9/13 - Clinical Implant Provisionals, Implant Provisional Lab, Custom Tray Fabrication

Question 1

are implant provisionals implant-borne or tissue borne

Answer 1

implant borne

Question 2

what are materials used for implant provisionals

Answer 2

1. plastic of titanium temporary/provisional abutment
2. acrylic (Jet or Trim)
3. Bis-acryle (integrity)
4. composite
5. denture tooth

Question 3

advantages of implant provisionals

Answer 3

1. fixed
2. tissue support
3. identify implant and/or angulation problems

Question 4

disadvantages of implant provisionals

Answer 4

1. esthetic challenges (immediate/early)
2. no removal during healing (immediate/early)
3. implant vulnerability (immediate/early)
4. no functional contribution (immediate/early)
5. increased cost

Question 5

what teeth do we provisionalize at creighton

Answer 5

anteriors

Question 6

what are implant provisionals intended for

Answer 6

1. post-surgical healing
2. soft tissue development
3. patient management
4. predict prosthetic form/contour
5. identify implant angulation problems
6. evaluate questionable implants

Question 7

when are implant provisionalization protocols IMMEDIATE

Answer 7

implants placed in function within 1 week of placement

Question 8

when are implant provisionalization protocols EARLY

Answer 8

implant in function between 1 week and 2 months after placement

Question 9

when are implant provisionalization protocols CONVENTIONAL/DELAYED

Answer 9

implant in function after 2 months healing

Question 10

what situations are immediate implant provisionals used

Answer 10

in situations when:
- adequate primary stability
- no centric, eccentric, or protrusive contacts
- esethetic gain outweights risks associated w/ immediage loading protocols
- patient compliance w/ protocols

Question 11

what is it called when the initial fixation of implant is sufficiently strong to withstand disloding forces

Answer 11

primary stability

Question 12

what are examples of how primary stability is mechanical in nature

Answer 12

1. osteotomy
2. bone density
3. implant geometry
4. thread pattern

Question 13

when is primary stability a MUST

Answer 13

in cases of immediate loading

Question 14

as primary stability decreases, what happens to cumulative and secondary stability?

Answer 14

cumulative stability slightly decreases then maintains plateau

secondary stability increases

Question 15

at creighton, when are implants considered progressive or delayed

Answer 15

after osteointegration

Question 16

at what weeks is the implant most vulnerable to forces and must be avoid removal of provisional

Answer 16

2-4 weeks (15-21 days)

Question 17

what can we do to test if implant is stable

Answer 17

1. insertion/removal torque values
2. periotest
3. resonance frequence analysis (RFA) expressed as ISQ

Question 18

what does RFA stand for

Answer 18

resonance frequency analysis

Question 19

does denser bone have lower or higher insertion torque values

Answer 19

HIGHER

Question 20

how does periotest work

Answer 20

a probe w/ accelerometer is placed on implant and calculates the contact time between the implant and probe

Question 21

what does periotest correlate to

Answer 21

1. micromovement
2. variability
3. lack of standardized values

Question 22

what does RFA measure

Answer 22

interfacial integrity between implant and bone

Question 23

what does RFA correlate with

Answer 23

implant bone contact and is expressed as ISQ

Question 24

what does ISQ range from? what is the acceptable range? meaning what?

Answer 24

range from 1-100, acceptable is 55-85 meaning it has osseointegrated

Question 25

what test provides variable results and interpretation of values

Answer 25

RFA

Question 26

when are we unable to do implant provisional

Answer 26

1. lack of primary stability 2. parafunctional habits 3. unable to eliminate centric/eccentric/protrusive contacts 4. non-compliant patient 5. non-esthetic zone 6. esthetic gain does not outweigh risk of implant complications

Question 27

when is prosthesis attached due to conventional loading

Answer 27

2 months post-implant placement (wait until implant osseointegrated)

Question 28

when is conventional loading used

Answer 28

1. sinus/ridge augmentation required 2. compromised primary stability 3. occlusal forces/parafunction

Question 29

advantages of conventional loading

Answer 29

1. ossointegrated implant 2. tissue sculpting 3. esthetics 4. functional loading

Question 30

disadvantages of conventional loading

Answer 30

1. removable interim provisional 2. lack tissue support during healing

Question 31

can you add and subtract material on provisional to sculpt tissue

Answer 31

YES

Question 32

what is the goal of soft tissue development

Answer 32

gingival symmetry with adjacent teeth

Question 33

what is OPTIMAL corono-apical position of implant

Answer 33

3-4 mm apical to proposed CEJ

Question 34

what corono-apical position of the implant is difficult to clean and manage deep sulcus?

Answer 34

>5 mm apical to proposed CEJ

Question 35

what corono-apical position of implant is unesthetic and results in short crown?

Answer 35

<3 mm apical to proposed CEJ

Question 36

if you don't have the option to do the optimal corono-apical position of implant and must choose between >5 mm or 3< mm, what should you choose?

Answer 36

better to do DEEPER (>5mm) than shallower

Question 37

what does blanching of soft tissue mean

Answer 37

soft tissue has too much pressure

Question 38

if tissue is constantly blanched, what is at risk

Answer 38

tissue necrosis

Question 39

after provisional insertion, how long should you wait to see if blanching goes away? what do you do if it does not come back after this time period?

Answer 39

rub for 5 minutes - if pink doesn't come back, provisional needs to be repositioned

Question 40

what is evident around implant due to a highly polished provisional and appropriate emergence?

Answer 40

healthy tissue and hemidesmosomes

Question 41

which teeth are higher of the anteriors?

Answer 41

central and canines are a "step" higher than laterals

Question 42

how long does it take for tissue to mature

Answer 42

1-4 months

Question 43

what is injected around soft tissue cast to insure an accurate soft tissue profile

Answer 43

PVS

Question 44

can you place composite around PVS on soft tissue cast?

Answer 44

yes

Question 45

when creating pick-up impression/open tray impression, what stays on impression?

Answer 45

coping stays on impression

Question 46

are custom abutments custom made to patient

Answer 46

YES

Question 47

what is the main advantage of custom abutments

Answer 47

control of margin position

Question 48

how are you able to control margin position in custom abutments

Answer 48

1. avoid sub-gingival margins 2. prevent residual cement 3. optimize abutment design

Question 49

what do you do on day of implant surgery

Answer 49

1. deliver essix retainer 2. index implants for provisional implant crown fabrication 3. confirm shade 4. complete records (note)

Question 50

how long do you wait between implant surgery and index before 2nd stage surgery/implant provisionals

Answer 50

4-6 months

Question 51

what implant piece is used to create impression

Answer 51

open-tray impression coping

Question 52

do you tighten open-tray impression coping with your hex drive or finger first?

Answer 52

finger first THEN drive

Question 53

how should impression PVS be placed around open-tray impression coping?

Answer 53

coping must be covered circumferentially and two teeth indexed on both sides

Question 54

what PVS is used for open-tray impression?why

Answer 54

clone bite or "O-bite" due to its greater rigidity and accuracy

Question 55

should you loosen the guide pin before removing the index

Answer 55

YES

Question 56

should you keep unscrewing the guide/survey pin until they become two separate pieces?

Answer 56

NO

Question 57

if you do not have an index, can you make an impression at the time of second stage and fabricate the provisional thereafter?

Answer 57

yes

Question 58

what implant piece do you place onto the open tray impression coping with the PVS

Answer 58

implant replica

Question 59

what should you used to widen the area on the stone cast so your impression coping fits thru

Answer 59

#8 acrylic round bur

Question 60

when impression coping is placed thru stone model, what should you cover with it?

Answer 60

fast set plaster

Question 61

what do you place in the facial aspect of the stone? why

Answer 61

a hole/window to allowed for material injection

Question 62

where do you place base plate wax on impression/stone?

Answer 62

around junction of impression coping and implant replica

Question 63

what do you used to load and placeplaster

Answer 63

monoject syringe

Question 64

do you inject plaster thru the facial or bottom of the cast? what should you make sure you do

Answer 64

thru facial - make sure everything stays stable with no movement of index

Question 65

when must you adjust the cylinder on the implant?

Answer 65

if matrix does not seat

Question 66

what do you place inside the access channel?

Answer 66

gauze/cotton and rope wax

Question 67

what can be placed over metal to prevent dark show thru of metal

Answer 67

opacifier (if PMMA is thin)

Question 68

where do you add inlay wax? why?

Answer 68

add to gingival embrasure area to allow removal of provisional without breaking adjacent teeth

Question 69

where to place coe-sep

Answer 69

stone and not cylinder

Question 70

what can be placed around putty matrix and stone model with JET to prevent disloding when placing in warm water

Answer 70

rubber bands

Question 71

do you open an access thru the jet material with round bur? do you remove the cotton and provisional?

Answer 71

yes, yes

Question 72

do you add monomer or polymer to PMMA first

Answer 72

monomer

Question 73

where should you not spill on provisional cylinder?

Answer 73

on internal fit

Question 74

you should adjust contacts to prevent wrap around contacts. what should you not touch

Answer 74

contact area (incisal third)

Question 75

do you hand tighten or use hex drive to connect provisional to stone

Answer 75

hand tighten

Question 76

whenever placing a new abutment or healing screw, you should always irrigate implant fixture with what? why?

Answer 76

chlorhexidine using monoject syringe this flushes saliva and bacteria out prior to seating abutment (high speed evac to remove excess)

Question 77

when placing the provisional into the patient, what should you use to fill the access chamber?

Answer 77

dental tape - cut excess so short 2-3 mm of cingulum or central fossa

Question 78

how much space is needed in provisional to place composite

Answer 78

2-3 mm

Question 79

do you need bonding agent when placing composite into provisional

Answer 79

NO! mechanical fit will keep it in place

Question 80

what are the materials that can be used for access hold filling?

Answer 80

1. plumber's tape/teflow + composite 2. gutta percha + composite 3. PVS material 4. cotton pellets + composite

Question 81

why dont we usually use guta percha for access hole filling

Answer 81

because difficult to remove

Question 82

what dont we usually use PVS material for access hole filling

Answer 82

dark

Question 83

why don't we usually use cotton pellets for access hole filling

Answer 83

pellets absorb saliva and become smelly over time

Question 84

implants provisionals must be what?

Answer 84

1. esthetic 2. smooth 3. contoured appropriately to shape tissue 4. used to communicate w/ lab 5. temporary (finite lifespan to materials)

Question 85

how many thicknesses of baseplate wax over TEETH for custom tray

Answer 85

2 thicknesses

Question 86

how many thickness of baseplate wac over IMPLANT SITES for custom tray

Answer 86

3 thickness

Question 87

what do you place between baseplate wax and triad

Answer 87

foil

Question 88

where can handle be placed on custom tray for implants

Answer 88

1. away from anterior implant site (need access to open tray impression coping pin) OR 2. on palate

Question 89

triad curing time for custom tray

Answer 89

intiial 2 min on stone cure another 2 minute without wax and foil