Implant Intro Flashcards

Question

Smoking and Implant SUCCESS

Answer 1

• Analyzed 7 articles with implant success data for smokers (12 to 48 months) – Varying success criteria in articles • Overall success rate: SMOKERS 77.0% NONSMOKERS 91.0% Pooled estimate of difference in overall success rate was 11.3% better for nonsmokers (p=0.005). Statistically significant, and impressive clinical difference.

Answer 2

– Smoking decreases implant survival, but mainly at maxillary sites – Smoking decreases implant success in both maxillary and mandibular sites – Impact of smoking is lower with use of microroughened surfaces than for machined surfaces

Answer 3

– Implant survival lower when subjects had more than 30% of teeth with bone loss >4mm (i.e., history of periodontitis) even if disease was currently under control!

Answer 4

O.R. for peri‐implantitis was 4.7 in subjects with >4mm bone loss at >30% of teeth compared to <30% of teeth at time of implant placement • % of subjects who developed peri‐implantitis requiring surgery, and/or systemic or local antibiotics: – Periodontally healthy = 10.7% – Hx of treated moderate periodontitis = 27.0% – Hx of treated severe periodontitis = 47.2%

Answer 5

Implant survival rates are slightly lower in patients with past hx of periodontitis, but survival rates are generally >90% with microroughened surfaces

Answer 6

– Periodontally healthy = 4.2mm – Hx of treated moderate periodontitis = 5.1mm – Hx of treated severe periodontitis = 5.5mm • % of implants having 6mm PD at 1+ sites during maint: – Periodontally healthy = 6.6% – Hx of treated moderate periodontitis = 29.5% – Hx of treated severe periodontitis = 45.6%

Answer 7

``` – to cover implant site – to ensure esthetic result – to allow long‐term maintenance of health ```

Answer 8

Prior or at implant placement

Answer 9

``` – to allow for implant placement – to ensure implant stability – to allow long‐term maintenance of health ```

Answer 10

Where it needs to be restoratively not where tissues are adequate. If tissues can't be augmented then implant shouldn't be used

Answer 11

``` – palpation – bone sounding – radiographs • Incisions should always be placed over bone • Implant must be placed in bone or bone must be augmented Anatomical Considerations • Where is the bone?? – palpation •Least accurate technique •Can determine gross bony contours •Often overestimates/underestimates amount of bone truly present ```

Answer 12

``` •Least accurate technique •Can determine gross bony contours •Often overestimates/underestimates amount of bone truly present The time to find out how much bone you have is not the day of surgery ```

Answer 13

``` • patient is anesthetized and probe is placed through soft tissue to bone • bone can be “mapped” and transferred to cast • Better to use template that covers entire F&L ```

Answer 14

•Very useful •Can still under/overestimate actual bone •Can choose between many types of radiographs (2‐D and 3‐D) – variations in magnification and image distortion can be critical •3‐D imaging is a huge plus for many patients; not as important for others

Answer 15

``` • Periapical 7% • Panographic 22‐28% • Cross‐sectional view  Linear tomography 10%  Computed tomography 0% ```

Answer 16

```  Nasal floor  Maxillary sinus  Incisive canal  Mental foramen  Mandibular canal ```

Answer 17

Know where bone is before first incision is made

Answer 18

``` Severe resorption can affect ability to place implants and patient’s ability to maintain implants – Implant may violate mandibular canal, maxillary sinus, bony concavity – Implant may not be positioned at same angles as the natural tooth • As ridge resorbs, implant placement may violate confines of mandible or maxilla ```

Answer 19

Historically 10 mm -Meta‐analyses show that with rough surface implants, survival rates are same for implants <10mm as for implants >10mm

Answer 20

Coronal Aspects

Answer 21

Poorest-max posterior | Best - Man Ant

Answer 22

>7-8mm total with 2 mm buccal and 1.5 mm L

Answer 23

3.4 mm to maintain gingival height | 2-3mm from CEJs of adjacent teeth

Answer 24

recent studies show that implants having narrower abutment connection (“platform switch) can be placed closer together than 3mm and not lose inter‐implant bone (some as close as 1.5‐2.0mm) – Keep in mind heat generation and bone trauma during osteotomy preparation on implants placed close together – Keep in mind emergence profile of final restorations for implants placed close together

Answer 25

• The manner in which the restoration emerges through the soft tissue from its base at the implant interface

Answer 26

– Earlier studies suggested that implant survival & success rates decreased in posterior areas of lesser bone quality •This was primarily true with machined Ti surfaces -roughened surfaces may not be as restricted

Answer 27

– Nasal cavity – Maxillary sinus – Nasopalatine canal/foramen; greater/lesser palatine foramina

Answer 28

– Mandibular canal; mental foramen – Lingual concavities/fossae (e.g., submandibular salivary gland fossa, inferior to mylohyoid ridge) • Perforation of lingual periosteum may have major negative effects (bleeding, nerve trauma)

Answer 29

– Lined by Schneiderian membrane – Pneumatization after early tooth loss

Answer 30

``` • Can limit elevation of lateral window during sinus elevation • Increase risk of membrane tear • 13/41 (32%) maxillae with >1 septum • 2/41 (5%) with 2 septa • 73% in premolar region • 20% in first molar region ```

Answer 31

``` • Nasopalatine nerve • Sphenopalatine artery – Remove contents – Bone graft – Only 4% would be in the way of an implant ```

Answer 32

``` • 88% of 22 skulls • 76% bilateral • Length ranged from 1-11mm with mean 4.13 ± 2.04mm ```

Answer 33

``` • Sublingual artery • Submental artery • Incisive artery • Median lingual foramen found 85- 99% • Inferior midline foramen found 76% ```

Answer 34

``` – Tongue, floor of mouth, lingual mucosa & gingiva – Can be damaged by lingual perforation of blades (uncommon because it is usually deep in floor of mouth & tongue) ```

Answer 35

``` – Palpable at anterior border of masseter m. – Can be damaged by deep facial releasing incisions and by lingual drill perforations in posterior mandible ```

Answer 36

``` – Gives off the inferior alveolar a. (can be damaged by invasion of mandibular canal) – Gives off palatine arteries (can be damaged by improper palatal incisions) – Gives off posterior superior a. (can be damaged by posterior superior releasing incisions) and sinus window preparation ```

Answer 37

``` – can be damaged by improper palatal incisions (usually releasing incisions made too far posteriorly or carried too far superiorly) – can be damaged by incisions for deep split thickness flaps or connective tissue grafts ```

Answer 38

``` – Terminal branches of major vessels – Critical for flap integrity & nourishment – Come from apical region to marginal and papillary gingiva – Can easily be damaged by incisions near base of flaps ```

Answer 39

branches of trigeminal nerve (V) – ophthalmic division (V1) – maxillary division (V2) – mandibular division (V3)

Answer 40

* Provide profound anesthesia * Aseptic technique * Antibiotics * Atraumatic tissue management

Answer 41

• Increased concentration (e.g., 1:50,000) causes greater local vasoconstriction but does not increase duration of action • May increase risk of flap necrosis

Answer 42

For mandibular implants, consider not using inferior alveolar nerve block anesthesia (infiltration only on facial, with block only of lingual nerve) – decreases risk of accidental invasion of mandibular canal – patient will “let you know” if you are getting close to mandibular canal – use of conscious sedation can be an aid in these cases – Digital radiography is BIG plus

Answer 43

• Pretreatment antimicrobial rinse (e.g., Listerine, CHX) • Sterile instrumentation • Sterile gloves • Do not contaminate implant surface • Use sterile irrigating solutions – Required by current CDC guidelines for any surgical procedure in which bone is exposed (meaning, implant surgery) – Irrigate, irrigate, irrigate (during surgery, implant placement; thorough irrigation under flaps before closure)

Answer 44

• For dental implant surgery, default answer has been “YES” – Based on original Branemark protocol – Very little data to show benefit of antibiotics for implant success/failure

Answer 45

to prevent one patient from having an implant failure, 33 patients would have to receive pre‐op antibiotics – **2013 update: NNT = 25***

Answer 46

• Sharp, smooth incisions (“an incision heals better than a tear”) • Careful flap reflection and retraction • Avoid flap tension – Watch your assistant!! – Excessive tension on a flap can cause a tear – Excessive pressure during retraction can cause vascular embarrassment to flap or pressure damage to nerves

Answer 47

* Flap design * Incisions and flap reflection * Implant placement * Hemostasis/suturing

Answer 48

– Envelope flap – Triangular flap – Pedicle flap

Answer 49

``` – Requires no releasing incisions – The longer the flap, the less tension is placed on the flap during retraction ```

Answer 50

``` – Requires single vertical releasing incision – Vertical releasing incision creates greater access to underlying bone, tooth, implant; less tension on flap than with envelope flap – Can be used to avoid placing releasing incision in esthetic area or area of critical anatomy ```

Answer 51

``` – Generally requires two vertical releasing incisions – Biggest benefit is ability to displace flap margin upon closure (apically positioned, coronally positioned, laterally positioned, etc.) – Excellent access to underlying bone, tooth, implant -Flap height to base should not exceed 2:1 – Releasing incisions may be nearly parallel, slight divergent, or widely divergent ```

Answer 52

– Placement of releasing incisions is critical • Incisions should be over bone •Place releasing incisions at line angles of teeth or implants •Generally do not split papilla with releasing incision •Do not place releasing incisions over root or implant prominences

Answer 53

Includes periosteum

Answer 54

Periosteum remains attached to bone

Answer 55

``` part full part partial – Usually full thickness in coronal aspect, split thickness apical to mucogingival junction (periosteal releasing incision allows dramatic improvement in flap mobility) – common for procedures requiring coronal flap positioning ```

Answer 56

– Sulcular incision | – Inverse bevel (“reverse bevel” or “step‐back”) incision

Answer 57

– Crestal incision – Vestibular incision – Palatally/Facially displaced incision

Answer 58

``` – preserves all keratinized tissue – easy to perform – used if clinician is satisfied with the form of the existing marginal & papillary gingiva ```

Answer 59

``` – apically positions flap margin – degree of “step back” can vary depending on goal – can be used to change form of existing marginal & papillary tissue (e.g., can make more accentuated scallop) ```

Answer 60

``` – Incision displaced to facial or lingual/palatal, but not way out in vestibule – Supposedly prevented exposure of implant during healing (except it didn’t) • Palatally displaced incisions increased risk of flap necrosis ```

Answer 61

Similar with ALL incisions

Answer 62

Crestal incision with slight off‐set

Answer 63

may include or not

Answer 64

``` – Papillae remain in place – Good if clinician is happy with current interproximal tissue – May limit surgical access in narrow edentulous areas ```

Answer 65

``` – Better access in limited space – Risks “loss” of papillae – Often better approach if bone is to be modified under flap (e.g. GBR procedures) ```

Answer 66

– copious irrigation while drilling (do not overheat bone) – drilling osteotomy done at higher speeds (~800‐1500 rpm, depending on system) • Some systems use slower speeds for larger diameter drills – implant placement done at low speeds (~15‐50 rpm)

Answer 67

47C | USAF birth year

Answer 68

• Must have good hemostasis before patient release • Pressure, pressure, pressure • Hemostatic agents rarely indicated (but may be helpful with larger bleed) • Do not use anesthetic agents with high epinephrine concentrations (e.g., 1:50,000) as “hemostatic agents” – once the effect wears off, bleeding will resume

Answer 69

``` can lead to major bleeding – Hematoma in floor of mouth – Airway embarrassment or occlusion – Death ```

Answer 70

• Use smallest needle and suture you can for a given area (depending on expected flap tension, etc.) • Put sutures in keratinized tissue if you can (vs. alveolar mucosa) – Better resistance to flap tension – Less discomfort for patient; easier to remove • Take big bites of tissue; keep needle punctures away from flap margins • Minimum number of sutures to achieve closure • Relieve tension from flap margins

Answer 71

• Eliminate dead space between flap and bone – PRESSURE!! – prevent hematoma formation (hematoma = great culture medium for microorganisms)