FINAL Flashcards by Casey Kariya

Osteoinduction is _ from _, derived from _

New bone formation from differentiation of osteoprogenitor cells derived from mesenchymal cells into osteoblasts

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Differentiation is induced by _ from _

Bone inductive proteins from bone matrix

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BMP does what

Initiates osteoinduction. Acts on progenitor cells to induce diff into osteoblasts

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BMP is higher in _ than _

Cortical bone than cancellous

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Osteoconduction is formation of new bone from _ or _ along a _

Host derived or transplanted osteoprogenitor cells

Along a biologic framework

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T/F osteoconduction produces new bone

FALSE, conducts bone forming cells from host into the scaffolding

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Osteogenesis is formation of new bone from _

Osteoprogenitor cells. It’s both inductive and conductive

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Two phase theory of osteogenesis.
Phase I is what:
What does it determine

Transplanted cellular bone produces new osteoid.

Determines QUANTITY of bone that the graft will form

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Two phase theory of osteogenesis.
Phase II is what
Determines what

Fiber and blood vessel proliferation, then osteogenesis. Woven bone replaced by lamellar. Graft resorbed, BMP released.

Determines QUALITY

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5 types of grafts and definition

Autograft - tissue from yourself
Allograft - other human
Xenograft - animal graft
Alloplast - synthetic (HA)
Recombinate graft - BMP

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How do Allografts and xenografts work

Osteoconduction

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1 reason BMP is not effective

Cost

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Tough issue when putting implants into grafted bone

Crown to root ratio

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Osteoclasts come from _

Osteoblasts come from _

Hematopoietic stem cells

Mesenchymal stem cells

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4 reasons for poor wound healing

Medications
Radiotherapy
Infection
Systemic disease

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3 types of drugs associated with MRONJ

Bisphosphonates
Anti-resorptive agents
Anti-angiogenic medications

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How do bisphosphonates work

Inhibit osteoclasts by binding to Ca2+

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Who would take bisphosphonates

Osteoporosis/osteopenia
Paget’s disease
Osteogenesis imperfecta

Solid tumors with bone metastasis
Hypercalcemia of malignancy
Multiple myeloma

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What makes the jaws unique for bone remodeling

Increased turnover (10 x long bones)
Thin overlying oral mucosa

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MRONJ
Stage 1
Stage 2
Stage 3

1: asymptomatic exposed bone, no infection
2: exposed bone, pain, infection
3: exposed/necrotic bone, pain, infection

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Osseus surgery if on IV BP

Avoid if at all possible

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PO BPs needing EXT

Informed consent, medical consult to see about drug holiday

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Three hypos of ORN

Hypoxia
Hypovascularity
Hypocellularity

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Osteomyelitis:

Bone infection.

Inflammation of bone marrow involving cancellous and cortical bone that tends to progress.

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Steps of osteomyelitis

``` Bacteria Inflammation Vascular compression Ischemia Necrosis ```

Osteomyelitis is found more in the _ than the _

Mandible

Why is osteomyelitis more common in mandible

Cortical bone more prone to damage on ext Blood supply of max is better

Radiographic findings of osteomyelitis

Moth eaten | Islands of non-resorbed bone

Antibiotic for osteomyelitis

Clindamycin

How long does dry socket last

A week

3 ways to restore lost tissue volume

Grafting Distraction Ortho eruption

GBR

Horizontal augmentation, flap, prepare site, place bone, membrane, primary closure

Block grafting:

Horizontal alveolar graft, shaped like a block Cortical w or w/o cancellous Block maintains space while remodeling

Pros/Cons of iliac crest donor site

P: lots of bone, no rejection C: need gen anesthesia, two surgeons, scar on hip

Diet modification after block graft

Non chew (scrambled eggs at most) for 12 days

T/F vertical augmentation is easily achieved

FALSE. No got way to do it currently

3 reasons not to do grafts for vertical gain

Risk of graft exposure Bad adaptation of graft to ridge Higher resorption rates

Advantages to distraction for vertical gain

Controlled New bone in gap Soft tissue envelope expands

Phases of distraction and length of each

Latency (4-7 d) Distraction (1 mm/day) Consolidation (2-3 months)

Two disadvantages of distraction

Distractor arm | Long consolidation phase

Sinus augmentation timeline for autograft vs allograft

Autograft in 4 months | Also in 6-8 months

Post op for sinus augmentation with perf

Nasal decongestant | Mucolytic

4 requirements for good implants

Healthy gingival collar Thick biotype gingiva No perio Adequate bone

T/F immediate implant should fill socket

FALSE

T/F Most people have enough bone for mand ant implants

True

Patient wants max ant implants, not a lot of bone, can’t do sinus augmentation

Angle implants/implants in nasal bones

Why are long angled implants usually not done

If patient can’t do sinus augmentation, they can rarely do general anesthesia

_ is needed before definitive removal of a pathological condition

Histological diagnosis

Reconstruction should be planned when

While planning excisional surgery

A true cyst contains a _

An epithelial lining

4 ways to manage cysts

Enucleation Enucleation and curettage Marsupialization Staged marsupialization and enucleation

When to do E&C

Removing known aggressive cyst like OKC Or 2nd surgery after the first was supposed to cure it

When to do marsupialization

Adjacent vital structures at risk Difficult surgical access to all portions of cyst Medical compromise

T/F marsupialization alone is done more frequently than other treatments

FALSE. Staged marsupialization and enucleation is done more

Advantages of marsupialization and enucleation

Thickened cystic lining Reduces morbidity Same as marsupialization

Cysts that probably require extraction

Dentigerous | OKC (potentially)

Management of jaw tumors depends on what 3 things

Lesion behavior An atomic location Desired reconstruction results

E&C indications

Slow growing, non-aggressive Most odontogenic tumors Medically compromised

Jaw tumor resection indications

Aggressive lesions either path or clinically | Difficult to remove by E&C alone

Most important part of workup

History

Pain history

``` Location Intensity Quality Onset Radiation Associated symptoms Alleviating factors Aggravating factors ```

Pts that will benefit from TMJ surgery

Mechanical or inflammatory joint disease Failed non-surgical therapy Muscle disorders are not only problem Invasive treatment will correct mechanical dysfunction

Why do arthroscopy instead of arthrocentesis

``` Long duration of symptoms History of failed steroid injection Long history of late, hard, painful pop Can’t get MRI Obesity ```

Pros/cons of arthroscopy

P: minimally invasive, excellent success C: not for advanced disease, failure requires open surgery, can injure middle ear or nerve

Arthrotomy:

Incision into joint

Arthroplasty

Repair, revision and or reconstruction of joint tissues

Meniscectomy or discectomy

Removal of disk

Main reason for arthrocentesis

Acute closed lock

Arthrocentesis affects _ space

Superior joint space

Arthroscopy benefits

Allows examination under anesthesia | Doesn’t reposition disk

T/F a healthy joint should be avascular and show bone and fibrocartilage

FALSE. Should be avascular and no bone, with fibrocartilage

Most common graft material for discectomy

Temporal fascia

Best material for condyle graft

Rib

Most common joint reconstruction for kids?

Costochondral rib, grows with patient

Indications for total joint replacement

Severe degeneration of condyle Recurrent fibrous or bony ankylosis Failure of other reconstructive procedure

Why not do total joint replacement

Expensive May not improve pain Treatment of last resort