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Dental Materials Supplemental Cards > Dental and Orofacial Implants and Tissue Bioengineering > Flashcards

Dental and Orofacial Implants and Tissue Bioengineering Flashcards

1
Q

what are endosseous implants?

A
  • the most common type of dental implant
  • sits in the bone
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2
Q

what are subperiosteal implants?

A
  • used in cases of atrophic bone
  • sits on top of bone
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3
Q

what are transosteal implants?

A
  • uncommon; higher failure rates
  • traverses the entire mandible
  • not used on the maxilla
  • disadvantage: complete facial butchery
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4
Q

what is the alveolar process?

A
  • ridge on the surface of mandible/maxilla where the teeth reside
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5
Q

what is basal bone?

A

bone underlying the alveolar process

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6
Q

alveolar bone proper vs supporting alveolar bone

A
  • alveolar bone proper
    • compact bone
      • cribriform plate, lamina dura
  • supporting alveolar bone
    • both compact and trabecular bone
      • cortical plates: compact bone component
      • central spongiosa: trabecular bone component
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7
Q

describe alveolar bone structure relative to implant placement

A
  • loading via mastication is critical for maintaining bone density
  • loss of alveolar bone in edentulous patients
    • no loading = no alveolar ridge, only basal bone
  • patient selection/site preparation is critical for high success rate of dental implants
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8
Q

what is osseointegration?

A
  • deposition of bone in close apposition to implant surface
  • process is mediated by mesenchymal progenitor cells
  • provides mechanical stability of implant and a tight seal
  • some debate as to how this occurs
    • osseointegration vs biointegration
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9
Q

describe the process of osseointegration

A
  • wound healing: space management
  • extraction of tooth leaves a hole
  • hole fills with a clot, which is then converted to a highly cellular granulation tissue
  • epithelial invasion vs. bone regeneration
  • osteoblast differentiation and bone deposition (osseointegration)
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10
Q

describe distance osteogenesis and contact osteogenesis

A
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11
Q

what is fibrous encapsulation?

A
  • formation of fibrous soft tissue (collagen) around implant
  • not good for mechanical anchoring
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12
Q

what can fibrous encapsulation result from?

A
  • peri-implantitis brought on by problems/delays in osseointegration
    • microbial infiltration or poor stability after placement
  • untimely space management = problems in wound healing
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13
Q

describe the mechanical forces acting on implants

A
  • tensile, compressive, and shear forces
  • up to 1250 N reported
  • material properties and integration of implants are ciritical due to the forces involved
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14
Q

T or F:

bone will resporb if it does not experience strain

A

true

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15
Q

what happens to bone if the elastic modulus is too high?

A
  • lower transfer of force to bone
    • leads to lower bone loading
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16
Q

describe the use of ceramics in implants

A

they tend to be stiff and do not transfer adequate strain to surrounding bone, resulting in stress shielding

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17
Q

describe titanium in dental implants

A

somewhat more elastic than ceramics and transfers some strain to surrounding bone

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18
Q

an implant material must be ___ but also have mechanical properties which are ___

A
  • structurally sound
  • physiologically compatible
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19
Q

bone is strongest when ___, weaker under ___ forces, and weakest when subjected to ___

A
  • compressed
  • tensile
  • shear
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20
Q

the ___ interface is critical when considering mechanical loading of implants

A

bone-implant

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21
Q

what happens to bone in apposition to smooth implants?

A
  • it is subjected to almost total shear when the implant is loaded
  • less surface area for attachment
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22
Q

why is added texture important for the success of implants?

A
  • added texture (ex. threads) engages bone in compression where it is strongest
  • interlocking also provides much better transfer of load to bone (less resorption) and increased surface area for attachment
23
Q

describe how alterations in length of implants can implicate implant loading

A
  • increasing length
    • increase surface area of attachment = descreased stress on bone
    • minimal advantage, as most force transfer happens at the upper part of an osteointegrated implant
24
Q

describe how alterations in width can have implications for implant loading

A
  • increasing width
    • increased surface area for attachment = decreased stress on bone
    • implant stiffness increases, leading to stress shielding of bone
25
Q

what is the most common material used for dental implants?

A
  • titanium
  • CP Ti or TI-6Al-4V alloy
26
Q

describe the properties of titanium that make it a good material for dental implants

A
  • elastic modulus
  • strength
  • immune-inert (not immunogenic)
  • low corrosion (passivation - continual presence of a passive oxide layer)
  • biocompatible (non-toxic)
27
Q

describe the ways in which titanium can be modified

A
  • alterations in oxide layer - oxide layer is mainly what biological systems interact with
  • coatings - biomemtic or ceramic
  • roughening/etching - grit blasting or acid etching
28
Q

describe the two ways in which surface modification enhances osseointegration

A
  1. osteoblast differentiation/migration
  2. improving the mechanical interlocking with bone tissue, providing better loading characteristics

*“optimal” surface is still unclear

29
Q

describe implant surface chemistry modification

A
  • refers to increasing oxide layer
  • TiO2 forms the stable oxide layer
  • oxide layer is generally biologically favorable (protein absorption)
  • modifications, such as hydroxylation, increase hydrophilicity (wettability)
  • anodization used to increase oxide layer thickness
30
Q

describe ceramic and glass coatings

A
  • applied to implants to increase cell attachment and help with wound healing
  • hydroxyapatite/tricalcium phosphate/bioglass
    • bioactive, although only as strong as the metal-ceramic interface
31
Q

describe implant coating components that increase cell attachment

A
  • short peptide sequences
    • integrin
    • RGD cell attachment sequences
    • collagen
    • fibrin
32
Q

describe implant coating components associated with wound healing

A
  • growth factors
    • TGFbeta1
    • FGF-2
    • VEGF
    • PDGF
33
Q

describe the survival rate of endosseous implants

A
  • 7 year survival rate of around 95%
  • careful patient selection plays a large role in the success rates
34
Q

describe patient selection for implants

A
  • patient selection is critical due to requirements for rapid osseointegration
  • must have good bone around the site to anchor implant during loading
    • many edentulous patients have atrophied bone - not good candidates
  • must not be compromised in terms of bone healing
    • diabetes, immune-compromised patients can pose problems
35
Q

what is tissue engineering?

A

a discipline which seeks to encourage the restoration of function and structure to a pre-injury state

36
Q

what are bioactive materials?

A

materials which are designed to drive repair/regeneration through the use of bioactive factors

37
Q

describe 3 key components in tissue engineering

A
  1. relevant cell source
  2. biomaterial or scaffold
  3. bioactive component to drive cell responses
38
Q

what are 4 general classifications of relevant cell sources?

A
  1. autograft
  2. allograft
  3. xenograft
  4. alloplast
39
Q

describe autograft

A

implanted material derived from the same individual as the implant is to be delivered to

40
Q

describe allograft

A

implanted material derived from another individual of the same species

41
Q

describe xenograft

A

implanted material derived from another species

42
Q

describe alloplast

A

implanted material is not derived from a living source or is “synthetic”

43
Q

dental pulp progenitor cells are a population of ___ progenitors resident in the dental pulp, derived from the ___

A
  • mesenchymal
  • neural crest
44
Q

dental pulp progenitor cells can theoretically differentiate to regenrate what 4 biological components?

A
  • vasculature
  • mineralized tissue
  • soft tissues
  • possibly nerves
45
Q

dental pulp progenitor cells represent a capacity of the tooth for ___

A

self repair

46
Q

describe cellular vs. acellular approaches to tissue engineering

A
  • addition of material containing cells vs. application of materials to existing tissues
  • tissues need cells to regenerate, but many tissues have cells containing the necessary cells (ex. capacity to self repair)
  • advantages and disadvantages:
    • soft tissues - peridontal ligament, dental pulp, oral mucosa, skin
    • hard tissues - bone, dentin, cementum?
47
Q

describe the practical difficulties of the isolation of dental pulp progenitor cells (DPPCs)

A
  • relatively low cell numbers
    • possibly around 1% of cells
  • lack of single specific marker to ID cells
48
Q

what is the gold standard for isolation of DPPCs?

A
  1. population doublings over long periods in culture
  2. multi-potency: ability to differentiate in various lineages
    1. adipose, endothelial, chondro-, osteo-
49
Q

DPPCs are adherent cells. What does that mean?

A
  • they attach to tissue culture plastic
  • they typically express high levels of alpha5beta1 integrin receptor, which binds fibronectin
    • fibronectin adhesion isolation
50
Q

what are 3 main challenges to overcome in oral tissue regeneration?

A
  • microbial infection
  • inflammation
  • regeneration
51
Q

through ___, it may be possible to manipulate the innate capacity of oral tissue to encourage ___ and/or ___

A
  • tissue regeneration
  • repair and/or regeneration
52
Q

describe the benefits of new bioactive materials

A
  • more options for practitioners
  • improved outcomes for patients
53
Q

what does it mean if a material is “biomimetic”?

A

mimicry of tissues/processes/structures that are biological

Dental Materials Supplemental Cards (6 decks)

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