A2 Flashcards
——- stent for CBCTs (——- mixed with acrylic 1:3 mix with liquid).
Barium sulfate
Get lateral excursion photos, if you take out the ——, it will lead to malocclusion elsewhere. ***This can happen with any small filling, be particularly weary of this on 2nd molars (first contact is here).
guidance form
Always get —- PTFE – the reason for this is that it is stretchy and thick enough to work. 5.0, 6.0, 7.0 do not stretch (change needle size of PTFE instead). Maybe 4.0 at largest. By the time you go to tighten and cut, it will be ——. Vicryl or nylon are 5-7.0.
3.0
thinner than it originally was
Most CBCT errors are in the — microm range
200-500
High resolution protocols do not lead to —–
3D models with higher accuracy.
If above mandibular canal, it has potential for —- origin. In canal is either ——- or ——-.
odontogenic
bloodborne (metastasis) or neuro
——- lesions are tough to differentiate and diagnose, especially in initial status of remodeling with radiolucency. This is tough to distinguish this from other apical lesions. Goes from radiolucent to mixed to radiopaque.
Fibrocementoosseous
Hounsfield value – ——-Air = -1000, bone 60-3000, water 0.
msCT radiodensity measurements.
——– assessment could easily help determine if a patient suffers from osteopenia or osteoporosis.
Mandibular canal width
Mandibular width should be 3mm or more to be categorized as healthy (cortex width)
Mandibular width should be —- or more to be categorized as healthy (cortex width)
3mm
A lesion that is not touching a junctional area between cortical and trabecular bone is——
more or less invisible. These are difficult to see.
Resiliance (movement) of tooth: Vertical (premolar with good perio) —–, horizontal = ——
50 micro
250 microm.
Implant mobility: Vertical —–, —— horizontally. This has a certain flexibility but it is much lower than a tooth.
2 micron
50 micron
Mixed implant-tooth FPDs are a compromise. Their prognosis isn’t great. Force is distributed to both tooth and implant. Implant takes up initial load. — lower 10 year survival rate.
10%
W distal cantilever, pressure zone on —-, tension on —– of —– abutment implant.
distal
mesial
middle
Implant sites Type 1: Advantage is ——
Type 2: Matured tissue, but you decrease —— and have not completely filled the ext site.
Type3, 4: —– more or less, but you lose bone contour.
sufficient bone contour, minimal soft tissue.
bone contour
Healed ridge
Only pre surgical antibiotics: 1.87% annual failure rate. 7 day post op antibiotics significantly —-
reduced annual fail rate.
Buccal positioning on soft tissue (relative to buccal surface of adjacent teeth)——
Lingual positioning on soft tissue: ——
- 8 mm mean
0. 6mm mean recession.
For transmucosal healing, you need some amount of ——-
soft tissue excess.
Inevitably, you will lose soft tissue and bone. Even with over 100-120% coverage of defect with tissue graft, you get down to around ——-
60% coverage at 6 months out.
Tunnel technique is extremely helpful to add ——. Maintain papilla, elevate flap on ——-. Then you tunnel from lateral teeth, while still maintaining —–.
Then a buccal incision is formed in —–, then you get a connective tissue graft, and string the connective tissue graft through the incision, up to the —- of the implant.
gingival body
buccal
papilla
vestibule
sulcus
Mean facial recession from —— is expected in immediate implants. This tends to mask the real trend. Max recession from —– has been recorded.
0.5-1.5 mm
3-6 mm
Mean gingival thickness for premolar to premolar is about —— Thick tissue is —–, thin tissue is —–. These need to be considered.
- 1mm.
- 5mm
- 8mm
Majority of recession between—–, however thick tissue did not get worse than —-. Large recession is almost always thin.
0.5-1mm
2mm
At transmucosal implants, improvements of soft tissue deficiencies are —— to perform compared to submerged healing procedures.
more difficult
For immediate, you need at least —- alveolar bone apical to tooth (between sinus), if not, you need a delayed approach with partial bone healing (3-4 months).
3mm
Implants placed in sites of perio removed teeth, are—–times more likely to fail than implants placed in other sites.
2.3
Studies found that —- weeks of waiting after perio ext is not enough to make the survival rate on par with a healthy periodontium.
6-8
By placing bone substitute between implant outer surface and buccal plate, we will lose —– of bone. Thus, if you want to maintain 100%, you need to place bone substitute outside (on buccal of buccal plate) of site.
50%
If infection, wait — weeks for placement.
6
How to check tissue biotype
Lift probe in sulcus facially – if you can see the probe thorugh tissue, it is thin biotype. Problem with thin biotype is facial gingival tissue stability.
Facial mucosa thickness: 0.7-1.5mm,—–and less thin, 1.1 to — is thick.
- 1
1. 5
Visual and direct measurement are both variable and non-definitive. As such, you need to approach every case as if——-
it had thin tissue.
Subepithelial connective tissue graft performed at time of placement – improves gingival thickness by almost ——. After 1 year the tissue became thicker. Even without tissue graft, the tissue gets thicker. Most implants are placed palatally, and this is why it is thought that this occurs. You need to be palatal to original position to achieve this.
1+mm
In order to fully shield from discoloration, almost every material required —- of gingiva. —- could hide zirconia only, —- had discoloration from every group. Thus, if you want to hide something, you may want to consider a connective tissue graft.
3mm
2mm
1.5mm
Normal crest is —- from FGM to bone, high crest is less than 3mm, low crest is more than 3mm.
3mm
In order to have gingiva, you need ——-. Facial gingiva has an —– to underlying bone, and this is also —–. Once you get over —– in facial gingiva, it has risk of recession and is unstable.
underlying bone to support it
adhesive relationship
3mm
3mm
Long story short, place the implant —– below ideal facial-gingival margin. Any deeper, and you have the risk of facial bone loss and thus gingival recession.
3-4mm
Place no more than —– deeper than FGM
3-4mm
Anterior bone: Class 1: ------- Class II: ------- Class III: -------- Clas IV: --------
buccal tilt, root in contact with buccal plate
Middle of plates
Touching palatal plate
Root wider than dimension of base of bone. Class 1 is best for immediate, class III then next best ideal. Most patients are class I.
Taper group in implants has less —– than parallel implant group when immediate placement is involved. That said, bone loss is good around parallels. Immediate implants are usually a good situation for a——
spinning issues
tapered implant.
Gap size, instead should be a guide to make sure that you do not place an implant in an area that will lead to exposure. If you don’t have enough of a gap, you are destabilizing the implant as you didn’t compensate for ———. So, how much does the ridge remodel?
average amount of facial remodeling
With graft (6months): —–. Without graft (6 months): —–
- 5mm bone loss
2. 6-4.6mm bone loss
If you look at buccal bone thickness along length of implant: buccal bone for teeth in esthetic zone is 1mm or less, thus you need a graft, as —— loss is expected. You will lose the buccal bone. So what size of gap should you leave?
1.5mm
*Gap size of —– at least in order to maintain the original width of the buccal plate
1.5mm
Equation for anteriors:
Facial bone+Implant diameter+Gap –facial loss with graft (1.2-1.5mm) = width of ridge.
Measure —- on CBCT buccal to existing tooth to make sure that you have space.
3mm
Another way: Resonance frequency analysis:
Pretty much put a tuning fork to an implant and see how it resonates. Magnetic pulses vibrate the smarteg… rewatch this section
Critical distance an implant can move is —– microns. This is more or less the PDL width of a strong tooth.
50-150
Torque measures resistance to —- forces.
shear
Immediate loading has its advantages as well. You find more —– production earlier when immediate loading occurs. Well controlled immediate loading can enhance osseointegration. This was verified in animal and (limited) human studies (10% greater).
osteoid
—– has been shown to positively effect healing
Micromotion
**If you have to graft, do not —-
load that implant**
Unique situation with implants: You can have —— tissue. The attachment for this is usually on —– bone.
keratinized unattached
peri-implant
If you soft tissue graft, you need contact to —-, otherwise it won’t be attached
bone
Bone sound for posterior extensions (make sure that you don’t have too much soft tissue height). Thinning out to less than—–can lead to bone loss.
2mm
Bundle bone varies in thickness, however it is thin. Usually —– thick.
0.4-0.5mm
3 months after ext: Buccal-lingual dimension lost —-% of ridge.
30%
12 month after ext: lost —-% of ridge buccal-lingually.
50
In height:
12 months after ext: —- loss in buccal portion of alveolar ridge relative to lingual portion.
1.2mm
Benefit of splinting is prosthetic – when you splint, the connector is in the frame, hence lower risk of —–
porcelain fracture.
Detaching mylohyoid leads to opening to —– and makes it prone to infection. Some techniques request going down to —– or beyond – this is risky.
mediastinum
mylohyoid
Amox 2g —-
Clinda 600mg ——
1hr before, 1 hr after
A1c – 3 month average. Normal blood glucose 80-120, Doc’s line in the sand is —-.
250
A1c – 3 month average. Normal blood glucose 80-120, Doc’s line in the sand is —-.
250
If an implant survives a —–, that implant will behave the same in a diabetic vs healthy pt.
year
IV bisphosphonates – —-% MRONJ risk. Bisphosphonates stay in the body for —- years.
10%
8-10
Coumadin best monitored by —- – extrinsic pathway = use PT. intrinsic = —- (pet and pitt)
PT
PTT
Design flap to give you —– from bony anatomical structures *foramen, canine eminence, etc). Normally incise right down crest, if you have less gingiva, consider a more lingual cut.
6+mm
Eval 9, 10, 11 CN with——-
“say ah”.
Attached gingiva is important to shield bone from bacteria. How much hard keratinized tissue is really needed around an implant? ——–. If you don’t have ——, consider a graft, or a 2 stage procedure. If you want to do single stage (healing abutment), get at least —– of torque. Benefit is that this is one surgery. Give —– above gingival crest for healing abutment in order to maintain hygiene.
2mm
25 nm
1-2mm
Lindeman bur: —–
Side cutting bur
Resorbable membranes should have —–. Also, no —- with resorbable membranes that are exposed.
primary closure
peridex
Transmucosal collar beneficial if you have a —–. Micromovement occurs at abutment/implant interface. If your implant rocks, you introduce bacteria, and that interface is key. If you move the interface away from bone, you reduce bone loss.
bony defect
Exposure of cover screw: If you do 2 stage and a week or two later the screw is exposed, this is fine. This is just the warning sign that the patient needs to really keep this clean. These cases are the ones that —-. You have to choose at this point to either totally open it or close it. Do not leave this in between.
lose bone
Peridex can help with —–. Generally, there is no specific rule on how much tissue will move in. After —- days do not touch the implant. If you get uncover 2 days in, go in and free up or close before day —. PTFE are the next gen of —- sutures. These can stay intraorally for a very long time. —- sutures are very smooth and easy to work with, but whenever you use a ——- suture, you need to leave longer threads. If you do not, you have less thread to resist tissue inflammation and untying.
gingival closure
3 days
3
gortex
Cytoplast/cytosurge
Peridex can help with —–. Generally, there is no specific rule on how much tissue will move in. After —- days do not touch the implant. If you get uncover 2 days in, go in and free up or close before day —. PTFE are the next gen of —- sutures. These can stay intraorally for a very long time. —- sutures are very smooth and easy to work with, but whenever you use a ——- suture, you need to leave longer threads. If you do not, you have less thread to resist tissue inflammation and untying.
gingival closure
3 days
3
gortex
Cytoplast/cytosurge
Allograft – —- months of healing.
4-5
PTFE membranes – dimple faces the ——.
soft tissue
Cortical bone is nice as it —– – do 50% 50% cortical cancellous.
maintains volume
Bond bone – —— – fast setting, goes away in —- months. Other products with HA last—–
osteoconductive
4-5
7-8.
Consider length that graft material stays around, if you are grafting a socket, you want that bone to disappear by—-months/be replaced by new bone. Other way around for other procedures. For graft and membrane, consider charging in the ballpark of 700? BIC = bone implant contact. Usually lift tissue—–or so into vestibule (for case on #2 soft tissue coverage).
4-5
5mm
Temp bond is nice because it is —- and easy to clean and —–.
water soluble
radiopaque
Temporary abutment in —- holds bone and forms gingiva. Deep class II is a contraindication for ——.
immediates
Best spot for FGG harvest is from——–to avoid anatomical sites. Make this —– palatally to gingival margin.
1st premolar back to molar
3-4mm
Sling: .
Come in on mesial, over palatal tissue, thorugh palatal tissue, back through distal, tie off in facial
Anterior pedicle graft – counting on
anterior vasculature off of incisive foramen to help.
Suture for pedicle:
Go up in vestibule, go through tissue on distal, back in on mesial of tissue, tunnel back between bone and socket out to buccal vestibule to again create a sling.
Mean loss on buccal aspect is —- of loss, lingual aspect is —– (average from central back to molars). This is the same for both maxilla and mandible.
- 5mm
1. 7mm
Lingual walls are frequently wider than the —-, modeling occurs at the same rate on buccal and lingual, and thus this inherent starting thickness accounts for the difference.
buccal wall
Buccal bone wall: reduction after 4 months is —-
Lingual bone wall: reduction after 4 months is —–
- 9mm
0. 8mm.
Buccal contour reduction of —- after ext. This leads to —– of vertical loss, and the major reduction will occur before — months. After 2-3 years, reduction of contour is —–
50%
2-4.5mm
4
40-60%.
Buccal resorption was —- lingual was —- after —– months.
56%,
30%
4 months
We can reduce resorption to —- with grafting.
15-20%
After immediate implant placement and flap elevation a mean buccal bone resorption of —- must be anticipated.
56%
Soft tissue preservation: —weeks after ext. We can either do a soft tissue graft, or combine soft tissue grafting with a bone substitute.
6-8
Connective tissue grafts over fresh extraction sites are mainly dependent on ——, but the bone underneath is —–. We need to be sure that the suturing of such a graft allows for ——.
underlying tissue vascularization
not important
vascularization
What if a graft becomes necrotic? Not having sufficient —- can ruin a punch graft – it needs 360 degrees of intact tissue contact to work.
Grafts should be covered —-, —— exposed. If you do not do this, it can lead to necrosis.
papilla
70%, 30%
Soft tissue management:
Before ext: —–
With extraction: ——-
After extraction (if infection present): —–
Ortho extrusion
punch technique, connective tissue graft
connective tissue graft
Ortho extrusion: By slowly extracting teeth ——, then retaining teeth for —– months (composite or wire splint).
(6-8 weeks)
4-6 months
Flap elevation causes a change of volume of —–mm. Graft material with punch technique improved results regardless of flap or not.
0.4-0.6
Graft material only has a benefit when the —— disappears.
multinuclear cells (inflammatory reaction)
Graft materials – namely a collagen plug – can reduce bone loss by —-
50%.
In order: bone graft w/punch, then bone graft w/collagen matrix, then TCP without soft tissue closure, then spontaneous healing in terms of favorability.
Flapless socket techniques only for defects missing less than —% of buccal plate.
50
Implant-tooth relationship results in a vertical soft tissue height loss of —- (—- for implant-implant). With an adjacent tooth, it is reasonable to have —- distance (this is to be expected, and will work aesthetically).
.5-1.5
1.5
4-4.5mm
How to predict ahead of time if there will be recession: Interproximal recession predictors:
missing contact point (you need an adjacent restoration). Second highest is surgery on edentulous area in order to place implant (including ridge recontouring), if the bone crest to the contact point distance is too high, if the pre-operative adjacent tooth bone level is already periodontally involved, interproximal recession can be affected. That said, implant-to-tooth distance has little affect.
Regarding vertical placement of an implant (subcrestal vs supracrestal) and bone loss: if you place the implant into the middle of the socket, you need to be placed —- subcrestal to end up at a flush implant. If you place —- from buccal plate, you need to be —- subcrestal to eventually reach a flush implant after modeling. If you place —- from the buccal plate, you can place it at the —- and be fine. This is due to the stability of the lingual plate.
2mm
2mm
1mm
4mm
crest
Vestibular incision subperiossteal tunnel access (VISTA).
This is an access to the area that allows approach to facial without making an incision through papilla – like a semilunar flap for approaching the periapical pathology and graft placement.
If replacing two centrals, you need to consider the —– and the subsequent additional recession of—- on average.
increased distance between two implants
1mm
You can only predict —- papilla height for adjacent implants, thus you need to accommodate with a longer contact.
3.5mm
Rate of ortho extrusion: — or less per month, then —-month holding period.
1mm
4-6
Short implants need to be —– consider splinting (not thoroughly documented yet), consider reducing occlusal table, especially if crown height is elongated.
1 crown per root/implant,
Be careful with placing mandibular overdenture implants too far —– – this can lead to —–
posterior
too much rocking. Consider in canine-lateral incisor region.
Absolute implant contraindications:
Recent MI or cerebrovascular accident.
Recent valve prosthetic placement or transplant
INR greater than 3-3.5, platelets under 50000/mm^3
Significant immunosuppression (white count under 1500 cells/mm^3, absolute neutrophil count under 1000 cells/mm^3)
Active cancer therapy
IV bisphosphonates
Psychiatric disorders
Absolute implant contraindications:
Recent MI or cerebrovascular accident.
Recent valve prosthetic placement or transplant
INR greater than 3-3.5, platelets under 50000/mm^3
Significant immunosuppression (white count under 1500 cells/mm^3, absolute neutrophil count under 1000 cells/mm^3)
Active cancer therapy
IV bisphosphonates
Psychiatric disorders
Bisphosphonate destruction:
Frozen type:
: abundant bone necrosis, empty haversian systems without cellular beta component
Bisphosphonate destruction:
Osteolytic type:
extensive osteolysis with/without sequestrum formation
Bisphosphonate destruction:
En block type:
en block sequestration with an implant (considerable BIC may be maintained).
Consider the possibility for late onset micro/macro vascular complications with —- pts
DM pts.
Bleeding disorders: —-.
refer. If you do this, use antifibrinolytic agents before and after for up to 7 days. Bone grafts, lifts are contraindicated. Use sutures with local measures added. Antibiotics are fine
Bleeding disorders: —-.
refer. If you do this, use antifibrinolytic agents before and after for up to 7 days. Bone grafts, lifts are contraindicated. Use sutures with local measures added. Antibiotics are fine
Ectodermal dysplasia:
Increased failure rate, especially in maxilla present.
Ectodermal bullosa:
main complication is bleeding ulcers and blisters, possible problems from microstomia. Just drill with less irrigation, place aspirator in contact with bone, not tissue.
Immunocompromised pts:
Cyclosporin impairs implant bone healing. Transplants are fine. Overall, this is case based, and there isn’t enough research.
Sjogren:
Can link a saliva electrostimulation device on a dental implant, still in research. No problems with implant, just be aware of the severity and manage it.
Osteoporotic pts with mental foramen wider than —- will have normal bone mineral density. Just evaluate bone density of these patients before proceeding.
MCW, PMI and KI are good tools to check for reduced bone mineral density.
4mm
If you are unable to place an aesthetic implant properly the first time and need to remove and heal, use a —- over the sx site in order to heal smoothly.
FGG
When grafting, consider using a —-, as it forces you to be sure that you used the right flap design. A small —- will only truly work with a passive tension, otherwise it will break.
thinner suture material
suture
Two piece ceramics problems: The abutment is usually —-, and this margin is extremely close to bone. Titanium inserts or screws have also been used, but there is absolutely no evidence on their use.
bonded or cemented
All ceramic crowns do not survive on —–. You would need a —- coping to have it survive. That said, chipping and roughening had a high rate of occurrence.
zirconia implants
zirconia
For zirconia implant insertion, —- is max torque, —- max speed (it doesn’t conduct heat, so you have to go far slower on insertion. Recommendation for osseointegration is — months for zirconia.
35 nm
15 rpm
3-6
When using benzos, go for something with faster —-.
metabilization
Optimal pore size that would occlude cells but allow passage of nutrients is —-micron.
0.45
Trim all membranes to have a — margin with regards to neighboring tooth roots.
1mm
Bone grows about — per month (remodeling rate on average). This is good to bring up when you talk about augmentation. This is good to tell people if they are iffy on time periods.
1mm
HA and tcp (tricalcium phosphate)– —–
TCP is replaced by bone, but HA stays. This is a consideration for bone substitute materials.
Consider speed of degradation – you need to have space for bone material to move. Opposite problem if too fast, where you won’t be able to have bone move in. TCP (bi-phasic) is more or less plaster of Paris). This is usually gone in — weeks and replaced with net of blood vessels.
2
Ion release from various graft materials plays a roll on osteoblasts – — in particular from bovine bone is beneficial.
silica
—% of ridge mineral density can be resorbed before any radiographic changes.
70%
Consider that resorbed ridges will have a lower chance of having —–.
attached gingiva
Problem with vertical bone graft is the amount of —- for nutrient maintenance. The longer the distance, the harder the graft.
vascular ingrowth
Sharp edges of bone graft can induce —-
pressure necrosis.
Interpositional graft: cut —–, raise it and screw it in place (with a gap in the middle), fill with bone substitute. Leave it for —- months. Benefit of this technique is that the —- stays on top of the ridge.
alveolar ridge
4 months
gingiva
Interpositional graft: cut —–, raise it and screw it in place (with a gap in the middle), fill with bone substitute. Leave it for —- months. Benefit of this technique is that the —- stays on top of the ridge.
alveolar ridge
4 months
gingiva
¼: Facial wall of the ridge is resorbed not more than half of the prospective implant height. Dehiscence defect, treat at same time of placement in a lot of cases. —–
GBR w/particulate graft, or if aesthetic, block graft.
½: Facial wall is resorbed more than half of the prospective implant height. Usually ——-
staged implant approach. GBR w/block graft. Alternatively, this is when you can do ridge splitting with simultaneous implants.
¾: ½ plus the lingual wall is resorbed. This is —-
staged placement, start with GBR and shell block, alternative is swinging interpositional graft.
4/4: ½ plus over half lingual wall resorption.
Staged implant placement, interpositional graft, or consider iliac onlay block graft, or in esthetic areas distraction osteogenesis can be done.
Problem with interpositional graft, need room between —-, otherwise it won’t work in mandible.
—– can be used to hold bone prior to final implant placement.
IAN canal and bone
Provisional implants (minis)
More —- you go in sinus, higher the rate of membrane perf.
mesial
—- sx can alter anatomy (used to treat sinusitis by performing buccal performation to remove all sinus membrane, then creating a new ostium to drain sinus toward nasal fossa). Much higher risk at this area.
Caldwell lucq
If patient was treated with polypectomy to solve for polyposis in nose. Often ENT will remove —- of sinus, and not having this can lead to issues with graft stabilization.
medial wall
Pathology: Inverted papilloma is a contraindication to DSE – this is a benign tumor that must be resected. Problem is that there is a risk of cancer degeneration in —- following sx. This is a hard contraindication.
4 years
Importance for custom healing abutments in posterior: you can make sure that your tissue emergence profile is wide – beauty of this is that you can —- and eliminate food traps that inevitably result from a poor emergence profile. Further, if you have the lab create a custom healing abutment, you don’t need to give them a final impression. Can send an implant impression with a scan body (it is effectively the impression coping but scanable). Labs will often send a temp for an immediate with proper occlusion – you will need to take it out of lateral and protrusive contacts.
drop contacts
If young, consider placing CEJ at —– (from bone to CEJ) instead of —–, in anticipation of bone loss.
4mm
3mm
—– can be linked with periodontitis.
Hyperlipedemia
Never have separate crowns with —– – when in doubt, have bridged FPDs.
porcelain
Engram –
habit that the body does that the patient is unaware of (imagine biting consistently away from CO). If the patient exhibits an engram, you MUST ID it. If your restoration is in the way of the engram, it could fail.
Alloderm
acellular dermal matrix (allograft – donor skin stripped of cells). No need to tissue match, it just serves as a scaffold.
Alloderm – 2 things to be aware of with these – try not to
leave it exposed, it degrades much quicker and looks terrible and smells terrible. It is unpleasant if exposed. Also, because it is dermal tissue, not connective tissue, it mimics tissue it is placed underneath. If you have a problem with keratinized tissue, you will have thick mucogingival tissue, not keratinized. To learn more about alloderm – look up Dr. Pat Allen – Dr. Wong and Folleck recommend this course.
See rotated mand canines – this may lead to ———–
a very thin incisal edge for the implant, or a rounded wear facet in what should be square teeth.
You can have too much keratinized tissue – this may necessitate a —– at the edentulous site. Also, don’t neglect looking at adjacent tissue around teeth – in this case the tissue around adjacent teeth was deficient but the edentulous site was adequate.
gingivectomy
Sx – pt who has a few drinks over the weekend – it’ll
impact bleeding on Monday. Make sure that they don’t drink (only tell this to non-alcoholics) leading up to sx.
if you do sedation, drinking and marijuana can impact —–.
benzos
Tenting screws: Dr. Foleck prefers not to do it, Dr. Wong would be ok with it. The decision between tenting screw and block graft would be down to the amount of bone that is needed. If you need —- of bone, this is a particulate, tent screw procedure. If it is —-, do a block graft – it is more predictable. Ultimately, a block is going to be more stable. Membrane choice is key as well. You will have a thin band of keratinized tissue, so consider need for tissue graft and consider PTFE membrane.
2-3mm
5+mm
Sandwich technique with piezo –
put a plate of bone in the trough, let heal, and go from there. You can make the incision with a circular saw, piezo, drill. You can make the incisions crestally and vertically, close them up and let them heal for 6 weeks, and you can then expand. This way, the periosteum is still holding it in place, so that if it breaks you are not SOL. NOTE: This is much easier to do on the maxilla, mandible is really hard. It can be done, but do the maxilla first. `
If you have no loss of VDO in AI patients, they will likely have —– to compensate for lost tooth structure.
supraeruption
Dentinogenesis imperfect can have —— – AI doesn’t tend to have problems with ——. Diseases affecting dentin can reflect —— defects.
bone density issues
bone density
bone mineralization
With big cases, 2 years on —- month recall, discussion will be had about whether or not you should taper off.
3 month
In teeth, lateral force is bourne by the —- of the tooth, whereas for implants it is in the —-.
apical third
crestal bone
If you have all anterior implant supported restorations (or full FP1-2), consider going into —–. Always have 2 teeth in contact during ——- to disperse force. Do not have balancing contacts in such cases. Still avoid —– contacts.
group function
canine guidance (canine, premolar or lateral)
protrusive
