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ABOMS > Implantology > Flashcards

Implantology Flashcards

1
Q

What allows for integration of an implant?

A

An oxide layer is formed on the surface of the implant that is protective and allows for osseointegration.

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2
Q

Increasing the diameter of an implant has 4 beneficial effects

A

-Minimizes inter proximal space and potential food impaction and improves oral hygiene
2-Minimizes component fracture
3-Reduces incidence of screw loosening
4-Improves emergence profile of crown

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3
Q

What is more important for an implant, width or length?

A

Width

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4
Q

Why are rough implants good?

Disadvantage

A

Rough implants increase surface area and bone-implant contact
-This leads to faster and strong osseointegration compared to machinee surface.

-Plaque retention, and peri0implantitis

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5
Q

External hex design problems?

A

1-Traditional design with butt-joint connection
2-Abutment screw loosening is probelmeatic

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6
Q

Internal hex design?

A

incorporates an antirational feature (hexagon, tripod, morse taper, internal grooves)

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7
Q

What is platform switching

2 points

A

-Use of a narrower restorative abutments on a wider implant body
-Shown to decrease crestal bone resorption by preventing migration of epithelium past the implant-abutment interface, enhancing the connective tissue-osseous attachment in the crestal area.

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8
Q

Why are tapered walls of implants important?

A

1-Allows compression of bone in poor-quality sites and distributes forces into surrounding bone.
2-Facilitates placement into anatomically constricted sites (buccal concavities, adjacent teeth)

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9
Q

Parallel wall versus tapered wall implants?

A

-In sites with poor bone quality, under preparation with tapered implant can achieve greater primary stability compared to that with parallel wall implant.

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10
Q

Pitch of an implant

Benefit?

A

Distance between adjacent threads

More threads, greater surface area per implant.

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11
Q

What kind of threads are better for soft bone?

A

1-Deeper threads because it increases surface area

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12
Q

What type of threads allows or easier placement of an implant in hard bone

A

Shallow threads

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13
Q

Name 4 risk factors associated with implant failure

A

1-Periodontal Disease
2-Smoking
3-Prior radiation treatment
4-Diabetes

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14
Q

Can pts with parafunctional habits have implants?

A

Yes, however additional implants are needed to reduce overload, or a night guard is necessary.

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15
Q

What is the vertical space required for a fixed restoration?

A

Cement retained (8 mm minimum)
Screw retained (6 mm minimum)

1 mm occlusal metal restoration (2 mm for porcelain)
5 mm abutment for cement restoration (1 mm sub gingival margin= total 6 mm)
2 mm soft tissue attachment

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16
Q

Ideal vertical space for implants

A

9-10 mm in posterior
10-12 mm in anterior

If >12 mm, teeth will be elongated and may required addition of pink tones in aesthetic areas.

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17
Q

Implants should be placed how far from adjacent tooth and adjacent implant.

A

1.5 mm from adjacent tooth to prevent bone loss
3.0 mm from adjacent implant to prevent bone loss

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18
Q

Minimum amount of buccal/lingual bone

A

1 mm

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19
Q

How many mm apical to gingival margin for appropriate emergence profile of crown?

A

3 mm

In a healthy periodontium the facial margin of the alveolar crest lies approximately 2 mm apical to the gingival margin, which courses near to the cementoenamel …

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20
Q

How many mm palatal to buccal walls in esthetic zone for appropriate crown emergence and to prevent buccal bone loss should an implant be placed

A

2 mm

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21
Q

How many mm above the IAN should an implant be placed

A

2 mm

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22
Q

How many mm anterior to mental Forman to avoid anterior loop of the mental nerve should an implant be placed

A

5 mm

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23
Q

Type I bone

A

Predominant cortical bone (anterior Mandible)
-overheating potential
-tapping of bone recommended to facilitate implant placement

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24
Q

Type II bone

A

Thick cortical bone and dense cancellous bone (mandible, anterior maxilla)

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25
Q

Type III bone

A

Thin cortical bone and dense cancellous bone (maxilla)

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26
Q

Type IV bone

A

-Predominantly cancellous bone (posterior maxilla)
-poor bone quality leads to lower success
-Consider osteotome technique to compress denser bone laterally next to implant
-Consider under preparation of site

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27
Q

What is the best bone for implant placement?

A

Type II-Thick cortical bone and dense cancellous bone (mandible and Ant maxilla)

-and-

Type III-Thin cortical bone and dense cancellous bone (maxilla)

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28
Q

Why is thick gingival biotype important

A

Probe is not visible

-Greater soft tissue stablity
-More predictable healing
-Less gingival discoloration from titanium show,
-Less gingival recession

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29
Q

Osseointegration

A

Direct structural and functional connection between bone and the surface of an implant that can survive normal loading conditions

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30
Q

What is the osseointegration window for implants

A

3 months in mandible and 6 months in maxilla but this has improved overtime.

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31
Q

T/F: mechanical stability is high after surgery and declines after time

A

True

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32
Q

What is the weakest time for implant placement

A

2-4 weeks

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33
Q

Osteoconduction

A

Recruitment of osteogenic cells to the implant surface via a matrix

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34
Q

Contact osteogenesis:

A

De novo bone formation on the implant surface

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35
Q

Distance osteogenesis:

A

New bone formation on the walls of the osteotomy site toward the implant surface.

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36
Q

Implant success:

A

Absence of implant mobility, per-implant radiolucency, and symptoms (pain, infection, numbness); crystal bone loss <0.2 mm per year following the first year of function

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37
Q

Speeds must be less than what to prevent overheating of bone

A

2000 rpm

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38
Q

Thermal necrosis occurs at what temp for implants

A

47 degrees Celsius
116.6 degrees F

39
Q

How much keratinized tissue should be left behind and why

A

2 mm

-Prevents functional stresses, improves hygiene, and avoids complications of mobile tissue including chronic inflammation, irritations and peri-implantitis

40
Q

What is required to place an immediate implant with a provisional prsthesis

A

primary implant stability with torque of >35 Ncm

41
Q

What are immediate implants place?

A

Develops and maintains soft tissue architecture in esthetic zone

42
Q

What is a Fixed PRM bridge and where are implants placed.

A

Fixed porcelain fused to metal bridge which requires 6-8 implants

Primary site-1st molar ( 2 implants_
Seoncdary site -Canine - (2 implants)
Tertiary site - Lateral incisors or 2nd premolar (2-4 implants.

43
Q

What is a hybrid prosthesis?

A

A fixed-detachable prosthesis, profile prosthesis

44
Q

What is the vertical space required for a fixed prosthesis?

A

15 mm from soft tissue to planned occlusal plane, more space allows for thickening of prosthesis, more strength.

2 mm: space under bar for hygiene
8 mm: cast framework
2 mm: acrylic
3 mm: teeth

45
Q

AP spread

A

distance between anterior and posterior implants measured from midline of arch and number of implants

46
Q

What is the measurement to of AP spread to prevent cantiliver

A

Less than 1.5 times the AP spread

Spread them apart to achieve first molar resotration

47
Q

Which of the following has the least AP spread?

A

Square-shaped arches, least AP spread

V-shaped arches, most AP spread

48
Q

Treatment plans regarding Rescue’s 1,2,3 bone concept

A
49
Q

How far apart should over denture implants be?

A

At least 20 mm

50
Q

What is the highest implant failure associated with

A

Maxillary overdenture of 4 implants connected with a bar due to higher loads

51
Q

What are the vertical height requirements for an overdenture

A

minimum of 12 mm from soft tissue
-1 mm for below bar for hygiene
-3 mm for bar and Hader clip (or 5 mm for bar and O ring)
-8 mm for tooth

52
Q

Combination syndrome

A

Atrophy of the edentulous anterior maxilla that develops in patients with a partially edentulous mandible and preserved anterior mandibular teeth. Treatmetn includes placing implants in the posterior maxilla to distribute forces to posterior occlusion nd off the anterior maxilla

53
Q

All on 4 principles

A

-Maximize angled spread, most anterior and posterior implants hold all the load

-Angle to avoid vital structures like the sinus and the mental nerve.

54
Q

When is an all on 6 used? (3 pts)

A

1-Large arch form
2-larger ridge discrepancies
3-higher potential failure (maxilla, smoking, diabetes, periodontal disease, bruxism)

55
Q

Zygomatic implants are used with what kind of prosthesis

A

A hybrid prosthesis.-fixed detachable prosthesis

56
Q

How much apical bone is required for primary stabilization?

A

2 to 3 mm of apical bone is required for primary stabilization

57
Q

Are single implants in immediate restorations left in or out of occlusion

A

Left in infraocclusion

58
Q

Primary stability of ____ NcM is mandatory for immediate implants.

A

30-35 Ncm

59
Q

Allografts or autografts have greater shrinkage rate?

A

Allografts have greater shrinkage rate

60
Q

Subepithelial connective tissue graft can thicken the gingiva by how much?

A

Can thicken gingival tussle by 3 mm in order to prevent recession and subsequent metal show.

61
Q

Osteoinduction:

A

Growth factos stimulate mesenchymal cells to differentiate into osteoblastic lineages

62
Q

Osteoconduction

A

Bone graft acts as a matrix for bone growht

63
Q

Osteogenesis:

A

Transplated osteoblasts and periosteum produced now bone

64
Q

Autogenous bone

A

-Gold standard
-Osteogenic, osteoinductive, and Osteoconductive

65
Q

Sites for autogenous bone:

A

Corticocancellous: Tibia, iliac crest
Cortical: Cranium, mandibular ramus, mandibular symphysis

66
Q

Allograft:

Contains what property?

A

Human bone graft
Osteoconductive-bone graft acts as a matrix for bone growth

67
Q

Xenograft or allograft-which resorbs slower?

A

Xenograft

68
Q

What quality does rhBMP have?

A

Osteoinductive, member of TGF (transforming growth factor) superfamily

-Aloows 4-6 months of bone healing before implant placement.

69
Q

Ridge Augmentation options-Think of 5

A

1-Onlay
2-Ridge split
3-Mesh
4-Sandwich osteotomy
5-Distraction osteogenesis

70
Q

How can you augment the vertical height of the alveolar crest (2 methods)

A

1-Mesh
2-Sandwich osteotomy

71
Q

How can you augment the width of the alveolar crest? (5 methods)

A

1-Only
2-Ridge split
3-Mesh
4-Sandwich ostetomy
5-Distraction osteogenesis

72
Q

What is an only graft

A

Fixation of cortical graft with screws; potential for resorption

73
Q

What is a ridge split require?

A

at least 3 mm of ridge required.

74
Q

How is a sandwich graft performed?

A

Interpositonal graft with superior plating of superior segment

75
Q

What is the rate at which distraction can occur?

A

5-7 day latency perio
0.5 mm 2 x day ( 1mm day)
2-3 months: Consolidation

76
Q

Tooth extraction leads to bone loss in what dimension

A

Buccolingual (50%) in 6 months

77
Q

Socket healing process,, 4 steps to month two

A
78
Q

Bone remodeling:

A

Turnover of bone characterized by osteoblastic formation balanced with osteoclastic resorption.

79
Q

Extraction sockets that benefit from bone modeling

A

-Sockets with wall defects and thin buccal bone

80
Q

Guided bone regeneration

A

Placing a barrier membrane to prevent invasion of nonosteogenic cell populations from surrounding soft tissues.

81
Q

What is the average sinus cavity volume for adults?

A

14.75 mL (ranges between 9-20 mL)

82
Q

Thickness of sinus membrane

A

0.13 to 0.50 mm

83
Q

Where does the maxillary sinus drain?

A

By ciliated epithelium to an osmium in the middle meatus of the nose.

84
Q

How much bone is needed to simultaneously place an implant with a sinus graft

A

3-5 mm, and you need priamry stability

85
Q

What is the summer technique

A

Osteotome use to elevate the floor of the sinus, achieve elevation of < 2 mm

86
Q

Which approach for sinus grafts depending on availability of bone.

A
87
Q

Peri-implantits most often occurs in what kind of restorative solution

A

overdentures

88
Q

Normal bone loss of implants

A

-Less than 1.5 mm at year 1 and <0.2 mm per year thereafter

89
Q

Peri-mplantitis

A

-Mucosal inflammation with los of supporting bone

90
Q

Which bacteria are associated with peri-implantitis

A

Similar to periodontitis:
GN, anaerobic bacteria
-Aggregatibacter anctiomycetemcomitans
-Porphymonas gingivalis
-Prevotella intermedia

91
Q

What surgical aspects can cause an implant to fail.

A

-Overheating bone, poor primary stability, dehiscence of thin bone.

92
Q

How can you remove bacteria biofiom to improve per-implantits

A

-Saline, abrasive pumice, citric acid, Preidex, Hydrogen peroxide, tetracycline, lasers

93
Q

Can you bone graft a peri-implantitis site.

A

Yes, you can but it requires one to fill osseous defect and use guided bone regeneration.

94
Q

What are the 6 risk factors associated with implant failure.

A

ABOMS (9 decks)

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