9/6 - Implant Surgery Basics, Flap Design, and Sutures Flashcards
if patient is allergic to penicillin or amox what do you prescribe
clindamycin
what are the CHX gluconate prescriptions
- rinse for 5 minutes prior to initiating surgery
- rinse daily for 10 days after surgery
what NSAIDS prescribed
ibuprofen or tylenol
what are medical pre-op management
medical hx and consent forms
what are supportive pre op management
antimicrobial mouth rinse, antibiotic pre load, NSAID preload, sedation
what are technical pre-op management
specialized set up, instrumentation, flap design, implants, components
type of flap designs
- full thickness
- split thickness
rationale for flap design
- identificaiton of anatomical structures
- incision outline
- execution
aim for surgical flaps
to gain acess and move tissue from one place to another
basic principles of surgical flaps
visualization, prevent flap necrosis, dehiscene or tearing
how to prevent flap necrosis
- base > apex
- length < base
- axial blood supply included in teh base
- handling case with care
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)
full thickness
what flap make incision where you release tissue in split thickness fashion TO PERIOSTEUM (periosteum stays intact w/ cortical bone)
partial thickness
without irrigation with sterile water or saline or a chilled irrigant, what do you risk
bone necrosis
drill speed for osteotomy
1000-1500 rpm MAX
hand position for bone prep drilling
straight in and out, no elliptical motion, no wrist movement
implant insertion torque and speed
<45 Ncm
15 rpm
abutment screw torque
25 Ncm
how to manage post surgically
- flap closure
- radiographs
- medicaitons
- instructions
what must flap primary closure be
water tight and tension free
what type of suture technique for flap closure
single interrupted
what are the types of multifilament sutures
non-absorbable: silk and polyester
absorbable: polygalactin and gut
what are the types of monofilament suturs
non-absorbable: polypropylene and nylon
absorbable: polyglecaprone
what is the purpose of sutures
- provide mech support to wound until soft tissue can withstand functional forces
- approximation of wound edges for primary intention healing
- flap is position passively before suturings
- sutures should not pull the flap into position under tension
how to make suturing minimally traumatic
- pass needle thru each side of incision separately
- pass needle thru mobile tissue
- suture every 5 mm
- smallest number of sutures for adequate support
- knot at needle insertion point
- no overly tight suture
when suturing, do you pass needle thru immobile or mobile tissue first
mobile
suture every ___ mm
5 mm
should smaller or more amount of sutures provide adequate support
smaller
knots should be place where? why?
at needle insertion point because they attract bacteria and may infect wound edges
overly tight sutures may cause what
local tissue necrosis and scars
what increases suture tension
wound edema and swelling
pull suture thru tissue until ___ cm tail remains
1-2 cm
the number of suture knots are determined by what
tensile strength and handling of suture material
how many suture knots for silk
3/+
how many suture knots for resorbable braided
4/+
how many suture knots for monofilament
6/+
what are complications related to improper suture
- hematoma, infection
- scar formation, stich marks
- wound dehiscence
- insufficient blood supply, edeme, altered healing
- systemic factors and habits
- implant failure
too much tension on suture =
aggravated by post-surgical edema
knots tied too loose =
wound opening
inappropriate knot type or position =
knot away from edges
sutures too close to edges =
dehiscence due to inflammation, swelling, decrease blood supply
can patient who received implant take COX2 inhibitors
no
osseointegration (w/ no grafting) for max anterior
4 month
osseointegration (w/ no grafting) for max posterior
4-5 months
osseointegration (w/ no grafting) for mand anterior
3-4 months
osseointegration (w/ no grafting) for mand posterior
4 months
during second stage uncovery procedure, should you anesthetize patient? what do you do after
yes duh - sound for implant head using perio probe
do you hand torque healing abutment
YES YES YES
implant insertion torque
<45 Ncm
advantages of biopsy punches
- clean
- quick
- no sutture needed
- ok in non esthetic areas
disadvantages of biopsy punches
- no direct eval of bone
- removal of keratinized tissue (and attached gingiva)
how are electrosurg contraindicated
- production of heat
- loss of attached gingiva
good for natural teeth not implant sites
how to test for ossointegration
radiograph, wiggle, tap, periotest, reverse torque
do you knot at wound location?
NO
entrance and exit of suture needle from wound should be how many mm? what angle of entrance?
2mm, 90 degrees
