8/16 - Prosthetically-Driven Implant Tx Planning, Denture Duplication, Central Incisor Wax-Up Flashcards
(150 cards)
1
Q
during pre-treatment evaluation, you must identify what?
A
- patient chief concern
- treatment expectations
2
Q
when do you identify prosthetic needs of patient
A
during comprehensive evaluation
3
Q
what is done during comprehensive examination
A
- systemic evaluation
- clinical examination
- radiographic examination
- esthetic examination
- extra/intraoral photographs
- mounted diagnostic casts
4
Q
what exams/assessments are done during clinical examination
A
- soft and hard tissue exam
- odontogram
- periodontal assessment
- caries risk assessment
5
Q
what is the goal of a treatment plan
A
establish a prosthetic need
6
Q
why obtain a panoramic radiograph?
A
allows you to look at the case as a whole, not tooth by tooth
7
Q
examples of risk factors that may decrease success of implants
A
- medical hx
- perio/endo
- parafunction
- occlusion
- bone resorption
8
Q
what must be done before considering any implant therapy
A
treat all pathologic conditions
9
Q
implants are an ___ procedure
A
elective
10
Q
implant procedures are based on patient’s ability to:
A
- withstand procedure
- heal
11
Q
what are examples that prevent patient from completely healing from procedure
A
smoking, diabetes, chronic kidney disease, bisphosphonate therapy, radiation therapy
12
Q
without risk factors, what is the success rate for implants at 5 years and 10 years?
A
5 years: 90-98%
10 years: 89-95%
13
Q
why does smoking lead to increase failure of implant therapy
A
it impairs neutrophils, alters blood flow, and diminishes O2 perfusion
14
Q
non-smokers have a ___ survival rate compared to smokers
A
3% higher
15
Q
there is a higher failure rate of implant survival in smokers where? what percentage?
A
maxilla has a greater than 9% failure rate due to highly trabecular bone
16
Q
is the failure of implant therapy in smokers dose dependent?
A
YES
17
Q
what forms of diabetes are a risk factor for failed implants
A
BOTH! type I and type II
18
Q
why does poor diabetic control lead to implant failure
A
leads to impaired wound healing and predisposition to infection
19
Q
do HbA1c readings or daily readings provide better judgement of pt diabetic control
A
HbA1c
20
Q
what HbA1c reading means pt has diabetes but is under long-term control
A
<7%
21
Q
what percent of pts with diabetes has successful control? what percent of early failures and late failures?
A
success: 85.6-94.3%
early failure: 2.2%
late failures: 7.3%
22
Q
how does chronic kidney disease lead to implant failure
A
increases serum FGF23 which can impair bone density
23
Q
chronic kidney disease can lead to deficiency in what? resulting in what?
A
vitamin D deficiency which can impair bone metabolism and osseointegration
24
Q
what supplement has been shown to improve healing in patients w/ chronic kidney disease
A
Vit D
25
when are IV bisphosphonate therapy used
management of cancer-relateda conditions
26
when is oral bisphosphonate therapy used
management of osteoporosis, Paget's , osteogenesis imperfecta
27
examples of bisphosphonate therapy brands
1. boniva
2. fosamax
3. reclast
28
what does BRONJ stand for
bisphosphonate-related osteonecrosis of the jaws
29
what is BRONJ
non-healing exposed bone in maxillofacial region
30
how long does BRONJ persist
>8 weeks
31
what is a major risk for BRONJ (0.8-12% cases)
IV bisphosphonates
32
there is a 5-20x higher risk of BRONJ with what?
dentral procedures after IV
33
what is a lower risk med of developing BRONJ after 3+ years of use (0.0003-0.06%)
oral bisphosphonate
34
what is the half life of oral bisphosphonates
10 years
35
what is the best indicator of healing for patients using oral bisphosphonates
how pts dealt w/ previous extractions or surgeries
36
pts undergoing radiation therapy are at risk of developing what
osteoradiocrenosis (ORN)
37
what is prolonged non-healing exposure of bone that is similar to BRONJ
osteoradiocrenosis (ORN)
38
where does ORN primarily occur in the mouth
mandible
39
what are examples of dental risk factors for implant therapy
1. perio disease
2. endodontic pathology
3. occlusion
4. bruxism/parafunction
5. home care
6. gingival display/biotype
7. esthetic expectations
40
does previous periodontal disease pose increased risk to long-term implant survival
YES - especially if patient is noncompliant
41
___ mm perio pockets, and __ mm of attached gingiva results in INCREASED risk of crestal bone loss
>4 mm perio pockets
<2 mm attached gingiva
42
when are endotontic cases w/ periapical pathology successful
after thorough socket debridement
43
what is a symptomatic lesion at the apex of an implant
retrograde peri-implantitis
44
when does retrograde peri-implantitis develop
shortly after placement
45
does the APICAL region of implant achieve normal bone to implant interface in retrograde peri-implantitis?
NO! occurs in CORONAL region
46
retrograde peri-implantitis is found in ___ and ___
1.6% of maxillary implants
2.7% of mandibular implants
47
what is associated w/ previously existing periapical lesion
development of retrograde peri-implantitis
48
occlusion mantra :(
broad stable posterior support and effective anterior guidance
49
when looking at pt occlusion, what must you do
1. reduce non-axial loading
2. stress distribution between fixed and removable prostheses
3. rule out bruxism/parafunction
50
parafunctional habits increase magnitude of stress by how much?
3-4x that regular chewing force
51
do you determine bone volume PRE or POST CBCT?
pre
52
what bone volume dimensions do you determine clinically?
B-L dimension and M-D dimension
53
what bone volume dimensions do you determine radiographically?
M-D dimension or vertical dimension
54
when determining the vertical dimension of bone volume thru radiographs, what must you look for?
1. maxilary sinus
2. inferior alveolar nerve/mental foramen
55
optimal B-L dimension for bone volume
1.5-2 mm on buccal plate
1.5-2 mm on lingual plate
56
minimal B-L dimension for bone volume
1 mm buccal plate
1 mm lingual plate
57
what is the equation for minimum width of ridge
1 mm tissue thickness + 1 mm buccal plate + implant diameter + 1 mm lingual plate + 1 mm tissue thickness
58
what is the minimal implant-implant distance?
>/= 3.0 mm
59
what is the minimum optimal distance from tooth to implants for emergence profile
3mm
60
what is the minimum distance from tooth to implant to prevent crestal bone and papilla loss for periodontal/tooth health
1.5 mm
61
what is the minimum distance from implant to implant to prevent crestal bone and papilla loss for periodontal/bone health?
3 mm
62
when looking at vertical bone volume, what must you ask?
1. is max sinus pneumatized in the site of proposed implant
2. is maxillary sinus augmentation (lift) necessary)
3. if sinus lift necessary, can it be done w/ direct or indirect?
63
what are the sinus augmentation techniques
1. indirect (vertical)
2. direct (lateral window)
64
what sinus augmentation technique is a blind procedure
indirect (vertical)
65
when can you do an indirect/vertical sinus augmentation
>5-6 mm bone loss from crest to sinus floor
66
thru indirect/vertical sinus augmentation, what can you gain in height?
maximum 3-4 mm
67
how are indirect/vertical sinus augmentations performed
thru implant osteotomy (crestal approach)
68
during indirect/vertical sinus augmentation, there is no direct visualization of what membrane?
Schneiderian membrane
69
what sinus augmentation can be done at creighton?
indirect/vertical
70
what is the objective of sinus augmentations
to obtain sufficient height of bone to place desired length of implant
71
when should you complete a direct/lateral window sinus augmentation
<5 mm bone from crest to floor of sinus and wants to gain >4mm bone height
72
do you get a direct visualization of membrane in direct/lateral window sinus augmentation?
YES
73
T/F: direct/lateral window sinus augmentations are performed as separate procedure or in conjunction with implant placement
TRUE
74
what is the opening called in direct/lateral window sinus augmentation
Caldwell-Luc opening
75
what is a Caldwell-Luc opening created for? what is done in it?
created to gain access to sinus. inside it, the membrane is liften and bone graft material is placed
76
vertical bone volume is also determined by proximity to what?
inferior alveolar nerve and mental foramen
77
what is the mimium length from apex of implant to vital structures
3 mm
78
the implant drill/osteotomy is ___ longer than implant length intended for placement
1 mm longer
79
why are longer implant lengths better
1. improved stress distribution
2. increase SA
3. improve crown to root ratio
80
what are the common lengths of implants? what length is available for limited use?
common: 8-13 mm (common for Astra EV)
limited use: 6 mm length
81
what length are short implants
<8mm length
82
advantages of short implants
1. avoid vertical augmentation procedures
2. avoid sinus augmentation
83
disadvantages of short implants
1. long clinical crowns
2. less surface area in bone
3. force management more difficult
84
inciso-implants should be placed ___ to proposed CEJ for proper emergence profile
3-4 mm apical
85
can you predict whether or not papilla will be present by measuring bone to interproximal contact?
YES
86
if bone to contact point is /= 7 mm, what percentage of time will papilla be present?
/= 7 mm = 27%
87
what is the distance from implant fixture and occlusal plane
interocclusal space
88
what is the minimum interocclusal space for fixed implant crown
5 mm
89
what is the minimum interocclusal space for fixed implant full arch
15 mm
90
what is the minimum interocclusal space for anteiror removable locator overdenture
6 mm
91
what is the minimum interocclusal space for posterior removable locator overdenture
9 mm
92
what is the minimum interocclusal space for removable conus/bar over denture
12-15 mm
93
increased crown:implant ratios results in what
more biochemical issues (more stress at neck where abutment is located)
94
what must the patient's maximum opening be at least? why?
max opening = 40 mm
needed for surgical access since drill + handpiece are 35 mm
95
what are the types of gingival display/biotype
high, medium, or low lip line
96
what biotype does a patient have low recession risk
low-scalloped, thick, stippled
97
what biotype does a patient have high recession risk and high risk loss of papilla
high scalloped, thin
98
what ASA classification is a pt favorable for implants
ASA I or II
99
what is the paradigm shift in implant placement?
80's was bone driven -> now it is PROSTHETICALLY DRIVEN
100
what does it mean for implants to be prosthetically driven?
implants are placed to support proshtesis and grafting procedures facilitate optimal prosthetic support
101
who is part of the multidisciplinary approach to tx planning
1. implant surgeon
2. orthodontist
3. restorative dentist
4. radiologist
5. lab tech
102
what establishes continuity between diagnosis, prosthetic planning, and surgical guiding
surgical guides
103
what guides surgeon to place implant in position to best support the prosthesis
surgical guides
104
how to create lab crafted surgical guide
1. diagnositc wax up
2. duplicate cast
3. 0.80" vacuuform suck-down
4. place pilot hole w/ round bur
105
what is used to create surgical guides at creighton?
digital fabrication: Implant concierge
106
what are the types of surgical guides made? explain each
1. pilot guide - guides 1st drill only and subsequent drills are free hand to allow for change of angle if necessary
2. fully guided - all drill sequences are guided and is depth guided
107
steps for completing implant
1. inderdepartmental consultation
2. obtain CBCT full arch scan
3. first look w/ Pros
108
what is done during interdepartmental consultation
1. obtain diagnostic casts and Trios intraoral scan
2. CBCT referral form
3. implant concierge check-off
4. diagnostic wax-up
5. scan diagnostic wax-up
6. VIP tx plan
7. tx plan presentation
109
what preliminary decisions are made during first look with pros
1. adjacent teeth
2. ortho
3. implant position and number
4. prosthetic design
5. hard/soft tissue augmentation
6. provisionalization
110
when do you select preliminary implant diameter and length that best supports prosthesis?
step 3 - first look with Pros
111
does implant diameter affect emergency profile
YES
112
what is the normal degree of emergence
15-30 degrees
113
are implant fixture triangular, rectangular, or round at cervical?
ROUND!
114
there are no locator abutments for what diameters
3.0 and 5.4 mm
115
there are no UCLA abutments for what implants
4.2 and 4.8 PROFILE implants
116
there are no zirconia abutments for what implants
3.0 mm
117
diagnostic wax ups must be free of what
voids or blebs
118
when do you turn in work authorization
after 1st look w/ Pros and wax-up are complete
119
when Julee creates implant concierge account, submits CBCT dicom files, and schedules a VIP meeting between surgeon, prosth, and student, what must you do?
respond to outlook email invitation
120
if you fail to show up to VIP treatment plan, what happens?
you will be charged $100 VIP fee and you will forfeit the case
121
what type of bone:
almost the entire jaw is comprised of homogenous compact bone
type 1
122
what type of bone:
a thick layer of compact bone surrounds a core of dense trabecular bone
type 2
123
what type of bone:
a thin layer of cortical bone surrounds a core of dense trabecular bone of favorable strength
type 3
124
what type of bone:
a thin layer of cortical bone surrounds a core of low density trabecular bone
type 4
125
what type of bone at anterior mandible
type 1 or 2
126
what type of bone at posterior mandible
type 2 or 3
127
what types of bone at anterior maxilla
type 3
128
what type of bone at posterior maxilla
type 4
129
need ___% of payment of surgical guide and ___% of payment of surgery to be done before scheduling patient
100% payment of surgical guide
50% payment of surgery
130
when is the treatment plan presentation done for patient? who must be present?
at pt's second appoint
surgeon, prosth, student, and patient must be present
131
what is discussed during tx plan presentation to pt
risks, benefits, and expectations of implant surgery and restoration
132
what forms are completed during tx plan presentation
implant conference form (in clinic attachments)
if surgeon is present:
1. implant surgery consent form
2. informed consent form for oral and maxillofacial surgery
133
what must you do one week prior to implant surgery?
1. check if implant surgical guide has arrived
2. check if proposed implant sizes are in stock
134
why complete denture duplication?
creates a guide when you have a fully edentulous patient and you need something to reference the prosthetic landmarks
135
what materials needed for denture duplication
1. pt max and mand dentures
2. denture duplicator
3. 6 packs of alginate, mixing bowl, spatula
4, #25 scalpel blade and handle
5. clear orthodontic resin
6. monomer
7. pressure pot
8. #8 acrylic round bur and handpiece
9. dental stoping or gutta percha (size 140)
136
how many packets of alginate for denture duplication
6 packets
137
what type of clear orthodontic resin to use for denture duplication
autopolymerizing clear acrylic
138
what size dental stopping or gutta percha for denture dupliation
140
139
how long should you let acrylic set before placing in pressure pots when completing denture duplication
5-10 minutes
140
why use place holes in acrylic and plate gutta percha in model for denture duplication?
so that during CBCT you can see exactly where you want to place implants
141
when obtaining denture tooth for wax-up, what should you trim?
cervical and lingual portion of tooth
142
steps for starting wax up
1. trim cervical and lingual portion of tooth
2. lute denture tooth w/ inlay wax and contour lingual w/ wax
3. create putty matrix
143
T/F: denture tooth should be superglued to model when completing wax up
FALSE. DO NOT SUPERGLUE!
144
what is a good example of putty matrix
adapts well, 2 teeth each side, and beyond teeth to gingiva
145
materials for wax-up duplication
1. impression tray
2. alginate
3. bowl
4. spatula
5. PAM COOKING SPRAY!
6. diagnostic wax up
146
steps for wax up duplication
1. spray cast w/ cooking spray
2. soak 10-15 minutes to hydrate
3. mix alginate
4. wipe over facial, lingual, occlusal or teeth to minimize bubbles
5. seat cast into impression tray
6. remove from impression and confirm no distortion/voids
7. pour microstone
8. reduce base of duplicate to allow for vaccuform adaptation
147
what is the stone duplicate used for when creating new model?
essix fabrication
148
T/F: you should reduce the base of duplicate to allow for vaccuform adaption
TRUE
149
what causes increased risk of OCN
>6500 cGY radiation
>5500 cGy w/ chemotherapy
150
odds ratio of periapical pathology on extracted tooth vs. adjacent tooth
extracted: 7.2
adjacent: 8.0
