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Intro to IMPLANTS > Exam 1 > Flashcards

Exam 1 Flashcards

1
Q

Initial definition of osseointegration?

A

“Direct structural and funcitonal connection between ordered, living bone and the surface of a load-carrying implant”

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2
Q

Later definition of osseointegration

A

“Process in which clinically asymptomatic rigid fixation of alloplastic materials is achieved and maintained in bone during functional loading”

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3
Q

On what level of magnification is osseointegration defined?

A

Light microscope

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4
Q

When was titanium originally used?

A

1950, titanium chambers embedded into soft tissue of ears of rabbits

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5
Q

When were implants first study for osseointegration?

A

1952

Branemark implanted titanium in rabbit femur

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6
Q

When were guidelines put in place for implants?

A

1982 - toronto

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7
Q

What Med history factors effect implant survival?

A

Smoking and radiation

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8
Q

Are implants contraindicated with smokers? What are the rates of success?

A

No
Smokers: 89%
Non Smokers: 96-98%

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9
Q

What pretx records are required for implants?

A
  1. Pano radiographs
  2. PA of edentulous area to be restored
  3. Implant Diagnostic Checklist
  4. Mounted dx cast and wax up
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10
Q

Diagnostic checklist

A
  1. Edentulous space to be restored
  2. Edentulous ridge
  3. Soft Tissue
  4. Occlusion
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11
Q

Edentulous space

A

MD width at least 6.5mm, ideally 7mm for single tooth
Double for two teeth
BL width - molar area at least 7mm
Height - PA radiograph is necessary
Max post/man ant = at least 10mm
Man post = at least 12 mm above IAN
Interocclusal space = at least 5mm from ridge crest to opposing dentition

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12
Q

Soft tissue

A

Thin biotype - difficult to manage esthetics

Thick biotype - predictable esthetics

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13
Q

Occlusion

A

Anterior guidance
Parafunction
Inter-arch relationship

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14
Q

TX planning options

A
  1. Nothing
  2. RPD
  3. FPD
  4. Implant Crown (IC)
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15
Q

Advantages of Implant Crowns

A
  1. Conservative
  2. Improved Hygiene
  3. Esthetics
  4. Maintains Bone
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16
Q

Disadvantages of IC

A
  1. May require additional surgery - graft/sinus lift
  2. Long tx time
  3. Expensive
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17
Q

Contraindications of implant tx

A
  1. Inadequate bone height and width

2. Presence of bone loss around adjacent teeth (anterior esthetics compromised)

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18
Q

Most common complication of implant restoration

A

Abutment screw loosening - easily managed

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19
Q

What has the highest survival rate in terms of prosthesis

A

Single tooth replacement with implants - 97%

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20
Q

Edentulous arch tx options

A
  1. Nothing
  2. Immediate denture
  3. Complete Denture
  4. Implant Overdenture
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21
Q

How many edentulous pt have implants?

A

1-5%

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22
Q

First choice tx for edentulous mandible

A

2-implant overdenture

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23
Q

What is the braenmark definition of osseointegration

A

Direct structural and functional connection between ordered, living bone and the surface of a load-carrying implant

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24
Q

What percentage of osseointegration takes place?

A

60-90%

25
Q

Implant success critieria

A
  1. No mobility
  2. No peri-implant radiolucency
  3. Vertical bone loss
26
Q

Predictors of implant success

A
  1. Implant material biocompatability
  2. Implant design and surface
  3. Bone quality and quantity
  4. Implant placement and restoration technique
27
Q

Implant materials and advantageous properties

A
  • Titanium
    1. Biocompatability
    2. High Strength
    3. Cost effective
28
Q

Primary Stability

A

Implant macrostructure - length/ diameter/ threads/ microgrooves

29
Q

Secondary stability

A

Surface roughness/ texture

30
Q

How do aggressive threads impact stability?

A

Increase it upon placement

Increase surface area once integrated

31
Q

What happens with primary and secondary stability over time?

A

Decrease in primary stability and increase in secondary stability between 2-4 weeks after implant placement

32
Q

Tapered implants

A
  1. Better primary stability
  2. mimics root anatomy
  3. Immediately after extraction or in healed sites
  4. Limited buccal plate thickness
  5. Limited inter-dental root space
  6. Sinus floor infracture cases
33
Q

Implant diameter is based on

A
  1. Available bone width
  2. Size of tooth replaced
  3. restoration contours (emergence profile)
  4. Occlusal load
34
Q

How does implant diameter effect surface area

A
  1. Increase implant diameter from 4 to 5mm increases SA by 25%
35
Q

How to select diamter?

A

Implant diameter should be within 1mm of the diameter of the restoration at CEJ

36
Q

Length dependent on..

A

Available bone
Anatomy
Longer implants = more SA for osseointegration
Immediate implant cases, primary stability is achieved by engaging apical 1/3rd of the socket

37
Q

Thread and monogrove features

A

Guide implant placement - active thread
Mechanical interlocking
Increases SA for greater BIC (bone to implant contact)

38
Q

How can implant surface topography be modified

A
  1. Acid etch
  2. Blasted surface
  3. Acid etched and blasted surface
  4. Oxidiezed surface
  5. Titanium plasma spray
39
Q

Can you have too rough of surface?

A

Yes, calculus becomes difficult to remove once attached if too rough of surface - perimplantitis

40
Q

D1 Description and Location

A

Dense cortical bone

Anterior mandible

41
Q

D2 Description and Location

A

Porus cortical and coarse trabecular bone
Ant and Post man
Post max

42
Q

D3 Description and Location

A

Porus cortical (thin) and fine trabecular bone
Ant and Post Max
Post Man

43
Q

D4 Description and Location

A

Fine trabecular

Post Max

44
Q

Stress

A

Magnitude of force/functional area over which it is applied

45
Q

Strain

A

Changed in length of a material/original length

46
Q

Bone density of Load transfer

A

Greater stress = greater strain
Excessive stress at B-I = crestal bone loss
Bone density is directly related to bone strength

47
Q

Greater bone density offers:

A

Greater BIC
Better stress distribution
BIC: Cortical bone (D1) > Trabecular bone (D4)
Greater implant surface area is required to obtain similar amount of BIC in soft bone
-Bone density down = need to increase implant surface area

48
Q

How to determine bone density?

A

CT Scan
Tactile sensation during surgery
*PA and pans NOT useful

49
Q

What is the imaging method of choice for gaining bone info?

A

CBCT

50
Q

How to reduce stress on less denser bone (D3, D4 bone)

A
  1. Reduce cantilever forces on the prostheses
  2. Reduce the amount of load - narrow occlusal table
  3. Occlusal force directed along the long axis of the tooth
51
Q

What tx modifications can accomodate for variations in bone density

A
  1. Reduce force of the prosthesis
  2. Increasing load bearing area
  3. Improving the design and surface
52
Q

How to reduce the stress in implant prostheses

A

First - decide type of prosthesis - fixed or removable prosthesis
Second - eval the amount of force that the implant restoration needs to withstand
Third - determine bone density at the implant site
Fourth - decide implant position and number

53
Q

Restorative dentists prescribe…

A

Implant brand, size (diameter/length) and location (depth and orientation) of implant placement that is most favorable for long term success of implant prosthesis

54
Q

What is important for optimal support and stability of hard and soft tissue?

A

Correct 3D Implant positioning

55
Q

CB

A

Crest of Bone

56
Q

CP

A

Contact Point

57
Q

What happens when CP-CB = 5mm or less

A

Papilla present almost 100% of the time

58
Q

What happens when CP-CB = 6mm?

A

Papilla present 56% of the time

59
Q

What happens when CP-CB > 7mm?

A

Papilla present 25% or less

Intro to IMPLANTS (2 decks)

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