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23 Implants > 8/9 - Implant Fundamentals, Implant Components > Flashcards

8/9 - Implant Fundamentals, Implant Components Flashcards

1
Q

what is a prosthetic device made of alloplastic material(s) implanted into the oral tissues beneath the mucosal or/and periosteal layer, and on/or within bone to provide retention and support for a fixed or removable dental prosthesis

A

dental implant

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2
Q

what is the 2nd oldest discipline in dentistry after exodontia

A

implant dentistry

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3
Q

what are the different mechanisms of fixation

A
  1. mucosal insert
  2. eposteal
  3. transosteal
  4. endosteal
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4
Q

what method of fixation:

any metal form attached to tissue surface of removable dental prosthesis that mechanically engages undercuts of a surgically prepared MUCOSAL site

A

mucusol insert

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5
Q

what method of fixation:

any dental implant receives primary support by means of RESTING ON BONE

A

eposteal

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6
Q

what mechanism of fixation does a subperiosteal implant use

A

eposteal

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7
Q

what method of fixation:

dental implant PENETRATES BOTH CORTICAL PLATES and passes thru full thickness of alveolar bone

A

transosteal

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8
Q

what method of fixation:

device placed INTO ALVEOLAR and/or basal bone of mandible or maxilla and TRANSECTING ONLY 1 CORTICAL PLATE

A

endosteal

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9
Q

what method of fixation do needle implants use

A

endosteal

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10
Q

what method of fixation do plate form/blade implants use

A

endosteal

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11
Q

what method of fixation do root form implants use

A

endosteal

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12
Q

what are the type of implants used today? examples?

A

root form - basket type, cylinder type, and lew screw

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13
Q

presence of a layer intervening fibrous CT between dental implant and adjacent bone is indicative of what

A

failed osseointegration (creates a pseudo-ligament)

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14
Q

what is the goal when placing implants

A

direct contact between bone and implant

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15
Q

what materials are used in implants

A
  1. aluminum oxide
  2. vitreous carbon
  3. silver
  4. brass
  5. chromium cobalt
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16
Q

what is a term coined by Branemark

A

osseointegration

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17
Q

what is a direct attachment of osseous tissue to an inert, alloplastic material w/o intervening CT

A

osseointegration

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18
Q

what is the bone implant interface

A
  1. implant surface (titanium)
  2. GAG (w/ chondroitin sulfate)
  3. mineralized matrix (no cellular elements)
  4. unmineralized fibrous matrix (osteoblasts)
  5. mineralized bone
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19
Q

how is osseoinegration achieved via the Branemark Era in 1952?

A
  1. pure titanium fixture
  2. surgical sterility
  3. atraumatic bone prep
  4. intimate physical contact
  5. sequestration for sufficient time
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20
Q

what are the guidelines for successful implant dentistry per Toronto Conference 1982

A

biomaterials, implant design, biomechanical factors, surface characteristics, health and bone quality, and surgical technique

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21
Q

why is titanium the preffered implant material

A
  1. biocompatible
  2. mechanically compatible
  3. morphologically compatible
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22
Q

what are the biocompatible characteristics of titanium

A
  1. resistant to corrosion
  2. self-passivating
  3. bio-inert
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23
Q

what does it mean that titanium is self-passivating

A

titatnium oxide layer formed on surface when exposed to atmosphere. TiO2 strnogly adhered to titanium surface, attracts proteins from extracellular fluid

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24
Q

what does it mean that titanium is bioinert

A

non-toxic to cells and per-implant tissues

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25
Q

is titanium hypersensitivity common

A

no it’s rare

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26
Q

what type of hypersensitivity is a titanium rxn

A

type 4

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27
Q

is a titanium Type IV HS immediate or delayed

A

delayed (>2 days)

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28
Q

is titanium HS a cell-mediated response

A

YES

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29
Q

what does it mean for implant material to be mechanically compatible

A

shaped to accept and transfer load (maximize SA, initial mechanical stability, and attach prostheses/abutments)

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30
Q

what does it mean for implant to be morphologically compatible

A

implant surface is modified to INCREASE bone contact and INCREASE wettability

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31
Q

how does one increase wettability

A

decrease contact angle = degcreased surface tension

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32
Q

what is the texture of implant materials

A

average roughness. 10-50 microns

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33
Q

how are implant materials surface treated

A

sand-blasted, acid-etched, plasma spray, HAP

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34
Q

is it okay if the implant surface from sterile packaging touches prepared site?

A

NO

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35
Q

what is the antibiotic oral rinse: creighton protocol

A

0.12% CHX gluconate rinse for 5 minutes prior to surgery

AND

daily for 10 days following surfery

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36
Q

another name for CHX gluconate

A

Peridex

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37
Q

what do studies show about the antibiotic oral rinse? (%-wise)

A

significant reduction of infectious complications (4.1% vs. 8.7%)

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38
Q

what is the antibiotic prescription Creighton protocol

A
  1. for medically compromised pts
  2. require dental premedication
  3. augmentation procedures
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39
Q

what must be done for atraumatic surgery

A
  1. flap management
  2. limit bone heat
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40
Q

when managing flap, what do you do

A
  1. limit flap retraction (flap primary blood supply to cortical plate)
  2. optimize position of keratinized tissue
  3. tension free, water tight flap closure
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41
Q

what must you do to limit bone heat during surgery

A

copious irrigation, slow drill speed, sharp drills, sequential drill sizes, gentle pressure

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42
Q

what temp should you not heat bone? what happens?

A

do not heat > 10 degrees celsius. results in bone necrosis and implant failure

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43
Q

how to achieve intimate physical contact of implant

A
  1. minimize over-preparation of site
  2. limit gap between implant and bone
  3. achieve primary stability
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44
Q

what is the insertion torque used for primary stability

A

25 Ncm-45 Ncm (Astra)

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45
Q

what is primary stability developed by

A
  1. undersized osteotomy
  2. threaded fixture
  3. tapered implant fixture
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46
Q

what is developed by compressive preload

A

undersized osteotomy

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47
Q

what is developed by clamping preload

A

threaded fixture

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48
Q

what is wedging preload

A

tapered implant fixture

49
Q

why immobolize

A
  1. allow bone formation
  2. prevent micro-movement
  3. prevent epithelial integration
50
Q

osseointegration time for mandibular anterior

A

3-4 months

51
Q

osseointegration time for mandibular posterior

A

4-6 months

52
Q

osseointegration time for maxillary anterior (ungrafted)

53
Q

osseointegration time for maxillary anterior (grafted)

54
Q

osseointegration time for maxillary posterior

A

4-6 months

55
Q

what are the stages of bone healing

A
  1. placement
  2. incorporation
  3. adaptation of bone mass
  4. adaptation of bone structure
56
Q

what does placement stage of bone healing rely on

A

primary stability

57
Q

when does the formation of blood clot occur during stage of bone healing

58
Q

what stage of bone healing: traumatized wound site - initiation of osteoclastic phase

59
Q

what days are the incorporation stage of bone healing

60
Q

what stage do fibroblasts proliferate into blood clot during bone heaing

A

incorporation

61
Q

what state during bone healing does organization begin and ECM is produced

A

incorporation

62
Q

what stage do osteoblast-like cells and new bone appear

A

incorporation

63
Q

what stage is woven bone deopsition

A

incorporation

64
Q

___ microns of micromovement = fibrointegration

A

> 150 microns

65
Q

what occurs during adaptation of bone mass to accept load during bone healing? what days?

A

parallel bone formed (60-90 days)

66
Q

what occurs during adaptation of bone structure to accept load during bone healing? what days?

A

lamellar bone formation (90= days). can withstand occlusal forces

67
Q

regarding the implant tissue interface, which is similar to teeth? which is not similar to teeth?

A

similar: attached gingiva, sulcular epithelium, and junctional epithelium
not similar: supracrestal CT

68
Q

what has a 2 mm wide band an a hemi-desmosomal attachment

A

junctional epithelium

69
Q

what has fibers parallel and circumferential to implant surface and less resistant to bacterial challenge

A

supracrestal CT attachment

70
Q

endosteal implants are what class of medical device

71
Q

how many implants placed per year

A

> 1 million

72
Q

what are the three shapes of titanium implant fixture

A

conical, straight, profile

73
Q

before prescribing antibiotic prescription under Creighton protocol, what must you check?

A

med history for allergies to meds (e.g. penicillin > amoxicillin > clindamycin)

74
Q

what is the brand of implants used at creighton

A

Astra EV (color-coded)

75
Q

what are the straight diameters for Astra EV

A

3.0, 3.6, 4.2, 4.8, 5.4 mm

76
Q

what are the conical diameters for Astra EV

A

4.2, 4.8 mm

77
Q

what are the profile diameters for Astra EV

78
Q

what is the purpose of slots and tabs in implant fixture

A
  1. anti-rotation
  2. allows positional index of implant 3-dimensionallly in bone and relative to adjacent teeth
79
Q

what is the hex driver used at creighton

A

0.050”=1.25 mm

80
Q

what does a hex driver tighten

A
  1. cover screws
  2. healing abutment
  3. abutment screws
  4. impression copings
81
Q

what is low profile, used at implant placement, and has tissue sutured over it?

A

cover screw

82
Q

___ mm = flare/diameter of healing abutment
___ mm = height of healing abutment

A

5.0 mm; 4.5 mm

83
Q

when are healing abutments placed

A

2nd stage (uncovering surgery)

84
Q

what are impression coping selections based on

A

diameter of implant (color of coping = specific diameter)

85
Q

open tray = ___
closed tray = ___

A

open = pick up
closed = transfer

86
Q

are impression copings self guiding? what does this mean?

A

YES! screw will not engage implant until seated correctly

87
Q

what captures positional index of implant relative to adjacent teeth for restoration

A

impression copings

88
Q

which impression copings provide a fixture level impression?

A

BOTH transfer (closed) and pick-up (open) tray

89
Q

when removing impression copings, what should you do immediately after? why?

A

place healing abutment immediately to avoid tissue collapse

90
Q

what is attached to impression coping and impression is poured over to incorporate into stone cast

A

implant replica

91
Q

what emulates implant and position in mouth 3-dimensionally so a restoration can be made

A

implant replica

92
Q

how can you tell whether or not an impression coping is “profile”

A

has a “P”

93
Q

what are examples of temporary abutments

A

titanium and TempDesign (plastic)

94
Q

what is used for provisional implant restorations and come in ‘engaging’ only

A

temporary abutments

95
Q

what is a prefabricated abutment where its selection is based on implant diameter and height of tissue

A

locator abutments

96
Q

what are the parts of locator core tool

A

male removal end, male seating end, abutment driver

97
Q

what is the function of the locator core tool

A
  1. place locator abutment
  2. seat retentive elements in pt denture
  3. remove retentive elements in pt dentuer
98
Q

where do you place locator driver? what is its function

A

fits into torque wrench
allows for delivery of a specific force

99
Q

what are locator impression copings

A

allow for abutment-level impression

impression coping looks like martini glass. locator abutment is placed on top of martini glass next to gingiva

100
Q

what are the locator components

A
  1. housings (silver bowl lookin things)
  2. block out spacer (disc with hole in middle)
  3. male nylon clips
  4. extended range male nylon clips
101
Q

what divergence to use male nylon clips

A

0-10 degrees

102
Q

what divergence to use extended range male nylon clips

A

10-20 degrees

103
Q

what torque to use on final abutment screws

104
Q

what torque to use on temporization or bridge screws

105
Q

what types of hex drivers can be used with torque wrench

A
  1. driver handle - surgical
  2. driver handle - prosthetic
106
Q

what is the CastDesign abutment also calle

A

UCLA abutment

107
Q

CastDesign abutment is used almost exclusively for what types of restorations?

A

screw-retained restorations

108
Q

in a CastDesign abutment, are the crown and abutment each a separate piece?

A

NO! crown + abutment = 1 piece

109
Q

what is the positional index of a CastDesign Abutment?

A

6 positional index

110
Q

what abutment is exclusively used at the dental school

A

custom abutments

111
Q

what is a custom-made abutment for patient/implant site

A

custom abutment

112
Q

how are custom abutments made

A

CAD designed and milled

113
Q

in custom abutments, are crowns and abutments 2 separate pieces?

A

YES! crown + abutment = 2 pieces

114
Q

what is the advantage of custom abutments

A

controlled contours and margin placement

115
Q

what materials are used to make custom abutments

A

titanium, gold-shaded titanium, and zirconia

116
Q

do custom abutments sit in one or multiple positions

A

one-position only!

117
Q

which custom abutment materials have a lifetime warrenty? which have a 5 year warrenty? why?

A

titanium and gold-shaded titanium = lifetime

zirconia = 5 years because very thin and tends to braek

118
Q

what are custom abutments used for removable overdenture cases?

A

conus abutments

119
Q

how many positions must conus abutments have?

A

at least 4

23 Implants (9 decks)

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