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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
describe alloplasts
- natural or synthetic - mostly osteoconductive - crystalline or amorphous - granular or molded
26
what are the types of alloplastic bone graft material
- ceramic: HA, TCP - calcium carbonate: Bio coral - biocompatible composite polymer - bioactive glass ceramic: bio glass
27
what are the barrier membrane characteristics
- biocompatible - stability for space maintenance - manipulability - primary closure throughout healing period is essential to GBR outcome
28
what is the gold standard for GBR
polytetrafluoroethylene (titanium mesh)
29
what is the non resorbable barrier membrane
polytetrafluoroethylene (titanium mesh)
30
what is the disadvantage to polytetrafluoroethylene (titanium mesh)
- flap management - 2nd surgical procedure to remove membrane
31
what is the natural resorbable barrier membrane and describe it
collagen of animal origin - enzymatic degradation - limited ability to maintain space - 4-6 months of retention
32
what are the types of natural resorbable barrier membranes and how long does each take to heal
- bio-gide: 3-4 months - collatape: 1-2 weeks - collaplug: 1-2 weeks
33
what is the synthetic resorbable barrier membrane
poly(lactic) and poly (glycolic) acid copolymers
34
describe synthetic resorbable barrier membranes
- degradation by hydrolysis - highly variable rate of membrane resorption (pH and material composition)
35
what are the types of synthetic resorbable barrier membranes and how long do they take to heal
- ossix plus: about 6 months - BioMend: 2-4 months
36
what are the augmentation procedures
- 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
37
what is GBR
ingrowth of osteogenic cells while preventing migration of unwanted cells
38
what is GTR
regeneration of periodontal apparatus
39
what is GTR for
periodontal regeneration to save teeth
40
what is GBR for
bone regeneration to place implants
41
what is GTR
exclusion of gingival connective tissue cells from the wound and prevention of epithelial downgrowth
42
when do you use a lateral window sinus lift
less than 4mm native maxillary alveolar bone
43
when do you use intracrestal sinus lift
more than 4mm native maxillary alveolar bone
44
what is the summers sinus lift
crestal access
45
what is the indication and results of tilotta sinus floor lift
- 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
what is the balloon modification
- catheter filled with saline - swelling the balloon -> push out the sinus membrane
47
what is the schneiderien membrane made of
- epithelium- pseudostratified ciliated columnar epithelium - CT -periosteum
48
the schneiderian membrane can support elevation in the sinus cavity of:
4-8mm
49
what are the advantages and disadvantages of balloon modification
- 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
what are the methods for sinus lifts
- crestal access -compacting bone - laterally and apically - apical deformation of sinus floor - bone graft placed at osteotomy site - dental implant placement
51
what does the bone graft placement at osteotomy site do
- serves as damper during floor fracture - gradual increase in pressure. leads to lifting of sinus membrane
52
what is the expected amount of sinus floor lift
1-2mm
53
what is the maximum sinus lift
5mm
54
what are the types of grafts
- autograft - allograft - xenograft - no graft
55
what are the complications of sinus lifts
- infection - pain, sinusitis - hemosinus - fistula - lack of primary stability - increase membrane lesion if lifted greater than 5mm - perforation of membrane
56
sinus membrane perforation has good prognosis if:
less than or equal to 3mm - membrane retains dome shape
57
when do you use a collagen membrane to close the tear
5-10mm
58
what do you use if the perforation is greater than 10mm
cross linked type 1 collagen membrane
59
osteotomes can enhance:
primary stability in low-density bone
60
compression with osteotomes will:
laterally condense bone
61
denser interface will improve:
initial bone to implant contact
62
what is the chance of perforation if the residual ridge is 3mm
85%
63
what is the chance of perforation if the residual ridge is 6mm
25%
64
risk factor for perforation _______ correlation with residual ridge height
do
65
predictable sinus lift result may be correlated to initial residual bone height of:
4-6mm
66
describe the infrequent occurrence of membrane tears
- adequate bone graft mass elevating the membrane - small size defect: good prognosis - osteotomy- sized defect: discontinue implant surgery
67
describe the successful creation of sub antral space
- gently tissue manipulation/accurate pre op x ray - may need little or no graft with implant insertion
68
what is the ridge expansion technique
- 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
ridge expansion technique is more commonly performed on maxilla or mandible
maxilla
70
why is ridge expansion done on maxilla more
- thinner cortical plate - softer medullary bone
71
what technique for ridge splitting is done on the maxilla
immediate ridge split (single stage)
72
techniques for ridge splitting are ______ based
location and bone type
73
what ridge splitting technique is done on the mandible
delayed ridge split (2 stage)
74
why is the delayed ridge split done on the mandible
- lower flexibility - thicker cortical plate - risk of mal-fracture
75
what is the minimum alveolar ridge width
2-4mm
76
what is the preferred alveolar ridge width
3mm or greater
77
_____ width around buccal and palatal region for implant is necessary
1mm
78
success rate of grafting is _____
90% or grater
79
major bone grafting can have a failure rate as high as:
30%
80
is immediate loading recommended in grafting
no
81
_______ loading protocol needed for graftign
two stage delayed
82
what is a zygoma implant
a graft-less implant solution, avoiding the maxillary sinuses
83
what are the indications for the zygoma implant
- 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
what are the considerations 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 2 conventional implants at anterior maxilla
85
what is the prosthetic consideration for zygoma implants
- incorporate sufficient rigidity and precision in prosthesis - decrease in bending moments - balance of functional, esthetic, phonetic and hygiene requirement especially hygiene maintenance
86
where are zygomatic implants usually placed
at premolar region slightly more palatal
87
implant head position will dictate:
future abutment screw position
88
what is the concept of AP spread
- 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
what are the surgical considerations for loading
- consider taper implants for increased initial implant stability - final torque greater than 35N - ISQ value greater than 60
90
what are the restorative considerations for loading
- 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
what is considered immediate loading
2 days
92
what is considered early loading
2 days-3 months
93
what is considered delayed/conventional loading
3 months- 6 months
94
what are the recommended radiographs for implants
- pano: anatomic structure and pathology detection - intraoral PA: supplement Pano - lateral ceph: sagittal relationship of jaws - CT: bone volume (width and height assessment)
95
what are the contraindications for implants
- acute sinus infection - maxillary or zygoma pathology - underlying uncontrolled systemic disease
96
what are the relative contraindications for implants
- chronic infectious sinusitis - bisphosphonates - smoking
97

Oral Surgery IV (10 decks)

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