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advanced implant options Flashcards

1
Q

bone loss timelinewith extractions
rehab options?

A
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2
Q

bone resorb patterns of max and man

A
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3
Q

bone types

A
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4
Q

integration times based on bone type

A
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5
Q

properties of bone grafts

A

osteogenesis, osteoinduction, osteoconduction

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6
Q

osteogenesis

A
  • viable cells contribute to new bone formation
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7
Q

osteoinduction

A
  • proteins, factors, hormones modulate host cells
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8
Q

osteoconduction

A
  • matrix/scaffold onto which new bone can form
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9
Q

autogenous bone graft

  • from?
  • preffered? properties?
  • donor sites
  • forms?
  • Cortical vs. Cancellous?
A
  • Same individual
  • Gold standard : Osteogenic, osteoinductive, & osteoconductive
  • Extra-oral vs. intra-oral donor sites
  • Intra-membraneous vs. cartilaginous
  • Block vs. particulate forms
  • Cortical vs. Cancellous
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10
Q

cons of autogenous

A
  • Need for second operative site
  • Insufficient amount of bone
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11
Q

cortical autogenous graft advantages

A

more bone morphogenic proteins (BMPs) & better structural support

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12
Q

cancellous autogenous graft advantage

A

more osteoblast precursor cells for greater osteogenic potential

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13
Q

healing time of autogenous graft

A

Healing time 3~7months

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14
Q

extra oral autogenous donor sites

A

skull, ribs, illiac crest, tibia

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15
Q

intra oral autogenous sites

A

man symphasis
ramus

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16
Q

Symphysis vs Ramus
as donor sites

A
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17
Q

allogratft

  • From?
    *properties
  • Types of Allografts?
A
  • From other individuals of the same species
  • Cadavers
  • Tissue bank
    * Osteoinduction & osteoconduction
  • Types of Allografts
  • Freeze-dried bone allograft (FDBA): 6-15 months
  • Demineralized freeze-dried (DFDBA) 6 months
  • Irradiated bone (2.5 million rads)
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18
Q

allograft advantages

  • available?
  • Eliminates?
  • Reduced?
  • Decreases?.
  • Fewer?
A
  • Ready availability
  • Eliminate second surgery
  • Reduced anesthesis & surgical time
  • Decrease blood loss
  • Fewer complication
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19
Q

allograft disadvantages

A
  • Associated with the use of
    tissues from another person
  • Immune responses
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20
Q

xenograft

  • from?
  • what is it?
  • Highly?
  • Rapid revitalized through?
  • resorbtion?
A
  • Different species
  • Anorganic bone treated to remove its organic component
  • Highly osteoconductive
  • Rapid revitalized through new blood vessels
  • Slowly resorbing matrix structure (6 months ~)
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21
Q

alloplasts properties
* Natural or Synthetic?
* Mostlywhat property?
* Variety of?
* Crystalline or amorphous?
* Granular or molded?
* take longer to?

A
  • Natural or Synthetic
  • Mostly osteoconductive
  • Variety of textures, sizes, and shapes
  • Crystalline or amorphous
  • Granular or molded
  • take longer to absorb
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22
Q

Type of Alloplastic Bone Graft material

A

I. Ceramic : HA, TCP
II. Calcium Carbonate : Bio Coral
III. Biocompatible composite polymer
IV. Bioactive glass ceramic : Bio-glass

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23
Q

barrier membrane characteristics
 Biocompatible?
 Stability for?
 Manipulable?
 closure form?

A

 Biocompatible
 Stability for space maintenance
 Manipulability
 Primary closure throughout healing period is essential to GBR outcome

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24
Q

non-resorb barrier membranes
GOldstandard for?
 Optimal?

A

 Polytetrafluoroethylene (e-PTFE, TR e-PTFE), or titanium mesh
* Titanium Reinforced PTFE Membranes (TR e-PTFE), Ti-Enforced microporous (ePTFE)
 Gold standard for GBR
 Optimal graft containment

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25
Q

nonresorb barrier mem cons

A

flap management
- 2nd surgical procedure to remove membrane

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26
Q

natural resorb barrier membranes
made of?
- degrades?
- Limited ability to?
- retention time frame?

A

Natural: collagen of animal origin
- Enzymatic degradation
- Limited ability to maintain space
- 4 to 6 months of retention

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27
Q

types of resorb barrier mem and resorb time frames

A
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28
Q

synthetic resorb barrier mem, made of?
- Degradation by?
- rate of membrane resorption?

A

 Synthetic: poly(lactic) and poly(glycolic) acid copolymers
- Degradation by hydrolysis
- Highly variable rate of membrane resorption (pH & material composition)

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29
Q

types f synthetic resorb barrier mem

A
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30
Q

available bone augmentation procedures

A
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31
Q

GBR

A
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32
Q

onlay block graft

A
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33
Q

what is GBR

A

ingrowth of
osteogenic cells
while preventing
migration of
unwanted cells

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34
Q

GTR

A

GTR = Regeneration of periodontal apparatus
Regeneration of alveolar bone, PDL, & cementum

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35
Q

GTR vs GBR

A

 GTR = Periodontal regeneration ( to SAVE teeth !)
 Same principle: exclusion of gingival connective tissue cells
from the wound and prevention of epithelial downgrowth.
These procedures allow cells with regenerative potential
(periodontal ligament [PDL], bone cells, and possibly
cementoblasts) entry into the wound site first.”
 GBR = Bone regeneration ( to PLACE implants !)

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36
Q
A

tenting screws with ti mesh

37
Q
A

ti enforced mem

38
Q

type of max sinus bone graft placement procedures

A

lateral window or intracrestal

39
Q

Lateral Window Sinus Lift procedure indication

A
  • Less than 4 mm native maxillary alveolar bone
40
Q

Intracrestal Sinus Lift indication

A
  • More than 4mm native maxillary alveolar bone
41
Q

lat sinus lift visualized

42
Q

what technique

A

distraction osteogenesis

43
Q

summer technique
 Indications: bone types/height?
 Results:
sub-sinus bone height? elevation? how much elevation without mucosal impairment is possible?

A

variatrion of basic sinus floor elevation
 Indication:
* Type III or IV bone
* Minimum bone height of 5mm
 Results:
* ↑initial sub-sinus bone height, ↑ elevation
* 4-6mm elevation w/o impairing mucosa is possible

44
Q

balloon mod for sinus lift

A

Catheter filled with saline
 Swelling the balloon
 push out sinus membrane

45
Q

histo?

limiting factor of modified sinus lift

A

Membrane can support elevation in the sinus cavity of 4-8mm

46
Q

avantages of modified sinus lifts

 invasive?
 surgical staging?
 graft?
 complications?
 Septum?

A

 Minimally Invasive
 Usually single surgery
 Little or no graft needed¹
 Less postoperative complication
 Septum Presence

47
Q

disdavntages of mod sinus lifts:
* lack of?
* limited elevation?
* uncertainty of?

A

Lack of direct visual control
 Elevation height may be limited to 1-2mm
Uncertainty of microperforation of Schneiderian membrane

48
Q

firts steps to summer technique
 access?
 bone?
 Apical Deformation of ?

A

 Crestal Access
 Compacting bone
* Laterally & apically
 Apical Deformation of sinus floor

49
Q

second step to summers

A

Bone graft placed at osteotomy site
* Serve as damper during floor fracture
* Gradual ↑pressure leads to lifting of sinus membrane

50
Q

what is done once summer is completed

A

place implant

51
Q

how much can be lifted?

52
Q

types of grafts

A

atuogenous
allograft
xenograft
no graft

53
Q

graft complications
 Infection
 sinus status?
 Fistula?
 Lack of?
 increase?
 Perforation?

A

 Infection
 Pain, sinusitis
 Hemosinus
 Fistula
 Lack of Primary stability
 increases membrane lesion if lifted >5mm
 Perforation of membrane

54
Q

Reiser et al membrane perforations
* ≤2mm (small): prognosis, shape?
* ≥ 2mm (+implant exposed to sinus): prediction, shape?

A
  • ≤2mm (small)
     Good prognosis
     Membrane retains dome shape
  • ≥ 2mm (+implant exposed to sinus)
     Difficult to predict
     Lack of shape and loss of space
55
Q

Pikos mem perf
* 5-10mm
 what used to close?
* >10mm
 mem?

A

Pikos
* 5-10mm
 Collagen membrane to close the tear
* >10mm
 Cross-linked type I collagen membrane

56
Q

Kasabah et al
* Large Perforation
 Absolute Contraindication to?
 Foreign bodies create?

A

 Absolute Contraindication to continuation of surgery!
 Foreign bodies create pathologies of mucos

57
Q

Osteotomes in low-density bone
* Compression wil?
* improves?

A

Osteotomes can enhance primary stability in low-
density bone
* Compression will laterally condense bone¹
* Denser interface improve initial bone-to-implant contact²

58
Q

residual ridge size and perforations

A

Residual ridge of 3mm  Perforation=85%³
Residual ridge of 6mm  Perforation=25%
* Risk factor for perforation do correlate with residual ridge height

59
Q

predictable results with mod sinus liftwith initial bone height?

A

Predictable result may be correlated to
* Initial residual bone height of 4-6mm

60
Q

invasiveness of modded sinus lift

A

Less invasive than lateral approach sinus lift

61
Q

mem tear occurance in mod sinus lift
* Small size defect:
* Osteotomy -sized defect:

A

Infrequent occurrence of membrane tears
* Adequate bone graft mass elevating the membrane
* Small size defect: good prognosis
* Osteotomy -sized defect: discontinue implant surgery

62
Q

Successful creation of sub-antral space

A
  • Gentle tissue manipulation / accurate pre op x-ray
  • May need little or no graft with implant insertion
63
Q

 Ridge Expansion Technique
 where?
 results?
 Dental implant placed where?
 Additional space filled with?

A

 Longitudinal Osteotomy on Alveolar bone
 Lateral reposition of buccal cortex
 Resulted in ↑alveolar width
 Dental implant placed between buccal and lingual cortex
 Additional space filled with bone graft materials.

64
Q

where is ridge expansion more commonly performed? why?

A

More common performed on Maxilla > Mandible
 Thinner cortical plate
 Softer medullary bone

65
Q

ridge expansion technique forms

A

immeadiate and delayed
Techniques are Location / Bone type based!

66
Q

Immediate Ridge Split (Single Stage)
 which arch?
 why?

A

 Maxilla
 Thinner cortical plate
 Softer medullary bone

67
Q

Delayed Ridge Split (2 Stage) used in which arch? why?

A

 Mandible
 Lower flexibility
 Thicker cortical plate
 Risk of mal-fracture

68
Q

Limiting Factors of ridge expansion:
 Minimum alveolar ridge width:
 width around implant necessary? which regions?

A

 Minimum alveolar ridge width: 2-4mm ( prefer ≥3mm)
 1mm width around implant is necessary: Buccal and palatal region

69
Q

ridge expansion
 implant placement?
 treatment time?
 cost?
 Barrier membrane?

A

 Simultaneous implant placement
 Reduced treatment time
 Reduced cost of surgery
 Barrier membrane usually not
needed

70
Q

d

disadvantages of ridge expansion:
Bone?
 Difficult on?
 Cannot Correct?
 Only ↑’s?
 Implant placed tends to situated where? why?

A

Bone loss
 Difficult on single tooth site
 Cannot Correct Vertical defect
 Only ↑alveolar width
 Implant placed tends to situated facially¹ due to remodeling and resportion of buccal plate

71
Q

immeadiate ridge split steps

72
Q

delayed ridge split steps

73
Q

Summary of ridge splits
 Immediate ridge split: excellent result in?
 Delayed ridge split: where?
 Expected width gain?
 better arch? why?

A

 Immediate ridge split: Excellent implant osseointegration result
 Delayed ridge split: Consideration for mandible
 Expected width gain: ~3mm or more
 Maxilla is more applicable: Due to bone type (3 or 4)

74
Q

Grafting Treatment Planning
 Success rate of?
 Major bone grafting can have a failure
rate as high as?
 Immediate loading?
 staged?

A

 Success rate of 90% or greater*
 Major bone grafting can have a failure rate as high as 30%
 Immediate loading is not recommended
 Two-stage delayed loading protocol needed

75
Q

when zygomatic implants would be used diagrammed

76
Q

Various Options for Maxillary Rehab

77
Q

Zygoma Implant

78
Q

Indications for Zygoma Implant

A

 Sufficient anterior bone + severely resorbed posterior 1
 Insufficient anterior bone (need ant graft) + severely resorbed posterior
 Partial Edentulous Maxilla with unilateral or bilateral loss
of posterior teeth + severe resorption
 Zygoma implant + Minimum of 2 regular implant

79
Q

Consideration for Zygoma Implant
 sinuses?
 radio?
 Traditional use of zygoma implants dictates room for?

A

Consideration for Zygoma Implant
 Clinically symptom free and pathology free sinuses
 Proper radiographic imaging for maxillofacial
region
 Traditional use of zygoma implants dictates room for at least TWO conventional implants at anterior maxilla

80
Q

Prosthetic Consideration of zygo implants

81
Q

Surgical Anatomical Consideration of zygo implants

 Usually at?
 Slightly?
 Confirm?
 Head position will dictate?

A

 Usually at premolar region
 Slightly more palatal
 Confirm implant head position
 Head position will dictate future abutment screw position

82
Q

Concept of AP-Spread for zygo implants

83
Q

loading time frames

84
Q

Surgical considerations for implant loading
 Consider taper implant for?
 Final torque >
 ISQ value >

A

 Consider taper implant for increased initial implant stability
 Final torque >35Ncm
 ISQ value >60

85
Q

restorative considerations for implant loading
 Minimum handling during?
 what should be eliminated
 Occlusal contacts?
 cateilver in immeadiate?
 Consider final abutment?

A

 Minimum handling during healing phase
 Load Distribution, cantilever / lateral forces eliminated
 Occlusal contact  at first 2-3 months
 No cantilever of all types in immediate function protocol
 Consider final abutment at time of implant placement

86
Q

Pre-operative Radiographic Exam
 Recommended Radiographs?
 Panorex:
 Intraoral PA:
 Lateral Cephalometric:
 CT:

A

 Panorex: Anatomic structure and pathology detection
 Intraoral PA: supplement Panorex
 Lateral Cephalometric: Sagittal relationship of jaws
 CT: Bone volume (width and height) assessment

87
Q

Contraindications of zygo implants
 sinus?
 pathology of?
 Underlying?
 Relative contraindications?

A

 Acute sinus infection
 Maxillary or zygoma pathology
 Underlying uncontrolled systemic disease
 Relative contraindications
 chronic infectious sinusitis
 bisphosphonates
 smoking

88
Q

Extra-Sinus Approach

A

 Some European clinicians are placing zygoma implant using extra-
sinus approach and claimed to have no problem

OS 3 (6 decks)

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