Dental Implant Surgery (Deeb) Flashcards
What things should be evaluated for edentulous pt when considering restoration with dental implants?
What is missing: Teeth, Bone, Tissue, or combination
How will the edentulous pt jaw collapse over time?
Maxilla resorbs up and back, mandible resorbs down and forward, decreasing the VDO and giving a CIII appearance
What is the average loss of bone height in the edentulous ridge?
1.24 mm
What is the percent loss of bone height in the edentulous ridge after 3 months?
11%
What is the percent loss of bone height in the edentulous ridge after 6 months?
22%
What is the average loss of bone in the buccal-lingual dimension in the edentulous ridge?
3.79 mm
What is the percent loss of bone in the buccal-lingual dimension in the edentulous ridge at 3 months?
32%
What is the percent loss of bone in the buccal- lingual dimension in the edentulous ridge at 6 months?
Approximately 50%
What is an implant consideration for the posterior maxilla edentulous ridge with respect to resorption?
Amount of bone between the edentulous ridge and the maxillary sinus decreases
f an edentulous defect is considered a Tooth only defect (just the tooth is missing), what prosthetic treatment is indicated?
Ceramo-metal prosthesis
If the edentulous defect is considered a Compostie defect (Tooth loss + Bone loss, or combo of all 3), what prosthetic treatment is indicated?
- Hybrid prosthesis
2. Removable prosthesis
If a duplicate denture is created and there is no space between the cervical portion of the denture teeth and the edentulous ridge, what defect type is it and what definitive prosthesis is indicated?
Tooth only defect
What is the goal of the hybrid prosthesis in a composite defect being restored with implant retention with respect to the implant ?
Avoid being able to see the implant fixture under/cervical to the replaced tooth
If a duplicate denture is created and there is moderate to significant space between the cervical portion of the duplicate denture teeth and the edentulous ridge, what defect diagnosis is it and what is definitive prosthesis?
Composite defect
Fixed or Hybrid or Removable are all indicated
2 basic considerations for planning implant restorations after determing the defect type and the definitive prosthesis?
- Number of implants
2. Location of implants
What are 6 factors affecting number of implants?
- Type of prosthesis
- Arch shape
- Opposing dentition
- Bruxism
- Bone quality
- Implant to crown ratio
Which prosthesis type requires more implants: a ceramometal prosthesis (restoring tooth only defect), or hybrid prosthesis (restoring a composite defect)?
Ceramometal
What is the distance that is determined by a line drawn from the distal portion of the distalmost implant on each side of the arch and another parallel line drawn through the center of the anteriormost implant from the cantilever?
A-P spread
What is desirable and why: a decreased or increased A-P spread?
Increased A-P spread (a longer A-P spread means an increase in the amount of cantilever allowed in the posterior implants)
What anatomic variation will affect the A-P spread(?
Arch shape
Which arch shape will have the greatest A-P spread: U.V, Square?
U and V
Which arch shape, because it has an increased A-P spread will require more implants?
U and V shaped
Which arch shape will have the greatest A-P spread: U, V, Square?
U and V
Which arch shape will have the least amount of A-P spread and therefore the least amount of cantilever off the posterior implant?
Square arch formation
Which arch shape, because it has an increased A-P spread will require more implants?
U and V shaped
Which arch shape, because of its decreased A-P spread, will require fewer implants?
Square
What has an effect on the occlusal force on an implant prosthesis?
Opposing dentition
What is the hierarchy of strength when considering how opposing occlusion will affect the planned implant prosthesis?
Edentulous<implant
Which opposing dentition will require more implants for the implant prosthesis: natural teeth/implant for the opposing dentition or denture/partial for the opposing occlusion?
Implant / natural teeth
What increases the failure rate of implant prosthesis?
Parafunctional habit
If the patient is a bruxer, will more or less implants be indicated for an implant prosthesis?
More
Of the four bone types (D1-D4) which is the densest?
D1
What bone type is found in the anterior mandible?
D1
What bone type is found in the posterior mandible?
D2
What bone type is found in the anterior maxilla?
D3
What bone type is found in the posterior maxilla?
D4
Which bone type requires more implants?
D3 and D4
What is a vertical cantilever with respect to implants?
Force on an implant that has a high crown to implant ratio (more crown than implant, e.g. a hybrid prosthesis on a reduced ridge
Which prosthesis requires more implants, one with a low crown:implant ratio or one with a high crown:implant ratio?
High crown : implant ratio
What are the 3 major forces on an implant?
- Compression
- Tension
- Shear
Where is the primary site for implant location?
First molar
Of the 3 forces, with which one is bone best suited?
Compression
Of the 3 forces, with which one is bone least suited?
Shear
Which places the most stress / least favorable on the implant: shear, tensile, compression?
Shear = most Compression = least
Why is shear more stressful on the implant?
It has a greater lateral component while the solely vertical component of compression directs forces along the vertical axis of the implant dissipating into the surrounding bone
What is a secondary site for implant location?
Canine
What force will be exerted not he secondary site canine implant location?
Shear force from canine guidance
What is a tertiary site for implant location?
Incisiors
What would be a reason for placing an implant in the tertiary site of an incisor?
To prevent a long-span bridge
What is a quaternary implant site?
Premolar
What is a reason for placing an implant in the quaternary premolar site?
Assist in dissipating occlusal forces
Generally, an implant prosthesis in the maxillae requires what range of implants?
6-10
Generally, an implant prosthesis in the mandible requires what range of implants?
5-8
What is a bone graft material that is taken from the host: e.g. rams, chin, or tibia?
Autogenous graft
What is a bone graft that is taken from a genetically similar donor e.g. cadaver graft?
Allogenic graft
What is a bone graft taken from a genetically dissimilar donor (e.g. bovine graft)?
Xenograft
What is a bone graft not taken from a living donor (e.g. bioengineered BMP-2 graft)?
Synthetic graft
Bio-Oss, calcium phosphates, calcium sulfates, collagen, freeze dried bone allograft (FDBA), Glass ionomers, hydroxyapatite (HA), and nickel titanium (NiTi) are: osteogenic, osteoinductive, or osteoconductive?
Osteoconductive
Bone Morphogenic protein (BMP), Demineralized Freeze Dried Bone Allograft (DFDBA), and DBM are: osteogenic, osteoinductive, or osteoconductive?
Osteoinductive
An autograft is: osteogenic, osteoinductive, or osteoconductive?
Osteogenic
How many screws are required to attach a block graft and what are the screws’ purpose?
Minimum of 2 screws. Purpose is to prevent rotation.
What is the key to success for a block graft?
Immobility
What are 2 ways to add bone to the sinus?
- Lateral window / conventional sinus lift
2. Internal sinus lift (through the implant site)
if there is less than 4mm bone between the ridge and the sinus, what sinus lift is indicated?
Conventional sinus lift
If there is 4-8mm bone between the ridge and the sinus, what sinus augmentation is indicated?
Conventional sinus lift with implant at the same site
If there is 8-10 mm bone between the ridge and the sinus, what sinus augmentation is indicated?
Internal sinus lift with implant at the same site
Which graft is easier: to make bone wider (body habits) or taller?
Wider (body habitus)
What are 2 implant options if a bone graft is not feasible (so much bone loss that a graft is not feasible, financial concerns, etc)?
- All on 4
2. Zygomatic implants
What is done with the 2 posterior implants in an All-on-4 implant prosthesis and why?
Angled with the connector to the posterior and the body to the anterior in order to avoid the mental nerve in the mandible and the maxillary sinus in the maxilla
What are 4 advantages to the All-on-4 implant prosthesis?
- Limited number of implants
- Good A-P spread
- No graft required
- No sinus lift
What is the only prosthesis that can be put on an All-on-4: ceramo-metal or hybrid?
Hybrid only
What is the disadvantage of the All-on-4 if one of the implants fail?
Then the whole thing fails (none-on-3)
What implant option could be done if there is avery limited bone in the pre maxilla and the patient had a history of failed bone grafts?
All on 4 with a hybrid prosthesis
What are 3 advantages of zygomatic implants?
- Cortical bone stability (maxilla and zygoma)
- No bone graft
- No sinus lift
What is the only prosthesis that can be attached to zygomatic implants?
Hybrid
What are 2 disadvantages of zygomatic implants beyond only accepting the hybrid prosthesis?
- Technique-sensitive
2. Speech interference
With respect to the All on 4 implant option and the zygomatic implant option, what advantages do they both share?
- No bone grafting
2. No sinus lift
What is the only prosthesis that an All on 4 implant option and the zygomatic implant option can accept?
Hybrid
What are 3 zones of the maxilla?
Zone I: Premaxilla
Zone 2: Premolars
Zone 3: Molars
If there is good bone in all 3 zones of the maxilla(premaxilla, premolar, and molar) what implant surgical approach is indicated?
Traditional (8.10 implants)
If there is good bone only in Zones I and II of the maxilla (Premaxilla and premolar), what surgical approach is indicated?
All-on-4 (2 vertical normal implants pre maxilla, 2 normal implants angled in premolar)
If there is good bone only in Zone I of the maxilla, what implant surgical approach is indicated?
Zygomatic implants (2 normal implants in the premaxilla, 2 zygomatic implants in the premolar)
If there is insufficient bone in all 3 zones of the maxilla, what implant surgical approach is indicated?
Quad zygoma
If patient has been missing teeth for a long time, what defect will you expect to restore: tooth only, tissue only, bone only, or composite and what prosthesis will that most likely indicate?
Composite defect, restore with hybrid
If choosing to do a conventional sinus lift and not place the implant at the same time, how long should you wait after the conventional sinus lift before placing the implant?
3-4 months
If a pt’s posterior mandible is extremely deficient in vertical height, what would be a good surgical option that would not require grafting?
All-on-4
If the pt presents with year long post-op paresthesia in the mandible from previous sugery, and the posterior mandible is veritically deficient, is there another implant option beyond the All-on-4?
Yes, could place 2 vertical normal implants in the posterior mandible without regard for the V3 since it is already injured
What is the benefit of placing implants in the posterior region of this vertically deficient posterior mandible versus doing the All-on-4 surgical technique?
it increases the A-P spread
As a completely prosthetic consideration, where do most full arch restorations end?
1st molar region (to give first molar occlusion)
Placing 8 implants in the maxilla, what will be the placement?
2 in the 1st molar region to dissipate occlusal force (primary site)
2 in the canine region to give lateral guidance and dissipate shear force (secondary site)
2 in the incisor region to prevent a long span bridge (tertiary site)
2 in the 1st premolar region to dissipate occlusal forces (quaternary site)
f you wanted to place 2 more implants to make a total of 10 implants in the maxilla and 2 each have been placed already in the 1st molar site, the canine site, the incisor site, and the 1st premolar site, where should the other 2 be placed: the 2nd molar site or the 2nd premolar site?
2nd premolar site
What are 3 reasons to choose the 2nd premolar site over the 2nd molar site for the 9th and 10th implant placement sites?
- Premolar will have more native bone while 2nd molar will require more grafting
- Prosthesis only planned for first molar occlusion and will not extend beyond
- 2nd molar implant will be more challenging (think about ability to fit handpiece in that area)
What is Lam’s rule of thumb for the time to wait after a sinus lift?
For each 1mm of lift, wait 1 month. E.g. require 7 mm bone , must wait total of 7 months
If pt has a U-shaped arch, poor bone quality, the planned prosthesis will oppose implants, and the pt has a history of bruxism, how many implants in the maxilla should be planned: 8 or 10?
10
When choosing between sinus lift to increase bone in the vertical for the maxilla and a bone graft in increase bone width in the maxilla, which one should be done first, the sinus lift or the bone graft?
Sinus lift
