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Osseointegration > Exam 1 > Flashcards

Exam 1 Flashcards

1
Q

Osseointegration definition

A

A direct functional and structural connection between living bone and the surface of a load carrying implant

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2
Q

Bone lost every time a flap is raised

A

about 0.7mm

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3
Q

Implant healing stages

A

2 hours after placement the wound chamber area (the deepest areas of the threads) fills with blood clot
At 4 days the wound chamber area is filling with fibroblasts
At 1 week woven bone osteoids are starting to form in the wound area.
At 2 weeks bone formation is developing
At 4 weeks the boney structures are starting to connect through to the base bone
at 12 weeks the wound chamber area is mostly remodeled

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4
Q

Contact osteogenesis

A

bone formation originating against the implant

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5
Q

Distant osteogenesis

A

Bone formation from the existing bone towards the implant

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6
Q

What healing stage are implants at their weakest point

A

4 weeks. Do not do anything to the implant at 4 weeks. Weaker than initial placement.

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7
Q

Biocompatibility

A

The ability of a material to perform with an appropriate host response in a specific application

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8
Q

Characteristics of mild implant failure

A

PD <4mm
Bleeding and purulent on gentle probing
Bone loss <25%

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9
Q

Characteristics of moderate implant failure

A

PD <6mm
Bleeding and purulent on gentle probing
bone loss 25-50%

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10
Q

Characteristics of Severe implant failure

A

PD >6mm
Bleeding and purulent on gentle probing
Bone loss >50%

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11
Q

Low surface energy

A

Tefflon - no water sticks to it. No cellular attachment will occur

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12
Q

High surface energy

A

Very hydrophylic. Will allow surface attachment of cells to this surface.

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13
Q

SLActive treatment

A

plasma treatment used to create superclean circuits. increases surface energy

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14
Q

Straumann loading time

A

SLActive claims to be able to load at 6 weeks rather than 8 weeks. Likely immediate loading is more successful as well

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15
Q

Downsides of rough implant surfaces

A

Bacteria can get in if recession occurs

rough edges break microscopically when implant is inserted. Tapping more important

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16
Q

type of attachment to implants

A

Hemidesmosomal

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17
Q

Common type of attachment around implants

A

long epithelial attachment as opposed to short epithelial attachment with inserted fibers into the tooth

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18
Q

Strength of epithelial attahcment around an implant

A

Much weaker, need to be much more careful probing around implants

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19
Q

Surface type epithelial cells like

A

Polished surface, horizontal grooves should be less than 10 microns in depth. laser Lock is deeper than this

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20
Q

Fibroblast movement

A

Move by themselves by grabbing a surface. Much better on a rough surface.

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21
Q

macrophages that cause healing around an implant

A

M2 - similar to the process of athersclerosos

M1 cause failure

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22
Q

Nobel implant surface

A

TiUnite
increases titanium oxide thickness
anodized surface

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23
Q

AstraTech surface

A

Fluoride modified surface
Stimumate osteoblast differentiation
improves osseointegration and decreases marginal bone loss in immediate loading protocols

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24
Q

Straumann implant surface

A

Acid etched

macrocraters overlayed with micropits

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25
Q

Risk factor definition

A

the probability of an individual developing a specific disease in a given period
Identified through longitudinal studies

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26
Q

Implant risk - Age

A

Does not seem to affect long term success rate

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27
Q

How to determine if a patient is done growing and can get their implant

A

lateral ceph 6 months apart. Still some debate if this means growth is fully stopped

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28
Q

Factors in considering success of an implant

A 
bone levels
cosmetic concerns
complications with prosth
BOP
pt expectations
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29
Q

implant risk factors - smoking

A

considered the strongest modifiable risk factor
>10 cigarettes a day has more than 20% failure rate
20/day is the highest failure rate
smoking cessation 1 wk prior and 8 weeks after implant success rates similar
higher failure rate in maxilla than mandible in smokers

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30
Q

Smoking changes in bone

A

increases proinflammatory cytokines, inhibits fibroblasts, abnormal PMN phagocytosis, altered lymphocyte, decreases vascularity, delayd

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31
Q

Implant risk factor - diabetes

A

Poorly controlled diabetes (HbA1c >7%) negatively affects osseointegration
well controlled has no effect
Antiseptic mouth rinses and OH maintenance helps in achieving successful osseointegration

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32
Q

Diabetes effects on bone

A

impairs growth and regeneration of blood vessels, impair collagen metabolism, impaired bone metabolism, and advanced glycation end products

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33
Q

Risk factors for implants - osteoporosis

A

unclear relationship with periodontitis
No convincing data for osseointegration
T score less than -2.5

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34
Q

Implant risk factors - bisphosphonates

A

Higher risk of MRONJ with implant or any surgical procedure. Separate informed consent form. IV much higher risk than oral

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35
Q

Risk factor for implants - previous periodontal disease

A

substantial increase in peri-implantitis. 3X higher

14X higher risk of peri-implant mucocitis

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36
Q

implant risk factor - grafted vs host bone

A

A little ambiguous but seems to be similar survival rates

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37
Q

Implant risk factor - bone quality

A

Class 1-3 same survival, class 4 lower with rough implant surfaces

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38
Q

Implant risk factors - Keratinized tissue

A

<2mm peri-implant mucosa should increased GI, PIU, bone loss, and BOP
Some studies showed no difference

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39
Q

Socket preservation phases of healing

A

Inflammatory - Coagulation day 1, inflammatory cell and granulation tissue day 2-3
Proliferative - fibrogenesis/provisional matrix day 7, woven bone formation day 14, bone modeling day 30, bone remodeling day 90

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40
Q

Alveolar socket healing

A

clot breakdown 48-72 hours as granulation tissue infiltrates. Epithelium at socket periphery start at 3-4 days.
Complete infiltration of granulation tissue and replacement of a clot in 7 days

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41
Q

If you have 0.5mm facial bone post extraction

A

You will lose all the facial plate during healing. Socket preservation is much more important in these cases
If you have less than 2mm socket graft, if you have more you can get away without it
Socket preserve any endo treatment, especially apico

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42
Q

Soft tissue formation in augmented healing

A

You get more soft tissue thickness naturally than in augmented healing. Can do extraction, wait 4-5 weeks, then do bone augmentation

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43
Q

Osteoinduction

A

the process of stimulating osteogenesis (demineralized exposes the cells to try to get more osteoinduction)

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44
Q

Osteoconduction

A

actinv as a scaffold for bone to build off of, keeping soft tissue out

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45
Q

Autograft as a bone material

A

Osteoconductive, but resorbs very quickly

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46
Q

Demineralized allograft

A

better for osteoinduction, have lost most of their structure, better for small sockets

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47
Q

Freeze dried allograft

A

better for osteoconduction, better for larger sockets as it lasts longer

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48
Q

Xenograft as a bone material

A

osteoconductive scaffold, very slow resorption, still there even 10 years out

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49
Q

Alloplasts as a bone material

A

lab fabricated, biologically inert osteoconductive

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50
Q

Socket seal procedure

A

in a 4 wall defect, use a soft tissue graft over the socket to seal it

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51
Q

ePTFE vs dPDFE membrane

A

ePTFE is porous and needs to be sealed the entire time otherwise it will get infected, dPDFE can be left exposed, much less porous

52
Q

Data collection for implants

A 
CC
Medical History/medications/allergies/smoking
Extraoral Exam
Intraoral exam
Soft tissue assessment
Smile line
OH frequency/plaque score
Occlusal assessment
Periodontal assessment
spacing (height, width)
KT
53
Q

Minimum spacing for an implant

A

1.5mm between teeth, 3mm between implants, 7mm occ height, 9 is better, 5 bare minimum

54
Q

Worst placement for an implant prosthetically

A

Shallow and facial

55
Q

3X3 rule

A

Implant head placement 3mm palatal, 3mm apical to the gingival zenith

56
Q

Papilla heights

A 
imp/imp - 3.5mm
imp-tooth - 4.5mm
tooth-tooth - 5mm
tooth-pontic - 5.5mm
pontic-pontic - 6mm
imp-pontic - 5.5mm
57
Q

Junctional epithelium thickness

A

0.97mm

58
Q

Connective tissue thickness

A

1.07mm

59
Q

Fiber terms for connective tissue

A 
Dentogingival
Dentoperiosteal
Alveologingival
Circumfrential
Semicircular
Transgingival
Intergingival
Transseptal
Interpapillary
60
Q

Junctional epithelium around implants

A

About 2mm wide with wider intercellular spaces compared to teeth. Biological width on average is 3.5mm instead of 2

61
Q

What is the anatomical shape of the sinus, and where are the walls

A 
pyramidal shaped cavity
Base - lateral nasal wall
apex - Zygomatic process
Ostium - 2/3 up the base
Superior - floor of orbit
Inferior - alveolar process
anterior/lateral - Cheek
Posterior - Infratermoral fossa/pterygopalatime fossa
62
Q

Anatomical surgical considerations for the maxillary sinus

A 
infraorbital foramen must be avoided (too high anyways)
Shape of sinus floor (door should follow shape, curved better than flat for indirect)
Sinus septum (impact window and more likely to perforate)
63
Q

Sinus membrane perforation

A 
Small perforations (<2mm) may come together when the membrane is folded
Medium (2-10mm) should be covered with a resorbable membrane/bioglues
Large >10mm perforation sutured, and sinus lift abandoned.
64
Q

Maxillary sinus anatomy paper

A

Van Den Bergh 2000

65
Q

primary septum maxillary sinus

A

septum that form when the sinuses are forming

66
Q

secondary semtum maxillary sinus

A

sinuses that form after the teeth are removed

67
Q

most common complication with osteotome other than membrane perforation

A

Benign paroxysmal positional vertigo - when the calcium carbonate crystals are dislodged by the hammer

68
Q

vessel that runs along the lateral wall of the sinus

A

Extraosseous Anastomosis of the posterior superior artery

69
Q

2 arteries that supply the maxillary sinus

A

inferior alveolar artery

posterior superior artery (extraosseus nd intraosseous anastomosis)

70
Q

Page 1976 - initial lesion

A

occurs 2-4 days after plaque accumulation
findings are subclinical (dilation of vessels, PMN migration, exudate from gingival sulcus is seen, serum proteins and extra-vascular fibrin, alteration of coronal JE

71
Q

Page 1976 - early lesion

A

4-7 days following plaque formation
gingivitis stage
dense lymphoid infiltrate in gingival connective tissue, making up 65% of total infiltrate
fibroblasts are 3X larger, and collagen loss is 60-70%
crevicular leukocytes reach peak 6-12 days from onset of gingivitis

72
Q

Page 1976 - established lesion

A

2-3 weeks after plaque accumulation
plasma cells are predominant with no significant bone loss
plasma cells are not restricted to reaction site any longer, and are clustered around blood vessels
proliferation and apical migration of JE may occur, and early pocket formation may be present

73
Q

Page 1976 - advanced lesion

A

Transition from gingivitis to periodontitis
no specific timeline for this stage to occur
periodontal pocket formation, ulceration, suppuration, alveolar bone loss, PDL destruction
Lesion is no longer localized, and extends apically and laterally
bone marrow distant from lesion converts to fibrous CT

74
Q

causes of sinus membrane damage

A

overfilling, infection, or perforation

75
Q

sinus membrane perforation most likely to occur

A

Sharp angle such as a ridge line or septa/spine

76
Q

pikos sinus perforation rate

A

20-60%
5-10mm repair with collagen membrane
10mm+ a cross-linked collagen membrane
85% of sinus membranes are closed within 48 hours

77
Q

Carreno - antibiotic susceptibility for sinus bacteria

A

92% - ampicillin and amoxi/clav
90% cefoxitin
some studies indicate that prophylaxis does not provide any advantage

78
Q

Kim 2006 primary vs secondary septum

A

primary occur when the sinus forms
secondary occur after extraction during pneumatization
septum present in 25% of sinuses, half in the middle 1/3 vs ant/post

79
Q

Najm 2013

A

sinus perforation is generally well tolerated, and rarely causes sinusitis

80
Q

Penarro 2008 - risks of osteotomes

A

paroxysmal positional vertigo

referral to otoneurological specialist recommended

81
Q

Pjetursson 2009 - indirect sinus lift success

A

grafting material produces more bone
implants placed with indirect sinus lift have similar success rates to conventional implants, however it is dependant on residual bone height

82
Q

Pjetursson 2014 - indirect sinus lifts

A

2-3mm sinus bump bone material is optional
5mm bone with indirect sinus is more important
if residual bone height is <4mm then higher implant failure rate
5-8mm and flat sinus floor, implant with or without grafting is indicated

83
Q

Aghaloo 2007

A

implant survival is 92% in aotogenous boe, and 95% in zenograft

84
Q

Pjetursson 2008 - lateral window success rates

A

higher success when barrier membrane placed over the lateral window
rough implants had higher survivial
particulate grafts are better than block grafts
sinus perforation is 20%

85
Q

sinus perforation - timing for reentry

A

6-8 weeks after first attempt

86
Q

implant placement after sinus augmentation

A

Van Den Burgh 4-6 months

my understanding 9 months

87
Q

Solar 1999 - vessel position in the maxilla

A

vascular supply from PSA artery and Infraorbital artery

the anterior/posterior boney window should be as small as possible

88
Q

short implants - marginal bone loss

A

does not seem to be related to crown to implant ratio

89
Q

tutak 2013 - short implant failure rates

A

lower in posterior maxilla
no evidence that splinting, length of cantilever, occlusal surface pattern, implant system, opposing arch dentition, bruxism influenced the outcome of any treatment

90
Q

Queiroz 2014

A

short implants have a slightly higher failure rate so patients should be warned
most failures are within he first year

91
Q

Bulagi 2015 - implant crown height

A

crown heights of 8mm-16mm
increased stress 34% at frame abutment
20% of off axis stress taken by the screw increasing the probability of fracture.

92
Q

Slotte 2014 - ultra short implants

A

4mm implants had a 92% survival after 5 years

no significant bone loss after 5 years

93
Q

Nissand 2014 - short implants vs vertically augmented bone

A

much less morbidity with short implants

argued that they are more prone to issues in the case of bone loss, but that is not proven

94
Q

Chapelle 2018 - gingival health

A

clinical gingival health on an intact periodontum
clinical gingival health on a reduced periodontium
BOP <10%, PD 3mm or less

95
Q

Chapelle 2018 - gingivitis classes

A

Gingivitis on an intact periodontum
Gingivitis on a reduced periodontium in a non-periodonitis patient (recession, crown lengthening)
Gingivitis on a successfully treated periodontitis patient

96
Q

modifyable gingivitis risk factors

A 
overhanging margins
oral dryness
smoking
diabetes
malnutrition
sex hormones
drug induced
97
Q

Trombelli 2018 gingivitis definition

A

localized gingivitis 10-30% BOP

generalized gingivitis 30% + BOP

98
Q

Trombelli 2018 - gingival index

A

0 - no inflammation
1 - slight inflammation/edema, no BOP
2 - moderate infalmmation/edema with BOP
3 - severe inflammation, spontaneous BOP

99
Q

Lang and Bartold 2018 - 4 categories of gingival health

A

Crest of bone to CEJ height range 1-3mm
1 - pristine periodontal health (very rare)
2 - well maintained clinical periodontal health on an intact periodontium
3 - clinical periodontal health on a reduced periodontium (successful treatment)
4 - periodontal disease remission/control with a reduced periodontum (incomplete resolution of disease or control of local factors)
5 - non-periodontitis reduced periodontium (recession, crown lengthening)

100
Q

Holmstrup 2018 - non-plaque induced gingival diseases

hereditary

A

hereditary gingival fibromatosis

rare - based on the som of sevenless gene

101
Q

Holmstrup 2018 - non-plaque induced gingival diseases

bacteria

A

necrotizing periodontal diseases (gingivitis, periodontitis, stomatitis)
stomatitis extends beyond the MGJ and >1cm
localized bacterial infections (gonorrhea, syphilis, TB - rare)

102
Q

Holmstrup 2018 - non-plaque induced gingival diseases

Viral

A

Coxsakie virus (hand/foot/mouth)
HSV1/2 - herpetic gingivastomatitis and recurrant herpes simplex lesions
varicella-zoster - during chicken pox, later in life shingles, unilateral trigeminal nerve
HPV - oral lesions benign and asymptomatic, may persist or spontaneously regress

103
Q

Holmstrup 2018 - non-plaque induced gingival diseases

Fungal

A

Candidosis - opportunistic

gingiva red with a granular surface

104
Q

Holmstrup 2018 - non-plaque induced gingival diseases

inflammatory immune conditions

A 
hypersensitivity reactions (contact allergy, plasma cell gingivitis, erythema multiforme)
auto-immune disease (pemphigus vulgaris, pemphigoid, lichen planus, lupus erythematous)
Granulomatous inflammatory conditions (TB, chrons, sarcoidosis)
105
Q

Holmstrup 2018 - non-plaque induced gingival diseases

reactive processes

A

Epiludes (fibroma, peripheral ossifying fibroma, pyogenic granuloma, peripheral giant cell granuloma (most prevalent))

106
Q

Holmstrup 2018 - non-plaque induced gingival diseases

neoplasms

A

pre-malignant (leukoplakia, Erythroplakia)

Malignant (SSC, Leukemia, Lymphoma)

107
Q

Holmstrup 2018 - non-plaque induced gingival diseases

endocrine

A

scurvy - vitamin C deficiency

108
Q

Holmstrup 2018 - non-plaque induced gingival diseases

Traumatic lesions

A

Frictional keratosis
tooth brushing induced gingival ulceration (differentiate between necrotizing)
self-harm

109
Q

Holmstrup 2018 - non-plaque induced gingival diseases

chemical insults

A 
Etching
theramal insults
Gingival pigmentation (drug induced/addisons/heavy metals etc)
smokers melanosis
drug induced pigmentation
amalgam tattoo
110
Q

Fan and Caton 2018 - occlusal trauma

A

NCCL may be occlusal trauma
occlusal trauma does not cause periodontitis
no strong evidence to support routine occlusal adjustments

111
Q

Cortellini and Bassada 2018 gingival biotypes

A

thin scalloped - triangular crown, low contacts to incisal edges, narrow KT
Thick scalloped - thick fibrotic gingiva, slender teeth, narrow KT, pronounced scalloping
Thick flat - square shaped teeth, broad contacts, broad KT, thick bone
Average width of KT for thick 5.72mm
Average width of KT for thin 4.15mm

112
Q

Cortellini and Brasada 2018 - gingival recession

A

Ortho 5-12% liklehood
thicker gingiva biotypes augmented by grafting are more stable than thin
if recession is untreated it will likely progress even with good OH
NCCL reduces root coverage probability

113
Q

Ercoli and Caton 2018 - dental prosthesis factors

A 
Subgingival class 2 fillings have more inflammation, and 0.2mm crestal bone loss
subgingival direct margins associated with localized gingivitis and increased PD
114
Q

Ercoli and Caton 2018

cervical enamel projections

A

found in 25-35% of mandibular nd 8-17% of maxillary molars

82.5% of molars with furcation involvement

115
Q

Papapanou 2018

A

reasons for new periodontitis classification
substantial overap between agressive and chronic, with no difference in etiology noted
features of periodontitis
interproximal CAL 2+mm at 2+ non-adjacent teeth.

116
Q

Tonetti 2018 - goals of staging and grading

A

staging - classify severity and extent, and assess complexity
grading - estimate future risk, estimate potential impact of patient’s health

117
Q

Tonetti 2018 - stages of periodontitis

A

I - very early attachment loss, borderland between gingivitis and periodontitis
II - established perio, but management still simple
III - significant damage and tooth loss will occur without treatment. masticatory function preserved, management complicated by intrabony defects/furcation/history of periodontal tooth loss/ridge defects complicating implant replacement
IV - significant damage and tooth loss has occured, loss of masticatory function, complicated by hypermobility (secondary occlusal trauma), posterior bite collapse, drifting, requires stabilization

118
Q

Tonetti 2018 - grading periodontitis

A

disease severity at presentation is an indirect assessment
CAL must be adjusted in some way based on number of missing teeth (unclear how we do this?)
risk factor will shift grade higher (smoking/diabetes)

119
Q

Berglundh and Armitage 2018

peri-implant health

A

PD usually greater than adjacent teeth, stable.

peri-implant epithelium is longer with no inserting CT onto the implant

120
Q

Berglundh and Armitage 2018

Peri-implant mucositis

A

BOP on simple probing
strong evidence of plaque etiology
3 weeks for resolution
plasma cells and lymphocytes which do not extend apical of the junctional epithelium

121
Q

Berglundh and Armitage 2018

Peri-implantitis

A

BOP +/- suppuration, progressive bone loss radiographically,
strongly associated with periodontitis

122
Q

Araujo and Lindhe 2018

peri-implant attachment

A

3-4mm height (margin to crest of peri-implant bone) JE 2mm, CT 1-2mm
most fibers are parallel to implant restoration
fibroblasts concentrated at the surface of the implant

123
Q

Heitz-Mayfield and Salvi 2018

peri-implant mucositis

A

peri-implant mucositis inflammatory infiltrate does not extend apical to the barrier epithelium. infiltration of B and T cells within 21 days
These sites are an increased risk of peri-implantitis

124
Q

Heitz-Mayfield and Salvi 2018

peri-implant mucositis risk factors

A

Biofilm acumulation, complaince with SPT, excess cement, improper restoration
Improved home care and mechanical debridement resolved 38% of peri-implant mucositis

125
Q

Schwarz 2018

peri-implantitis

A

requires radiographic confirmation
dominated by plasma cells and lymphocytes
peri-implant lesions are twice as wide as periodontitis (3.5mm2 vs 1.5mm2)
lesions tend to evolve circumfrentially

126
Q

Schwartz 2018

risk factors of peri-implantitis

A 
history of periodontitis
lack of SPT
Smoking is not
Diabetes is not
Excess cement is a potential risk factor
poor placement may lead to poor OH, but not a risk factor
occlusal overload is not conclusive
titanium particles is not conclusive
<2mm KT leads to more plaque but not changes in bone level

Osseointegration (1 decks)

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