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implant 2 > 2/27 - grafting > Flashcards

2/27 - grafting Flashcards

1
Q

complications of block graft

A

dehiscence

fracture of the graft

fracture of mandible

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2
Q

distraction osteogenesis

A

making bone longer

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3
Q

guided bone regeneration

A

bone formation only

want bone formation before soft tssue

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4
Q

collagen membrane is resorbable?

A

yes

vs titanium

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5
Q

clinical handeling better in

A

resorbable ones

- bioresorbable

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6
Q

sinus augmentation

before - what do need to check

A

history of sinusitis
post nasal ldrip
sinus pathology
CBCT evaluation of the sinus

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7
Q

residual height of bone over 5 with sinus lift?

A
  1. simultaneous
  2. external sinus life
    6-9months healing
    implant placement
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8
Q

residual height of bone over 5 with sinus lift?

A
  1. simultaneous
  2. external sinus life
    6-9months healing
    implant placement
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9
Q

pedicle graft ideal for

A

soft tissue height augmentation

idel in cases of decreased vascularity of the recipient site

in cases where bone and soft tissue grafting is planned

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10
Q

shallow plat

vs deep

A

artery closer or farther from CEJ of the teeth

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11
Q

bone grafts are always

A

prosthetically driven

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12
Q

bone graft healing

A

non vascularized bone grafts heal through a sequence of events

bone grafts initially undergo partial necrosis - osteocyte dath

followed by an inflammatory stage - existing bone is replaced with new bone by osteoblasts brught n by invading vessels

creeping substitution – the slow process of vessel invasion and bony replacement

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13
Q

creeping substitution

A

the slow process of vessel invasion and bony replacement

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14
Q

revascularization in cancellous graft

A

rapidly and completely due to its open architecture that allows easy invasion of blood vessels

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15
Q

revascularization in cortical graft

A

slowly and incompletely due to its dense lamellar structure

vessels must penetrate along haversan and volkmans canals

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16
Q

inlay vs onlay graft

A

interposition (inlay) grafts maintained volume and persevered significantly better than onlay grafts
- onlay only get blood from underneath

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17
Q

embriological origin of grafts

A

those from calvarial and facial sites have SUPERIOR VOLUMETRIC maintenance and survivial over the grafts from rib, tibia, or iliac crest

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18
Q

wolf’s law

A

normal skeletal bone has the ability to adapt to the physical stresses through the process of remodeling

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19
Q

rigid fixation

A

results in PRIMARY BONE HEALING
- effects of this on bone grafts are results in bone graft survivial, greater bony union, increase d primary bone healing and rapid revascularization by virtue of graft IMMOBILITY

20
Q

recipient site factors

A

grafts placed in an avascular bed do NOT survive well, other factors at the recipient site include prior irriadiation, infection, and tissue scaring

21
Q

best grafts are __ and __ because

A

cancellous for apid revacularixation and cortical to resist resorption

22
Q

example of block grafts

A 
chin
ramus
body
hip
calvarium
23
Q

keys to the graft

A

● You want rigid fixation
● Want good adaption to the graft
● PASSIVE TISSUE CLOSURE
● AND FOR TO SIX MONTH healing

24
Q

complications of block grafts

A

dehiscence
failure of the graft
fracture of the mandible

25
Q

basic characteristics of barrier membrane

A 
biocompatibility 
cell oclussion 
tissue integration 
spacce making and space 
maintenance 
clinical handeling 
limited suceptibilty to complications
26
Q

membranes that space making and space maintenance

A

capacity to resist collapse under in vivo conditions and therefore to create and maintain sufficient volume during the healing process

COLLAGEN AND TITANIUM REINFORCED

27
Q

NON resorbable membrane

A

expanded PTFE

polytetrafluoroethylene

rigidity achieved with fluorinated ethylene propylene

28
Q

complications in GBR

A

class I - class IV

29
Q

class I complication in GBR

A

small exposure less than 3 mm without purulent discharge

30
Q

class II complication in GBR

A

large exposure more than 3 mm without purulent discharge

31
Q

class III complication in GBR

A

membrane exposure with purulent discharge

32
Q

class IV complication in GBR

A

abscess formation without membrane exposure

33
Q

approahes to sinus augmentation

A

crestal approach
- internal approach

lateral window approach

34
Q

info to gather for sinus augmentation

A

history of sinusitis

post nasal drip?

sinus pathology?

CBCT evaluation of the sinus

35
Q

one or two stage sinus lift ?

waiting period?

A

4-5 mm of bone height is a pre-requisite for one stage implant placement and sinus lift

less than 5 mm residual height of bone = NO immediate

wait 6-9 months

36
Q

soft tissue grafts

A

subepithelial CT graft

epithelial CT graft

combination

37
Q

techniwues for soft tissue grafts

A

tunnel

free graft

pedicle graft

38
Q

indications for pedicled graft

A

ideal for soft tissue HEIGHT augmentation

ideal in cases of decreased vascularity of the recipient site
- stays attached to the blood supply

in cases where bone and soft tissue grafting planned

39
Q

want to increase thickness of attached use?

A

subepithelial CT grafft

40
Q

epithelial CT graft

A

must be split thickness flaps

immobilization is key

41
Q

benefits of talking to patient about smoking

A

just three minutes could make a successful case

if stop for 8 weeks post op can reach success rates of non smokers

42
Q

smoking is ___ indication

A

relative contraindicication

43
Q

creeping substitution

A

osteoconduction
allows for osteioinduction

Once the graft has undergone some amount of necrosis and resorption, it then acts as a scaffold for neoangiogenesis to occur within the graft.
This vessel penetration of the graft allows
osteogenic cells to invade the graft and create new bone formation. This series of
events is termed osteoconduction (creeping substitution)

44
Q

osteoinduction

A

During the proliferative
phase of the graft take, certain molecules induce significant amounts of mitosis of
osteoprogenitor cells and then direct these cells to be committed into differentiated
osteoblasts. This phenomenon is called osteoinduction, and of these molecules
bone morphogenic protein (BMP) is one that has been extensively studied and
has been shown to have significant impact on new bone formation, particularly
BMP-2, BMP-4, and BMP-7

45
Q

three directions to pay attentiont to with implants

A

mesiodistal

apico-coronal

orofacial dimensions

implant 2 (11 decks)

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