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Classic Literature > 34 - GBR > Flashcards

34 - GBR Flashcards

1
Q

Sinus and ridge augmentation implant survival

A

• Aghaloo 2007
○ Sinus survival for implants: 81-96%. Xenograft best, alloplast worst
Ridge augmentation survival for implants: 75-96%. GBR 95% w/ good long term studies, others are lacking good long term data.

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2
Q

Soft tissue complications

A

Lim 2018 - SR MA, soft tissue complications 16.5%. Of these, 35% membrane exposure and 35% soft tissue dehiscence. Resorbable vs non-resorbable membrane, no difference.

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3
Q

Membrane exposure complications

A

Garcia 2018 - SR MA, membrane exposure. 74% more ridge width gain and 27% more defect reduction for implants without membrane exposure.

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4
Q

Block graft complications

A

Chaushu 2010 - SR MA, block grafts. Membrane exposure 30%, associated with ~20% graft failure. Incision line opening 30%, associated w/ ~20% graft failure. 40% infection of grafted site

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5
Q

Decortication

A

Greenstein - animal studies, no evidence

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6
Q

2 horizontal ridge augmentation techniques

A

○ Sterio 2013 - Cancellous MCBA + bovine pericardium. 86% success w/ 2.6mm width gain and 66% graft resorption
Caldwell 2015 - Alloderm GBR + tacks + bone (Block graft from mandibular ramus ground up + FDBA or FDBA alone). 88% success w/ 3.2mm width gain and 14% graft resorption No difference between the two grafts

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7
Q

Titanium mesh ridge augmentation

A

Ricci 2013 - SR for titanium mesh. 98% success, graft type did not matter. 4.16mm horizontal gain. 22% mesh exposure, did not result in increased infection or decreased bone formation.

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8
Q

Block graft ridge augmentation

A

El-Nayef 2018 - SR MA, block graft better maintained volume of augmentation. Horizontal gain, 4mm for block and 2.5mm for GBR

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9
Q

Vertical ridge augmentation

A

Camps - Font 2016. MA, vertical augmentation vs short implants. No difference for implant or prosthetic failure. Vertical 44% complication rate, OR 8

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10
Q

Chin/iliac crest graft

A

Matsumoto 2012 - Chin/iliac crest graft. 4 months sufficient healing time. Histologically, woven bone + marrow spaces + osteoblasts on trabecular layer + Haversian systems present

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11
Q

Implant defects, best for augmentation

A

Schwarz 2010 - Only circumferential defect w/o dehiscence were favorably treated

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12
Q

Best predictor of sinus disease

A

Beaumont - No difference in age/gender/smoking status for sinus conditions. Significant relationship between history of symptoms and a positive diagnosis of sinus disease.

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13
Q

When is ENT referral needed?

A

Carmeli 2011 - >5mm irregular mucosal thickening, circumferential thickening, or complete mucosal thickening w/ high risk for ostium obstruction. Referral to ENT needed

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14
Q

ChP and membrane thickening

A

Phothikhun 2012 - Mucosal thickening 42% and mucosal cysts 16% of patients. Severe periodontitis patients (>50% bone loss) were 3X more likely to have mucosal thickening. Mucosal thickening not associated w/ PARL or RCT.

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15
Q

Who first introduced sinus lift?

A

Tatum

Boyne

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16
Q

Increased sinus pneumatization w/:

A

Sharan 2008 - Increased sinus pneumatization: Teeth surrounded by a superiorly curving sinus floor, tooth roots protruding into sinus cavity (CBCT), extraction of 2nd molars, and extraction of several adjacent posterior teeth or extraction of a tooth with missing adjacent tooth

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17
Q

Septa

A

○ Van Zyl 2009 - 69% patient prevalence, 56% sinus prevalence. Average height 6.2mm. 25% anterior, 51% middle, 24% posterior. Medial-lateral orientation w/ mesial slant
No significant difference between edentulous and dentate

18
Q

Vasculature

A

○ Rosano 2011 - Cadaver dissection, 100% anastomosis between alveolar antral artery and infraorbital artery.
Radiographically, bony canal seen 47% of the time. Lowest border of AAA may be adhered to sinus membrane. Use caution when not visualized radiographically and residual ridge is <3mm tall

19
Q

Buccopalatal distance

A

Avila 2010 - As bucco-palatal distance increases, the % vital bone formation after augmentation decreased. Allow more healing time in larger sinus cavities for additional bone formation. Vital bone based on BP distance:

20
Q

Palatonasal recess

A

Chan 2013 - Palatal wall + lateral nasal wall. High risk sites for perforation are PNR <15mm from alveolar crest and angulation <90 and are more common at premolars. Molar sites PNR more obtuse angles but likely closer to alveolar crest

21
Q

Membrane perforation. Thick or thin?

A

○ Monje 2016 - Thickness 1.17mm. Histologic 0.48mm, CBCT 1.3mm. Smoking, age, and periodontal status trend towards thicker membrane. Trend for more perforations w/ thicker membrane. Perforation 15%
Lum 2016 - Perforations occur more frequently in patients w/ minimal ridge height and thinner membranes. Thickness: Perforation 0.84mm, no perforation 2.6mm. Ridge height: Perforation 2.8mm, no perforation 4.2mm. Perforations 28%

22
Q

Membrane perforation and implant survival

A

De Almedia Ferreira - No difference in implant survival in augmented sines + perforation. Similar amounts of vital bone. 51% residual BioOss at 6 months

23
Q

Smoking

A

Peleg 2006 - Simultaneous implant placement, Stage 2 surgery 6-9 months later. Smoking decreased to 2-5 cigarettes/day 1 week prior, 0 cigarettes day prior and 10 days post-op. Failure rates not significant between smoking and non-smokers at 9 years.

24
Q

Membrane changes after lift

A

Makary 2015 - Transient thickening of sinus membrane at 1 week due to inflammatory reaction. Reaches baseline at 9 months. Physiological re-adaptation and increased ciliary action leads to thinner sinus membrane at 12 months

25
Q

Volume changes after lift

A

Shanbhag 2014 - SR MA, volumetric changes. 14-75% volume reduction at 6 months. Expect 20-30% volume reduction at 6 months using bone substitute or composite graft (autogenous/allograft)

26
Q

Crestal sinus lift - best scenario

A

Chen 2017 - 35% reduction in bone volume over 3 years w/ osteotome sinus lift. More stable w/ concave sinus floor w/ small intruding angle (angle between implant axis and tangent line of maxillary sinus floor) due to more native bone. More reduction w/ obtuse intruding angle and flat sinus floor

27
Q

Amount of crestal lift per vertical height

A

Sonoda 2017 - 6mm of vertical bone height can be achieved w/ a 0.3mL of bone graft. A ratio of vertical elevation height to buccopalatal or mesiodistal <0.8mm needed to avoid sinus membrane perforation AKA can’t have a tall peak of bone but need a wide bubble of bone.

28
Q

Crestal lift w/o graft

A

Si 2016 - Osteotome sinus floor elevation w/o bone graft. 2-3mm of lift remained stable over 9 years. Implant survival 90%

29
Q

BPPV

A

• Sammartino 2011 - Benign paroxysmal positional vertigo: Short term recurrent episodes of vertigo and nystagmus (involuntary eye movement). Incidence increases w/ age, females 2X.
○ Otoliths (calcium carbonate grains in inner ear) detached and float around in endolymph into the semicircular canals
○ Epley Maneuver
○ Sit upright, turn head to symptomatic side at 45 degree angle and hold for 20 seconds
○ Turn head 90 degrees to other side and hold for 20 seconds
○ Roll the body in the facing direction, pointing head/nose down and hold for 20 seconds
○ Return to sitting position and remain for 30 seconds
Repeat 3 times, patients w/ experience vertigo

30
Q

Ridge split ridge augmentation

A

El-Nayef 2015 - SR, 95-97% implant survival. Better horizontal bone gain w/ partial thickness flap and with addition of bone grafting materials. Mills - maxilla partial thickness, mandible full thickness

31
Q

Borg

A

70%/30% FDBA and DFDBA vs FDBA
dPTFE

36% vs 24% vital bone

32
Q

Eskow

A

Cortical vs cancellous FDBA + Collaplug
18-20 weeks
No difference
Greater cortical residual graft

33
Q

Demetter & Calahan

A

Cortical vs cancellous vs 50/50

No difference vital bone

34
Q

Wood

A

FDBA vs DFDBA + Collaplug

38% DFDBA
25% FDBA

35
Q

Iasella

A

FDBA/TCN/BioMend vs no ridge preservation
4-6 months

1.2 vs 2.6mm HZ loss
Gain buccal soft tissue

36
Q

Whetman

A

DFDBA 8-10 vs 18-20

47% vs 32% vital bone
Vital bone inversely related to % residual graft

37
Q

Nelson

A

70/30 8-10 vs 18-20 weeks

40% vs 18% vital bone

38
Q

Lai

A

BioOss vs Porcine ZCore

No difference

39
Q

Walker

A

Molars

FDBA + dPTFE vs control

No difference width, better for height

40
Q

Al-Harthi

A

FDBA + Collaplug

41
Q

Duong

A

Histo from Walker and Al-Harthi

Control 37%

Classic Literature (38 decks)

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