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
2
Q
what is the 2nd oldest discipline in dentistry after exodontia
A
implant dentistry
3
Q
what are the different mechanisms of fixation
A
- mucosal insert
- eposteal
- transosteal
- endosteal
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
5
Q
what method of fixation:
any dental implant receives primary support by means of RESTING ON BONE
A
eposteal
6
Q
what mechanism of fixation does a subperiosteal implant use
A
eposteal
7
Q
what method of fixation:
dental implant PENETRATES BOTH CORTICAL PLATES and passes thru full thickness of alveolar bone
A
transosteal
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
9
Q
what method of fixation do needle implants use
A
endosteal
10
Q
what method of fixation do plate form/blade implants use
A
endosteal
11
Q
what method of fixation do root form implants use
A
endosteal
12
Q
what are the type of implants used today? examples?
A
root form - basket type, cylinder type, and lew screw
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)
14
Q
what is the goal when placing implants
A
direct contact between bone and implant
15
Q
what materials are used in implants
A
- aluminum oxide
- vitreous carbon
- silver
- brass
- chromium cobalt
16
Q
what is a term coined by Branemark
A
osseointegration
17
Q
what is a direct attachment of osseous tissue to an inert, alloplastic material w/o intervening CT
A
osseointegration
18
Q
what is the bone implant interface
A
- implant surface (titanium)
- GAG (w/ chondroitin sulfate)
- mineralized matrix (no cellular elements)
- unmineralized fibrous matrix (osteoblasts)
- mineralized bone
19
Q
how is osseoinegration achieved via the Branemark Era in 1952?
A
- pure titanium fixture
- surgical sterility
- atraumatic bone prep
- intimate physical contact
- sequestration for sufficient time
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
21
Q
why is titanium the preffered implant material
A
- biocompatible
- mechanically compatible
- morphologically compatible
22
Q
what are the biocompatible characteristics of titanium
A
- resistant to corrosion
- self-passivating
- bio-inert
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
24
Q
what does it mean that titanium is bioinert
A
non-toxic to cells and per-implant tissues
25
is titanium hypersensitivity common
no it's rare
26
what type of hypersensitivity is a titanium rxn
type 4
27
is a titanium Type IV HS immediate or delayed
delayed (>2 days)
28
is titanium HS a cell-mediated response
YES
29
what does it mean for implant material to be mechanically compatible
shaped to accept and transfer load (maximize SA, initial mechanical stability, and attach prostheses/abutments)
30
what does it mean for implant to be morphologically compatible
implant surface is modified to INCREASE bone contact and INCREASE wettability
31
how does one increase wettability
decrease contact angle = degcreased surface tension
32
what is the texture of implant materials
average roughness. 10-50 microns
33
how are implant materials surface treated
sand-blasted, acid-etched, plasma spray, HAP
34
is it okay if the implant surface from sterile packaging touches prepared site?
NO
35
what is the antibiotic oral rinse: creighton protocol
0.12% CHX gluconate rinse for 5 minutes prior to surgery
AND
daily for 10 days following surfery
36
another name for CHX gluconate
Peridex
37
what do studies show about the antibiotic oral rinse? (%-wise)
significant reduction of infectious complications (4.1% vs. 8.7%)
38
what is the antibiotic prescription Creighton protocol
1. for medically compromised pts
2. require dental premedication
3. augmentation procedures
39
what must be done for atraumatic surgery
1. flap management
2. limit bone heat
40
when managing flap, what do you do
1. limit flap retraction (flap primary blood supply to cortical plate)
2. optimize position of keratinized tissue
3. tension free, water tight flap closure
41
what must you do to limit bone heat during surgery
copious irrigation, slow drill speed, sharp drills, sequential drill sizes, gentle pressure
42
what temp should you not heat bone? what happens?
do not heat > 10 degrees celsius. results in bone necrosis and implant failure
43
how to achieve intimate physical contact of implant
1. minimize over-preparation of site
2. limit gap between implant and bone
3. achieve primary stability
44
what is the insertion torque used for primary stability
25 Ncm-45 Ncm (Astra)
45
what is primary stability developed by
1. undersized osteotomy
2. threaded fixture
3. tapered implant fixture
46
what is developed by compressive preload
undersized osteotomy
47
what is developed by clamping preload
threaded fixture
48
what is wedging preload
tapered implant fixture
49
why immobolize
1. allow bone formation
2. prevent micro-movement
3. prevent epithelial integration
50
osseointegration time for mandibular anterior
3-4 months
51
osseointegration time for mandibular posterior
4-6 months
52
osseointegration time for maxillary anterior (ungrafted)
4 months
53
osseointegration time for maxillary anterior (grafted)
6 months
54
osseointegration time for maxillary posterior
4-6 months
55
what are the stages of bone healing
1. placement
2. incorporation
3. adaptation of bone mass
4. adaptation of bone structure
56
what does placement stage of bone healing rely on
primary stability
57
when does the formation of blood clot occur during stage of bone healing
placement
58
what stage of bone healing: traumatized wound site - initiation of osteoclastic phase
placement
59
what days are the incorporation stage of bone healing
0-60 days
60
what stage do fibroblasts proliferate into blood clot during bone heaing
incorporation
61
what state during bone healing does organization begin and ECM is produced
incorporation
62
what stage do osteoblast-like cells and new bone appear
incorporation
63
what stage is woven bone deopsition
incorporation
64
___ microns of micromovement = fibrointegration
>150 microns
65
what occurs during adaptation of bone mass to accept load during bone healing? what days?
parallel bone formed (60-90 days)
66
what occurs during adaptation of bone structure to accept load during bone healing? what days?
lamellar bone formation (90= days). can withstand occlusal forces
67
regarding the implant tissue interface, which is similar to teeth? which is not similar to teeth?
similar: attached gingiva, sulcular epithelium, and junctional epithelium
not similar: supracrestal CT
68
what has a 2 mm wide band an a hemi-desmosomal attachment
junctional epithelium
69
what has fibers parallel and circumferential to implant surface and less resistant to bacterial challenge
supracrestal CT attachment
70
endosteal implants are what class of medical device
Class OOO
71
how many implants placed per year
>1 million
72
what are the three shapes of titanium implant fixture
conical, straight, profile
73
before prescribing antibiotic prescription under Creighton protocol, what must you check?
med history for allergies to meds (e.g. penicillin > amoxicillin > clindamycin)
74
what is the brand of implants used at creighton
Astra EV (color-coded)
75
what are the straight diameters for Astra EV
3.0, 3.6, 4.2, 4.8, 5.4 mm
76
what are the conical diameters for Astra EV
4.2, 4.8 mm
77
what are the profile diameters for Astra EV
4.2, 4.8
78
what is the purpose of slots and tabs in implant fixture
1. anti-rotation
2. allows positional index of implant 3-dimensionallly in bone and relative to adjacent teeth
79
what is the hex driver used at creighton
0.050"=1.25 mm
80
what does a hex driver tighten
1. cover screws
2. healing abutment
3. abutment screws
4. impression copings
81
what is low profile, used at implant placement, and has tissue sutured over it?
cover screw
82
___ mm = flare/diameter of healing abutment
___ mm = height of healing abutment
5.0 mm; 4.5 mm
83
when are healing abutments placed
2nd stage (uncovering surgery)
84
what are impression coping selections based on
diameter of implant (color of coping = specific diameter)
85
open tray = ___
closed tray = ___
open = pick up
closed = transfer
86
are impression copings self guiding? what does this mean?
YES! screw will not engage implant until seated correctly
87
what captures positional index of implant relative to adjacent teeth for restoration
impression copings
88
which impression copings provide a fixture level impression?
BOTH transfer (closed) and pick-up (open) tray
89
when removing impression copings, what should you do immediately after? why?
place healing abutment immediately to avoid tissue collapse
90
what is attached to impression coping and impression is poured over to incorporate into stone cast
implant replica
91
what emulates implant and position in mouth 3-dimensionally so a restoration can be made
implant replica
92
how can you tell whether or not an impression coping is "profile"
has a "P"
93
what are examples of temporary abutments
titanium and TempDesign (plastic)
94
what is used for provisional implant restorations and come in 'engaging' only
temporary abutments
95
what is a prefabricated abutment where its selection is based on implant diameter and height of tissue
locator abutments
96
what are the parts of locator core tool
male removal end, male seating end, abutment driver
97
what is the function of the locator core tool
1. place locator abutment
2. seat retentive elements in pt denture
3. remove retentive elements in pt dentuer
98
where do you place locator driver? what is its function
fits into torque wrench
allows for delivery of a specific force
99
what are locator impression copings
allow for abutment-level impression
impression coping looks like martini glass. locator abutment is placed on top of martini glass next to gingiva
100
what are the locator components
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
what divergence to use male nylon clips
0-10 degrees
102
what divergence to use extended range male nylon clips
10-20 degrees
103
what torque to use on final abutment screws
25 Ncm
104
what torque to use on temporization or bridge screws
15 Ncm
105
what types of hex drivers can be used with torque wrench
1. driver handle - surgical
2. driver handle - prosthetic
106
what is the CastDesign abutment also calle
UCLA abutment
107
CastDesign abutment is used almost exclusively for what types of restorations?
screw-retained restorations
108
in a CastDesign abutment, are the crown and abutment each a separate piece?
NO! crown + abutment = 1 piece
109
what is the positional index of a CastDesign Abutment?
6 positional index
110
what abutment is exclusively used at the dental school
custom abutments
111
what is a custom-made abutment for patient/implant site
custom abutment
112
how are custom abutments made
CAD designed and milled
113
in custom abutments, are crowns and abutments 2 separate pieces?
YES! crown + abutment = 2 pieces
114
what is the advantage of custom abutments
controlled contours and margin placement
115
what materials are used to make custom abutments
titanium, gold-shaded titanium, and zirconia
116
do custom abutments sit in one or multiple positions
one-position only!
117
which custom abutment materials have a lifetime warrenty? which have a 5 year warrenty? why?
titanium and gold-shaded titanium = lifetime
zirconia = 5 years because very thin and tends to braek
118
what are custom abutments used for removable overdenture cases?
conus abutments
119
how many positions must conus abutments have?
at least 4
