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implant 2 > 2/20 - implant surgery > Flashcards

2/20 - implant surgery Flashcards

1
Q

medical history - does age matter

A

if amount of bone - is there no

but if person is growing!!! –> then this is something to consider

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2
Q

medical history to consider

A
  1. age
  2. immunosupression
    - active ones like on RA
  3. osteoporosis
    - not statistically significant
  4. diabetes
    - no statisticlly difference
  5. radiation
    - has an effect on success rate
  6. smoking
    - this is a big one – big risk factor for implant ffailure
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3
Q

medical history to consider

A
  1. age
  2. immunosupression
    - active ones like on RA
  3. osteoporosis
    - not statistically significant
  4. diabetes
    - no statisticlly difference
  5. radiation
    - has an effect on success rate
  6. smoking
    - this is a big one – big risk factor for implant ffailure
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4
Q

younger age with implant

A

no - dont do it

can become anklyosis and can sink in

esepecillay in the anterior maxillary region

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5
Q

implant surfaces with smoker and non smoker

A

smoker – decreased failure rate by using rough surfaced vs machine surfaces

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6
Q

anatomical location worse in smokers where

A

in maxilla

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7
Q

dose effect of smoking with implants

A

more than 10 years or more than 10 cigarettes a day

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8
Q

grafting in smokers

A

incidence in failure is higher risk

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9
Q

gingival biotype

A

thick or thin

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10
Q

thick bio-type

A

square teeth
contact point more apical
flat gingival architecture

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11
Q

thin bio-type

A

triangular or oval
contact point more coronal
scalloped gingval tissue
thin gingival tissue

also refelcts the bone underneath
- like thinner plates and fenestrations

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12
Q

interocclusal distance in cement retained / screw retained

A

posterior 7-8
anterior 9-10

screw retained minimum – 5-6

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13
Q

interocclusal for bar supported over denture

A

12 mm

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14
Q

room for hybrid - interocclusal space

A

15-18 mm

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15
Q

inter-occlusal space evaluation

A

have to do it on articulaotr to know dimensions

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16
Q

pattern of bone loss what is hard to build

A

hard to build bone verticall

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17
Q

pattern of bone loss dimensions

A

360 around
vertical 1.2-2
horizontal 1.34-1.4!!!!

circumferential - 360 degrees around the implant

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18
Q

dentla hisotry that is important

A

hx of periodonttiis - results in higher chances of peri implantitis and marginal bone loss is higher

if history of previous implant / grafting failure

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19
Q

dose effect of smoking that is important to consider

A

increased in more than 10 cigs a day or 10 + years of smoking

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20
Q

interocclusal space needed for cement retained in posteiro and anterio

A

posterior 7-8

anterior 9-10

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21
Q

interocclusal space needed for screw retained in posteiro and anterio

A

minimum is 5-6 mm

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22
Q

space needed for implant supported overdenture

A

12 mm

need to establish VDP - then mount and measure to soft tissue

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23
Q

bony anatomy of alveolar crest class I, II, III?

A

I - horizzontal loss = easiest to correct

class II - vetical harder

class III = both and hardest

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24
Q

implications of thicker gingival architecture

A

square teeth and contact point more apical

flatter gingival architecture with likely thick buccal plate and miniml fenestrations / dehiscence

25
Q

implications of thinner gingival architecture

A

triangle teeth with contact more coronal

scalloped

gignival tissue - mroe likely to end up with recession and thinner buccal plate and more fenestrations / dihiscences

26
Q
  • magnification rate of
    PA?
    Pano?
    CBCT?
A

PA = 14%

Pano =23.5%

CBCT = 18% (least = ideal)

27
Q

mental foramen? anterior loop?

A

anterior loop 28% on pano and 34% on CT scan

3mm from foramen and 2 mm anteior to it so 5 MM TOGETHER

28
Q

distance to keep from IAN

A

2 mm

29
Q

distnace to buccal plate?
lingual?
nasal cavity?

A

buccal = 2 mm

lingual = mm

nasal = 1 mm

30
Q

Pattern of Bone Loss Around Implants

A

bio width
- similar to this

o 1.3-1.4mm horizontal
o 1.2-2mm vertically
o Circumferential around implant

31
Q

less than 1 mm b/w implant and tooth what happens

A

more bone loss

average of 2.2 mm vs 1.2 (normal average loss)

32
Q

inter implant distance

A

• Horizontal loss is around 1.34 to 1.4mm in dimension
• Average vertical bone loss in between two adjacent implants
o Inter-implant distance <3mm
 Vertical bone loss = 1.04mm
o Inter-implant distance > 3mm
 Vertical bone loss = 0.45mm

33
Q

contraindiation for implant surgery?

A

ONLY THOSE
WITH BISPHOSPHANATES FOR CANCER DIAGNOISS IS THE ONLY ABSOLUTE CONTRAINDICATION FOR IMPLANT PLACEMENT
AS LONG AS CONDITION IS UNDER CONTROL

osteoporosis, diabetes, radiation not contraindicated but MUST BE CONTROLLED

34
Q

You get more remodeling and more resorption in the bone?

A

in a thin biotype in

35
Q

interocclusal space needed for hybrid

A

15-18 mm

36
Q

one of worst thing can do for esthetics

A

place the implant too buccal

37
Q

use of antiobioics?

A

less failure rates if used PRE-OPERATIVELY

38
Q

established principles for implant success

A
  • Primary stability
  • Countersink below the crest of bone
  • LONG submerged healing period (3-6mo)
  • Maintenance of minimally loaded implant for 3-6mo
39
Q

weaket point in stability vs time?

A

3 weeks out

40
Q

stability vs time?

A

• With immediate implant, we have mechanical stability at first
• Weakest point is 3 weeks out
o Want to load implant immediately, or wait for healing
o We are losing primary stability at this point and there is not a lot of osseointegration
 OLD BONE = primary stability
 NEW BONE = secondary stability

41
Q

How important is surgical experience?

A
  • <50 implants placed = 5.9% failure rate

* >50 implants placed = 2.4% failure rate

42
Q

pre op abx

A
  • Twice failure rate without
  • No abxs = 4%
  • Abx, any type and dose = 1.5%
  • Abx (AHA) = 1.4%
43
Q

pre op CHX?

A
  • No CHX = 8.7% infection
  • CHX = 4.1% infection
  • Infection = 12% fail
  • No infection = 2% failure
44
Q

in order to reduce bone injury - maintain__

A

maintain as much vital bone in contract with implant by reducing thermal / mechanial trauma

45
Q

do not exceed what torque

A

do not exceed 60 NCm torque – increases microdamage to bone

46
Q

drill speed at

A

800-1200 RPM
with copious irrigation

pre tap in dense bone

use 35 NCM

47
Q

temp which bone cell death could occur

A

40 C at 7 minutes and 1 minute at 47 celcius

48
Q

pre op antibiotic

A

a. Amox 1-2g before, 500mg PO 3x/day for 10d

b. Clindamcyin 600mg before procedure then 3x/day for 10d (if cant take amox)

49
Q

CHX rinse how long after

A

10 days

also b4 too

50
Q

implant mm from example

A
  1. 5
  2. 3
  3. 0
  4. 0
51
Q

maxillary over dentures minimum of

mandibular over denture miniimum of

A

4 implants

mandibular = minimum of 2 implants

52
Q

options after extraction of a tooth

A

immediate implant

ridge preseration

spontaneous healing

53
Q

marginal section importance

A

critical for proper esthetics

54
Q

spontaneous healing vvs bio oss

A

spontaneous heal lost 30% of surface area of the marginal portion vs bio oss collagen grafted sites gained 1.7% in surface area at the marginal portion

55
Q

immediate implant placment does not what

A

placing an implant immediately following extraction does NOT maintain the original height and widdth of the socket which are always subject to remodeling

56
Q

criteria to place immediate

A
  • Intact buccal plate (thick is ideal)
  • No more than 3mm probing on facial
  • Ideal soft tissue
57
Q

shape of defect

A
  • Narrow is better! Healing comes from the side
  • Better access
  • V shaped defect, possible to place immediate implant with GBR  recession of 0.5mm or more, 8.3% change
  • U and UU shaped  NO immediate placement, 42.8% and 100% risk of recession >0.5mm
58
Q

bone morphology for immediate placement

A 
•	Bone apical to root tip 
o	Need to have enough initial stability or implant will fail 
o	Want 4mm apical to implant 
•	Palatal bone morphology 
•	Implant shape 
o	Tapered = more stability

implant 2 (11 decks)

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