Implants In The Esthetic Zone

Question 1

No difference in survival rate of implants with regards to their anatomical location

Answer 1

Eckert and wollen

Question 2

Henry and colleagues : multicenter study - success rate of ____ in anterior maxillary. However esthetic failure rate _____ in these areas

Answer 2

96%
9%

Question 3

What do you need to understand when placing an implant in an esthetic zone

Answer 3

Biological principles
Anatomic principles
Surgical principles
Prosthetic principles

Question 4

It has been suggested that implants should be placed only after the age of __ in females and ___ in males to avoid problems caused by further skeletal growth

Answer 4

15
18

Question 5

_____ last to grow
______ skeletally mature faster than _____

Answer 5

Premaxilla
Females
Males

Question 6

What does some evidence show with continuous vertical growth of the maxilla?

Answer 6

Continuous growth after age 18 - issue not totally resolved

Question 7

What is necessary to evaluate growth plate fusion ?

Answer 7

Wrist x ray
Lateral cephalometric radiograph

Question 8

Mandible

Pattern of bone growth may bring about _____ positioning of the implant in case it is placed _____
Increase in mandibular length is limited to the ______ _____ _____ to accommodate the permanent molars

Answer 8

Lingual
Early
Primary second molars

Question 9

What is the most ideal anatomical lip line

Answer 9

Low

Question 10

Alveolar ridge

Answer 10

Adequate width

Question 11

Status of mucosa

Answer 11

Loss of architecture of gingival and its papilla due to loss of tooth — can lead to black triangle

Question 12

What type of soft tissue is more prone to recession ?

Answer 12

Thin and scalloped gingival margin (compared to thick and flat gingival phenotype)

Question 13

Soft tissue thickness (phenotype)

Answer 13

Thick is more ideal !

Question 14

Keratinized tissue

Answer 14

Minimum of 2mm KT required for implant and or tooth

Question 15

Mucogingival junction symmetry

Answer 15

Esthetics

Question 16

Presence/absence of papilla/black triangle

Answer 16

Tissue shaping with provisionals

Question 17

Which garber class is more ideal

Answer 17

Garber class I

Question 18

Favorable horizontal and vertical levels of both soft tissue and bone are present

Answer 18

Garber class I

Question 19

No vertical bone loss and slight 1-2 mm horizontal bone deficiency

Answer 19

Garber class 2

Question 20

No vertical bone loss and horizontal bone loss greater than class II (2mm)

Answer 20

Garber class 3

Question 21

No vertical bone loss but significant horizontal loss
Crater defect/depression

Answer 21

Garber class 4

Question 22

Sites with extensive apicocoronal (vertical) bone loss present
A significant challenge to the surgeon

Answer 22

Garber class 5

Question 23

4 main factors directly affect the esthetic outcome of implant supported restorations

Answer 23

Implant placement
Soft tissue management
Bone grafting considerations
Prosthetic considerations

Question 24

Flap design for surgery

Answer 24

Conservative
Flap should be jagged
Only when necessary - can destroy blood supply

Question 25

Implant placement

Answer 25

Implant position Implant size

Question 26

Too buccal position

Answer 26

Dehiscence and gingival recession

Question 27

Too palatal position

Answer 27

Improper restoration, not hygienic, not ethic

Question 28

Where must the centerline of the implant be located

Answer 28

At or near the center of the tooth it replaces Buccal aspect of implant platform just touches imaginary line that touches the incisal edges of the adjacent teeth

Question 29

Patients presenting with a thin gingival bio type

Answer 29

Palatoversion is desirable Prevents showing of metal collar

Question 30

Distance between implant-tooth

Answer 30

1.5 mm at least

Question 31

Distance between implant -implant

Answer 31

3 mm at least

Question 32

___ mm inter implant distance prevents overlap of horizontal bone loss (saucerization) between implants (maintains papilla)

Answer 32

3

Question 33

In the case of max central incisor site, may be desirable to place the implant slightly to the _____ to mimic the natural asymmetry of the gingival contour often seen in these teeth

Answer 33

Distal

Question 34

Most apical point of clinical crown. Generally distal. Lateral - exception and are in the center

Answer 34

Gingival zenith

Question 35

Ideal apico-coronal position

Answer 35

3-4 mm apical to adjacent CEJ Use gingival margin in case of recession Allows for running room for emergence profile - easier to clean

Question 36

What does implant size selection depend on

Answer 36

Dimension of the edentulous crest Proximity of adjacent roots Final restoration - molar vs mand central incisor, canine, max central incisors Maintain at least 3 mm inter implant distance at the crest

Question 37

Distance between the underlying interproximal alveolar crest heigh on the adjacent natural teeth and the final prosthetic contact point dictates the presence or absence of _______ ________

Answer 37

Interdental papilla

Question 38

If the distance is more than _____, the complete papilla formation will be compromised. Often leads to _____ ____

Answer 38

5 mm Black triangle

Question 39

Average height interdental papilla between adjacent implants

Answer 39

3.4 mm

Question 40

What can papillary height be influenced by

Answer 40

Spacing between implants Placement of the contact point

Question 41

Type 1 - immediate

Answer 41

Immediately after ext

Question 42

Type 2- early

Answer 42

4-8 weeks later (soft tissue healed)

Question 43

Type 3 - early delayed

Answer 43

12-16 weeks later (bone formation in clinical and Radiographic evaluation)

Question 44

Type 4 - delayed

Answer 44

More than 16 weeks

Question 45

Following tooth removal, a considerable amount of ____ _____ takes place in both ____-_____ or ______-_____ dimensions

Answer 45

Ridge collapse Buccal -lingual Apical-coronal

Question 46

An average of ____ - _____ original height and width is expected to be lost after tooth ext with the greatest loss happening within the first ____ years

Answer 46

1/3rd 1/5th 2

Question 47

Width loss without ridge preservation

Answer 47

30-35%

Question 48

Width loss with ridge preservation is

Answer 48

15%

Question 49

Buccal bone in esthetic zone is primarily made of ____ _____ ____. Function is to attach ____ _____. Following ext , most buccal bone is ____

Answer 49

Cortical bundle bone PDL fibers Lost

Question 50

As the bone thickness in buccal are approached ____ to ____, bone loss decreased significantly, and some evidence of bone ____ was seen

Answer 50

1.8 2 mm Gain

Question 51

Implant angulation

Answer 51

Mimic adjacent teeth

Question 52

Poor angulation can

Answer 52

Alter screw access hole - post = central fossa, ant = cingulum Poor esthetic result Difficult home care Undesirable cantilevers

Question 53

Optimal esthetic result is achieved only with ideal ____ _____ placement

Answer 53

3D implant

Question 54

4 positional parameters contribute to the success of the restoration

Answer 54

Buccolingual Mesiodistal Apicocoronal position relative to implant platform Angulation of implant

Question 55

Prosthetic design factors

Answer 55

Cement vs screw retained