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23 Implants > 8/16 - Prosthetically-Driven Implant Tx Planning, Denture Duplication, Central Incisor Wax-Up > Flashcards

8/16 - Prosthetically-Driven Implant Tx Planning, Denture Duplication, Central Incisor Wax-Up Flashcards

1
Q

during pre-treatment evaluation, you must identify what?

A
  1. patient chief concern
  2. treatment expectations
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2
Q

when do you identify prosthetic needs of patient

A

during comprehensive evaluation

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3
Q

what is done during comprehensive examination

A
  1. systemic evaluation
  2. clinical examination
  3. radiographic examination
  4. esthetic examination
  5. extra/intraoral photographs
  6. mounted diagnostic casts
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4
Q

what exams/assessments are done during clinical examination

A
  1. soft and hard tissue exam
  2. odontogram
  3. periodontal assessment
  4. caries risk assessment
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5
Q

what is the goal of a treatment plan

A

establish a prosthetic need

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6
Q

why obtain a panoramic radiograph?

A

allows you to look at the case as a whole, not tooth by tooth

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7
Q

examples of risk factors that may decrease success of implants

A
  1. medical hx
  2. perio/endo
  3. parafunction
  4. occlusion
  5. bone resorption
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8
Q

what must be done before considering any implant therapy

A

treat all pathologic conditions

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9
Q

implants are an ___ procedure

A

elective

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10
Q

implant procedures are based on patient’s ability to:

A
  1. withstand procedure
  2. heal
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11
Q

what are examples that prevent patient from completely healing from procedure

A

smoking, diabetes, chronic kidney disease, bisphosphonate therapy, radiation therapy

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12
Q

without risk factors, what is the success rate for implants at 5 years and 10 years?

A

5 years: 90-98%
10 years: 89-95%

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13
Q

why does smoking lead to increase failure of implant therapy

A

it impairs neutrophils, alters blood flow, and diminishes O2 perfusion

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14
Q

non-smokers have a ___ survival rate compared to smokers

A

3% higher

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15
Q

there is a higher failure rate of implant survival in smokers where? what percentage?

A

maxilla has a greater than 9% failure rate due to highly trabecular bone

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16
Q

is the failure of implant therapy in smokers dose dependent?

A

YES

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17
Q

what forms of diabetes are a risk factor for failed implants

A

BOTH! type I and type II

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18
Q

why does poor diabetic control lead to implant failure

A

leads to impaired wound healing and predisposition to infection

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19
Q

do HbA1c readings or daily readings provide better judgement of pt diabetic control

A

HbA1c

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20
Q

what HbA1c reading means pt has diabetes but is under long-term control

A

<7%

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21
Q

what percent of pts with diabetes has successful control? what percent of early failures and late failures?

A

success: 85.6-94.3%
early failure: 2.2%
late failures: 7.3%

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22
Q

how does chronic kidney disease lead to implant failure

A

increases serum FGF23 which can impair bone density

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23
Q

chronic kidney disease can lead to deficiency in what? resulting in what?

A

vitamin D deficiency which can impair bone metabolism and osseointegration

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24
Q

what supplement has been shown to improve healing in patients w/ chronic kidney disease

A

Vit D

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25
Q

when are IV bisphosphonate therapy used

A

management of cancer-relateda conditions

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26
Q

when is oral bisphosphonate therapy used

A

management of osteoporosis, Paget’s , osteogenesis imperfecta

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27
Q

examples of bisphosphonate therapy brands

A
  1. boniva
  2. fosamax
  3. reclast
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28
Q

what does BRONJ stand for

A

bisphosphonate-related osteonecrosis of the jaws

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29
Q

what is BRONJ

A

non-healing exposed bone in maxillofacial region

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30
Q

how long does BRONJ persist

A

> 8 weeks

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31
Q

what is a major risk for BRONJ (0.8-12% cases)

A

IV bisphosphonates

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32
Q

there is a 5-20x higher risk of BRONJ with what?

A

dentral procedures after IV

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33
Q

what is a lower risk med of developing BRONJ after 3+ years of use (0.0003-0.06%)

A

oral bisphosphonate

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34
Q

what is the half life of oral bisphosphonates

A

10 years

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35
Q

what is the best indicator of healing for patients using oral bisphosphonates

A

how pts dealt w/ previous extractions or surgeries

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36
Q

pts undergoing radiation therapy are at risk of developing what

A

osteoradiocrenosis (ORN)

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37
Q

what is prolonged non-healing exposure of bone that is similar to BRONJ

A

osteoradiocrenosis (ORN)

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38
Q

where does ORN primarily occur in the mouth

A

mandible

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39
Q

what are examples of dental risk factors for implant therapy

A
  1. perio disease
  2. endodontic pathology
  3. occlusion
  4. bruxism/parafunction
  5. home care
  6. gingival display/biotype
  7. esthetic expectations
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40
Q

does previous periodontal disease pose increased risk to long-term implant survival

A

YES - especially if patient is noncompliant

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41
Q

___ mm perio pockets, and __ mm of attached gingiva results in INCREASED risk of crestal bone loss

A

> 4 mm perio pockets
<2 mm attached gingiva

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42
Q

when are endotontic cases w/ periapical pathology successful

A

after thorough socket debridement

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43
Q

what is a symptomatic lesion at the apex of an implant

A

retrograde peri-implantitis

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44
Q

when does retrograde peri-implantitis develop

A

shortly after placement

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45
Q

does the APICAL region of implant achieve normal bone to implant interface in retrograde peri-implantitis?

A

NO! occurs in CORONAL region

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46
Q

retrograde peri-implantitis is found in ___ and ___

A

1.6% of maxillary implants
2.7% of mandibular implants

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47
Q

what is associated w/ previously existing periapical lesion

A

development of retrograde peri-implantitis

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48
Q

occlusion mantra :(

A

broad stable posterior support and effective anterior guidance

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49
Q

when looking at pt occlusion, what must you do

A
  1. reduce non-axial loading
  2. stress distribution between fixed and removable prostheses
  3. rule out bruxism/parafunction
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50
Q

parafunctional habits increase magnitude of stress by how much?

A

3-4x that regular chewing force

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51
Q

do you determine bone volume PRE or POST CBCT?

A

pre

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52
Q

what bone volume dimensions do you determine clinically?

A

B-L dimension and M-D dimension

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53
Q

what bone volume dimensions do you determine radiographically?

A

M-D dimension or vertical dimension

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54
Q

when determining the vertical dimension of bone volume thru radiographs, what must you look for?

A
  1. maxilary sinus
  2. inferior alveolar nerve/mental foramen
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55
Q

optimal B-L dimension for bone volume

A

1.5-2 mm on buccal plate
1.5-2 mm on lingual plate

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56
Q

minimal B-L dimension for bone volume

A

1 mm buccal plate
1 mm lingual plate

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57
Q

what is the equation for minimum width of ridge

A

1 mm tissue thickness + 1 mm buccal plate + implant diameter + 1 mm lingual plate + 1 mm tissue thickness

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58
Q

what is the minimal implant-implant distance?

A

> /= 3.0 mm

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59
Q

what is the minimum optimal distance from tooth to implants for emergence profile

A

3mm

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60
Q

what is the minimum distance from tooth to implant to prevent crestal bone and papilla loss for periodontal/tooth health

A

1.5 mm

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61
Q

what is the minimum distance from implant to implant to prevent crestal bone and papilla loss for periodontal/bone health?

62
Q

when looking at vertical bone volume, what must you ask?

A
  1. is max sinus pneumatized in the site of proposed implant
  2. is maxillary sinus augmentation (lift) necessary)
  3. if sinus lift necessary, can it be done w/ direct or indirect?
63
Q

what are the sinus augmentation techniques

A
  1. indirect (vertical)
  2. direct (lateral window)
64
Q

what sinus augmentation technique is a blind procedure

A

indirect (vertical)

65
Q

when can you do an indirect/vertical sinus augmentation

A

> 5-6 mm bone loss from crest to sinus floor

66
Q

thru indirect/vertical sinus augmentation, what can you gain in height?

A

maximum 3-4 mm

67
Q

how are indirect/vertical sinus augmentations performed

A

thru implant osteotomy (crestal approach)

68
Q

during indirect/vertical sinus augmentation, there is no direct visualization of what membrane?

A

Schneiderian membrane

69
Q

what sinus augmentation can be done at creighton?

A

indirect/vertical

70
Q

what is the objective of sinus augmentations

A

to obtain sufficient height of bone to place desired length of implant

71
Q

when should you complete a direct/lateral window sinus augmentation

A

<5 mm bone from crest to floor of sinus and wants to gain >4mm bone height

72
Q

do you get a direct visualization of membrane in direct/lateral window sinus augmentation?

73
Q

T/F: direct/lateral window sinus augmentations are performed as separate procedure or in conjunction with implant placement

74
Q

what is the opening called in direct/lateral window sinus augmentation

A

Caldwell-Luc opening

75
Q

what is a Caldwell-Luc opening created for? what is done in it?

A

created to gain access to sinus. inside it, the membrane is liften and bone graft material is placed

76
Q

vertical bone volume is also determined by proximity to what?

A

inferior alveolar nerve and mental foramen

77
Q

what is the mimium length from apex of implant to vital structures

78
Q

the implant drill/osteotomy is ___ longer than implant length intended for placement

A

1 mm longer

79
Q

why are longer implant lengths better

A
  1. improved stress distribution
  2. increase SA
  3. improve crown to root ratio
80
Q

what are the common lengths of implants? what length is available for limited use?

A

common: 8-13 mm (common for Astra EV)
limited use: 6 mm length

81
Q

what length are short implants

A

<8mm length

82
Q

advantages of short implants

A
  1. avoid vertical augmentation procedures
  2. avoid sinus augmentation
83
Q

disadvantages of short implants

A
  1. long clinical crowns
  2. less surface area in bone
  3. force management more difficult
84
Q

inciso-implants should be placed ___ to proposed CEJ for proper emergence profile

A

3-4 mm apical

85
Q

can you predict whether or not papilla will be present by measuring bone to interproximal contact?

86
Q

if bone to contact point is </= 5 mm, 6 mm, or >/= 7 mm, what percentage of time will papilla be present?

A

</= 5 mm = 98%
6 mm = 56%
>/= 7 mm = 27%

87
Q

what is the distance from implant fixture and occlusal plane

A

interocclusal space

88
Q

what is the minimum interocclusal space for fixed implant crown

89
Q

what is the minimum interocclusal space for fixed implant full arch

90
Q

what is the minimum interocclusal space for anteiror removable locator overdenture

91
Q

what is the minimum interocclusal space for posterior removable locator overdenture

92
Q

what is the minimum interocclusal space for removable conus/bar over denture

93
Q

increased crown:implant ratios results in what

A

more biochemical issues (more stress at neck where abutment is located)

94
Q

what must the patient’s maximum opening be at least? why?

A

max opening = 40 mm
needed for surgical access since drill + handpiece are 35 mm

95
Q

what are the types of gingival display/biotype

A

high, medium, or low lip line

96
Q

what biotype does a patient have low recession risk

A

low-scalloped, thick, stippled

97
Q

what biotype does a patient have high recession risk and high risk loss of papilla

A

high scalloped, thin

98
Q

what ASA classification is a pt favorable for implants

A

ASA I or II

99
Q

what is the paradigm shift in implant placement?

A

80’s was bone driven -> now it is PROSTHETICALLY DRIVEN

100
Q

what does it mean for implants to be prosthetically driven?

A

implants are placed to support proshtesis and grafting procedures facilitate optimal prosthetic support

101
Q

who is part of the multidisciplinary approach to tx planning

A
  1. implant surgeon
  2. orthodontist
  3. restorative dentist
  4. radiologist
  5. lab tech
102
Q

what establishes continuity between diagnosis, prosthetic planning, and surgical guiding

A

surgical guides

103
Q

what guides surgeon to place implant in position to best support the prosthesis

A

surgical guides

104
Q

how to create lab crafted surgical guide

A
  1. diagnositc wax up
  2. duplicate cast
  3. 0.80” vacuuform suck-down
  4. place pilot hole w/ round bur
105
Q

what is used to create surgical guides at creighton?

A

digital fabrication: Implant concierge

106
Q

what are the types of surgical guides made? explain each

A
  1. pilot guide - guides 1st drill only and subsequent drills are free hand to allow for change of angle if necessary
  2. fully guided - all drill sequences are guided and is depth guided
107
Q

steps for completing implant

A
  1. inderdepartmental consultation
  2. obtain CBCT full arch scan
  3. first look w/ Pros
108
Q

what is done during interdepartmental consultation

A
  1. obtain diagnostic casts and Trios intraoral scan
  2. CBCT referral form
  3. implant concierge check-off
  4. diagnostic wax-up
  5. scan diagnostic wax-up
  6. VIP tx plan
  7. tx plan presentation
109
Q

what preliminary decisions are made during first look with pros

A
  1. adjacent teeth
  2. ortho
  3. implant position and number
  4. prosthetic design
  5. hard/soft tissue augmentation
  6. provisionalization
110
Q

when do you select preliminary implant diameter and length that best supports prosthesis?

A

step 3 - first look with Pros

111
Q

does implant diameter affect emergency profile

112
Q

what is the normal degree of emergence

A

15-30 degrees

113
Q

are implant fixture triangular, rectangular, or round at cervical?

114
Q

there are no locator abutments for what diameters

A

3.0 and 5.4 mm

115
Q

there are no UCLA abutments for what implants

A

4.2 and 4.8 PROFILE implants

116
Q

there are no zirconia abutments for what implants

117
Q

diagnostic wax ups must be free of what

A

voids or blebs

118
Q

when do you turn in work authorization

A

after 1st look w/ Pros and wax-up are complete

119
Q

when Julee creates implant concierge account, submits CBCT dicom files, and schedules a VIP meeting between surgeon, prosth, and student, what must you do?

A

respond to outlook email invitation

120
Q

if you fail to show up to VIP treatment plan, what happens?

A

you will be charged $100 VIP fee and you will forfeit the case

121
Q

what type of bone:

almost the entire jaw is comprised of homogenous compact bone

122
Q

what type of bone:

a thick layer of compact bone surrounds a core of dense trabecular bone

123
Q

what type of bone:

a thin layer of cortical bone surrounds a core of dense trabecular bone of favorable strength

124
Q

what type of bone:

a thin layer of cortical bone surrounds a core of low density trabecular bone

125
Q

what type of bone at anterior mandible

A

type 1 or 2

126
Q

what type of bone at posterior mandible

A

type 2 or 3

127
Q

what types of bone at anterior maxilla

128
Q

what type of bone at posterior maxilla

129
Q

need ___% of payment of surgical guide and ___% of payment of surgery to be done before scheduling patient

A

100% payment of surgical guide
50% payment of surgery

130
Q

when is the treatment plan presentation done for patient? who must be present?

A

at pt’s second appoint
surgeon, prosth, student, and patient must be present

131
Q

what is discussed during tx plan presentation to pt

A

risks, benefits, and expectations of implant surgery and restoration

132
Q

what forms are completed during tx plan presentation

A

implant conference form (in clinic attachments)

if surgeon is present:
1. implant surgery consent form
2. informed consent form for oral and maxillofacial surgery

133
Q

what must you do one week prior to implant surgery?

A
  1. check if implant surgical guide has arrived
  2. check if proposed implant sizes are in stock
134
Q

why complete denture duplication?

A

creates a guide when you have a fully edentulous patient and you need something to reference the prosthetic landmarks

135
Q

what materials needed for denture duplication

A
  1. pt max and mand dentures
  2. denture duplicator
  3. 6 packs of alginate, mixing bowl, spatula
    4, #25 scalpel blade and handle
  4. clear orthodontic resin
  5. monomer
  6. pressure pot
  7. # 8 acrylic round bur and handpiece
  8. dental stoping or gutta percha (size 140)
136
Q

how many packets of alginate for denture duplication

137
Q

what type of clear orthodontic resin to use for denture duplication

A

autopolymerizing clear acrylic

138
Q

what size dental stopping or gutta percha for denture dupliation

139
Q

how long should you let acrylic set before placing in pressure pots when completing denture duplication

A

5-10 minutes

140
Q

why use place holes in acrylic and plate gutta percha in model for denture duplication?

A

so that during CBCT you can see exactly where you want to place implants

141
Q

when obtaining denture tooth for wax-up, what should you trim?

A

cervical and lingual portion of tooth

142
Q

steps for starting wax up

A
  1. trim cervical and lingual portion of tooth
  2. lute denture tooth w/ inlay wax and contour lingual w/ wax
  3. create putty matrix
143
Q

T/F: denture tooth should be superglued to model when completing wax up

A

FALSE. DO NOT SUPERGLUE!

144
Q

what is a good example of putty matrix

A

adapts well, 2 teeth each side, and beyond teeth to gingiva

145
Q

materials for wax-up duplication

A
  1. impression tray
  2. alginate
  3. bowl
  4. spatula
  5. PAM COOKING SPRAY!
  6. diagnostic wax up
146
Q

steps for wax up duplication

A
  1. spray cast w/ cooking spray
  2. soak 10-15 minutes to hydrate
  3. mix alginate
  4. wipe over facial, lingual, occlusal or teeth to minimize bubbles
  5. seat cast into impression tray
  6. remove from impression and confirm no distortion/voids
  7. pour microstone
  8. reduce base of duplicate to allow for vaccuform adaptation
147
Q

what is the stone duplicate used for when creating new model?

A

essix fabrication

148
Q

T/F: you should reduce the base of duplicate to allow for vaccuform adaption

149
Q

what causes increased risk of OCN

A

> 6500 cGY radiation
5500 cGy w/ chemotherapy

150
Q

odds ratio of periapical pathology on extracted tooth vs. adjacent tooth

A

extracted: 7.2
adjacent: 8.0

23 Implants (9 decks)

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