Advanced Surg: Implants Flashcards
WHich directions does max resorb?
Up and in
Which direction does mand resorb?
Down and out
Bone type
* Almost entirely Compact bone
5months to integrate
Type I
Bone type
* Thin cortical bone + Low density trabecular bone
8 months to integrate
Type IV
Bone type
* Thin cortical bone + Dense trabecular bone
6 months to integrate
Type III
Bone type
* Thick cortical bone + Dense trabecular bone
4 months to integrate
Type II
- viable cells contribute to new bone formation
Osteogenesis
- proteins, factors, hormones modulate host cells
- Osteoinduction
- matrix/scaffold onto which new bone can form
- Osteoconduction
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
Cortical: more bone morphogenic proteins (BMPs) & better structural
support
* Cancellous: more osteoblast precursor cells for greater osteogenic potential
* Healing time 3~7months
Disadvantage:
- Need for second operative site
- Insufficient amount of bone
Autogenous bone graft
Where are the two most common sites for bone graft harvesting intraorally?
Symphysis and Ascending Ramus
- 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)
Advantages: - Ready availability
- Eliminate second surgery
- Reduced anesthesis & surgical time
- Decrease blood loss
- Fewer complication
Disadvantages: - Associated with the use of
tissues from another person - Immune responses
Allograft
- Different species
- Anorganic bone treated to remove its organic component
- Highly osteoconductive
- Rapid revitalized through new blood vessels
- Slowly resorbing matrix structure (6 months ~)
Xenograft
Natural or Synthetic
* Mostly osteoconductive
* Variety of textures, sizes, and shapes
* Crystalline or amorphous
* Granular or molded
* Type of Alloplastic Bone Graft material
I. Ceramic : HA, TCP
II. Calcium Carbonate : Bio Coral
III. Biocompatible composite polymer
IV. Bioactive glass ceramic : Bio-glass
Alloplasts
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
Disadvantage
- flap management
- 2nd surgical procedure to remove membrane
Nonresorbable barrier membranes
Are resorbable or non resorbable membranes more ideal for GBR?
Nonresorb
ingrowth of
osteogenic cells
while preventing
migration of
unwanted cells
GBR
What procedure should be done in the following situation?
* Less than 4 mm native maxillary alveolar bone
Lateral Window Sinus Lift procedure
What procedure should be done in the following situation?
* More than 4mm native maxillary alveolar bone
Intracrestal Sinus Lift
What type of tissue composes the Schniderian membrane?
Pseudostratified ciliated columnar epithelium
How much sinus elevation can the Schniderian membrane support
4-8 mm
ADVANTAGE
Minimally Invasive
Usually single surgery
Little or no graft needed¹
Less postoperative complication
Septum Presence
DISADVANTAGE
Lack of direct visual control
Elevation height may be limited to 1-
2mm
Uncertainty of microperforation of
Schneiderian membrane
Intracrestal Sinus Lift
How much can you actually lift?
1-2 is safe
5mm can be done
5+ is pushing it
If the ridge is less than ___ mm of vertical height, 85% perf rate
3mm
What is the technique often used for intracrestal sinus lift?
Summers technique
Ridge Expansion Technique
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.
More common performed on Maxilla > Mandible
Thinner cortical plate
Softer medullary bone
Ridge splitting
What arch is ridge splittling more commonly performed on?
Max
What is the most important factor for ridge splitting on mand?
Preserving vasculartiy
What direction is an implant usually displaced in a ridge splitting procedure?
Facially
What is the minimum alveolar thickness needed for ridge splitting to be done?
2-4 mm
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
Grafting Treatment Planning
What type of implant is used for pts who don’t want any grafting?
Zygomatic implants
If bone is only present in zone 1 (anterior), what procedure can be done for implants?
Zygomatic implants
If bone is only present in zone 1 (anterior) and zone 2 what procedure can be done for implants?
All on 4
HOw long after placing zygomatic implants should the prosthesis be placed?
24-48 hours (immediate
What is the minimum number of implants needed in addition to zygomatic implants in anterior?
at least 2 other implants
How are zygomatic positioned intraorally?
Typically in pm region slightly more palatally placed
Contraindications
Acute sinus infection
Maxillary or zygoma pathology
Underlying uncontrolled systemic disease
Relative contraindications
chronic infectious sinusitis
bisphosphonates
smoking
Zygomatic implants
