Implant site prep

Question 1

How much hard tissue is needed

Answer 1

> 6mm

Question 2

Types of hard tissue augmentation

Answer 2

– Particulate grafts
– Block grafts
– Membrane tenting
– Sinus lift
• Tissue Engineering
– PDGF
– BMP-2

Question 3

Prereqs for bone formation

Answer 3

– adequate blood supply
– space for new bone
formation
– exclusion of competing
tissues

Question 4

Challenges to
obtaining predictable
bone growth:

Answer 4

– rapid soft tissue
formation
– lack of space for
bone in-growth

Question 5

Guided bone regeneration

Answer 5

• Procedures attempting
to regenerate lost
bone
– Protection of bone
regeneration against
overgrowth by rapidly
proliferating nonosteogenic
tissues

Question 6

Ideal membranes for GBR

Answer 6

• Biocompatible
• Occlusive
• Space-making
• Capable of tissue
integration
• Clinically manageable

Question 7

Barrier membranes for GBR

Answer 7

– nonresorbable (e-PTFE)

– resorbable (collagen, polymers)

Question 8

Space-making materials for gbr

Answer 8

– autogenous/allogeneic/xenogeneic bone grafts
– alloplasts (synthetic grafts)
– tenting pins
– titanium reinforced membranes

Question 9

Tenting and membrane

fixation pins:

Answer 9

– stainless steel
– titanium
– resorbable pins

Question 10

Indications for GBR

Answer 10

Inadequate bone volume
– unable to achieve primary implant stability
– bone defects large / extended
– implant cannot be placed in proper position
– esthetic demands
• Proximity to anatomic structures
– mandibular nerve
– maxillary sinus

Question 11

Surgical Procedures for GBR

Answer 11

1. Ridge Preservation
   (extraction sites)
2. Ridge Augmentation
3. Sinus Augmentation

Question 12

Results of ext

Answer 12

– Loss of bone more buccal than lingual
– Horizontal loss may be up to 4.4 mm
– Vertical loss may be up to 1.2 mm
– Greatest changes occurring with in first 6 months
– Soft tissue changes may challenge our esthetics

Question 13

Ridge Augmentation

Answer 13

– to develop new bone volume prior to implant
placement (staged therapy)
– to augment existing bone at time of implant
placement (simultaneous therapy)
– many principles similar to ridge preservation

Question 14

Ridge Augmentation

– How long do I wait before placing implant?

Answer 14

• Minimum waiting time unknown
• Depends on material used to augment (block vs.
particulate graft)
• Recommend at 4 to 6 months (longer for particulate
allograft/ xenograft)
– Some prefer shorter waiting times

Question 15

Autogenous Block Grafting

key points

Answer 15

– Need monocortical block only!
– Must have sufficient A-P dimension in symphysis
region
– Bi-cortical block may result in severe hemorrhage
• Bur can cut thru lingual periosteum into floor of mouth
• Can cause severe hematoma (airway obstruction)

Question 16

Piezosurgery

Answer 16

• Precision osteotomies; 24-30k Hz
• Safer in proximity to soft tissues
– Surgical action of tip ceases when in contact with soft tissue
– Membrane perforation – most common complication
• Conventional – 20-30%
• Piezo – 5% (Vercellotti, et al., 2005)
• Split ridge applications for implant placement

Question 17

Sinus Augmentation

Answer 17

– to develop new bone volume in the sinus prior to
implant placement (staged therapy)
– to augment existing bone in the sinus at time of
implant placement (simultaneous therapy)

Question 18

Commonly Used Growth Factors

Answer 18

Platelet-rich plasma (PRP)
Marx
Enamel matrix derivatives (EMD)
Emdogain®
Platelet-derived growth factor (PDGF)
Gem 21S®
Bone morphogenic protein-2 (BMP-2)
INFUSE®

Question 19

BMP

Answer 19

-In vitro studies have shown that BMP causes the chemotactic
migration of bone-forming cells to the site of local
concentration.
-exposure to BMP causes the cell specific
proliferation of undifferentiated human mesenchymal stem
cells.
-Comprehensive analysis of osteogenic activity of 14 types of
BMPs. BMP 2, 6, and 9 play an important role in inducing
osteoblast differentiation of mesenchymal stem cells

Question 20

How much bone at the max sinus floor to do osteotome v lateral windo

Answer 20

5-6mm for osteotome

other wise lat window.