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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
# nonresorb barrier mem cons
flap management - 2nd surgical procedure to remove membrane
26
natural resorb barrier membranes made of? - degrades? - Limited ability to? - retention time frame?
Natural: collagen of animal origin - Enzymatic degradation - Limited ability to maintain space - 4 to 6 months of retention
27
types of resorb barrier mem and resorb time frames
28
synthetic resorb barrier mem, made of? - Degradation by? - rate of membrane resorption?
 Synthetic: poly(lactic) and poly(glycolic) acid copolymers - Degradation by hydrolysis - Highly variable rate of membrane resorption (pH & material composition)
29
# types f synthetic resorb barrier mem
30
available bone augmentation procedures
31
GBR
32
onlay block graft
33
what is GBR
ingrowth of osteogenic cells while preventing migration of unwanted cells
34
GTR
GTR = Regeneration of periodontal apparatus Regeneration of alveolar bone, PDL, & cementum
35
GTR vs GBR
 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 !)
36
tenting screws with ti mesh
37
ti enforced mem
38
type of max sinus bone graft placement procedures
lateral window or intracrestal
39
Lateral Window Sinus Lift procedure indication
* Less than 4 mm native maxillary alveolar bone
40
Intracrestal Sinus Lift indication
* More than 4mm native maxillary alveolar bone
41
# lat sinus lift visualized
42
what technique
distraction osteogenesis
43
summer technique  Indications: bone types/height?  Results: sub-sinus bone height? elevation? how much elevation without mucosal impairment is possible?
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
# balloon mod for sinus lift
Catheter filled with saline  Swelling the balloon  push out sinus membrane
45
# histo? limiting factor of modified sinus lift
Membrane can support elevation in the sinus cavity of 4-8mm
46
# avantages of modified sinus lifts  invasive?  surgical staging?  graft?  complications?  Septum?
 Minimally Invasive  Usually single surgery  Little or no graft needed¹  Less postoperative complication  Septum Presence
47
disdavntages of mod sinus lifts: * lack of? * limited elevation? * uncertainty of?
Lack of direct visual control  Elevation height may be limited to 1-2mm  **Uncertainty of microperforation of Schneiderian membrane**
48
firts steps to summer technique  access?  bone?  Apical Deformation of ?
 Crestal Access  Compacting bone * Laterally & apically  Apical Deformation of sinus floor
49
second step to summers
Bone graft placed at osteotomy site * Serve as damper during floor fracture * Gradual ↑pressure leads to lifting of sinus membrane
50
what is done once summer is completed
place implant
51
how much can be lifted?
52
types of grafts
atuogenous allograft xenograft no graft
53
graft complications  Infection  sinus status?  Fistula?  Lack of?  increase?  Perforation?
 Infection  Pain, sinusitis  Hemosinus  Fistula  Lack of Primary stability  increases membrane lesion if lifted >5mm  Perforation of membrane
54
Reiser et al membrane perforations * ≤2mm (small): prognosis, shape? * ≥ 2mm (+implant exposed to sinus): prediction, shape?
* ≤2mm (small)  Good prognosis  Membrane retains dome shape * ≥ 2mm (+implant exposed to sinus)  Difficult to predict  Lack of shape and loss of space
55
Pikos mem perf * 5-10mm  what used to close? * >10mm  mem?
Pikos * 5-10mm  Collagen membrane to close the tear * >10mm  Cross-linked type I collagen membrane
56
Kasabah et al * Large Perforation  Absolute Contraindication to?  Foreign bodies create?
 Absolute Contraindication to continuation of surgery!  Foreign bodies create pathologies of mucos
57
Osteotomes in low-density bone * Compression wil? * improves?
Osteotomes can enhance primary stability in low- density bone * Compression will laterally condense bone¹ * Denser interface improve initial bone-to-implant contact²
58
residual ridge size and perforations
Residual ridge of 3mm  Perforation=85%³ Residual ridge of 6mm  Perforation=25% * Risk factor for perforation do correlate with residual ridge height
59
predictable results with mod sinus liftwith initial bone height?
Predictable result may be correlated to * Initial residual bone height of 4-6mm
60
invasiveness of modded sinus lift
Less invasive than lateral approach sinus lift
61
mem tear occurance in mod sinus lift * Small size defect: * Osteotomy -sized defect:
Infrequent occurrence of membrane tears * Adequate bone graft mass elevating the membrane * Small size defect: good prognosis * Osteotomy -sized defect: discontinue implant surgery
62
Successful creation of sub-antral space
* Gentle tissue manipulation / accurate pre op x-ray * May need little or no graft with implant insertion
63
 Ridge Expansion Technique  where?  results?  Dental implant placed where?  Additional space filled with?
 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
where is ridge expansion more commonly performed? why?
More common performed on Maxilla > Mandible  Thinner cortical plate  Softer medullary bone
65
ridge expansion technique forms
immeadiate and delayed Techniques are Location / Bone type based!
66
Immediate Ridge Split (Single Stage)  which arch?  why?
 Maxilla  Thinner cortical plate  Softer medullary bone
67
Delayed Ridge Split (2 Stage) used in which arch? why?
 Mandible  Lower flexibility  Thicker cortical plate  Risk of mal-fracture
68
Limiting Factors of ridge expansion:  Minimum alveolar ridge width:  width around implant necessary? which regions?
 Minimum alveolar ridge width: 2-4mm ( prefer ≥3mm)  1mm width around implant is necessary: Buccal and palatal region
69
ridge expansion  implant placement?  treatment time?  cost?  Barrier membrane?
 Simultaneous implant placement  Reduced treatment time  Reduced cost of surgery  Barrier membrane usually not needed
70
# d disadvantages of ridge expansion: Bone?  Difficult on?  Cannot Correct?  Only ↑'s?  Implant placed tends to situated where? why?
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
immeadiate ridge split steps
72
delayed ridge split steps
73
Summary of ridge splits  Immediate ridge split: excellent result in?  Delayed ridge split: where?  Expected width gain?  better arch? why?
 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
Grafting Treatment Planning  Success rate of?  Major bone grafting can have a failure rate as high as?  Immediate loading?  staged?
 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
when zygomatic implants would be used diagrammed
76
Various Options for Maxillary Rehab
77
Zygoma Implant
78
Indications for Zygoma Implant
 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
Consideration for Zygoma Implant  sinuses?  radio?  Traditional use of zygoma implants dictates room for?
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
Prosthetic Consideration of zygo implants
81
Surgical Anatomical Consideration of zygo implants  Usually at?  Slightly?  Confirm?  Head position will dictate?
 Usually at premolar region  Slightly more palatal  Confirm implant head position  Head position will dictate future abutment screw position
82
Concept of AP-Spread for zygo implants
83
loading time frames
84
Surgical considerations for implant loading  Consider taper implant for?  Final torque >  ISQ value >
 Consider taper implant for increased initial implant stability  Final torque >35Ncm  ISQ value >60
85
restorative considerations for implant loading  Minimum handling during?  what should be eliminated  Occlusal contacts?  cateilver in immeadiate?  Consider final abutment?
 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
Pre-operative Radiographic Exam  Recommended Radiographs?  Panorex:  Intraoral PA:  Lateral Cephalometric:  CT:
 Panorex: Anatomic structure and pathology detection  Intraoral PA: supplement Panorex  Lateral Cephalometric: Sagittal relationship of jaws  CT: Bone volume (width and height) assessment
87
Contraindications of zygo implants  sinus?  pathology of?  Underlying?  Relative contraindications?
 Acute sinus infection  Maxillary or zygoma pathology  Underlying uncontrolled systemic disease  Relative contraindications  chronic infectious sinusitis  bisphosphonates  smoking
88
Extra-Sinus Approach
 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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