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Final: Alveolar Ridge Preservation Flashcards

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1
Q

What are the types of bone loss for Maxilla vs Mandible?

A
  • Maxilla:
    • Horizontal Resorption
  • Mandible:
    • Anterior=Horizontal
    • Posterior=Vertical
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2
Q

Periodontium Anatomy

A
  • Bundle Bone
  • Cortical Bone
  • Cancellous Bone
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3
Q

Bundle Bone

A
  • Lines socket
  • Directly connected to tooth structure
    • Sharpeys fibers
  • 1st to degrade after extraction
  • Next to PDL of drifting teeth
  • Alveolar Bone Proper
    • Cribiform Plate
    • Lamina Dura
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4
Q

Cortical Bone

A
  • Aka: Compact Bone
  • Outer wall of bone
    • Continuous with bundle bone
    • Dense & Strong
  • Primarily Lamellar Bone
  • Provides primary stability to implant
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5
Q

Cancellous Bone

A
  • aka Spongy or Trabecular Bone
  • Below Cortical Bone
  • Radiographic appearance→Mesh work
  • Trabeculae: Primarily lamellar bone
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6
Q

Alveolar Bone Loss

A
  • Horizontal or Vertical defects
    • occur due to
      • tooth loss
      • fractures
      • pathology
    • Compromise ideal implant placement→Unfavorable outcome
  • Johnson:
    • Fastet resorption: 1-6 months
  • Carl & Perspm
    • Most bone loss= 6-24 months
  • Amler or Nevin
    • Most tissue contour Loss: 1st month
      • avg 3-5mm in width at 6 months
  • Ashman:
    • Bone Shrinkage in 2-3 years:
      • 40-60% of height and width
    • Life Bone loss rate:
      • 0.5-1.0%/year
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7
Q

Alveolar Bone Loss Classification: Edentulous Jaw

A

A-E; A=normal

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8
Q

Socket Healing: Research Studies

A
  • Araujo:
    • Flap vs Flapless Ext=No Difference
  • Scala
    • Monkey Study
  • Tan
    • Systemic Review
    • rapid reduction in first 3-6 months
  • Chappus
    • Facial Bone wall > 1mm (Bone Loss 1.1 mm)
    • Facial Bone wall ≤ 1mm (Bone loss 7.5 mm)
  • Schropp
    • Ext Posterior Teeth
    • Lose 50% of width in 12 months
      • ⅔ in 3 months
  • Farmer:
    • Ext anterior teeth (Esthetic zone)
    • Lose 15% width in 6-8 weeks
    • Greatest bone loss= Coronal & Vertical
  • Cardaropoli:
    • Dog teeth
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9
Q

Ridge Preservation

A
  • Aka:
    • site preservation
    • Socket preservation
  • minimize vertical and horizontal ridge alterations in post-ext sites
    • Decreases bone resorption
      • DOES NOT PREVENT
  • No Superior Techniques
  • No Flap ⇣ resorption rate
  • No RP→ ⇡ orofacial dimension of bone
  • Dimensional Changes within 6 months
    • Mean horizontal reduction=3.8 mm
    • Mean Vertical Reduction=1.24 mm
  • Can Perform under a non-implant restoration to maintain tissue level
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10
Q

Ridge Preservation: Treatment Considerations

A
  • Careful technique
  • Minimal traumatic extraction
    • careful elevation, lunation, and suturing (Criss-cross/Cruciate)
  • Preserve Buccal Plate
    • if damaged, repair during ext
  • Section tooth if necessary
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11
Q

Why do we ant to preserve the ridge?

A
  • Maintain:
    • existing soft & hard tissue envelope
    • stable ridge volume
      • optimal fxn & esthetics
  • Simplify subsequent tx
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12
Q

Ridge Preservation: Contraindications vs Indications

A
  • Contraindications:
    • Infection
    • Radiation
    • Bisphosphonates
  • Indications:
    • Implant placed at later time
    • Contour ridge for conventional prosth tx
    • Positive cost vs benefits
    • Adolescents
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13
Q

Ridge Preservation: Clinical Recommendations

A
  • Elevate Flap and Place:
    • biomaterials
      • ridge contour or barrier membrane
    • Devices
      • ridge contour
  • Primary Wound Closure
    • no comparison studies
      • soft tissue punch, CT graft, etc.
  • Materials with low resorption and replacement rate
    • No difference b/w materials (fillers, membranes)
      • except collagen plug alone
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14
Q

What are the different types of bone grafts?

A
  • Autograft
  • Allograft
  • Xenograft
  • Alloplast
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15
Q

Autograft

A
  • Same person
    • Intraoral or extraoral
      • Tuberosity
      • chin
      • ramus
      • calvarium
      • tibia
      • iliac crest
  • osteogenesis
  • osteoconduction
  • osteoinduction
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16
Q

Allograft

A
  • From Different person
  • DFDBA, FDBA, Puros
  • Osteoinductive
  • Osteoconductive
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17
Q

Xenograft

A
  • From different species
  • Bovine (Bio-Oss), Horse (Equimatrix)
  • Osteoconductive
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18
Q

Alloplast

A
  • Synthetic
  • GEM21
  • Osteoinductive
  • Osteoconductive
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19
Q

Post-extraction Site Classifications:

A
  • Class I
    • Intact Extraction Site
    • favorable anatomical conditions
  • Class 2
    • Intact Extraction Site
    • partially favorable anatomical conditions
  • Class 3:
    • Partially Compromised Extraction Site
    • unfavorable anatomical conditions
  • Class 4:
    • Severely Compromised Extraction Site
    • Unfavorable anatomical conditions
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20
Q

Class 1 Post-Extraction Site Classification

A
  • Intact Extraction Site
    • Favorable Anatomical Conditions
  • Buccal cortical Plate
    • Intact or ≤ 20% wall damage
  • Soft Tissue Level
    • Optimal
  • Bone Anatomy
    • Good for 3D implant position & Primary Stability
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21
Q

Class 2 Post-Extraction Site Classification

A
  • Intact Extraction Site
    • Partially Favorable Anatomical Conditions
  • Buccal cortical Plate
    • Intact or ≤ 20% wall damage
  • Soft Tissue Level
    • Optimal
  • Bone Anatomy
    • Difficult Implant Position & Primary Stability due to
      • Perio defects and lesions
      • Adjacent anatomical structures
        • maxillary sinus floor
        • IAN
        • nasopalatine canal
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22
Q

Class 3 Post-Extraction Site Classification

A
  • Partially compromised Extraction Site
    • Unfavorable Anatomical Conditions
  • Buccal cortical Plate
    • 20-50% resorption
  • Soft Tissue Level
    • Suboptimal
      • soft tissue inflammation
      • thin and scalloped gingival phenotype
  • Bone Anatomy
    • Good for 3D implant position & Primary Stability
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23
Q

Class 4 Post-Extraction Site Classification

A
  • Severely compromised Extraction Site
    • Unfavorable Anatomical Conditions
  • Buccal cortical Plate
    • > 50% resorption
  • Soft Tissue Level
    • Suboptimal
      • soft tissue inflammation
      • thin and scalloped gingival phenotype
  • Bone Anatomy
    • Difficult implant position & Primary Stability due to:
      • perio defects & lesions
      • adjacent structures
        • Maxillary sinus floor
        • IAN
        • Nasopalatine canal
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24
Q

Socket Shield Technique

A
  • Leave natural buccal root of tooth
  • place implant in it
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25
Dehiscence
* A Slice without coronal bone
26
Fenestration
* a window apical of coronal bone * intact coronal bone
27
How does a socket extraction remodel over time?
* Contains clots then osteoblasts * Day 14=Woven Bone * Until bone is completely filled at Day 180
28
What is the rationale for alveolar ridge preservation?
* Place implants later * Contour ridge for conventional prosthetic tx * positive cost to benefits * adolescents
29
Which materials are used for alveolar ridge preservation?
* Autografts * Allografts * Xenografts * Alloplasts
30
Socket Healing After Extraction
* Day 7-14: * Granulation Tissue w/bundle bone degradation * Day 30: * Lamellar bone starts to form * Day 60 * More Fat Deposition * Day 90: * Good amount of bone
31
Ridge Augmentation Techniques
* Distraction Osteogenesis * high risk of infection & failure * Guided Bone Regeneration (GBR) * Block Autograft * Block Allograft * Ridge Split Techniques * Combination
32
Guided Bone Regeneration
* Use barrier membranes to direct growth of new bone & soft tissue * sites w/insufficient volumes or dimensions * used for fxn, esthetics, or restoration * Based on Guided Tissue Regeneration (GTR) principles * Introduced by Dahlin * rats * 1988
33
GBR Regeneration Process
1. Blood Clot 2. Angiogenesis 1. develop new blood vessels 3. Granulation Tissue 4. Osteogenic cells migrate 1. periphery→center 5. Deposits woven bone 6. Lamellar bone forms 7. Remodeling 1. resembles bone growth
34
GBR: PASS Principle
* Primary Closure * periosteal releasing incision * remove membranes after 4-6 mos * Angiogenesis (Blood Flow) * formation of new BVs * Stability * Suture and anchor membrane and flaps * Space Maintenance * membrane b/w bone graft and gingiva
35
What is the Principle of Combination Therapy
* Membrane * provides barrier * Graft * scaffold * space maintenance
36
Ideal Membrane Characteristics
* Biocompatible * Cell Occlusiveness * Tissue Integration * protect blood clot * wound stabilized * Space making * for progenitor cells * Manage Clinical * Facilitate migration and proliferation of progenitor cells * Bacterial infection resistant
37
Types of Barrier Membranes
* Non-Resorbable * ePTFE, dPTFE * socket grafting) * Millipore * Cellulose acetate * Titanium * Resorbable: * Collagen * Synthetic: PLA, PGA, PLGA * ADM
38
New Membranes
* Alginate * New degradable copolymers * Hybrid or nanofibrous membranes * Amniotic membranes
39
Porosity Principle
* _Porosity_ * 50-100 um → Bone ingrowth * \> 100 um (101-150)→ High vascular tissue * \> 150 um→ Bone with osteons
40
GBR vs GTR
* GBR * on edentulous ridges * GTR * around teeth
41
Osteogenesis
* cells in graft form new bone
42
Osteoinduction
* Chemical Process * BMPs convert neighboring cells→ osteoblasts→form Bone * BMPs=molecules in graft
43
Osteoconduction
* Physical Effect * Graft Matrix forms _scaffold_ * outside cells penetrate the graft → form new bone
44
Osteopromotion
* Materials that support: * wound healing * tissue regeneration * do not initiate de novo tissue formation
45
Autograft
* Same person * intraoral or extraoral * tuberosity, chin, ramus, calvarium, tibia, iliac crest * osteogenesis * osteoconduction * osteoinduction
46
Allograft
* From a different person * DFDBA, DFBA, Puros * Osteoinductive * Osteoconductive
47
Xenograft
* From a different species * Bovine (Bio-Oss), Horse (Equimatrix) * Osteoconductive
48
Alloplasts
* Synthetic * GEM21 * osteoinductive * osteoconductive
49
Growth Factors
* GFs * rhBMP2 * PDGF-BB * FGF2 * Controversial Evidence * Rapid Clearance→ insufficient GF conc in bone defects * Deliver w/supra-physiological non-standard doses → therapeutic efficacy
50
Neo-osteogenesis
* de novo bone formation beyond genetic skeletal envelope * achieved by applying GBR principle
51
Factors that Influence GBR Success
* Patient Factors * smoking * Excessive Swelling * Passive Flap tension * Cortical Penetration * Defect morphology * length * angle * Membrane fixation * Materials used * Horizontal Augmentation * predictable and successful * Vertical Augmentation * More challenging * Less than horizontal gain * Decreased implant success & survival
52
Block Graft
* Block Graft vs GBR * Greater Ridge Width Gain * Lower Implant Success * Block Graft vs Autogenous Particular Graft * Greater: * bone to implant contact * Bone Fill * Less Mean height Gain
53
Khoury's Split Bone Block Technique
* Bone Block + GBR
54
Ti-Mesh Membranes
* Titanium Meshes * used w/particulate bone for large defects * oxide layer promotes * cell colonization * differentiation of osteogenic lines * Not mainstrem * technique sensitive * Cost
55
Alveolar Ridge Split (ARS)
* Splits crest cortical bone * creates horizontal dimensions * immediate or delayed implant placement * can be combined with GBR * Only D3 or D4 bone Types
56
GBR: Other Principles
* _Thin layer of soft-tissue ingrowth_ * under the membrane * initial blood clot shrinks→air entrapped or membrane micromovement * _Micromovement:_ * Fibrous Tissue
57
Alveolar Ridge Split: 4 Anatomical Requirements
* Minimal horizontal bone width= 2 mm * Minimal Vertical Bone Height=10 mm * No concavity * Horizontal osteotomes ≥ 1mm from tooth
58
Guided Implant Surgery: General Info
* Developed in Mid 1990s * CBCT allowed: * volumetric jaw bone imaging * low cost and radiation * Large amount of info pre-op * available bone volume and quality * location of anatomy and pathology * Completely planned pre-op
59
Guided Implant Surgery: Workflow
Exam→Planning→Execution
60
Guided Implant Surgery: Examination & Limits
* requires CBCT * used with flap and flapless approach * No Flap=No Graft * Edentulous vs partially edentulous patients * Edentulous: * 1 Scan System: * create radiopaque resin replica of pts prosthesis * 2 Scan System: (Dual scan w/Fiducial Markers) * 1st-with prosthesis markers & Bite registration * 2nd- with prosthesis markers * Partial Edentulous: * Virtual Computerized Prosthetic Wax-up * Scan analogue or cast * data superimposed on CBCT * Limits: * Prosthetic Thickness for correct segmentation * artifacts * Motion-during CBCT * Metal * Correct tooth setup * Incorrect * fiducial markers (Double-scan) * Matching of scan and CBCT
61
Implant Placement: Pitfalls
* Patient movement while drilling * Limited surgery time due to LA * restricted visual field * mental transfer of 2D x-ray to 3D * Esthetics * Biomechanics * Functional Constraints of prosthesis
62
Guided Implant Surgery Involves:
* CBCT * extraoral and intraoral scanners * rapid prototyping and 3D printing * Guided Surgery
63
Guided Implant Surgery: Planning & Limits
* 3rd party software * plan implant placement and fixation pins/screws * Digital info→ produce stent with analogue method or CAM rapid prototyping (Milling or 3D printing) * Limits: * not enough inter arch space * Unavailable Drill lengths (Drills to long) * Thin guide material→ Break * Printing Angulation Error (0.25-1.5°)
64
Guided Implant Surgery: Execution & Limits
* Try guide in mouth before surgery * bite index, mini-screws, fixation pins and temp implants can be used * punch technique-Flapless approach * Drill Keys-Drills w/physical or visual stop * Accuracy: * Limits: * Rotated guide→Inaccurate implant position * Fix with bite index * check Occlusal of guide * Local anesthesia changes mucosa * Depth (Most significant error) * Debris within osteotomy * Deformed Guide * Low gray values
65
Accuracy
* difference b/w the: * planned (what you want) and * inserted (what you actually got) implant placement * 4 parameters (Deviation of the \_\_) (Van Ash/Tahm) * entry point (0.99/0.9 mm) * Apex (1.24/1.39 mm) * Long Axis (3.81 /3.5°) * Depth * Guide vs no guide: * Significant Deviation * Guides: Tooth supported\> Mucosa supported\> Bone supported
66
What are the main steps to plan a guided surgery?
* CBCT * extra/intraoral scanners * 3D printing
67
What are the indications of guided surgery?
* Limited Mouth Opening * No flap needed * Have Time to plan * Whenever you can do it
68
What are the limitations of guided surgery?
* Correct and accurate images * Insufficient arch space * cumulative deviation * mucosal changes * deviation of depth * breaking of guide
69
Peri-Implant Health
* No Inflammation * No BOP * No Suppuration * No ⇡ PDs * No Bone Loss * only bone remodeling
70
Peri-Implant Mucositis
* BOP * Suppuration-maybe * No PD Change * with or without * No Bone Loss
71
Peri-Implant Implantitis
* BOP * Suppuration-maybe * ⇡ PD * Bone Loss * if no previous exam data: * BOP * Suppuration (maybe) * PD ≥ 6mm * Bone Level ≥ 3mm apical to most coronal intraosseous part of implant
72
Peri-Implant Hard and Soft Tissue Deficiences
* Hard Tissue * Before Implant Placement * Systemic Diseases * Tooth Loss * Trauma * Trauma from Tooth Extraction * Periodontitis * Endo Infection * Longitudinal Root Fractures * Posterior Maxilla Bone Height * After Implant Placement * Systemic Diseases * Healthy Defects * Implant Malposition * Peri-implantitis * Mechanical Overload * Soft Tissue Thickness * Soft Tissue: * Before Implant placement: * Systemic Diseases * Tooth Loss * Periodontal Disease * After: * No Buccal Bone * Papilla Height * Keratinized Tissue * Tooth Migration * Life-Long Skeletal Changes
73
Peri-implantitis vs Peri-mucositis: Etiology & Tx
* Mucositis: * Etiology: Xs Cement (86%) * remove XS and GBR * Implantitis: * Etiology: Plaque * mechanical debridement * resolves in 3 weeks
74
Clinical Differences b/w healthy periodontal and peri-implant tissues
* No visual differences * PD: * Implant \> Tooth * Interproximal Papilla: * Implant=Shorter
75
What does a peri-implant exam consist of?
* Inflammation: * visual * probing * BOP * PD * Mucosal Margin migration * Palpation
76
Ailing Implant vs Failing Implant vs Failed Implant
* Ailing: * No Mobility * No Inflammation * Radiographic Bone Loss * Failing Implant: * No Mobility * Inflammation * Progressive Bone Loss * Failed: * Mobile * Non-functional * Need to remove
77
CIST
* Cumulative Interceptive Supportive Therapy * Based one periodic diagnosis * 4 Treatment Modalities: * A= Mechanical * B= Antiseptic Treatment * C: Antibiotic Tx * D: Regeneratie or resectie surgery
78
Peri-implant disease: Risk Factors
* Poor Plaque Control * No Maintenace * Smoking/Diabetes * History of Perio
79
What should you do after finishing implant supported prosthesis?
* Baseline: * radiographs * PD * Radiographs after loading period * Bone Level Reference after remodeling
80
Patient Plaque Control around Implant
* Methods: * Floss * Sulcular Bass Brushing Technique * Cleans under mucosa * caution with Narrow WKG * After osseointegration: * Interdental Brush * Rubber Tip
81
Professional Plaque Control around Implant
* Perio Maintenance: * 3-4 months if tooth loss due to caries or perio * Minimal Damage to transmucosal surfaces when removing plaque and calc * ex: Polished titanium implant collar * Gold or ceramic surfaces * use most scalers and curettes w/no damage * ex: Plastic, gold coated, stainless steel * Metal Probe * no concern→Minimal surface alteration * Plastic Probe=Effective * Rubber Cup & Polishing Paste * remove biofilm * machined and polished surfaces * Ultrasonic Instruments w/metal tips * Magnetostrictive or Pizoelectric * ex: Cavitron * Caution→Surface irregularities * use special tip * Friendly Materials for Abutment: * Teflon * Titanium * Gold * Plastic Tips
82
What to evaluate for Implant Prosthesis: At Delivery vs F/u Visits
* Delivery: * Radiograph=Baseline * Complete seating * Implant Abutment Interface * Cement retained * No XS cement * F/u Visits * loose screws or fractures * Replace: * Loose screws & toque down * worn out retentive parts * Hader Clips * Locator attachment inserts * Occlusal guards
83
What are the main peri-implant diseases?
* Health * Mucositis * Implantitis * Hard & Soft Tissue Defiicencies
84
What are the main treatment modalities for peri-implantitis?
* Mechanical Debridement * Antiseptic Tx * ANtibiotic Tx * Regenerative or Resective Sx
85
Why does excess cement cause peri-implantitis?
* Allows bacterize to colonize→ ⇡Inflammation around implant
86
Types of Implant Complications?
* Biologic * Esthetic * Mechanical
87
Biologic Implant Complications
* Mucosal Inflammation * Mucosal Hyperplasia * Mobility * BOP * Suppuration * ⇡ PD * BL * Thread Exposure * Peri-implant diseases * Pain
88
Esthetic Implant Complications
* Poor positioning * Poor Restoration * Poor Appearance * inadequate tx planning * Recession * Hard & Soft Tissue Deficiency
89
Mechanical Implant Complication
* Screw Loose * Screw Frature * Meshwork Fracture * Ceramic Fracture * Implant Fracture
90
Prosthetic Design
* Proper Assessment * crucial for dx and tx plan * proper emergence profile * Innaccurate assessment * Prosthesis Misfit * Passive Misfit ⇡Burden on Bone * Bacteria Colonize space b/w prosthesis * Biocompatabilty * Zirconia \> Metal
91
Excess Cement
* Peri-implantitis (81%) * Increase: * Plaque * Bleeding index * Suppuration * Fistula * Radiographs can't detect * Cement Types→ proliferation of bacterial strains * Impossible to remove all excess when abutment margin≥ 1 mm subg
92
Types of Cement
* Methacrylate * Bacterial Colonization * Zinc Oxide Non-Eugenol * Less host response in vitro
93
What are some techniques to minimize excess cement?
* Teflon Tape * Venting * Dual Cord * Dummy abutment
94
Cemented retained vs Screw Retained Complications
* Cemented Retained * BIologic complications * plaque control to prevent * Screw Retained * Technique Complication * preferred due to: * retrievability * High Biologic compatibility
95
What are some crucial factors for cement retained restorations?
* Implant position * Abutment selection * Retention Design * Margin Position
96
Fracture and Loosening?
* Facilitate Peri-implant disease * bacteria colonize spaces
97
Lack of Keratinized Mucosa
* Increase: * Plaque accumulation * inflammation * recession * attachment loss * Increase Keratinized Tissue w/Tissue Graft * Reduce Gingival Complications: * physical compression * contact w/ restorative material * Biofilm
98
Open Contacts
* Proximal Contact tightness Decreases overtime * replace restoration * Modify restoration * restore adjacent tooth * associated w/peri-implantitis
99
Retrograde implantitis
* Previous RCT on Adjacent teeth * not curetted well after extraction
100
Maxillary Sinus Augmentation: History
* Boyne & James: 1980 * first published technique * Tatum: 1986 * crestal approach * Summers: 1994 * Osteotome technique * Sinus Consensus: 1996 * predictable & effective
101
Alternatives to Sinus Augmentation
* RPD * Fixed Bridges * Cantilevers * Implants: * Short * Zygomatic * Tilted
102
Maxillary Sinus Anatomy:
* Shape: * Pyramidal * Membrane: * Lined by Pseudostratified columnar epithelium * + periosteum→ Schneiderin Membrane (0.3-0.8m) * Size: 12-15 mL * Dimensions: * Length: 38-45 mm * Height: 26-45 mm * Width: 25-35 mm * Septa: * Normally In premolar Area * Ostium * 40 mm from floor * 6 walls: * Anterior * Posterior * Superior * Inferior * Medial * Lateral
103
Maxillary Sinus Function
* Warm Air * Lighten Head * Voice Resonance * Dissipate Heat
104
Sinus Anatomy Classification
Height from alveolar crest * SA-1 * \> 12 mm * SA-2 * 10-12 mm * SA-3 * 5-10 mm * SA-4 * \<5 mm
105
Sinus Augmentation: Indications vs Contraindications
* Indications: * Posterior Maxilla Lacks vertical dimension * alveolar ridge resorption * sinus pneumatization * Contraindications: * Relative: * Treatable sinus pathology * Smoking * Absolute: * Treated Sinus pathology that left irreversible dysfxn
106
Pre-Op Sinus Evaluation
* Medical Contra-indication * CBCT Scan * ENT Consult * sinus problems * Destructive sinus surgery * Delay Sinus Surgery due to: * nasal congestion * sinusitis * Respiratory Tract Infection * Sinus pathology 30% * Thickend mucosa (65%)
107
Pre-Op Sinus Medicines
* Antibiotics: * Amoxicillin * Clindamycin * Can be mixed in graft * 1:4 (Antibiotic:Graft) * Decongestants * maintain patent ostium * Oxymetazoline (Afrin) * Pseudoephedrine * Anti-inflammatory * Decreased edema & post-op pain * Medrol dose pack * Ibuprofen 800 mg * Analgesics * Hydrocodone w/acetaminophen (Vicoden) * Codeine w/Acetaminophen (Tylenol #3)
108
Surgical Technique
* Osteotome (transcrestal) * SA-2 and SA-3 * Lateral Approach (Window) * SA-3 and SA-4
109
Osteotome Technique
* Aka Transcrestal * SA-2 and SA-3 * Instrument: OSteotomes * Curved tip * straight or angled * Implant Survival Rate: * Bone Height: * ≥ 5mm = 96% * \< 4 mm = 86% * Advantages: * less * invasive * painful * risk of infection * Disadvantages: * Blind * perforation * Lack Control
110
Osteotome Technique: Advantages vs Disadvantages
* Advantages: * Less * Invasive * risk of infeciton * painful * overhead * Disadvantages: * Lack control * Blind * Membrane perforation
111
Osteotome Technique: Research studies
* Implant Survival Rate: * Bone Height ≥ 5mm → 96% * Bone Height \< 4 mm → 86%
112
Lateral Approach
* Aka Window * S3-S4 * More invasive * direct vision of sinus * Instruments: * Pizoelectric surgery * Sinus Elevators * Kerrison Rongeur
113
Osteotome vs Lateral Approach: Bone Height Gain Success Rate
* Osteotome: * Bone Height Gain: 3.5 mm * Success Rate: 95% * Lateral Approach: * Bone Height Gain: 12.7 mm * Success Rate: 100%
114
Pizoelectric Sinus Elevation
* Reduced perforation risk * Ultrasonic Vibrations * Hydropneumatic pressure
115
Sinus Augmentation: Risks and Complications During Surgery Early Post Op Late Post op
* During Surgery: * Sinus mucosa perforation * Schneiderin Membrane perforation (most common) * Fracture ridge * Obstruct Ostium * Inadequate Fill * Bleeding * Damage teeth * Early Post-op * Wound Dehiscence * Acute Sinusitis * Exposed membrane * Lose implant or graft * Late Post-op * insufficient quality or quantity of bone forming in sinus graft * oro-antral fistula * Chronic bone pain * remove implant * Chronic Sinus Disease
116
Sinus Perforation
* Incidence: 10-30% * Pizo reduces to 7% * Causes: * Tear membrane during prep * Fracture window * Elevate membrane * Septa or pathologic conditions * Very thin membrane * Increase risk of infection * delay implant placement * contaminated mucosa in graft
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What nerves innervate the maxillary sinus
* Superior Alveolar N * Infraorbital N.
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What Blood Vessels Innervate the maxillary sinus?
* Posterior Superior Alveolar A. * Infraorbital A. * Posterior Lateral Nasal A.
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Amoxicillin
* Pre-op med * 1g 1hr before surgery * 500 mg qid 5-7 days
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Clindamycin
* Pre-op Med * 300 mg 1 hr before surgery * 150 mg tid 5-7 days
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Oxymetazoline
* aka Afrin * Decongestant * 1 hour before surgery until * 2 days after surgery
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Pseudoephedrine
* decongestant * 1 tablet tid on day of surgery * 2 days after surgery if perforation
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Ibuprofen
* Anti-inflammatory * 800 mg * 1 tablet tid 7 days after surgery
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What can cause a Sinus perforation
* Tear membrane during prep * Fracture window * Elevate membrane * Septa or pathologic conditions * Very thin membrane

Implantology (15 decks)

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