Factors Effect Flashcards
What are the factors effects implant osseointegration ?
1- implant material ( Ti gold standard )
2- implant finish
3- status of the bone
4- implant loading condition
5- surgical techniques
6- Macro and micro design of implant
What is Osseointegration ?
Direct interaction between implant and bone at microscopic level
Asymptomatic rigid fixation of alloplastic material during function
What is the type of stability in primary and secondary ?
Primary : pure mechanical ( micro motion lead to failure )
Secondary : is the long term success , biochemical ( after healing of bone ) and depends on the degree of bone formation
Deferences between bone remodeling and modeling :
Remodeling : replace old bone with new bone ( Slow / same shape ) , Decrease primary increase secondary
Modeling : changing the shape/size of bone as response to force or stress ( fast / different shape )
Repair : physiological process were body facilitate repair of bone fracture
Bone regeneration : development of new bone in deficient sites with using surgical protocols ( osteogenesis, osteoinduction, and osteoconduction )
What are the components of osteogenesis,
osteoinduction, and osteoconduction ?
Bone graft + osteoblasts = OSTEOGENESIS
Bone graft + angiogenesis = OSTEOCONDUCTION
Bone graft + growth factors = OSTEOINDUCTION
Implant with Higher survival rate sites to lower survival rate and why :
- Anterior mandibular teeth ( 100 % ) thick outer cortical bone
- Anterior maxillary teeth ( 94 % )
- Posterior mandibular teeth ( 92% ) neurovascular bundle’s
- Posterior maxillary teeth ( Nasal floor and maxillary sinus )
What imagine modality to see bone density?
CBCT
Alveolar bone proper “Cortical bone” other names ?
- Lamina dura ( RO lining )
- cribriform plate ( because of blood vessels )
- bundle bone ( because of pdl fibers )
Deference between cortical and cancellous bone ?
- Cortical bone Microscopic structure is osteon and it’s organized and surrounds blood vessels
- cancellous bone microscopic structure is trabeculae and it’s unorganized and surrounds blood vessels
Osseointegration Prerequisites ?
• Precise fit
• Primary stability ( Achieved in surgery place and torque measurement )
• Bioinert No - tissue reation )
• Bioactive ( + favorable tissue reaction )
Osseointegration Process :
0 day ( 2 hours ) : production of Coagulum
4 weeks : New trabecular bone
6 weeks : Dense trabecular bone
12 weeks : New mature bone
BIC is what ?
Bone to implant contact and measures degree pf ossteointegration
Most common incision
Creatal incision ( should be beveled and suitable for submerged and non submerged )
In case of bone grafting what incision should we use ?
Vertical releasing incision
( should be beveled 45- 60 degree to the center of the flap not the IDP and not of middle of facial surface )
( Should extend beyond the muccogingival line and AVOID it in palatal/ lingual ( thicker fibers )
In implant osteotomy what is the benefit of placing surgical guide template ?
Directs the angulation of the implant
What torque and speed we use in implant osteotomy ?
Low speed (1500 - 2000 rpm ) , High torque , copious irrigation ,
Generic drilling sequence ?
- blade no 12
- Pilot drill ( low speed diamond with taper end ) ( 1.5-2 mm hight ) drill into center by 7-9 mm
- position verification ( must take PA with it to asses position and angulation ) ( maximum speed 800 rpm )
- 2nd Twist drill ( re assess the position and angulation) ( 2.5 mm in width ) ( maximum speed 800 rpm )
- final shaping drill ( widen the osteotomy to implant diameter )
- Taper drill or thread former ( only for thicker bone ) less than 30 rpm
- implant insertion 45 Ncm by hand piece or hand ratchet then take PA
Sequence change according to the implant and bone ( soft or hard ).
Methods of measuring implant stability( primary ) include :
- Percussion testing
- Insertion torque (IT) by a machine that determine the stability of the implant, it gives readings: 15,25,30,35
- Reverse torque test
1 stage vs 2 stage approach ?
1-stage approach (non submerged):
- Healing Abutment
- one surgical intervention.
- shortens treatment times.
- Partially edentulous patients
2-stage (submerged) :
- cover scrow
- when primary stability not obtained and GTR
- when expected that removable temporary prostheses could transmit excessive forces
- fully edentulous patients.
When to remove sutures?
After 7-10 days ( should use CHX 0, 12 % )
What is the most common suturing material ?
Non absorbable like :
silk use for flap because it’s cheaper
Nylon
Absorbable material for sutauing used for what?
Extraction & Bone graft ( we use figure of 8 for it )
Most commonly used suturing technique?
Simple interrupted
When late complications aries and what is it ?
After 3 months
- Implant mucositis : inflammation of soft tissue
- Perimplantitis: inflam. of the bone cause bone loss
- Implant fracture
When immature collagen start to form?
After 2 weeks
Implant loading condition :
Immediate : 48 hours
Early : 48 hours to 3 months
Conventional : 3-6 months
Delayed : 6-12 months
In the case of inadequate primary stability :
May select to increase the diameter of the implant being placed and/or avoid immediate loading.
Aim of dental implant design?
1- Maximise osseointegration: Maximise cell activity and bone apposition at the bone-to-implant contact (BIC)
2- Maintenance: Balance between Biological vs biomechanical factors
Most commimgly used and more successful material?
CPTi
Titanium (Ti) and its alloys are commonly used materials dental implants due to :
their mechanical and chemical properties.
• high strength to weight ratio
• high yield and fatigue strength
• relatively low modulus counteracting the effects of stress shielding.
Benefits of passive titanium oxide (TiO2) passive film at the surface and where it found?
In Tiatinum and it’s alloy and it’s biocompatible ( react with water ion and serum protein ) to resists corrosion .
Dose old age effect implant survival ?
No , Older the patient more successful the implant
Does diabetes effect implant ?
Yes , chronic Hyperglycemia increase inflamation to the site of implant will cause bone loss and implant failure
AGEs ( Advanced glycation end product effect wound healing )
Does CVD ( HTN ) effects implant survival ?
No , but effect bleeding >2.5 and ischemia
Dose osteoporosis effect implant survival ?
- Oral and Low dose IV of BP / low risk of MRONJ
- IV BP / High risk of MRONJ ( Absoulte contraindication )
How soft tissue effect implant ?
- Increase keratinized tissue will increase esthetic and hygiene and patient comfort /decrease reccesion
- THICK biotype is better
Best types of cortical bone ?
II / III
Treatment options for post extraction ?
- 0 : immediate/ same day
- 4-8 weeks : early , soft tissue healing
- 12-16 weeks : partial bone healing
- > 6 months : complete bone healing
