Implants

Question 1

When treatment planning the zygomatic (Zygomaticus) implant, which of the following requirements must be met?
(A) Posterior wall of the maxillary sinus must be at least 4 mm thick
(B) Ability to place two anterior maxillary conventional implants
(C) Minimum of 10 mm of thickness of the body of the zygoma
(D) Minimum of 42 mm between the two zygomatic implants

Answer 1

B

Question 2

Which adjunctive implant surgical technique would optimally address a 15 mm vertical deficiency of bony and soft tissues in the anterior maxillary alveolus?
(A) Insertion of hydroxylapatite blocks using a tunneling technique
(B) Distraction osteogenesis
(C) Onlay bone grafting
(D) Subepithelial grafting

Answer 2

B

Question 3

Connective tissue grafts are less predictable if performed at the time of:
(A) extraction.
(B) cortico-cancellous grafting.
(C) implant placement.
(D) implant uncovering.

Answer 3

B

Question 4

When performing a ridge splitting technique to expand the edentulous ridge for insertion of an interpositional bone graft prior to implant placement, what is the preferred preoperative minimum ridge width?
(A) 1 mm
(B) 2 mm
(C) 3 mm
(D) 4 mm

Answer 4

C

Question 5

For a subantral osseous augmentation, non-resorbable HA can be added to autogenous bone in order to:
(A) add bulk to the graft.
(B) improve initial implant stability.
(C) decrease infection rate.
(D) improve osteogenesis.

Answer 5

A

Question 6

Following anterior tooth removal, how long does it take to get 3-4 mm of both buccal-lingual and apico-coronal ridge resorbtion?
(A) 1 month
(B) 3 months
(C) 6 months
(D) 1 year

Answer 6

C

Question 7

In harvesting subepithelial connective tissue grafts, the advantage of a dual incision is:
(A) graft thickness is defined by the second incision.
(B) it allows for primary closure.
(C) donor site pain is uncommon.
(D) a dressing is rarely needed at the donor site.

Answer 7

A

Question 8

Antibiotic therapy in dental implant surgery:
(A) eliminates postoperative infection.
(B) decreases incidence of early peri-implantitis.
(C) reduces integration time of implants.
(D) decreases the failure rate of implants.

Answer 8

D

Question 9

Which of the following is most important for implant health over time?
(A) Adequate volume of good quality soft tissue
(B) Osseointegration
(C) Adequate inter-occlusal space
(D) Adequate bone graft consolidation

Answer 9

B

Question 10

Osteogenesis occurs with which of the following grafting materials?
(A) Allogeneic bone grafts
(B) Xenograft bone grafts
(C) Alloplastic bone grafts
(D) Autogenous bone grafts

Answer 10

D

Question 11

When compared to subepithelial connective tissue grafts, free gingival grafts:
(A) result in less scarring.
(B) revascularize more rapidly.
(C) are less predictable for root coverage.
(D) provide superior color matching.

Answer 11

C

Question 12

The palatal roll technique for soft tissue augmentation around implants:
(A) is only useful with small gingival defects.
(B) can correct horizontal defects up to 5 mm.
(C) can be used to reconstruct the papilla.
(D) should be performed one month prior to uncovering an implant.

Answer 12

A

Question 13

Connective tissue grafts are less predictable if performed at the time of:
(A) extraction.
(B) cortico-cancellous grafting.
(C) implant placement.
(D) implant uncovering.

Answer 13

B

Question 14

When performing a ridge splitting technique to expand the edentulous ridge for insertion of an interpositional bone graft prior to implant placement, what is the preferred preoperative minimum ridge width?
(A) 1 mm
(B) 2 mm
(C) 3 mm
(D) 4 mm

Answer 14

C

Question 15

For a subantral osseous augmentation, non-resorbable HA can be added to autogenous bone in order to:
(A) add bulk to the graft.
(B) improve initial implant stability.
(C) decrease infection rate.
(D) improve osteogenesis.

Answer 15

A

Question 16

Following anterior tooth removal, how long does it take to get 3-4 mm of both buccal-lingual and apico-coronal ridge resorbtion?
(A) 1 month
(B) 3 months
(C) 6 months
(D) 1 year

Answer 16

C

Question 17

n harvesting subepithelial connective tissue grafts, the advantage of a dual incision is:
(A) graft thickness is defined by the second incision.
(B) it allows for primary closure.
(C) donor site pain is uncommon.
(D) a dressing is rarely needed at the donor site.

Answer 17

A

Question 18

A grafted socket/implant site in the esthetic zone should be approached using a flapless technique when:
(A) the osseous level is at least 3 mm below the alveolar plane.
(B) the mucogingival junction is at a crestal position.
(C) alveolar width is 6 mm or greater.
(D) adjacent subpapillary bone is compromised.

Answer 18

D

Question 19

Which of the following is most important for implant health over time?
(A) Adequate volume of good quality soft tissue
(B) Osseointegration
(C) Adequate inter-occlusal space
(D) Adequate bone graft consolidation

Answer 19

B

Question 20

Appropriate placement of an endosseous dental implant is determined by:
A. Placing the implant where available bone exists.
B. Where the patient expects the implant to be placed.
C. A surgical guide fabricated for the placement of the implant.
D. Placing the implant where adequate soft tissue exists to submerge the implant.

Answer 20

ANSWER: C
RATIONALE:
Implant placement should be guided by the prosthetic requirements, and may be best accomplished by using a surgical guide. Contemporary tissue grafting and regenerative techniques allow fixture placement in prosthetically appropriate positions.
REFERENCE:
Principles of Oral & Maxillofacial Surgery, Peterson, Indresano, Marciani, Roser; 1997, Vol 2, page 1144

Question 21

Regarding platelet rich plasma is use in bone grafting procedures, which statement is most accurate?
A. It involves bank blood, concentrate added to a bone graft.
B. Autologous whole blood containing leukocytes and fibrinogen which promote clotting
within the graft
C. Primary use is in the donor site to prevent an osseous defect.
D. Efficacy stems from concentration of growth factors by sequestering and concentrating
autologous platelets.

Answer 21

ANSWER: D
RATIONALE:
Platelet-rich plasma is an autologous source of platelet-derived growth factor and transforming growth factor beta that is obtained by sequestering and concentrating platelets by centrifugation. This technique produces a concentration of human platelets containing growth promoting substances (including platelet-derived growth factor and transforming growth factor beta) within them. These growth factors increase the maturation rate 1.5 to 2 times compared to grafts without platelet-rich plasma.
REFERENCE:
Marx RE, Carlson ER, Eichstaedt RM, Schimmele SR, Strauss JE; Platelet-rich plasma; Growth factor enhancement for bone grafts. Oral Surgery, Oral Medicine, Oral Pathology, Vol 85, No. 6, June 1998, page 638

Question 22

What is the minimum radiographically safe minimal distance that an implant may be placed from the superior lamina of the inferior alveolar canal when utilizing a panoramic radiograph?
A. 0.5 mm
B. 1.0 mm
C. 2.0 mm
D. 5.0 mm

Answer 22

ANSWER: C
RATIONALE:
When using a panoramic radiograph, variations in vertical magnification within the radiographic image make a safety margin of 2.0mm between the end of the implant and the inferior alveolar canal desirable. Because of its greater precision, computed tomography enables the clinician to select an implant that will be 1.0mm above the canal. Implant burs vary depending on the manufacturer and the surgeon must understand that the specified length (for example, a 10mm marking) may not reflect an additional millimeter included for drilling efficiency.
REFERENCE:
Kraut RA, Chalal O. Management of patients with trigeminal nerve injuries after mandibular implant placement. JADA 133(10): 1351-4, 2002 Oct
Tarnow DP, Magner AW, Gletcher P. The effect of the distance from the contact point to the crestal bone on the presence or absence of the interproximal dental papilla. Journal of Periodontology 1992 Dec:63(12) 995-996.

Question 23

The recommended solution for irrigation during implant site preparation is:
A. chilled normal saline
B. chilled sterile water
C. body temperature Dextrose 5% in sterile water
D. body temperature sterile water

Answer 23

ANSWER: A
RATIONALE:
Chilled solution is recommended for better cooling. Water, and other hypotonic solutions have been shown to cause rapid death of bone cells.
REFERENCE:
Giglio, Laskin, “ Perioperative Errors Contributing to Implant Failure”, OMS Clinics of North America, May 1998, p.200

Question 24

Peri-implantitis can be categorized as:
A. an early failure
B. a late failure
C. a complication of overheating of the bone
D. a complication of rough –surface implants

Answer 24

ANSWER: B
RATIONALE:
Peri-implantitis is defined as radiographically detectable peri-implant bone loss occurring after initial successful osseointegration combined with soft tissue inflammation lesion that demonstrates suppuration and probing depths of 6mms or more. The process begins at the coronal aspect of the implant, whereas the more apical portion remains clinically stable (osseointegrated).
REFERENCE:
Truhlar, “Peri-implantitis”, OMS Clinics of North America, May 1998, p. 299-301

Question 25

Using the buccal object rule, if the x-ray cone is moved away from the area in question, and the crown of an impacted tooth (when compared to adjacent erupted tooth roots) appears to move in the same direction as the cone, the crown is considered to have which position compared to the erupted tooth roots?
A. buccal
B. gingival
C. palatal/lingual
D. distal

Answer 25

ANSWER: C
RATIONALE:
The SLOB rule states: “Same Lingual Opposite Buccal.” In this situation, the cone was moved away and the crown of the impacted tooth moved in the same direction (same), so the object is palatal or lingual to the adjacent erupted tooth roots.
REFERENCE:
Felsenfeld and Aghaloo, “ Surgical exposure of impacted teeth”, OMS Clinics of North America, May 2002, p.188

Question 26

Which of the following fuided tissue membrane material is non-resorbable?
A. polylactic acid
B. glycolide and trimethylene carbamate copolymer
C. expanded polytetrafluoroethylene
D. freeze-dried xenographic lamellar bone

Answer 26

ANSWER: C
RATIONALE:
Exanded polytetraflurothylene is the most studied and widely used non-resorbable material used for guided tissue regeneration. The other listed materials are resorbed and avoid the necessity of a procedure to harvest a non-resorbable material.
REFERENCE:
Garg, “ Bone induction with/without membranes and using platelet-rich plasma”, OMS Clinics of North America, August 2001, p. 438

Question 27

Which syndrome is not associated with multiple impacted teeth?
A. Cleidocranialdysplasia
B. Down syndrome
C. Gardner syndrome
D. Peutz-Jaeger syndrome

Answer 27

ANSWER: D
RATIONALE:
Peutz-Jaeger syndrome exhibits autosomal dominant inheritence, peroral ephilides, and nonmalignant intestinal polyposis. There are no supernumerary or impacted teeth associated with this syndrome. Cleidocranial dyspalsia is inherited autosomal dominant and the patients usually have short stature, long necks with drooping shoulders due to absent or hypoplastic clavicles. These patients may exhibit maxillary hypoplaisa with possible submucous clefting and supernumerary teeth. Down syndrome (also known as trisomy 21) is usually caused by mititoc chromosomal nondisjunction, resulting in an extra chromosome. Variable mental retardation, congenital heart disease, T cell and B cell dysfunction, increased incidence of acute lymphocytic leukemia, predilection for Alzheimer disease, fissured tongue, macroglossia, oral cefting, and multiple impacted teeth are all features of Down syndrome. Gardner syndrome is also autosomal dominant with premalignant intestinal polyposis, multiple osteomas, fibromas of the skin, epidermal trichilemmal cysts, and supernumerary impacted teeth.
REFERENCE:
Zeitler, D. Management of Impacted Teeth Other Than Third Molars. OMFS Clinics of NA 5:95-103, 1993.

Question 28

Surgical uprighting of a mesioangular impacted mandibular second molar will usually also require:
A. removal of buccal bone
B. bonding of a bracket
C. removal of the adjacent impacted third molar
D. intentional root fracture

Answer 28

ANSWER: C
RATIONALE:
Removal of buccal bone is not advised as the second molar may not be stable when uprighted. A bracket is usually unnecessary. Intentional root fracture will doom the procedure. Removal of the impacted third molar is often necessary to create space, since the uprighting cause distalization of the second molar crown.
REFERENCE:
Zeitler D. Management of Impacted Teeth Other Than Third Molars. OMFS Clinics of NA 5:95- 103, 1993.

Question 29

The lingual nerve lies above the mandibular 3rd molar alveolar crest which percentage of the time?
A. 14
B. 32
C. 68
D. 86

Answer 29

ANSWER: A
RATIONALE:
The lingual nerve has been found to be superior to the lingual alveolar crest in the third molar region 14.07% of the time.
REFERENCE:
Belinia, H. et al. “An Anatomic Study of the Lingual Nerve in the Third Molar Region” JOMS 58 (2000) pp 649-651

Question 30

pon extraction of a tooth, the healing process begins. The major source of angioblastic and fibroblastic proliferation in the post extraction socket is derived from the:
A. open marrow space surrounding the socket.
B. cortical walls of the socket.
C. remnants of the periodontal ligament.
D. surrounding gingival tissue.

Answer 30

ANSWER: C
RATIONALE:
The cortical bone between the coagulum and the cancellous bone would act a barrier to the healing of the dental alveolus except for the presence of the periodontal ligament. The periodontal ligament is a major source for angioblastic and fibroblastic proliferation into the blood coagulum.
REFERENCE:
Alling, C.C., Alling, R.D. “Biology and Prevention of Alveolar Osteitis” SORM Vol. 4, Number 1