revision Flashcards
1
Q
tooth-implant prosthesis:
ADV:
DISADV:
A
ADV:
- cheaper
- more tx options
- cantilever elimination
- ADDITIONAL SUPPORT FOR THE TOTAL LOAD ON THE DENTITION
DISADV:
- risk of osseointegration failure
- risk of marginal bone loss
- more periodontal and prosthodontic complications
- more need for repair and maintenance
- INTRUSION OF TEETH
- risk of excessive stress on implant
2
Q
most common biological complications of tooth to implant prosthesis:
A
periapical lesions and caries but also: -tooth fractures -fistulas -loss of osseointegration -periodontal pathology
3
Q
most common technical complications of tooth to implant prosthesis:
A
porcelain occlusal fracture and screw loosening but also: -retention loss -cement failure -screw fracture
4
Q
intrusion of teeth - percentage:
A
0 - 5.2%
5
Q
rigid connection or non-rigid connection between teeth and implants?
A
rigid connection
bc the non-rigid have more technical complications
6
Q
which is better; tooth-implant prosthesis or implant-implant prosthesis?
A
implant-implant prosthesis is better
bc of increased no of biological and technical complications with implant-tooth prosthesis
7
Q
diagnostic phase planning for implant placement includes:
A
no of implants position of implants angulation of implants dimension needed design of finalized prosthetic rehabilitation
8
Q
surgical guide use:
A
- for desired implant position and angulation
- for abutment dimension and angulation
- if there is a need for soft/hard tissue augmentation before or during implant placement
9
Q
distance needed between two implants placed:
A
3 mm space
bc we want space for OH, otherwise it will fail
10
Q
pink porcelain use:
A
high lip line - used only for aesthetics
11
Q
technical complications of implant supported FPDs:
A
- veneer fractures -> most common
- screw loosening
- abutments/screw fracture
- implants fracture
- occlusal restoration loss
12
Q
solution for a two rooted or three rooted tooth extraction:
A
sectioning
for a less traumatic procedure
13
Q
what will be missing from the extraction site once a tooth is removed?
A
PDL
14
Q
alveolar bone morphology depends on:
A
tooth size
tooth shape
events occurring during tooth eruption
erupted teeth inclination
15
Q
alveolar bone morphology of long and narrow teeth:
A
more delicate alveolar process, in particular in the frontals, a thin, fenestrated buccal bone plate
so with thin biotype and long narrow teeth there is a thin or non-existent buccal plate
16
Q
where would we see an impact of a thin or non-existent buccal plate?
A
in:
orthodontic movements
periodontitis
recessions
17
Q
what do we expect to have when we have subgingival restoration margins in a thin biotype?
A
recessions
18
Q
what do we expect to have when we have subgingival restoration margins in a thick biotype?
A
inflammation
19
Q
attachment apparatus components:
A
periodontal ligaments
cement
alveolar bone
20
Q
what will happened to the bone when there are multiple tooth extractions and then subsequent restoration with RPDs?
A
reduced size of ridge in both horizontal and vertical dimension
21
Q
bone resorption depends on:
A
- thin or thick biotype
- pressure on the area
- why you lost teeth (caries or perio)
- original dimension (height and width)
- > thin bone plate (<1 mm wide) lose more dimension than plates > 1 mm wide
- not the same for everyone
- same resorption process for both single and multiple teeth being extracted
22
Q
bone reduction percentages in 3m and 12m after tooth extraction:
A
3m: 30%
12m: 50%
23
Q
clinical ramifications concerning prosthetic rehabilitation after teeth being extracted:
A
implants - bone augmentation
bridge - space b/w pontic/bridge?
complaints for:
anteriors: aesthetics
posteriors: food impaction
24
Q
factors that will influence changes in the bone after tooth extraction:
A
- traumatic injuries (ex: during extraction or after an accident)
- tooth related diseases (ex: periodontitis or apical periodontitis)
25
classification of residual jaw shape:
In groups A and B, substantial amounts of the ridge still remain
In groups C, D, and E, only minute amounts of hard tissue remain
A and B: can place a full mouth denture or implants
Vs
C, D, E: problems with placing a denture or implant
26
4 different groups of jawbone quality:
Quality 1 to 4: less cortical bone, more bundle bone present
Quality 1: thick and resistant bone – very good for dentures, not very good for implants – there is no proper blood supply to the area so you might have problems with osseointegration
Vs
Quality 4: it is so soft so there is no primary stability so when you are placing an implant you might need to stop before placing the correct size, there is a lot of bleeding upon working
27
clinical ramifications of tooth extraction:
| 4 pictures
```
thin or thick bony plate
small (incisor) or big (molar) socket
bone augmentation needed
implant placement
food impaction problems
```
28
What do we expect to see when removing a tooth?
Bone resorption and then soft tissue follows
29
When you have resorption occurring, and you want to replace a missing tooth with a prosthesis, what are your concerns?
- resorption of buccal bone
- adjacent teeth recession leading to root exposure and sensitivity
- aesthetics
- food impaction
30
When would be the optimal time to plan the restorative treatment of a patient?
Prior to teeth extraction
31
which has less traumatic change after extraction?
- lower anteriors
- lower molars
- upper anteriors
- upper molars
-lower anteriors
32
post extraction healing stages:
- epithelial cells (fastest cells) proliferation
- keratinization covering extraction site
- bone cells (osteoclasts, osteoblasts) multiplication (so bone builds up in the socket)
- resorption (a little, especially on the buccal plate)
- bone and soft tissue loss
33
type 1 implant placement:
-immediate placement after extraction
- ADV: 1 surgery, less tx time, less visits (patient friendly bc you do it in 1 go), bone augmentation favorable
- DISADV: high risk procedure, need experience, inadequate soft tissue, aesthetical problems
34
type 2 implant placement:
- when the socket is covered with mucosa
- best solution
- after 4-8w before socket coverage with soft tissue
- ADV: good aesthetics and predictable, less tx time, favorable bone augmentation procedure, allows pathology resolution
- DISADV: 2 surgeries, not easy (the least no of disadv), more tx time than type 1, socket wall resorption
35
type 3 implant placement:
- when bone fill is required within the extraction socket
- after 10-16w
- ex: after big tooth extraction or huge defect (ex: periapical lesion, periodontitis, tooth fracture, huge bone loss)
- ADV: favorable bone augmentation procedure, allows pathology resolution, easier to manage mucosa during flap elevation
- DISADV: 2 surgeries, more tx time, additional resorption
36
type 4 implant placement:
- everything is completely healed
- when the patient asks for it or for financial reasons
- after 4m or 6-12m
- ADV: complete healing, allows pathology resolution, only minor additional change of the ridge may occur
- DISADV: 2 surgeries, more tx time, might require complicated bone augmentation procedures
37
flap closure methods:
1st approach: requires primary wound closure which leads to submerged healing
2nd approach: allows for a transmucosal position of implant/healing cap which leads to transmucosal healing
-> If its not that big bone augmentation, then you go to the transmucosal healing
38
In which clinical situation you would prefer to have healing and then bone? What would you see in your initial radiograph?
after big tooth extraction or huge defect (ex: periapical lesion, periodontitis, tooth fracture, huge bone loss)
so it’s better to wait a little bit longer
39
aspects evaluated during tx planning phase:
- overall tx objective
- tooth location in oral cavity (aesthetic zone or not)
- bone and soft tissue anatomy at the site
- adaptive changes of alveolar process following tooth extraction
40
which factors differentiate someone from having periodontitis or not?
susceptibility
| genetics
41
risk factors for periodontitis:
smoking
| uncontrolled diabetes
42
clinical parameters that should be noted before placing an implant:
* OH habits
* plaque score – very important
* presence of BoP (should be less than 20%)
* periodontal probing depth
* soft tissue levels
* thick and thin gingival biotypes (thick is preferred)
* restorative conditions of adjacent teeth
* edentulous regions (horizontal or vertical defects)
43
panoramic indications:
partially dentate
| edentulous patient
44
CBCT indications:
* when clinical examinations or conventional radiography have failed to adequately identify the relevant anatomic boundaries or the absence of pathology
* can provide additional information and help minimize the risk of damage to important anatomic structures
* requirement for a more extensive augmentation procedure
* implant positioning improvement with the use of radiographic templates and surgical guides
45
Esthetics:
Patient is influenced by:
Clinician is influenced by:
```
Patient is influenced by their:
•self-perception
•social environment
•media
•dental history
```
Clinician is influenced by:
•current dental knowledge
•experience
•available medical checklists – evidence based
46
What would be a method for the patient to visualize the final esthetic result before treatment begins?
Mock-up
47
Which alternative tx modalities are available to replace a tooth in the esthetic zone?
*SOS*
If you have a patient that is 16-year-old (boy/girl) – what would you exclude?
* Conventional FPD comprising cantilever units
* Adhesive, RBB (cantilever)
* Conventional RPDs
* Tooth-supported overdentures
* Orthodontic therapy
* Implant-supported prostheses
* Combinations of the above
implants
48
How can orthodontic treatment be used to enhance the final esthetic result in a patient with missing teeth in the anterior zone?
* With forced eruptions
* Changing the distribution pattern of the edentulous spaces by turning a neighboring two-unit space into two one-unit spaces
* The temporary implant may serve as anchorage
49
In which cases an implant supported solution is preferred?
* unrestored, healthy neighboring teeth
* overly prepared teeth or compromised risky abutments
* diastemata
50
options of provisional prosthesis following tooth extraction prior to implant placement:
- Acrylic RPD
- Essix provisional splint (removable prosthesis)
- Resin-bonded pontics or bridge (Maryland)
51
Acrylic RPD:
ADV:
DISADV:
ADV:
•Simple to construct
•Cheap
•Easy to adjust and fit
DISADV:
•May apply too much pressure to the healing site
•Not comfortable
•Aesthetically might not be that good for patients
52
Essix provisional splint (removable prosthesis):
ADV:
DISADV:
ADV:
•Doesn’t apply pressure on the healing site
•Protects the underlying soft tissue and implant during healing phase
•Can be used in cases of limited interocclusal space or in deep anterior overbite
DISADV:
•Unable to mold the surrounding soft tissue
•Lack of patient compliance can cause rapid occlusal wear from the vacuum form material
53
Resin-bonded pontics or bridge (Maryland):
ADV:
•More comfortable from a functional and phonetic point of view
•More esthetic
-Better option than removable, because you don’t have anything moving around and pushing the tissue, you have something that is stable; bonded and is aesthetically good
DISADV:
•Their removal and rebonding after the surgical intervention requires more time and work from the dentist
54
peri-implant health =
* absence of clinical signs of inflammation (ex: swelling, redness)
* absence of bleeding/suppuration on gentle probing
* no increase in probing depth compared to previous examinations
* no bone loss
55
peri-implant mucositis =
* bleeding and/or suppuration on gentle probing
| * no bone loss
56
When you have bone loss for the first time then it is:
- peri-mucositis
- peri-implantitis
peri-implantitis
57
When you have increased PPD then it is:
- peri-mucositis
- peri-implantitis
-peri-implantitis
58
let’s say you see a patient for the first time and the implant area has bleeding on probing, suppuration and bone loss. What would you characterize it?
- peri-mucositis
- peri-implantitis
-peri-implantitis
59
if it is your own patient, and you have multiple radiographs in a sequence where the bone level is the same (stable) and all of a sudden you have BoP, but you don’t have PPD (more than what you had before) then probably it will be:
- peri-mucositis
- peri-implantitis
-peri-mucositis
60
Is peri-implant mucositis a reversible disease?
Yes, because there is no bone loss. (It is like gingivitis – inflammation of soft tissue)
61
What is the aetiology of peri-mucositis?
Plaque (remove plaque then -> reversed)
62
peri-implantitis =
= a plaque-associated pathological condition that occurs in tissues around dental implants
Characteristics:
•bleeding and/or suppuration on gentle probing
•increased probing depth compared to previous examinations - probing depths of ≥ 6 mm (subgingivally)
•bone loss - bone levels ≥ 3 mm apical of the most coronal portion of the intra-osseous part of the implant
63
What is the difference in disease progression between periodontitis and peri-implantitis?
peri-implantitis -> faster than in periodontitis and occurs in a non-linear and accelerating pattern
Due to micro-rough surface of implant, which is paradise for bacteria to stick to, difficult for us to clean, so accelerated progression
64
risk factors for peri-implantitis:
- patients with poor plaque control who do not attend regular maintenance therapy
- rough surface
- uncontrolled diabetes
- bad OH
- smoking
- history of severe periodontal disease (the main risk factor is)
65
the difference between severe perio disease and others are:
genetics
66
most common complications regarding tooth supported single crowns:
* post-cementation endodontic therapy (3%) - first
* porcelain fracture (3%)
* loss of retention (2%)
* periodontal disease (0.6%)
* caries (0.4%)
67
most common complications regarding tooth supported FPDs:
* caries (18% abutments; 8% prostheses)
* need for endodontic treatment (11% abutments; 7% prostheses)
* loss of retention (7%)
* esthetics (6%)
* periodontal disease (4%)
* tooth fracture (3%)
* prosthesis fracture (2%)
* porcelain veneer fracture (2%)
68
complications regarding implant supported restorations:
| these do not apply:
Pulpal complications, periodontal disease (for here would be peri-implantitis) and caries
69
Would you recommend a tooth supported restoration to a periodontal patient?
yes but OH and maintenance are important
70
Would you recommend an RPD to a periodontal patient? What would be your risks and most important factors to consider?
not the ideal option, but you can
OH and more recalls are important
risk for technical complications such as loss of retention, loss due to abutment fracture and material complications
71
use of non-vital teeth as abutments:
increased loss of retention
| fracture of teeth and cores
72
Objectives of perio tx:
Maintain, improve and preserve dentition, periodontium, implants and peri-implant tissues
73
Portion of collagen fibers penetrating into cementum and bone:
Sharpey fibers
74
In which disease you still have sharpey fibers intact in sockets? What would be the tx?
Acute perio abscess
AB and instrumentation of the pocket
-in periodontitis you don’t have them
75
Is periodontitis a consequence of gingivitis?
Not always
76
Is periodontitis linear?
No, it is a non-linear disease with bursts and rests
77
If you stop brushing, gingival inflammation will occur when?
Might start in 10 days but in 21 days definitely you will have
78
Describe the gingiva
```
Reddish
Swollen interdental papilla
Gingival recession
No stippling of the gingiva
Reduced scalloped outline
```
79
Medications causing gingival enlargement:
Anti-seizure - Phenytoin
Immunosuppressant - Cyclosporine A
Calcium channcel blocker - nifedipine
80
Necrotizing ulcerative periodontitis characteristics:
```
Loss of interdental papillae!
Plaque
Redness
Swelling
Bleeding
```
81
What induces necrotizing ulcerative periodontitis?
Malnutrition
Stress
Smoking
Bad OH
82
How can you treat necrotizing ulcerative periodontitis?
Antibiotics
Hydrogen peroxide mouthwash
debridement
83
Single periodontal abscess can be found when?
- incomplete calculus removal or forcing calculus deeper in the socket
- after perio surgery
- after perio tx
- after systemic antibiotic tx
- due to recurrent disease
- foreign body impaction
84
Multiple periodontal abscess occurs when?
Uncontrolled diabetes mellitus
| Impairment of immune system
85
What would you ask to see if the DB is controlled?
Hb1Ac levels -> less than 7
86
Tx for abscess:
acute:
Vs
chronic:
acute abscess:
- AB and then
- LA
- scaling and root planning
- OHI
chronic abscess:
- LA
- scaling and root planning
- drainage if needed
- OHI
87
Which is worse?
- Endo-perio lesion
- Perio-endo lesion
Perio-endo lesion bc it reaches the apex and infects the pulp - doubtful prognosis
Endo-perio:
Necrotic tooth
Accessory canals spread of infection
Deep Pocket depths
88
Non-surgical tx steps:
```
OHI
Plaque disclosing agents
Smoking sensation if needed
Anesthesia
Scaling and root planning
Re-evaluation (after 3w then 6w)
Check if surgery is needed
```
89
Major risk factor of periodontitis:
Smoking
90
First evaluation appointment steps after non-surgerical tx:
- Check plaque reduction with plaque disclosing tablets
- Do perio chat (PPD, furcation, plaque, mobility, BoP, recessions)
- OHI
91
Red complex bacteria:
P gingivalia
T forsythia
T denticola
92
common reasons of implant loss:
- excessive or premature loading
- > excess forces leading to osseointegration failure
- trauma from surgeries
- > inflammation leading to osseointegration failure
- cement retention
- > excess cement leading to overflood of bacteria etc
- dentist
- infection/contamination
93
When do we observe the majority of implant loss occurring and why?
before functional loading
- didn't follow the protocol
- iatrogenic factor
- soft bone
- no implant-bone contact
94
What is the min thickness of bone necessary to prevent bone dehiscence around an implant?
min 1 mm thickness of B plate
95
risk factors for implant loss:
- bone type IV
- smoking
- parafunctional habits
- radiation therapy
- occlusal loading
- history of periodontal disease
96
how would you treat a malpositioned implant?
if not visible: nothing
if visible: repeat - go minimally invasive as possible, augment soft tissue minimally, don't touch the crown, do a more apical flap and place soft graft, then pray otherwise refer
97
malpositioned implant =
= an implant placed in a position that creates restorative and biomechanical challenges
98
reasons for placing an implant with poor prosthetic angulation:
- bone deficiency
- GBR wasn’t performed
- no surgical guides
- lack of skill to make GBR
- not correct tx planning
99
complications of placing an implant with poor prosthetic angulation:
- prosthetic complications
- screw loosening
- decementation
- aesthetic problems
- difficulty in OH and biologic complications
100
how to prevent malpositioning of an implant:
- proper tx plan
- skills
- augmentation procedures with the use of biomaterials, autografts or allografts
101
Aa =
= aggregatibacter actinomycetemcomitans
