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D2 Spring > Implants - Lecture 5: Wound Healing & Anatomical Considerations > Flashcards

Implants - Lecture 5: Wound Healing & Anatomical Considerations Flashcards

1
Q

Layer of fibrous CT formed between a dental implant and surrounding bone

A

Fibro-osseous integration

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2
Q

Initially good success rates, but extremely poor long-term success; seen in earlier implant systems

A

Fibro-osseous integration

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3
Q

Considered a “failed implant” by today’s standards; no bone direct contact w/ implant

A

Fibro-osseous integration

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4
Q

Tissue-to-implant contact

A

Fibro-osseous integration

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5
Q

The direct contact between living bone and a functionally loaded dental implant surface without interposed soft tissue at the light microscope level

A

Osseointegration

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6
Q

Bone-to-implant contact

A

Osseointegration

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7
Q

A time-dependent healing process whereby clinically asymptomatic rigid fixation of implant is achieved and maintained in bone during functional loading

A

Osseointegration

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8
Q

Clot forms within minutes

A

Hemostasis

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9
Q

Recruitment of immune cells

A

Inflammation

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10
Q

Angiogenesis of fibroblast activity

A

Proliferation

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11
Q

Maturation of bone (osseointegration)

A

Remodeling

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12
Q

What are the 4 phases of healing for an implant?

A

Hemostasis
Inflammation
Proliferation
Remodeling

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13
Q

Time after implant placement?

Blood clot is in contact with the implant surface: erythrocytes, neutrophils, and macrophages are trapped in a network of fibrin

A

First few hours

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14
Q

Time after implant placement?

The clot is replaced by granulation tissue composed by mesenchymal cells; disorganized CT matrix and the first vessel sprouts are evident

A

3-4 days

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15
Q

Time after implant placement?

Most of the inflammatory cells are resorbed and immature woven bone can be evidenced together with newly formed vessels

A

1 week

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16
Q

Time after implant placement?

Woven bone formation is more pronounced and surrounds the whole implant mixed with old bone which is a clear sign of osteogenesis. Osteoclast formation is evidenced and contributes to bone remodeling

A

2 weeks

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17
Q

Time after implant placement?

Newly formed mineralized bone extends from the prepared bone surface to the implant coating

A

4 weeks

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18
Q

Time after implant placement?

Bone enters the remodeling phase, more mature bone with the presence of primary and secondary osteons is evident

A

6-12 weeks

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19
Q

What are the 2 types of stability involved with osseointegration?

A

Initial
Secondary

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20
Q

The degree of tightness of a dental implant immediately after placement in its prepared osteotomy

A

Initial stability

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21
Q

An implant is considered to have initial stability if it is clinically _________ at the time of placement

A

immobile

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22
Q

The fixation of a dental implant to the bone over time and after osseointegration has occurred

A

Secondary stability

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23
Q

Bone interface is stronger on the day of implant placement compared to ___________ later

A

3 months

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24
Q

What is needed for osseointegration? (4)

A
  1. Biocompatible material (the implant)
  2. Atraumatic surgery to minimize tissue damage
  3. Implant placement in intimate contact w/ bone
  4. Immobility of the implant during healing
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25
For osseointegration, supporting bone must be in _________ contact w/ implant surface (no PDL)
direct
26
For osseointegration, there must be a CT zone where fibers run _______________ to the implant surface and there are no inserting fibers
parallel
27
What 3 factors influence healing?
Systemic Local Technique
28
What are 3 systemic factors that influence healing?
Smoking Diabetes Meds (bisphosphonates)
29
What are 3 local factors that influence healing?
Surgical trauma Implant surface Infection
30
What are 2 technique factors that influence healing?
Flapless Open surgery
31
Smokers have ________ as many implant failures than non-smokers
twice
32
Smokers have decreased resistance to ____________ and ____________
inflammation; infection
33
Smokers have high failure rates of ___________ and ___________
implants; bone grafts
34
In regards to smoking, what is a relative contraindication for implants?
Any amount of smoking
35
In regards to smoking, what is an absolute contraindication for implants?
Excessive smoking (more than 1.5 packs/day)
36
There is a direct correlation btwn osseointegration and ___________ control
glycemic
37
Diabetics patients are prone to developing _____________ and ___________ complications
infection; vascular
38
In regards to diabetes, what is a relative contraindication for implants?
Insulin-controlled diabetes
39
In regards to diabetes, what is NOT a contraindication for implants?
Well-controlled diabetes
40
What are bisphosphonates used to treat? (3)
Osteoporosis Metastatic bone cancer Paget disease
41
Reduce bone resorption via direct effect on osteoclasts
Bisphosphonates
42
Can cause drug-induced necrosis of the jaw
Bisphosphonates
43
In regards to bisphosphonates, what is a relative contraindication for implants?
Oral bisphosphonates
44
In regards to bisphosphonates, what is an absolute contraindication for implants?
IV bisphosphonates
45
The surgical process of the implant osteotomy preparation and implant insertion results in a regional acceleratory phenomenon of bone repair around the implant interface
Surgical trauma
46
The implant-bone interface is weakest and most at risk for overload at _________ weeks after surgical insertion because the surgical trauma causes bone remodeling at the interface
3-6 weeks
47
Proven to be critical for adhesion and differentiation of cells during the bone remodeling process essential to osseointegration
Implant surface
48
In regards to implant surface, what usually has weaker bone integration?
Smooth Minimally rough
49
In regards to implant surface, what usually has stronger bone integration?
Moderately rough
50
What type of implant surface? 0-0.4 um
Smooth
51
What type of implant surface? 0.5-1 um
Minimally rough
52
What type of implant surface? 1-2 um
Moderately rough
53
What 4 parts of the implant surface are directly related to an increased success rate?
Increased SA Increased cellular attachment Increased primary stability Increased bone implant contact
54
What is the effect on the implant surface? Etching w/ acid Blasting w/ an abrasive material Tx w/ lasers
Subtractive
55
Which subtractive method? Hydrochloric acid, sulfuric acid, hydrofluoric acid, and nitric acid
Etching w/ acid
56
Which subtractive method? Alumina, titanium oxide, and hydroxyapatite (HA)
Blasting w/ an abrasive material
57
Which subtractive method? Increased hardness, corrosion resistance, and purity with a standard roughness
Tx w/ lasers
58
What is the effect on the implant surface? Hydroxyapatite coating and titanium plasma spraying Oxidation or anodization
Additive
59
Which additive method? Stimulated bone growth during healing phase
Hydroxyapatite coating and titanium plasma spraying
60
Which additive method? Electrochemical process thickens and roughens the titanium oxide layer on the surface of implants
Oxidation or anodization
61
Pros: less invasive, maintains tissue vasculature, no vertical incisions, less discomfort Cons: malpositioning (unless guided)
Open surgery x flapless
62
Bone quality in the posterior maxilla is typically the __________ of any area
poorest
63
Which structure? Bone resorption and increased pneumatization of the sinus
Maxillary sinus
64
Vital structures that define anatomic limitations of maxillary implant placement
Nasal cavity Incisive canal
65
Implants should be placed _____ mm short of the nasal floor and should not be placed in the maxillary __________
1 mm; midline
66
The anterior loop of IAN measurement should be added to the _____ mm safety zone to ensure adequate space between the implant and the foramen
2 mm
67
There is a minimum ______ mm safe distance btwn an implant and IAN
2 mm
68
What is super important to make sure the IAN is ok?
Pre, intra, and post-op PAs (and take CBCT if not sure)
69
Used for general assessment
Pano
70
Used for precise anatomic mapping
CBCT

D2 Spring (69 decks)

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