The surgical aspects of implant treatment

Question 1

What preoperative preparations do we need to make before implant surgery

Answer 1

1. Proper diagnostics
2. Treatment plan
   3Pt explanation, warnings and informed consent

Question 2

How do we carry out asepsis of the implant site

Answer 2

1. Chlorohexidine mouth rinse pre op
2. Skin preperation
3. Isolation of surgical field with barrier draping
4. Protection of patient and staff from cross infection

Question 3

What are the stages of traditional implant surgery 1st stage

Answer 3

1. Asepsis
2. LA
3. Incision
4. Flap reflection
5. Bone preparation
6. Positional guide
7. Enlarging osteotomy site
8. Placement, torque and primary stability
9. Cover screw placement, wound closure and temporisation

Question 4

What do we mean by bone preparation

Answer 4

Getting through the soft tissue remnants to the bone

Cresting a flatten or scallop ridge crest

Question 5

Talk through atraumatic implant site preparation

Answer 5

1. Low speeds/ high torque
2. Sharp graduated drills
3. Efficient cooling/ evacuation of debris

Question 6

What can happen if don’t have adequate cooling during bone preparation

Answer 6

If temperature reaches above 47 degrees fro 1 min bone necrosis will occur

Question 7

What are the 4 different bone types called

Answer 7

I
II
III
IV

Question 8

Describe bone quality I

Answer 8

Homogenous cortical bone

Question 9

Describe bone quality II

Answer 9

Thick cortical bone with marrow centre

Question 10

Describe bone quality III

Answer 10

Thin cortical bone with dense trabecular bone of good strength

Question 11

Describe bone quality IV

Answer 11

Very thin cortical bone with low density trabecular bone of poor strength

Question 12

Name the 3 positions we need to consider when placing our implant

Answer 12

1. Mesio distal
2. bucco palatally
3. Apico coronally

Question 13

What post operative considerations need to be made after implant surgery

Answer 13

1. Avoid disturbing the surgical site
2. Avoid alcohol, smoking and vigorous exercise
3. Antibiotics
4. Analgesics
5. Cholorhexidine mouth rinse
6. Ice pack
7. Keep wel hydrated
8. Balanced soft diet

Question 14

After the first stage of implanted surgery is completed what do we wait for

Answer 14

For the bone and implant to integrate

Question 15

Talk through the steps of the 2nd stage of implant surgery

Answer 15

1. Simple crest incisor
2. Reflection of soft tissues
3. Removal of cover screw
4. Check bone
5. Placement of healing abutment
6. Soft tissue sculpting
7. Placement of sutures
8. Allow soft toss healing for 4 weeks

Question 16

If we find soft tissue is lacking interdentally between multiple implants what can we do

Answer 16

Implant exposure using rotation finger flaps

Question 17

what are rotational finger flaps called

Answer 17

Palacci flaps

Question 18

How do we create palace flaps

Answer 18

1. Create a crystal incision
2. Reflect flap to buccal
3. Connect healing abutments
4. Semi lunar incisors from distal of implant
5. Rotate mini finger flaps medial into internal space and suture

Question 19

What do we space on the implant after the second stage

Answer 19

A provisional crown fro 3 months to allow soft tissue remodelling

Question 20

What do we mean by immediate placement of implants

Answer 20

Implants placed in to extraction sockets

Question 21

What do we mean by delayed/ early placement of implants

Answer 21

Implants placed in to extraction sockets 6-8 weeks post extraction

Question 22

What do we mean by delayed/ late placement of implants

Answer 22

Implant placed more than 3 months post extraction

Question 23

What considerations do we need to make before immediate placement of implants

Answer 23

1. Bone quality and quantity
2. Integrity of buccal plate
3. Implant to bone gap
4. Primary stability
5. Infection
6. Soft tissue biotype
7. Temporisation

Question 24

How do we carry out immediate implant placement

Answer 24

1. Careful removal of tooth
2. Assess bone
3. Use pilot drill to establish orientation of implant
4. Protection of buccal plate of bone
5. Prepare site Using direction indicator and surgical guide
6. Implant placement
7. Graft material between implant and socket wall
8. Placement of healing abutment

Question 25

How do we carry out delayed immediate implant placement

Answer 25

1. Extract teeth 2. Soft tissue healing over 6 weeks 3. Flap reflection 4. Contour down bone 5. Implant placement with surgical guide 6.

Question 26

List the different techniques we can use to augment deficient ridges

Answer 26

1. Ridge expansion 2. Guided bone regeneration 3. Block only grafts 4. Maxillary sinus grafts 5. Combination procedures

Question 27

What is ridge expansion

Answer 27

mechanically pushing out the buccal plate of bone to create space for an implant rather than drilling a hole for the implant

Question 28

How do we carry out guided bone regeneration

Answer 28

1. use a choral to remove bone chips from surrounding bone 2. Decorticate the bone a chisel or bur 3. Place bone chips over the implant site and adjacent area to augment deficient site 4. Biomaterials can be used further augment the site and protect autogenous bone chips for resorption 5. Collagen membrane is placed over the area

Question 29

Why is a collagen membrane placed over there area following guided bone regernation

Answer 29

To protect the soft tissues in growth

Question 30

Where can ewe harvest block bone cells fro a block only graft

Answer 30

The mental region

Question 31

Name a technique we can use to carry out maxillary sinus graft

Answer 31

Lateral windows technique

Question 32

Talk though the lateral window technique

Answer 32

1. Use large particles of bovine bone granules mixed with bone chips and blood to graft the sinus floor 2. Porcine collagen membrane is placed over the lateral window and stabilised with titanium tacks prior to closure 3. 6 months needed for healing before implant placed