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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?

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
Q

Supporting bone in _________ contact w/ implant surface (no PDL)

A

direct

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26
Q

Fibers running parallel to implant surface and no inserting fibers

A

CT zone

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27
Q

What 3 factors influence healing?

A

Systemic
Local
Technique

28
Q

What are 3 systemic factors that influence healing?

A

Smoking
Diabetes
Meds (bisphosphonates)

29
Q

What are 3 local factors that influence healing?

A

Surgical trauma
Implant surface
Infection

30
Q

What are 3 technique factors that influence healing?

A

Flapless
Open surgery

31
Q

Smokers have ________ as many implant failures than non-smokers

32
Q

Smokers have decreased resistance to ____________ and ____________

A

inflammation; infection

33
Q

Smokers have high failure rates of ___________ and ___________

A

implants; bone grafts

34
Q

In regards to smoking, what is a relative contraindication for implants?

A

Any amount of smoking

35
Q

In regards to smoking, what is an absolute contraindication for implants?

A

Excessive smoking (more than 1.5 packs/day)

36
Q

There is a direct correlation btwn osseointegration and ___________ control

37
Q

Diabetics patients are prone to developing _____________ and ___________ complications

A

infection; vascular

38
Q

In regards to diabetes, what is a relative contraindication for implants?

A

Insulin-controlled diabetes

39
Q

In regards to diabetes, what is not a contraindication for implants?

A

Well-controlled diabetes

40
Q

What are bisphosphonates used to treat?

A

Osteoporosis
Metastatic bone cancer
Paget disease

41
Q

Reduce bone resorption via direct effect on osteoclasts

A

Bisphosphonates

42
Q

Can cause drug-induced necrosis of the jaw

A

Bisphosphonates

43
Q

In regards to bisphosphonates, what is a relative contraindication for implants?

A

Oral bisphosphonates

44
Q

In regards to bisphosphonates, what is an absolute contraindication for implants?

A

IV bisphosphonates

45
Q

The surgical process of the implant osteotomy preparation and implant insertion results in a regional acceleratory phenomenon of bone repair around the implant interface

A

Surgical trauma

46
Q

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

47
Q

Proven to be critical for adhesion and differentiation of cells during the bone remodeling process essential to osseointegration

A

Implant surface

48
Q

In regards to implant surface, what usually has weaker bone integration?

A

Smooth
Minimally rough

49
Q

In regards to implant surface, what usually has stronger bone integration?

A

Moderately rough

50
Q

What type of implant surface?

0-0.4 um

51
Q

What type of implant surface?

0.5-1 um

A

Minimally rough

52
Q

What type of implant surface?

1-2 um

A

Moderately rough

53
Q

What 4 parts of the implant surface are directly related to an increased success rate?

A

Increased SA
Increased cellular attachment
Increased primary stability
Increased bone implant contact

54
Q

What is the effect on the implant surface?

Etching w/ acid
Blasting w/ an abrasive material
Tx w/ lasers

A

Subtractive

55
Q

What is the effect on the implant surface?

Hydroxyapatite coating and titanium plasma spraying
Oxidation or anodization

56
Q

Pros: less invasive, maintains tissue vasculature, no vertical incisions, less discomfort

Cons: malpositioning (unless guided)

A

Open surgery x flapless

57
Q

Bone quality in the posterior maxilla is typically the __________ of any area

58
Q

Bone resorption and increased _____________ of the sinus

A

pneumatization

59
Q

Vital structures that define anatomic limitations of implant placement

A

Nasal cavity
Incisive canal

60
Q

Implants should be placed _____ mm short of the nasal floor and should not be placed in the maxillary __________

A

1 mm; midline

61
Q

The anterior loop of IAN measurement should be added to the _____ mm safety zone to ensure adequate space between the implant and the foramen

62
Q

There is a minimum ______ mm safe distance btwn an implant and IAN

63
Q

What is super important to make sure the IAN is ok?

A

Pre, intra, and post-op PAs

(and take CBCT if not sure)

64
Q

Used for general assessment

65
Q

Used for precise anatomic mapping

D2 Spring (38 decks)

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