9/6 - Implant Surgery Basics, Flap Design, and Sutures

Question 1

if patient is allergic to penicillin or amox what do you prescribe

Answer 1

clindamycin

Question 2

what are the CHX gluconate prescriptions

Answer 2

1. rinse for 5 minutes prior to initiating surgery
2. rinse daily for 10 days after surgery

Question 3

what NSAIDS prescribed

Answer 3

ibuprofen or tylenol

Question 4

what are medical pre-op management

Answer 4

medical hx and consent forms

Question 5

what are supportive pre op management

Answer 5

antimicrobial mouth rinse, antibiotic pre load, NSAID preload, sedation

Question 6

what are technical pre-op management

Answer 6

specialized set up, instrumentation, flap design, implants, components

Question 7

type of flap designs

Answer 7

1. full thickness
2. split thickness

Question 8

rationale for flap design

Answer 8

1. identificaiton of anatomical structures
2. incision outline
3. execution

Question 9

aim for surgical flaps

Answer 9

to gain acess and move tissue from one place to another

Question 10

basic principles of surgical flaps

Answer 10

visualization, prevent flap necrosis, dehiscene or tearing

Question 11

how to prevent flap necrosis

Answer 11

1. base > apex
2. length < base
3. axial blood supply included in teh base
4. handling case with care

Question 12

what flap makes incision into tissue until cortical plate and you reflect entire periosteum mucosa away from bone so goes TO THE BONE (bone itself exposed)

Answer 12

full thickness

Question 13

what flap make incision where you release tissue in split thickness fashion TO PERIOSTEUM (periosteum stays intact w/ cortical bone)

Answer 13

partial thickness

Question 14

without irrigation with sterile water or saline or a chilled irrigant, what do you risk

Answer 14

bone necrosis

Question 15

drill speed for osteotomy

Answer 15

1000-1500 rpm MAX

Question 16

hand position for bone prep drilling

Answer 16

straight in and out, no elliptical motion, no wrist movement

Question 17

implant insertion torque and speed

Answer 17

<45 Ncm
15 rpm

Question 18

abutment screw torque

Answer 18

25 Ncm

Question 19

how to manage post surgically

Answer 19

1. flap closure
2. radiographs
3. medicaitons
4. instructions

Question 20

what must flap primary closure be

Answer 20

water tight and tension free

Question 21

what type of suture technique for flap closure

Answer 21

single interrupted

Question 22

what are the types of multifilament sutures

Answer 22

non-absorbable: silk and polyester
absorbable: polygalactin and gut

Question 23

what are the types of monofilament suturs

Answer 23

non-absorbable: polypropylene and nylon
absorbable: polyglecaprone

Question 24

what is the purpose of sutures

Answer 24

1. provide mech support to wound until soft tissue can withstand functional forces
2. approximation of wound edges for primary intention healing
3. flap is position passively before suturings
4. sutures should not pull the flap into position under tension

Question 25

how to make suturing minimally traumatic

Answer 25

1. pass needle thru each side of incision separately 2. pass needle thru mobile tissue 3. suture every 5 mm 4. smallest number of sutures for adequate support 5. knot at needle insertion point 6. no overly tight suture

Question 26

when suturing, do you pass needle thru immobile or mobile tissue first

Answer 26

mobile

Question 27

suture every ___ mm

Answer 27

5 mm

Question 28

should smaller or more amount of sutures provide adequate support

Answer 28

smaller

Question 29

knots should be place where? why?

Answer 29

at needle insertion point because they attract bacteria and may infect wound edges

Question 30

overly tight sutures may cause what

Answer 30

local tissue necrosis and scars

Question 31

what increases suture tension

Answer 31

wound edema and swelling

Question 32

pull suture thru tissue until ___ cm tail remains

Answer 32

1-2 cm

Question 33

the number of suture knots are determined by what

Answer 33

tensile strength and handling of suture material

Question 34

how many suture knots for silk

Answer 34

3/+

Question 35

how many suture knots for resorbable braided

Answer 35

4/+

Question 36

how many suture knots for monofilament

Answer 36

6/+

Question 37

what are complications related to improper suture

Answer 37

1. hematoma, infection 2. scar formation, stich marks 3. wound dehiscence 4. insufficient blood supply, edeme, altered healing 5. systemic factors and habits 6. implant failure

Question 38

too much tension on suture =

Answer 38

aggravated by post-surgical edema

Question 39

knots tied too loose =

Answer 39

wound opening

Question 40

inappropriate knot type or position =

Answer 40

knot away from edges

Question 41

sutures too close to edges =

Answer 41

dehiscence due to inflammation, swelling, decrease blood supply

Question 42

can patient who received implant take COX2 inhibitors

Answer 42

no

Question 43

osseointegration (w/ no grafting) for max anterior

Answer 43

4 month

Question 44

osseointegration (w/ no grafting) for max posterior

Answer 44

4-5 months

Question 45

osseointegration (w/ no grafting) for mand anterior

Answer 45

3-4 months

Question 46

osseointegration (w/ no grafting) for mand posterior

Answer 46

4 months

Question 47

during second stage uncovery procedure, should you anesthetize patient? what do you do after

Answer 47

yes duh - sound for implant head using perio probe

Question 48

do you hand torque healing abutment

Answer 48

YES YES YES

Question 49

implant insertion torque

Answer 49

<45 Ncm

Question 50

advantages of biopsy punches

Answer 50

1. clean 2. quick 3. no sutture needed 4. ok in non esthetic areas

Question 51

disadvantages of biopsy punches

Answer 51

1. no direct eval of bone 2. removal of keratinized tissue (and attached gingiva)

Question 52

how are electrosurg contraindicated

Answer 52

1. production of heat 2. loss of attached gingiva good for natural teeth not implant sites

Question 53

how to test for ossointegration

Answer 53

radiograph, wiggle, tap, periotest, reverse torque

Question 54

do you knot at wound location?

Answer 54

NO

Question 55

entrance and exit of suture needle from wound should be how many mm? what angle of entrance?

Answer 55

2mm, 90 degrees