Board scenario questions Flashcards
What is the normal blood glucose when fasting, before meals and after meals?
Fasting blood glucose test: 70-130 mg/dL. 3.9-7.1 mmol/L
- Before meal, under 125 mg/dL. 6.9 mmol/L
- After meal, 140 mg/dL. 7.8 mmol/L
Diabetic patients, ADA recommends a post-meal glucose level of less than 10 mmol/L,180mg/dL and fasting plasma glucose of 3.9-7.2 mmol/L, 70-130mg/dL
Effect of diabetes on implant
No difference in osseointegration rates
but maybe slower in healing process.
Aghaloo et al. (2019).
Studies have high heterogeneity.
Could be recognized as a potential risk factor for delyaed osseointegration, the occurrence of peri-implant inflammation and poor implant survival.
No difference in the survival rates in the first few years of diabetic compared to the healthy. However, in the long term, the risk of implant loss seems to be increased as previous studies could show.
Wagner et al. (2022)
What is MRONJ?
exposed bone or bone that can be probed introaral or extraoral fistula, in oral maxillofacial region lasting more than 8 weeks in patients with history of taking anti-resorptive/ anti-angiogenic medication, but no history of having radiation therapy to the jaw or no obvious metastatic disease to the jaw.
Incidence of MRONJ in specific groups
Estimated incidence of in cancer patients treated with anti-resorptive or anti-angiogenic drugs: 1%
in osteoporosis patients treated with anti-resorptive drugs: 0.01- 0.1%
Which medications may be associated with increased implant failure?
SSRI:
- Citalopram
- Fluoxeline
PPI:
- Omeprazole
- -Azoles
Smoking on implants?
Smoking can increase:
1. implant failure by 123%. 2.23 x greater
2. Post-operative infection
3. Marginal bone loss
Nicotine inhibits enzymes that affect osteoblasts that is responsible for osseointegration
Nicotine induces vasoconstriction that affects blood perfusion.
What is signs and symptoms of hypoglycaemia?
Signs:
1. confusion and aggression
2. Sweating
3. Tachycardia (heart rate >110 per min)
Symptoms:
1. shaking and trembling
2. Difficulty in concentration
3. slurring of speech
4. Headache
5. Fitting
6. unconsciousness
Management of hypoglycaemia
- Assess the patient
- administer 100% oxygen - flow rate: 15 L/min - If the patient remains conscious and cooperative,
- administer oral glucose (10-20g) repeated, if necessary, after 10 -15 minutes - If the patient is unconscious or uncooperative,
- administer glucagon, 1 mg i.m injection
- administer oral glucose (10-20) mg when the patient regains consciousness. - If the patient does not respond or any difficulty is experienced, call for an ambulance.
Follow-up interval for immediate denture?
24-48 hrs
1 week
1 month
2-3 month: relining
3-6 month: rebase or new CRDP
Systemic complication of denture plaque biofilm on oral mucosal membrane in patients with COPD?
Acute excerbations of COPD.
Microorganisms can be aspirated off the denture plaque biofilm into the lower respiratory tract and could reduce the patient’s immunity and cause pneumonia.
COPD patients who are using acrylic dentures in oral cavity, are exposed to denture stomatitis and oral candidiasis.
The results showed a greater frequency of prosthetic stomatitis complicated by mucosal infections among COPD patients compared to the healthy patietnts.
What clinical assessment should be made for implants in esthetic zone?
- medical status
- smoking habits
- Gingival display at full smile
- Width of edentulous span
- Shape of tooth crowns
- Restorative status of neighboring teeth
- Gingival phenotype
- Infection at implant site
- Soft tissue anatomy
- Bone level at adjacent teeth
- Facial bone wall phenotype
- Bone anatomy at alveolar crest
- Patient’s esthetic expectations
Chappuls and Martin, 2017
What factors should be accounted for implants in esthetic zone?
<Surgical>
1. Bone volume
- horizontal
- vertical
2. Keratinized tissue
- 4 mm : low in difficulty
- 2-4 mm : medium
- <2 mm : high
3. Soft tissue quality
4. Proximity to vital anatomical structures.
5. Papilla recession
<Restorative>
1. Prosthetic volume
2. Interocclusal space
3. Volume and characteristics of the edentulous ridge
4. Occlusal scheme
5. Occlusal parafunction
<Site>
1. Access
2. Interim prosthesis
3. Implant-supported provisional restoration
4. number and location of implants
5. loading protocols
- conventional/early : low risk
- immediate : high risk
SAC
</Site></Restorative></Surgical>
What is accuracy of static guide surgery?
Total mean error of 1.12 mm (maximum of 4.5 mm) at the entry point of the osteotomy and 1.39 mm at the apex (maximum of 7.1 mm).
Angular difference between planned and obtained position was 3.53 degrees (maximum of 21.16 degrees)
Tahmaseb et al.
Which type of surgical guide shows the most accuracy?
Tooth supported
Tooth-mucosa
Mucosa
Bone
Ideal position of implants?
- Implant platform 3-4 mm apical to CEJ
- Angulation of implant directed to cingulum
- 1.5 mm distant from tooth
- 2 mm buccal bone
- Emergence profile: 15 degrees -
- More than 30 degrees leads to a higher prevalence of peri-implantitis or marginal bone loss, compared to a smaller EA <30 degrees.
Testori et al. - Predicted height of interdental papilla
- Implant-implant : 3.5 mm
- Tooth-implant : 4.5 mm
- Implant-pontic: 5.5 mm
- Tooth-tooth : 5 mm
- Pontic-pontic: 6 mm
- Tooth- pontic: 6.5 mm
Salama et al.
What are the differences between nonabsorbable and absorbable membranes?
