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Oral Surgery IV > Advanced Surgical Implantology > Flashcards

Advanced Surgical Implantology Flashcards

1
Q

what is the bone loss timeline after TE

A
  • progressive/irreversible bone resorption
    -atrophic bone
  • limit dental implant options
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2
Q

what is type I bone

A

almost entirely compact bone

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3
Q

what is type II bone

A

thick cortical bone and dense trabecular bone

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4
Q

what is type III bone

A

thin cortical bone and dense trabecular bone

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5
Q

what is type IV bone

A

thin cortical bone and low density trabecular bone

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6
Q

what is type I bone like and how long does it take to integrate

A
  • oak wood
  • 5 months
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7
Q

what is type II bone like and how long does it take to integrate

A
  • pine wood
  • 4 months
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8
Q

what is type III bone like and how long does it take to integrate

A
  • balsa wood
  • 6 months
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9
Q

what is type IV bone like and how long does it take to integrate

A
  • stryofoam
    8 months
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10
Q

what is osteogenesis

A

viable cells contribute to new bone formation

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11
Q

what is osteoinduction

A

proteins, factors, hormones modulate host cells

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12
Q

what is osteoconduction

A
  • matrix/scaffold onto which new bone can form
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13
Q

what is the autogenous bone graft

A

same individual

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14
Q

what is the gold standard of autogenous bone graft

A

osteogenic, osteoinductive and osteoconductive

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15
Q

what is the disadvantage of autogenous bone graft

A
  • need for second operative site
  • insufficient amount of bone
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16
Q

what are the types of autogenous bone grafts

A
  • extra oral vs intra oral donor site
  • intra membranous vs cartilaginous
  • block vs particulate forms
  • cortical vs cancellous
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17
Q

describe cortical autogenous bone grafts

A

more bone morphogenic proteins and better structural support

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18
Q

describe cancellous autogenous bone grafts

A

more osteoblast precursor cells for greater osteogenic potential

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19
Q

what is the healing time for autogenous bone graft

A

3-7 months

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20
Q

where are the common intra oral and extra oral sites for autogenous bone grafts

A
  • extra: symphis
  • intra: ramus
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21
Q

describe the allograft

A
  • from individuals of the same species
  • cadavers
  • tissue bank
    -osteoinduction and osteoconduction
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22
Q

what are the types of allografts and how long do they take to heal

A
  • freeze dried bone allograft: 6-15 months
  • demineralizaed freeze dried: 6months
  • irradiated bone
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23
Q

what are the advantages and disadvantages of allograft

A
  • advantages: ready availability, eliminate second surgery, reduced anesthesis and surgical time, decrease blood loss, fewer complications
  • disadvantages: associated with the use of tissues from another person, immune responses
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24
Q

describe the xenograft

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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25
Q

describe alloplasts

A
  • natural or synthetic
  • mostly osteoconductive
  • crystalline or amorphous
  • granular or molded
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26
Q

what are the types of alloplastic bone graft material

A
  • ceramic: HA, TCP
  • calcium carbonate: Bio coral
  • biocompatible composite polymer
  • bioactive glass ceramic: bio glass
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27
Q

what are the barrier membrane characteristics

A
  • biocompatible
  • stability for space maintenance
  • manipulability
  • primary closure throughout healing period is essential to GBR outcome
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28
Q

what is the gold standard for GBR

A

polytetrafluoroethylene (titanium mesh)

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29
Q

what is the non resorbable barrier membrane

A

polytetrafluoroethylene (titanium mesh)

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30
Q

what is the disadvantage to polytetrafluoroethylene (titanium mesh)

A
  • flap management
  • 2nd surgical procedure to remove membrane
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31
Q

what is the natural resorbable barrier membrane and describe it

A

collagen of animal origin
- enzymatic degradation
- limited ability to maintain space
- 4-6 months of retention

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32
Q

what are the types of natural resorbable barrier membranes and how long does each take to heal

A
  • bio-gide: 3-4 months
  • collatape: 1-2 weeks
  • collaplug: 1-2 weeks
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33
Q

what is the synthetic resorbable barrier membrane

A

poly(lactic) and poly (glycolic) acid copolymers

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34
Q

describe synthetic resorbable barrier membranes

A
  • degradation by hydrolysis
  • highly variable rate of membrane resorption (pH and material composition)
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35
Q

what are the types of synthetic resorbable barrier membranes and how long do they take to heal

A
  • ossix plus: about 6 months
  • BioMend: 2-4 months
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36
Q

what are the augmentation procedures

A
  • onlay block graft
  • guided bone regeneration:tenting screws/titanium re-enforced membrane
  • sinus augmentation: lateral approach, soket lift
  • ridge split technique/ridge expansion
  • distraction osteogenesis
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37
Q

what is GBR

A

ingrowth of osteogenic cells while preventing migration of unwanted cells

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38
Q

what is GTR

A

regeneration of periodontal apparatus

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39
Q

what is GTR for

A

periodontal regeneration to save teeth

40
Q

what is GBR for

A

bone regeneration to place implants

41
Q

what is GTR

A

exclusion of gingival connective tissue cells from the wound and prevention of epithelial downgrowth

42
Q

when do you use a lateral window sinus lift

A

less than 4mm native maxillary alveolar bone

43
Q

when do you use intracrestal sinus lift

A

more than 4mm native maxillary alveolar bone

44
Q

what is the summers sinus lift

A

crestal access

45
Q

what is the indication and results of tilotta sinus floor lift

A
  • indication: type III or IV bone, minimum bone height of 5mm
  • results: increase in initial sub-sinus bone height, increase in elevation, 4-6mm elevation without imparing mucosa is possible
46
Q

what is the balloon modification

A
  • catheter filled with saline
  • swelling the balloon -> push out the sinus membrane
47
Q

what is the schneiderien membrane made of

A
  • epithelium- pseudostratified ciliated columnar epithelium
  • CT
    -periosteum
48
Q

the schneiderian membrane can support elevation in the sinus cavity of:

49
Q

what are the advantages and disadvantages of balloon modification

A
  • advantages: minimally invasive, usually single surgery, little or no graft needed, less postoperative complication, septum presence
  • disadvantages: lack of direct visual control, elevation height may be limited to 1-2mm, uncertainty of microperforation of schneiderian membrane
50
Q

what are the methods for sinus lifts

A
  • crestal access
    -compacting bone - laterally and apically
  • apical deformation of sinus floor
  • bone graft placed at osteotomy site
  • dental implant placement
51
Q

what does the bone graft placement at osteotomy site do

A
  • serves as damper during floor fracture
  • gradual increase in pressure. leads to lifting of sinus membrane
52
Q

what is the expected amount of sinus floor lift

53
Q

what is the maximum sinus lift

54
Q

what are the types of grafts

A
  • autograft
  • allograft
  • xenograft
  • no graft
55
Q

what are the complications of sinus lifts

A
  • infection
  • pain, sinusitis
  • hemosinus
  • fistula
  • lack of primary stability
  • increase membrane lesion if lifted greater than 5mm
  • perforation of membrane
56
Q

sinus membrane perforation has good prognosis if:

A

less than or equal to 3mm
- membrane retains dome shape

57
Q

when do you use a collagen membrane to close the tear

58
Q

what do you use if the perforation is greater than 10mm

A

cross linked type 1 collagen membrane

59
Q

osteotomes can enhance:

A

primary stability in low-density bone

60
Q

compression with osteotomes will:

A

laterally condense bone

61
Q

denser interface will improve:

A

initial bone to implant contact

62
Q

what is the chance of perforation if the residual ridge is 3mm

63
Q

what is the chance of perforation if the residual ridge is 6mm

64
Q

risk factor for perforation _______ correlation with residual ridge height

65
Q

predictable sinus lift result may be correlated to initial residual bone height of:

66
Q

describe the infrequent occurrence of membrane tears

A
  • adequate bone graft mass elevating the membrane
  • small size defect: good prognosis
  • osteotomy- sized defect: discontinue implant surgery
67
Q

describe the successful creation of sub antral space

A
  • gently tissue manipulation/accurate pre op x ray
  • may need little or no graft with implant insertion
68
Q

what is the ridge expansion technique

A
  • longitudinal osteotomy on alveolar bone
  • lateral reposition of buccal cortex
  • results in increased alveolar width
  • dental implant placed between buccal and lingual cortex
  • additional space filled with bone graft materials
69
Q

ridge expansion technique is more commonly performed on maxilla or mandible

70
Q

why is ridge expansion done on maxilla more

A
  • thinner cortical plate
  • softer medullary bone
71
Q

what technique for ridge splitting is done on the maxilla

A

immediate ridge split (single stage)

72
Q

techniques for ridge splitting are ______ based

A

location and bone type

73
Q

what ridge splitting technique is done on the mandible

A

delayed ridge split (2 stage)

74
Q

why is the delayed ridge split done on the mandible

A
  • lower flexibility
  • thicker cortical plate
  • risk of mal-fracture
75
Q

what is the minimum alveolar ridge width

76
Q

what is the preferred alveolar ridge width

A

3mm or greater

77
Q

_____ width around buccal and palatal region for implant is necessary

78
Q

success rate of grafting is _____

A

90% or grater

79
Q

major bone grafting can have a failure rate as high as:

80
Q

is immediate loading recommended in grafting

81
Q

_______ loading protocol needed for graftign

A

two stage delayed

82
Q

what is a zygoma implant

A

a graft-less implant solution, avoiding the maxillary sinuses

83
Q

what are the indications for the zygoma implant

A
  • sufficient anterior bone and severely resorbed posterior
  • insufficient anterior bone and severely resorbed posterior
  • partial edentulous maxilla with unilateral or bilateral loss of posterior teeth and severe resorption (zygoma implant and minimum of 2 regular implants)
84
Q

what are the considerations for zygoma implant

A
  • clinically symptom free and pathology free sinuses
  • proper radiographic imaging for maxillofacial region
  • traditional use of zygoma implants dictates room for at least 2 conventional implants at anterior maxilla
85
Q

what is the prosthetic consideration for zygoma implants

A
  • incorporate sufficient rigidity and precision in prosthesis
  • decrease in bending moments
  • balance of functional, esthetic, phonetic and hygiene requirement especially hygiene maintenance
86
Q

where are zygomatic implants usually placed

A

at premolar region slightly more palatal

87
Q

implant head position will dictate:

A

future abutment screw position

88
Q

what is the concept of AP spread

A
  • limit/eliminate posterior cantilever - increased AP spread decreases forces on distal implants
  • additional implants at canine region - further reduces stress values on framework
  • AP spread is still observed on resorbed maxilla
89
Q

what are the surgical considerations for loading

A
  • consider taper implants for increased initial implant stability
  • final torque greater than 35N
  • ISQ value greater than 60
90
Q

what are the restorative considerations for loading

A
  • minimum handling during healing phase
  • load distribution cantilever/lateral forces elimination
  • occlusal contact decreased at first 2-3 months
  • no cantilever final abutment at time of implant placement
91
Q

what is considered immediate loading

92
Q

what is considered early loading

A

2 days-3 months

93
Q

what is considered delayed/conventional loading

A

3 months- 6 months

94
Q

what are the recommended radiographs for implants

A
  • pano: anatomic structure and pathology detection
  • intraoral PA: supplement Pano
  • lateral ceph: sagittal relationship of jaws
  • CT: bone volume (width and height assessment)
95
Q

what are the contraindications for implants

A
  • acute sinus infection
  • maxillary or zygoma pathology
  • underlying uncontrolled systemic disease
96
Q

what are the relative contraindications for implants

A
  • chronic infectious sinusitis
  • bisphosphonates
  • smoking

Oral Surgery IV (4 decks)

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