T Flashcards
(126 cards)
1
Q
What are the three major groups of dental implants?
A
Sub periosteal, transosteal, endosteal.
2
Q
Subperiosteal
A
On bone. Designed primarily to anchor dentures in the completely edentulous pt. Metal framework that attaches on top of the jawbone, but underneath the gingiva.
3
Q
Transosteal
A
Through bone. Designed to anchor dentures in the completely edentulous pt. Metal pin or u-shaped frame that passes through the jaw bone and gume tissue into the mouth. Made of titanium.
4
Q
Endosteal
A
In bone. Placed within alveolar or basal bone. Partially or completely edentulous pts.
5
Q
What is the type of implants that we use today?
A
Endosteal
6
Q
What was the main reason previous subperiosteal implants failed?
A
Made of chrome-colbalt or similar alloys that were subject to corrosion (release of metallic ions into tissue). Lead to acute and chronic inflammatory responses resulting in encapsulation of the implant with fibrous connective tissue. Epithelial migration, development of extended peri-implant pockets led to exposure of the implant framework and its eventual removal.
7
Q
What is another name for transosteal implants?
A
Staple Implants.
8
Q
What were blade implants used for?
A
Narrow ridges. Required the support of natural teeth.
9
Q
What form of transosteal implants do we use today?
A
Root form!
10
Q
What is Osseointegration?
A
Direct structural and functional connection between live bone and the surface of an implant under load.
Upon placement, bone is deposited on the surface of the implant, firmly anchoring it to the surrounding bone. There is no fibrous CT interface between the implant and bone, thus no epithelial migration.
11
Q
Who discovered Osseointegration?
A
P. I. Branemark in the 1960s.
12
Q
What makes titanium unique?
A
Spontaneously forms a coating of titanium dioxide. Titanium dioxide is stable, biologically intert and promotes the deposition of a mineralized bone matrix on its surface. Easy to divide into useful shapes which maintain their strength. Strong. Resistant to corrosion. Light weight
13
Q
What are some designs of the titanium implant?
A
Blades, cylinder, screw, mini implants.
14
Q
Which osseointegrates faster? MX or MN?
A
MN!
15
Q
How long is osseointegration for the MN?
A
6-8 weeks. (1.5-2 months)
16
Q
How long is osseointegration of the MX?
A
2-6 months.
17
Q
What is the quality of bone classification system based upon?
A
Based on its radiographic appearance and resistance at drilling.
18
Q
Type 1 bone
A
Comparable to oak wood, which is very hard and dense. Found in anterior MN.
19
Q
Type 2 bone
A
Comparable to pinewood. Not as hard as type 1. Found in posterior MN.
20
Q
Type 3 bone
A
Comparable to basala wood. Less dense than type 2. Found in anterior MX.
21
Q
Type 4 bone
A
Comparable to styrofoam. Found in posterior MX.
22
Q
How is survival rates affected with varying bone density?
A
Not a huge difference until type 4. ~97% to ~88%
23
Q
What is the implant procedure sequence?
A
Consultation and tx plan. Surgical placement. Final impressions. Fabrication of prosthesis. Hygiene maintenance.
24
Q
When is the radiographic stent fabricated?
A
During the consultation and dental evaluation.
25
When are preliminary impressions taken?
During the consultation and dental evaluation.
26
When do you do the diagnostic wax up?
Following the dental consultation and evaluation.
27
What is the radiographic and surgical template?
A guide used to assist on treatment planning and proper surgical placement and angulation of dental implants.
28
What do most implant complications arise from?
Too buccal of a position.
29
How is the development of peri-implantitis similar to periodontitis?
Implant provides a surface for attachment and microbial colonization.
30
Does a hx of periodontitis increase the long-term risk of peri-implantitis?
Yes!
31
What is peri-implant mucositis?
Presence of imflammation in the mucosa of an implant with no signs of loss of supporting bone.
32
What is the prevalence of peri-implantitis mucositis?
80% of patients!
33
What is peri-implantitis?
Inflammation in the mucosa in addition to loss of supporting bone.
34
What is the prevalence of peri-implantitis?
28-56% of patients.
35
What makes a pt. high risk for peri-implantitis?
Lack of SPT (Supportive Periodontal Therapy), systemic conditions and environmental factors.
36
What preventative measures can you take before implant placement?
Treat periodontal disease before hand. Shorter recalls and proper treatment planning.
37
What are preventative measures you can take after placement?
Prevent or minimize recurrence and progression of disease. Prevent or reduce the incidence of tooth loss. Increase the probability and treating in a timely manner, other conditions in the mouth. Update hx. intra and extraoral assesment, check mucosa around implant, occlusion and integrity of restoration. Radiographs as needed.
38
Should you probe a healthy implant?
Yes! But, steel probes can abrade the implant surface. You should probe approximately 2-3 times a year.
39
How often should you take radiographs?
Initial placement, at 3-4 months to verify osseointegration, at time of restoration and as needed based on signs and symptoms of peri-implantitis.
40
What should be the frequency of maintenance?
Most studies recommend 3 months, based on recolonization and maintaining the stability of the clinical parameters. Maintenance should be tailored to risk assessment.
41
What are the features of periimplant mucositis?
Signs of gingival inflammation, deeper probing depths, NO radiographic evidence of bone loss.
42
What are the clinical implications of periimplant mucositis?
It is the obvious precursor of peri-implantitis. (thing gingivitis and periodontitis). Treat for prevention!
43
What are the clinical features of peri-implantitis?
Bleeding, deeper probing depths, suppuration, bone loss, mobility.
44
What is the CIST protocol?
Cumulative, Interceptive, Supportive, Therapy.
45
How do we treat peri implantitis?
Mechanical debridement, antiseptics, abx, surgical procedures, explanation.
46
Is it beneficial to use antiseptics?
According to a 2012 study, no. But, the studies were underpowered and there may be some utility.
47
Do abx work to treat peri-implantitis? What is the abx of choice?
Significan reduction with systemic abx. Amoxicillin and metronidazole.
48
Autograft
A graft transferred from a donor site to a recipient site within the same individual.(illiac crest)
49
Allograft
A graft from a donor species that is the same as the recipient species (cadaver)
50
Xenograft
A graft originally harvested from a donor species which is different than the recipient species. (cow or horse)
51
Alloplast
An inorganic material used as a bone substitute.
52
What are the 3 qualities of a bone graft?
Osteogenic, osteoinductive, osteoconductive.
53
Osteogenic
Quality of an autogenous graft which enables it to lead to bone formation via transplant of viable osteoblasts within the graft.
54
Osteoinductive
Quality of a biologic adjunct, growth factor or graft material which leads to differentiation of osteoprogenitor cells into osteoblasts.
55
Osteoconductive
Quality of a graft material which allows it to serve as a scaffold for deposition of osteoid.
56
Why do we graft?
To prevent bone loss and to gain bone.
57
How much of the ridge height and ridge is lost following extractions?
40% of height and 60% of width only 6 months post extraction. With most being lost in the first 3 months.
58
When do you graft?
At the time of extraction. When a site has bone loss.
59
Class 1 Seibert Classification
Bucco-lingual loss of tissue with normal ridge height in an apico-coronal dimension.
60
Class 2 Seibert
Apico-coronal loss of tissue with normal ridge width in a bucco-lingual dimension
61
Class 3 Seibert
Combination of bucco-lingual and apico-coronal loss of tissue resulting in loss of normal height and width.
62
Is grafting effective?
Yes! Same long term success when placed in grafted vs. native bone.
63
What are the different types of ways to graft?
Socket grafting, guided bone regeneration, sinus augmentation, ridge split.
64
Guided bone regeneration-particulate graft
???
65
Guided Bone regeneration-block graft
???
66
How long should we wait before placing implants with socket graft?
3-6 months
67
How long should we wait before placing implants with Guided Bone Regeneration
4-6 months
68
How long should we wait before placing implants following sinus augmentation?
5-6 months
69
How long after placement should you wait before restoring?
Generally 2-6 months. It depends on the location in the mouth, type of implant, health of patient, and if grafting was performed.
70
Screw vs. cement aesthetics
Cement is better
71
Screw vs. cement retrievability
Screw is better
72
screw vs. cement retention
Both are good.
73
Screw vs. cement passivity
Cement is better.
74
Screw vs. cement occlusion
:) and :(?
75
Screw vs. cement long term treatment planning
Screw is better.
76
What are the 3 types of prefabricated abutments?
Locator abutments (for dentures). Straight abutments (basic restoration), Angle abutments (hard to restore)
77
What type of implant restoration do you use with prefab abutments?
Cement retained.
78
What are the two types of of custom abutments?
UCLA (Gold or castable) Cad Cam (Ti, Zr)
79
How much torque do you use for zimmer?
30 N/cm
80
How much torque do you use for Straumann?
35 N/cm
81
What is compact's bone response to implant placement?
Bleeding, necrosis, resorption, new bone formation.
82
What is the healing response dependent upon?
Surface chemistry, energy, topography and contaminants. Surgical trauma (don't get too hot!), exact osteotomy, soft tissue management.
83
What happens in the initial contact of the healing response?
Plasma proteins coat the surface and there is clot formation. Inflammation and peri-implant bone necrosis (.5-1 mm) occurs followed by vascular ingrowth and formation of a collagen rich matrix and osteoblast synthesis of a bone matrix.
84
What happens in the remodeling phase of the healing response?
Osteoclast and osteoblast remodeling of initial bone matrix resulting in mature haversian bone system in contact with the implant surface. OSTEOINTEGRATION BITCHES.
85
What is primary integration?
A nonmobile contact between the osteotomy and implant. Achieved through macro-retentive features such as threads, solid body press fit, sintered beads, etc.
86
What is secondary integration?
Osteoconduction and osteoinduction. Enhancing the in-migration of bone from the surface of the osteotomy and biologically manipulation of the types of cells that grow onto the implant surface.
87
What are the implant's micro-retentive features?
Machined and coated surfaces. Increases secondary integration. Accomplished through sand or grit blasting followed by acid etching.
88
What is the transmucosal attachment?
Junctional epithelium that is approximately 2 mm long and attached to the implant/abutment complex with hemidesmosomes. CT zone that integrates and run parallel to the implant .
89
What type of microbes are found in peri-implant mucositis and peri-implantitis?
gram - anaerobic
90
What are the 3 sizes of implants and where are they used?
3.3 mm, 4.1 mm and 4.8 mm. Anteriors, premolars and MX centrals, and molars.
91
What's the difference between 1 stage and 2 stage surgery?
Whether or not you leave the implant covered or uncovered by tissue.
92
What do you need for immediate placement?
Absence of active infection, bony defects and gingival recession. Good position of the tooth and atraumatic extraction. Good primary stability and lingual placement of the implant. It needs to be 1 mm below the crest of the bone and you graft the jumping distance.
93
What does MD position determine?
Papilla morphology.
94
What does BL position determine?
Crown dimensions.
95
What does Apico-Coronal position determine?
Emergence profile.
96
What is the magic number between implants?
3 mm?
97
What is the minimum MD dimension for 2 standard 4 mm diameter implants?
1.5 mm + 4 mm + 3 mm + 4 mm + 1.5 mm = 14 mm
98
How much buccal and lingual bone do you need?
1 mm of thickness!
99
What is the magic number for Crown Height Space?
7-8 mm
100
What does CHS measure?
From the occlusal plane to the crest of the bone.
101
What is the normal distance between the platform and the CEJ of the restored tooth?
2 mm.
102
What is included in the total restoration's height?
Length of implant until platform, platform to CEJ, length of clinical crown.
103
What level do you place scalloped implants.
Midline at bone level.
104
What are the components of an implant?
Implants/fixtures, impression copings, analogs/replicas, abutments, connection armamentaria.
105
Machined vs. enhanced surface
??
106
What materials can implants be made out of?
Titanium, zirconium, tantalum, titanium-zirconia. MOSTLY ZIRCONIUM.
107
What materials can implants be made out of?
Titanium, zirconium, tantalum, titanium-zirconia. MOSTLY ZIRCONIUM.
108
Tissue level vs. Bone level implants
Bone level, the platform is at bone. Good for esthetics, bad because microgap is right near the bone. Tissue level, platform is at tissue. Bad for esthetics good because microgap is away from bone.
109
What is an impression coping?
Device that registers the position of the dental implant or abutment relative to the adjacent structures. Indexed to assure reproducible 3D location.
110
Fixture Level Impression Coping: Where does it attach? Radiograph? Open or closed?
Impression is made directly to the fixture. X-ray is needed to verify seating. Can be open or closed tray.
111
Describe open tray technique?
Registers both position of the fixture and the orientation of the fixture hex. Becomes locked into the final impression, that's why an open tray is needed. After the tray is removed, a fixture analog is connected and the model is poured. High precision impression.
112
Describe Closed tray technique
No additional preparation of the tray. Still a high precision impression.
113
What's the difference between closed tray and open tray impression coping?
Open tray has undercuts, closed tray is tapered.
114
Which is more accurate, splinted vs. nonsplinted?
Splinted for both partially and completely edentulous.
115
Which is more accurate between closed tray and open tray?
Open! No difference for partially edentulous.
116
What happens to the accuracy of implant impressions if the angulation is greater than 20 degrees.
It's affected!
117
Fixture Analogs/Replicas
Allows creation of a model with the same characteristics as a given intraoral fixture. They have identical internal connection, but not the same body.
118
How do you prevent ingestion/aspiration?
PREVENTION. Patient postitioning, placement of gauze screen, instruments fastened with dental floss. Have a plan ready.
119
What is the difference between implant supported and implant retained?
Supported: All load applied to prosthesis is on the implants. They provide full support, retention and stability.
Retained: Load is shared between implants and supporting tissues. They provide retention only.
120
Is a 2-implant overdenture retained or supported?
Implant retained with implant and tissue support
121
Is a 4 implant overdenture retained or supported?
Implant retained and depending on location of implants and AP spread can be either implant supported or implant/tissue supported.
122
Is a 6 or more overdenture retained or supported?
Implant retained and supported.
123
Indications for 2 implant overdentures
Elderly, fully edentulous people who don't like their current dentures.
124
Contraindications for 2 implant overdentures
Not enough bone (less than 5 mm of thickness and 7 mm height. Just don't like dentures. Medical conditions. AGE IS NOT A CONTRAINDICATION
125
Does splinting affect clinical success in edentulous anterior mn?
No!
126
Bars vs. Locators
Bars: Adds to splinting effect, less maintenance over time and can correct off angled implant problems.
Locators: Limited interocclusal space. Less technique sensitive.
