

Answer 32

abscess formation without membrane exposure

Question 33

approahes to sinus augmentation

Answer 33

crestal approach - internal approach lateral window approach

Question 34

info to gather for sinus augmentation

Answer 34

history of sinusitis post nasal drip? sinus pathology? CBCT evaluation of the sinus

Question 35

one or two stage sinus lift ? | waiting period?

Answer 35

4-5 mm of bone height is a pre-requisite for one stage implant placement and sinus lift less than 5 mm residual height of bone = NO immediate wait 6-9 months

Question 36

soft tissue grafts

Answer 36

subepithelial CT graft epithelial CT graft combination

Question 37

techniwues for soft tissue grafts

Answer 37

tunnel free graft pedicle graft

Question 38

indications for pedicled graft

Answer 38

ideal for soft tissue HEIGHT augmentation ideal in cases of decreased vascularity of the recipient site - stays attached to the blood supply in cases where bone and soft tissue grafting planned

Question 39

want to increase thickness of attached use?

Answer 39

subepithelial CT grafft

Question 40

epithelial CT graft

Answer 40

must be split thickness flaps | immobilization is key

Question 41

benefits of talking to patient about smoking

Answer 41

just three minutes could make a successful case if stop for 8 weeks post op can reach success rates of non smokers

Question 42

smoking is ___ indication

Answer 42

relative contraindicication

Question 43

creeping substitution

Answer 43

osteoconduction allows for osteioinduction Once the graft has undergone some amount of necrosis and resorption, it then acts as a scaffold for neoangiogenesis to occur within the graft. This vessel penetration of the graft allows osteogenic cells to invade the graft and create new bone formation. This series of events is termed osteoconduction (creeping substitution)

Question 44

osteoinduction

Answer 44

During the proliferative phase of the graft take, certain molecules induce significant amounts of mitosis of osteoprogenitor cells and then direct these cells to be committed into differentiated osteoblasts. This phenomenon is called osteoinduction, and of these molecules bone morphogenic protein (BMP) is one that has been extensively studied and has been shown to have significant impact on new bone formation, particularly BMP-2, BMP-4, and BMP-7

Question 45

three directions to pay attentiont to with implants

Answer 45

mesiodistal apico-coronal orofacial dimensions