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Implantology > Final: Alveolar Ridge Preservation > Flashcards

Final: Alveolar Ridge Preservation Flashcards

1
Q

What are the types of bone loss for Maxilla vs Mandible?

A
  • Maxilla:
    • Horizontal Resorption
  • Mandible:
    • Anterior=Horizontal
    • Posterior=Vertical
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2
Q

Periodontium Anatomy

A
  • Bundle Bone
  • Cortical Bone
  • Cancellous Bone
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3
Q

Bundle Bone

A
  • Lines socket
  • Directly connected to tooth structure
    • Sharpeys fibers
  • 1st to degrade after extraction
  • Next to PDL of drifting teeth
  • Alveolar Bone Proper
    • Cribiform Plate
    • Lamina Dura
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4
Q

Cortical Bone

A
  • Aka: Compact Bone
  • Outer wall of bone
    • Continuous with bundle bone
    • Dense & Strong
  • Primarily Lamellar Bone
  • Provides primary stability to implant
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5
Q

Cancellous Bone

A
  • aka Spongy or Trabecular Bone
  • Below Cortical Bone
  • Radiographic appearance→Mesh work
  • Trabeculae: Primarily lamellar bone
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6
Q

Alveolar Bone Loss

A
  • Horizontal or Vertical defects
    • occur due to
      • tooth loss
      • fractures
      • pathology
    • Compromise ideal implant placement→Unfavorable outcome
  • Johnson:
    • Fastet resorption: 1-6 months
  • Carl & Perspm
    • Most bone loss= 6-24 months
  • Amler or Nevin
    • Most tissue contour Loss: 1st month
      • avg 3-5mm in width at 6 months
  • Ashman:
    • Bone Shrinkage in 2-3 years:
      • 40-60% of height and width
    • Life Bone loss rate:
      • 0.5-1.0%/year
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7
Q

Alveolar Bone Loss Classification: Edentulous Jaw

A

A-E; A=normal

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8
Q

Socket Healing: Research Studies

A
  • Araujo:
    • Flap vs Flapless Ext=No Difference
  • Scala
    • Monkey Study
  • Tan
    • Systemic Review
    • rapid reduction in first 3-6 months
  • Chappus
    • Facial Bone wall > 1mm (Bone Loss 1.1 mm)
    • Facial Bone wall ≤ 1mm (Bone loss 7.5 mm)
  • Schropp
    • Ext Posterior Teeth
    • Lose 50% of width in 12 months
      • ⅔ in 3 months
  • Farmer:
    • Ext anterior teeth (Esthetic zone)
    • Lose 15% width in 6-8 weeks
    • Greatest bone loss= Coronal & Vertical
  • Cardaropoli:
    • Dog teeth
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9
Q

Ridge Preservation

A
  • Aka:
    • site preservation
    • Socket preservation
  • minimize vertical and horizontal ridge alterations in post-ext sites
    • Decreases bone resorption
      • DOES NOT PREVENT
  • No Superior Techniques
  • No Flap ⇣ resorption rate
  • No RP→ ⇡ orofacial dimension of bone
  • Dimensional Changes within 6 months
    • Mean horizontal reduction=3.8 mm
    • Mean Vertical Reduction=1.24 mm
  • Can Perform under a non-implant restoration to maintain tissue level
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10
Q

Ridge Preservation: Treatment Considerations

A
  • Careful technique
  • Minimal traumatic extraction
    • careful elevation, lunation, and suturing (Criss-cross/Cruciate)
  • Preserve Buccal Plate
    • if damaged, repair during ext
  • Section tooth if necessary
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11
Q

Why do we ant to preserve the ridge?

A
  • Maintain:
    • existing soft & hard tissue envelope
    • stable ridge volume
      • optimal fxn & esthetics
  • Simplify subsequent tx
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12
Q

Ridge Preservation: Contraindications vs Indications

A
  • Contraindications:
    • Infection
    • Radiation
    • Bisphosphonates
  • Indications:
    • Implant placed at later time
    • Contour ridge for conventional prosth tx
    • Positive cost vs benefits
    • Adolescents
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13
Q

Ridge Preservation: Clinical Recommendations

A
  • Elevate Flap and Place:
    • biomaterials
      • ridge contour or barrier membrane
    • Devices
      • ridge contour
  • Primary Wound Closure
    • no comparison studies
      • soft tissue punch, CT graft, etc.
  • Materials with low resorption and replacement rate
    • No difference b/w materials (fillers, membranes)
      • except collagen plug alone
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14
Q

What are the different types of bone grafts?

A
  • Autograft
  • Allograft
  • Xenograft
  • Alloplast
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15
Q

Autograft

A
  • Same person
    • Intraoral or extraoral
      • Tuberosity
      • chin
      • ramus
      • calvarium
      • tibia
      • iliac crest
  • osteogenesis
  • osteoconduction
  • osteoinduction
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16
Q

Allograft

A
  • From Different person
  • DFDBA, FDBA, Puros
  • Osteoinductive
  • Osteoconductive
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17
Q

Xenograft

A
  • From different species
  • Bovine (Bio-Oss), Horse (Equimatrix)
  • Osteoconductive
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18
Q

Alloplast

A
  • Synthetic
  • GEM21
  • Osteoinductive
  • Osteoconductive
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19
Q

Post-extraction Site Classifications:

A
  • Class I
    • Intact Extraction Site
    • favorable anatomical conditions
  • Class 2
    • Intact Extraction Site
    • partially favorable anatomical conditions
  • Class 3:
    • Partially Compromised Extraction Site
    • unfavorable anatomical conditions
  • Class 4:
    • Severely Compromised Extraction Site
    • Unfavorable anatomical conditions
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20
Q

Class 1 Post-Extraction Site Classification

A
  • Intact Extraction Site
    • Favorable Anatomical Conditions
  • Buccal cortical Plate
    • Intact or ≤ 20% wall damage
  • Soft Tissue Level
    • Optimal
  • Bone Anatomy
    • Good for 3D implant position & Primary Stability
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21
Q

Class 2 Post-Extraction Site Classification

A
  • Intact Extraction Site
    • Partially Favorable Anatomical Conditions
  • Buccal cortical Plate
    • Intact or ≤ 20% wall damage
  • Soft Tissue Level
    • Optimal
  • Bone Anatomy
    • Difficult Implant Position & Primary Stability due to
      • Perio defects and lesions
      • Adjacent anatomical structures
        • maxillary sinus floor
        • IAN
        • nasopalatine canal
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22
Q

Class 3 Post-Extraction Site Classification

A
  • Partially compromised Extraction Site
    • Unfavorable Anatomical Conditions
  • Buccal cortical Plate
    • 20-50% resorption
  • Soft Tissue Level
    • Suboptimal
      • soft tissue inflammation
      • thin and scalloped gingival phenotype
  • Bone Anatomy
    • Good for 3D implant position & Primary Stability
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23
Q

Class 4 Post-Extraction Site Classification

A
  • Severely compromised Extraction Site
    • Unfavorable Anatomical Conditions
  • Buccal cortical Plate
    • > 50% resorption
  • Soft Tissue Level
    • Suboptimal
      • soft tissue inflammation
      • thin and scalloped gingival phenotype
  • Bone Anatomy
    • Difficult implant position & Primary Stability due to:
      • perio defects & lesions
      • adjacent structures
        • Maxillary sinus floor
        • IAN
        • Nasopalatine canal
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24
Q

Socket Shield Technique

A
  • Leave natural buccal root of tooth
  • place implant in it
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25
Q

Dehiscence

A
  • A Slice without coronal bone
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26
Q

Fenestration

A
  • a window apical of coronal bone
    • intact coronal bone
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27
Q

How does a socket extraction remodel over time?

A
  • Contains clots then osteoblasts
  • Day 14=Woven Bone
  • Until bone is completely filled at Day 180
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28
Q

What is the rationale for alveolar ridge preservation?

A
  • Place implants later
  • Contour ridge for conventional prosthetic tx
  • positive cost to benefits
  • adolescents
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29
Q

Which materials are used for alveolar ridge preservation?

A
  • Autografts
  • Allografts
  • Xenografts
  • Alloplasts
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30
Q

Socket Healing After Extraction

A
  • Day 7-14:
    • Granulation Tissue w/bundle bone degradation
  • Day 30:
    • Lamellar bone starts to form
  • Day 60
    • More Fat Deposition
  • Day 90:
    • Good amount of bone
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31
Q

Ridge Augmentation Techniques

A
  • Distraction Osteogenesis
    • high risk of infection & failure
  • Guided Bone Regeneration (GBR)
  • Block Autograft
  • Block Allograft
  • Ridge Split Techniques
  • Combination
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32
Q

Guided Bone Regeneration

A
  • Use barrier membranes to direct growth of new bone & soft tissue
    • sites w/insufficient volumes or dimensions
    • used for fxn, esthetics, or restoration
  • Based on Guided Tissue Regeneration (GTR) principles
  • Introduced by Dahlin
    • rats
    • 1988
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33
Q

GBR Regeneration Process

A
  1. Blood Clot
  2. Angiogenesis
    1. develop new blood vessels
  3. Granulation Tissue
  4. Osteogenic cells migrate
    1. periphery→center
  5. Deposits woven bone
  6. Lamellar bone forms
  7. Remodeling
    1. resembles bone growth
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34
Q

GBR: PASS Principle

A
  • Primary Closure
    • periosteal releasing incision
    • remove membranes after 4-6 mos
  • Angiogenesis (Blood Flow)
    • formation of new BVs
  • Stability
    • Suture and anchor membrane and flaps
  • Space Maintenance
    • membrane b/w bone graft and gingiva
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35
Q

What is the Principle of Combination Therapy

A
  • Membrane
    • provides barrier
  • Graft
    • scaffold
    • space maintenance
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36
Q

Ideal Membrane Characteristics

A
  • Biocompatible
  • Cell Occlusiveness
  • Tissue Integration
    • protect blood clot
    • wound stabilized
  • Space making
    • for progenitor cells
  • Manage Clinical
  • Facilitate migration and proliferation of progenitor cells
  • Bacterial infection resistant
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37
Q

Types of Barrier Membranes

A
  • Non-Resorbable
    • ePTFE, dPTFE
      • socket grafting)
    • Millipore
      • Cellulose acetate
    • Titanium
  • Resorbable:
    • Collagen
    • Synthetic: PLA, PGA, PLGA
    • ADM
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38
Q

New Membranes

A
  • Alginate
  • New degradable copolymers
  • Hybrid or nanofibrous membranes
  • Amniotic membranes
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39
Q

Porosity Principle

A
  • Porosity
    • 50-100 um → Bone ingrowth
    • > 100 um (101-150)→ High vascular tissue
    • > 150 um→ Bone with osteons
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40
Q

GBR vs GTR

A
  • GBR
    • on edentulous ridges
  • GTR
    • around teeth
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41
Q

Osteogenesis

A
  • cells in graft form new bone
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42
Q

Osteoinduction

A
  • Chemical Process
  • BMPs convert neighboring cells→ osteoblasts→form Bone
    • BMPs=molecules in graft
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43
Q

Osteoconduction

A
  • Physical Effect
  • Graft Matrix forms scaffold
    • outside cells penetrate the graft → form new bone
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44
Q

Osteopromotion

A
  • Materials that support:
    • wound healing
    • tissue regeneration
  • do not initiate de novo tissue formation
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45
Q

Autograft

A
  • Same person
  • intraoral or extraoral
    • tuberosity, chin, ramus, calvarium, tibia, iliac crest
  • osteogenesis
  • osteoconduction
  • osteoinduction
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46
Q

Allograft

A
  • From a different person
  • DFDBA, DFBA, Puros
  • Osteoinductive
  • Osteoconductive
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47
Q

Xenograft

A
  • From a different species
  • Bovine (Bio-Oss), Horse (Equimatrix)
  • Osteoconductive
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48
Q

Alloplasts

A
  • Synthetic
  • GEM21
  • osteoinductive
  • osteoconductive
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49
Q

Growth Factors

A
  • GFs
    • rhBMP2
    • PDGF-BB
    • FGF2
  • Controversial Evidence
    • Rapid Clearance→ insufficient GF conc in bone defects
    • Deliver w/supra-physiological non-standard doses → therapeutic efficacy
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50
Q

Neo-osteogenesis

A
  • de novo bone formation beyond genetic skeletal envelope
  • achieved by applying GBR principle
51
Q

Factors that Influence GBR Success

A
  • Patient Factors
    • smoking
  • Excessive Swelling
  • Passive Flap tension
  • Cortical Penetration
  • Defect morphology
    • length
    • angle
  • Membrane fixation
  • Materials used
  • Horizontal Augmentation
    • predictable and successful
  • Vertical Augmentation
    • More challenging
    • Less than horizontal gain
    • Decreased implant success & survival
52
Q

Block Graft

A
  • Block Graft vs GBR
    • Greater Ridge Width Gain
    • Lower Implant Success
  • Block Graft vs Autogenous Particular Graft
    • Greater:
      • bone to implant contact
      • Bone Fill
    • Less Mean height Gain
53
Q

Khoury’s Split Bone Block Technique

A
  • Bone Block + GBR
54
Q

Ti-Mesh Membranes

A
  • Titanium Meshes
  • used w/particulate bone for large defects
  • oxide layer promotes
    • cell colonization
    • differentiation of osteogenic lines
  • Not mainstrem
    • technique sensitive
    • Cost
55
Q

Alveolar Ridge Split (ARS)

A
  • Splits crest cortical bone
    • creates horizontal dimensions
    • immediate or delayed implant placement
  • can be combined with GBR
  • Only D3 or D4 bone Types
56
Q

GBR: Other Principles

A
  • Thin layer of soft-tissue ingrowth
    • under the membrane
    • initial blood clot shrinks→air entrapped or membrane micromovement
  • Micromovement:
    • Fibrous Tissue
57
Q

Alveolar Ridge Split: 4 Anatomical Requirements

A
  • Minimal horizontal bone width= 2 mm
  • Minimal Vertical Bone Height=10 mm
  • No concavity
  • Horizontal osteotomes ≥ 1mm from tooth
58
Q

Guided Implant Surgery: General Info

A
  • Developed in Mid 1990s
  • CBCT allowed:
    • volumetric jaw bone imaging
      • low cost and radiation
    • Large amount of info pre-op
      • available bone volume and quality
      • location of anatomy and pathology
  • Completely planned pre-op
59
Q

Guided Implant Surgery: Workflow

A

Exam→Planning→Execution

60
Q

Guided Implant Surgery: Examination & Limits

A
  • requires CBCT
  • used with flap and flapless approach
    • No Flap=No Graft
  • Edentulous vs partially edentulous patients
    • Edentulous:
      • 1 Scan System:
        • create radiopaque resin replica of pts prosthesis
      • 2 Scan System: (Dual scan w/Fiducial Markers)
        • 1st-with prosthesis markers & Bite registration
        • 2nd- with prosthesis markers
    • Partial Edentulous:
      • Virtual Computerized Prosthetic Wax-up
      • Scan analogue or cast
      • data superimposed on CBCT
  • Limits:
    • Prosthetic Thickness for correct segmentation
    • artifacts
      • Motion-during CBCT
      • Metal
    • Correct tooth setup
    • Incorrect
      • fiducial markers (Double-scan)
      • Matching of scan and CBCT
61
Q

Implant Placement: Pitfalls

A
  • Patient movement while drilling
  • Limited surgery time due to LA
  • restricted visual field
  • mental transfer of 2D x-ray to 3D
  • Esthetics
  • Biomechanics
  • Functional Constraints of prosthesis
62
Q

Guided Implant Surgery Involves:

A
  • CBCT
  • extraoral and intraoral scanners
  • rapid prototyping and 3D printing
  • Guided Surgery
63
Q

Guided Implant Surgery: Planning & Limits

A
  • 3rd party software
    • plan implant placement and fixation pins/screws
  • Digital info→ produce stent with analogue method or CAM rapid prototyping (Milling or 3D printing)
  • Limits:
    • not enough inter arch space
    • Unavailable Drill lengths (Drills to long)
    • Thin guide material→ Break
    • Printing Angulation Error (0.25-1.5°)
64
Q

Guided Implant Surgery: Execution & Limits

A
  • Try guide in mouth before surgery
    • bite index, mini-screws, fixation pins and temp implants can be used
  • punch technique-Flapless approach
    • Drill Keys-Drills w/physical or visual stop
  • Accuracy:
  • Limits:
    • Rotated guide→Inaccurate implant position
      • Fix with bite index
      • check Occlusal of guide
    • Local anesthesia changes mucosa
    • Depth (Most significant error)
      • Debris within osteotomy
      • Deformed Guide
      • Low gray values
65
Q

Accuracy

A
  • difference b/w the:
    • planned (what you want) and
    • inserted (what you actually got) implant placement
  • 4 parameters (Deviation of the __) (Van Ash/Tahm)
    • entry point (0.99/0.9 mm)
    • Apex (1.24/1.39 mm)
    • Long Axis (3.81 /3.5°)
    • Depth
  • Guide vs no guide:
    • Significant Deviation
  • Guides: Tooth supported> Mucosa supported> Bone supported
66
Q

What are the main steps to plan a guided surgery?

A
  • CBCT
  • extra/intraoral scanners
  • 3D printing
67
Q

What are the indications of guided surgery?

A
  • Limited Mouth Opening
  • No flap needed
  • Have Time to plan
  • Whenever you can do it
68
Q

What are the limitations of guided surgery?

A
  • Correct and accurate images
  • Insufficient arch space
  • cumulative deviation
  • mucosal changes
  • deviation of depth
  • breaking of guide
69
Q

Peri-Implant Health

A
  • No Inflammation
  • No BOP
  • No Suppuration
  • No ⇡ PDs
  • No Bone Loss
    • only bone remodeling
70
Q

Peri-Implant Mucositis

A
  • BOP
  • Suppuration-maybe
  • No PD Change
    • with or without
  • No Bone Loss
71
Q

Peri-Implant Implantitis

A
  • BOP
  • Suppuration-maybe
  • ⇡ PD
  • Bone Loss
  • if no previous exam data:
    • BOP
    • Suppuration (maybe)
    • PD ≥ 6mm
    • Bone Level ≥ 3mm apical to most coronal intraosseous part of implant
72
Q

Peri-Implant Hard and Soft Tissue Deficiences

A
  • Hard Tissue
    • Before Implant Placement
      • Systemic Diseases
      • Tooth Loss
      • Trauma
      • Trauma from Tooth Extraction
      • Periodontitis
      • Endo Infection
      • Longitudinal Root Fractures
      • Posterior Maxilla Bone Height
    • After Implant Placement
      • Systemic Diseases
      • Healthy Defects
      • Implant Malposition
      • Peri-implantitis
      • Mechanical Overload
      • Soft Tissue Thickness
  • Soft Tissue:
    • Before Implant placement:
      • Systemic Diseases
      • Tooth Loss
      • Periodontal Disease
    • After:
      • No Buccal Bone
      • Papilla Height
      • Keratinized Tissue
      • Tooth Migration
      • Life-Long Skeletal Changes
73
Q

Peri-implantitis vs Peri-mucositis: Etiology & Tx

A
  • Mucositis:
    • Etiology: Xs Cement (86%)
    • remove XS and GBR
  • Implantitis:
    • Etiology: Plaque
    • mechanical debridement
      • resolves in 3 weeks
74
Q

Clinical Differences b/w healthy periodontal and peri-implant tissues

A
  • No visual differences
  • PD:
    • Implant > Tooth
  • Interproximal Papilla:
    • Implant=Shorter
75
Q

What does a peri-implant exam consist of?

A
  • Inflammation:
    • visual
    • probing
      • BOP
      • PD
      • Mucosal Margin migration
    • Palpation
76
Q

Ailing Implant vs Failing Implant vs Failed Implant

A
  • Ailing:
    • No Mobility
    • No Inflammation
    • Radiographic Bone Loss
  • Failing Implant:
    • No Mobility
    • Inflammation
    • Progressive Bone Loss
  • Failed:
    • Mobile
    • Non-functional
    • Need to remove
77
Q

CIST

A
  • Cumulative Interceptive Supportive Therapy
  • Based one periodic diagnosis
  • 4 Treatment Modalities:
    • A= Mechanical
    • B= Antiseptic Treatment
    • C: Antibiotic Tx
    • D: Regeneratie or resectie surgery
78
Q

Peri-implant disease: Risk Factors

A
  • Poor Plaque Control
  • No Maintenace
  • Smoking/Diabetes
  • History of Perio
79
Q

What should you do after finishing implant supported prosthesis?

A
  • Baseline:
    • radiographs
    • PD
  • Radiographs after loading period
    • Bone Level Reference after remodeling
80
Q

Patient Plaque Control around Implant

A
  • Methods:
    • Floss
    • Sulcular Bass Brushing Technique
      • Cleans under mucosa
      • caution with Narrow WKG
    • After osseointegration:
      • Interdental Brush
      • Rubber Tip
81
Q

Professional Plaque Control around Implant

A
  • Perio Maintenance:
    • 3-4 months if tooth loss due to caries or perio
  • Minimal Damage to transmucosal surfaces when removing plaque and calc
    • ex: Polished titanium implant collar
  • Gold or ceramic surfaces
    • use most scalers and curettes w/no damage
    • ex: Plastic, gold coated, stainless steel
  • Metal Probe
    • no concern→Minimal surface alteration
    • Plastic Probe=Effective
  • Rubber Cup & Polishing Paste
    • remove biofilm
    • machined and polished surfaces
  • Ultrasonic Instruments w/metal tips
    • Magnetostrictive or Pizoelectric
      • ex: Cavitron
    • Caution→Surface irregularities
      • use special tip
  • Friendly Materials for Abutment:
    • Teflon
    • Titanium
    • Gold
    • Plastic Tips
82
Q

What to evaluate for Implant Prosthesis: At Delivery vs F/u Visits

A
  • Delivery:
    • Radiograph=Baseline
    • Complete seating
      • Implant Abutment Interface
    • Cement retained
      • No XS cement
  • F/u Visits
    • loose screws or fractures
      • Replace:
        • Loose screws & toque down
        • worn out retentive parts
          • Hader Clips
          • Locator attachment inserts
    • Occlusal guards
83
Q

What are the main peri-implant diseases?

A
  • Health
  • Mucositis
  • Implantitis
  • Hard & Soft Tissue Defiicencies
84
Q

What are the main treatment modalities for peri-implantitis?

A
  • Mechanical Debridement
  • Antiseptic Tx
  • ANtibiotic Tx
  • Regenerative or Resective Sx
85
Q

Why does excess cement cause peri-implantitis?

A
  • Allows bacterize to colonize→ ⇡Inflammation around implant
86
Q

Types of Implant Complications?

A
  • Biologic
  • Esthetic
  • Mechanical
87
Q

Biologic Implant Complications

A
  • Mucosal Inflammation
  • Mucosal Hyperplasia
  • Mobility
  • BOP
  • Suppuration
  • ⇡ PD
  • BL
  • Thread Exposure
  • Peri-implant diseases
  • Pain
88
Q

Esthetic Implant Complications

A
  • Poor positioning
  • Poor Restoration
  • Poor Appearance
    • inadequate tx planning
  • Recession
  • Hard & Soft Tissue Deficiency
89
Q

Mechanical Implant Complication

A
  • Screw Loose
  • Screw Frature
  • Meshwork Fracture
  • Ceramic Fracture
  • Implant Fracture
90
Q

Prosthetic Design

A
  • Proper Assessment
    • crucial for dx and tx plan
    • proper emergence profile
  • Innaccurate assessment
    • Prosthesis Misfit
      • Passive Misfit ⇡Burden on Bone
      • Bacteria Colonize space b/w prosthesis
    • Biocompatabilty
      • Zirconia > Metal
91
Q

Excess Cement

A
  • Peri-implantitis (81%)
    • Increase:
      • Plaque
      • Bleeding index
      • Suppuration
      • Fistula
  • Radiographs can’t detect
  • Cement Types→ proliferation of bacterial strains
  • Impossible to remove all excess when abutment margin≥ 1 mm subg
92
Q

Types of Cement

A
  • Methacrylate
    • Bacterial Colonization
  • Zinc Oxide Non-Eugenol
    • Less host response in vitro
93
Q

What are some techniques to minimize excess cement?

A
  • Teflon Tape
  • Venting
  • Dual Cord
  • Dummy abutment
94
Q

Cemented retained vs Screw Retained Complications

A
  • Cemented Retained
    • BIologic complications
      • plaque control to prevent
  • Screw Retained
    • Technique Complication
    • preferred due to:
      • retrievability
      • High Biologic compatibility
95
Q

What are some crucial factors for cement retained restorations?

A
  • Implant position
  • Abutment selection
  • Retention Design
  • Margin Position
96
Q

Fracture and Loosening?

A
  • Facilitate Peri-implant disease
    • bacteria colonize spaces
97
Q

Lack of Keratinized Mucosa

A
  • Increase:
    • Plaque accumulation
    • inflammation
    • recession
    • attachment loss
  • Increase Keratinized Tissue w/Tissue Graft
    • Reduce Gingival Complications:
      • physical compression
      • contact w/ restorative material
      • Biofilm
98
Q

Open Contacts

A
  • Proximal Contact tightness Decreases overtime
    • replace restoration
    • Modify restoration
    • restore adjacent tooth
  • associated w/peri-implantitis
99
Q

Retrograde implantitis

A
  • Previous RCT on Adjacent teeth
    • not curetted well after extraction
100
Q

Maxillary Sinus Augmentation: History

A
  • Boyne & James: 1980
    • first published technique
  • Tatum: 1986
    • crestal approach
  • Summers: 1994
    • Osteotome technique
  • Sinus Consensus: 1996
    • predictable & effective
101
Q

Alternatives to Sinus Augmentation

A
  • RPD
  • Fixed Bridges
  • Cantilevers
  • Implants:
    • Short
    • Zygomatic
    • Tilted
102
Q

Maxillary Sinus Anatomy:

A
  • Shape:
    • Pyramidal
  • Membrane:
    • Lined by Pseudostratified columnar epithelium
        • periosteum→ Schneiderin Membrane (0.3-0.8m)
  • Size: 12-15 mL
  • Dimensions:
    • Length: 38-45 mm
    • Height: 26-45 mm
    • Width: 25-35 mm
  • Septa:
    • Normally In premolar Area
  • Ostium
    • 40 mm from floor
  • 6 walls:
    • Anterior
    • Posterior
    • Superior
    • Inferior
    • Medial
    • Lateral
103
Q

Maxillary Sinus Function

A
  • Warm Air
  • Lighten Head
  • Voice Resonance
  • Dissipate Heat
104
Q

Sinus Anatomy Classification

A

Height from alveolar crest

  • SA-1
    • > 12 mm
  • SA-2
    • 10-12 mm
  • SA-3
    • 5-10 mm
  • SA-4
    • <5 mm
105
Q

Sinus Augmentation: Indications vs Contraindications

A
  • Indications:
    • Posterior Maxilla Lacks vertical dimension
      • alveolar ridge resorption
      • sinus pneumatization
  • Contraindications:
    • Relative:
      • Treatable sinus pathology
      • Smoking
    • Absolute:
      • Treated Sinus pathology that left irreversible dysfxn
106
Q

Pre-Op Sinus Evaluation

A
  • Medical Contra-indication
  • CBCT Scan
  • ENT Consult
    • sinus problems
    • Destructive sinus surgery
  • Delay Sinus Surgery due to:
    • nasal congestion
    • sinusitis
    • Respiratory Tract Infection
  • Sinus pathology 30%
    • Thickend mucosa (65%)
107
Q

Pre-Op Sinus Medicines

A
  • Antibiotics:
    • Amoxicillin
    • Clindamycin
    • Can be mixed in graft
      • 1:4 (Antibiotic:Graft)
  • Decongestants
    • maintain patent ostium
    • Oxymetazoline (Afrin)
    • Pseudoephedrine
  • Anti-inflammatory
    • Decreased edema & post-op pain
    • Medrol dose pack
    • Ibuprofen 800 mg
  • Analgesics
    • Hydrocodone w/acetaminophen (Vicoden)
    • Codeine w/Acetaminophen (Tylenol #3)
108
Q

Surgical Technique

A
  • Osteotome (transcrestal)
    • SA-2 and SA-3
  • Lateral Approach (Window)
    • SA-3 and SA-4
109
Q

Osteotome Technique

A
  • Aka Transcrestal
  • SA-2 and SA-3
  • Instrument: OSteotomes
    • Curved tip
      • straight or angled
  • Implant Survival Rate:
    • Bone Height:
      • ≥ 5mm = 96%
      • < 4 mm = 86%
  • Advantages:
    • less
      • invasive
      • painful
      • risk of infection
  • Disadvantages:
    • Blind
    • perforation
    • Lack Control
110
Q

Osteotome Technique: Advantages vs Disadvantages

A
  • Advantages:
    • Less
      • Invasive
      • risk of infeciton
      • painful
      • overhead
  • Disadvantages:
    • Lack control
    • Blind
    • Membrane perforation
111
Q

Osteotome Technique: Research studies

A
  • Implant Survival Rate:
    • Bone Height ≥ 5mm → 96%
    • Bone Height < 4 mm → 86%
112
Q

Lateral Approach

A
  • Aka Window
  • S3-S4
  • More invasive
  • direct vision of sinus
  • Instruments:
    • Pizoelectric surgery
    • Sinus Elevators
    • Kerrison Rongeur
113
Q

Osteotome vs Lateral Approach:

Bone Height Gain

Success Rate

A
  • Osteotome:
    • Bone Height Gain: 3.5 mm
    • Success Rate: 95%
  • Lateral Approach:
    • Bone Height Gain: 12.7 mm
    • Success Rate: 100%
114
Q

Pizoelectric Sinus Elevation

A
  • Reduced perforation risk
  • Ultrasonic Vibrations
  • Hydropneumatic pressure
115
Q

Sinus Augmentation: Risks and Complications

During Surgery

Early Post Op

Late Post op

A
  • During Surgery:
    • Sinus mucosa perforation
      • Schneiderin Membrane perforation (most common)
    • Fracture ridge
    • Obstruct Ostium
    • Inadequate Fill
    • Bleeding
    • Damage teeth
  • Early Post-op
    • Wound Dehiscence
    • Acute Sinusitis
    • Exposed membrane
    • Lose implant or graft
  • Late Post-op
    • insufficient quality or quantity of bone forming in sinus graft
    • oro-antral fistula
    • Chronic bone pain
      • remove implant
    • Chronic Sinus Disease
116
Q

Sinus Perforation

A
  • Incidence: 10-30%
    • Pizo reduces to 7%
  • Causes:
    • Tear membrane during prep
    • Fracture window
    • Elevate membrane
    • Septa or pathologic conditions
    • Very thin membrane
  • Increase risk of infection
    • delay implant placement
  • contaminated mucosa in graft
117
Q

What nerves innervate the maxillary sinus

A
  • Superior Alveolar N
  • Infraorbital N.
118
Q

What Blood Vessels Innervate the maxillary sinus?

A
  • Posterior Superior Alveolar A.
  • Infraorbital A.
  • Posterior Lateral Nasal A.
119
Q

Amoxicillin

A
  • Pre-op med
  • 1g 1hr before surgery
  • 500 mg qid 5-7 days
120
Q

Clindamycin

A
  • Pre-op Med
  • 300 mg 1 hr before surgery
  • 150 mg tid 5-7 days
121
Q

Oxymetazoline

A
  • aka Afrin
  • Decongestant
  • 1 hour before surgery until
    • 2 days after surgery
122
Q

Pseudoephedrine

A
  • decongestant
  • 1 tablet tid on day of surgery
  • 2 days after surgery if perforation
123
Q

Ibuprofen

A
  • Anti-inflammatory
  • 800 mg
  • 1 tablet tid 7 days after surgery
124
Q

What can cause a Sinus perforation

A
  • Tear membrane during prep
  • Fracture window
  • Elevate membrane
  • Septa or pathologic conditions
  • Very thin membrane

Implantology (15 decks)

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