implants lists from lectures

Question 1

what functions do the healing cap have?

Answer 1

The Healing Cap:
prevents the soft tissue from collapsing
and prevents the tongue and cheek from irritation.

The Snappy Abutment Healing cap does not maintain the mesial distal restorative dimension nor does it maintain the opposing occlusion from super erupting.

Question 2

what will a well made temporary do?

Answer 2

A well-made temporary will :
maintain the mesial distal restorative dimension,
prevent opposing teeth from over eruption
and will flare the tissue tunnel because of the natural divergence of the temporary contours.
Maintaining the restoration site dimensions and opposing teeth minimizes adjustments.
Providing flare to the tissue tunnel makes seating, cementation and cleanup easier.

Question 3

what are widths of strauman regular neck and wide neck?

Answer 3

Regular Neck (4.8 mm)
Wide Neck (6.5 mm)

Question 4

what about height of strauman?

Answer 4

regularn neck 4.0mm, 5.5mm, 7.0mm

wide neck 4.0mm and 5.5mm

Question 5

why do you remove the lip of a temporary coping for solid abutment?

Answer 5

so that excess cement will flow out so you can seat it correctly

Question 6

how much distance should you have from the abutment height to the opposing occlusion?

Answer 6

2.0mm

Question 7

if you have to modify the abutment (solid abutment) what is the minimum height needed?

Answer 7

3.0mm for proper stability and retention

Question 8

what is included in a treatment plan?

Answer 8

• health history
  Complete electronic health record in Axium and get signature
  Note any significant findings
  Check specific risk factors (smoker, diabetes, steroid and bisphosphonate use) List other medications
  Take periapical of implant site ( if not previously done )
• oral health
  Evaluate oral hygiene
  Evaluate general periodontal condition Evaluate general tooth condition Identify missing teeth
• implant site
  Missing Tooth - site #
  Evaluate adjacent teeth condition (unrestored to highly restored)
  Evaluate adjacent teeth periodontal condition (bone height, tissue height) Evaluate ridge height (compare crest of ridge to adjacent marginal gingival) Palpate ridge shape (note ridge concavities, hour glass shape, exostosis) Evaluate soft tissue (color, MGJ height)
• implant site model evaluation
  Measure MD restorative dimension (adjacent tooth to adjacent tooth)
  Measure OG restorative dimension (from crest of ridge to adjacent tooth marginal ridge). Evaluate opposing dentition for proper plane of occlusion (occlusoplasty, restoration needed?)
• radiographic evaluation
  Measure M-D width between adjacent roots
  Evaluate bone for any pathology, root tips
  Measure absolute ridge height (crest of bony ridge to inferior alveolar nerve) Approximate usable ridge height (reduced by 2 mm clearance and narrow crests) Approximate “crown to root” ratio (restoration above bone/fixture in bone)
• fixture, abutment and crown selection
  Select fixture system, width, and length relative to site, bone volume, and occlusal load. Select type of abutment (stock, solid, screw retained)
  Select type of crown and shade

Question 9

what are key factors to consider regarding implant therapy versus endodontic treatment (6)?

Answer 9

1. Crown:root ratio
2. mobility
3. predictability of endodontic success
4. risk of recurrent periodontal infection
5. strategic nature of the tooth: e.g. abutment for prosthesis, etc.
6. Patient’s expectations

Question 10

what is the minimum required implant length?

Answer 10

8mm

Question 11

what is the wait time for second stage surgery after first stage?

Answer 11

this is left for a prescribed healing period (usually 3

months in the mandible (4 in posterior mandible) and 6 months in the maxilla), depending on the quality of bone.

Question 12

what’s the criteria of a successful implant (5)?

Answer 12

The individual implant remains immobile clinically.
! Peri-implant radiolucency is not seen on Periapical
radiographs.
! One year after loading of the implant, vertical bone loss should not exceed 0.2 mm annually.
! Individual implants should be free of pain, infection, neuropathies, or violation of the mandibular canal.
! At the end of 5-year and 10-year observation periods, a success rate of 85% and 80% is appreciated, respectively.

Question 13

what is the rationale for recall maintenance (3)?

Answer 13

Identify patients who are at risk for peri-implantitis
! Institute an appropriate maintenance protocol
! Document and treat any lesions that might occur in a timely manner.

Question 14

who are high risk patient for peri-implantitis/

Answer 14

!  Partially edentulous
!  Pre-existing chronic periodontitis
!  Diabetes mellitus (with poor metabolic control) 
!  Poor plaque control
!  Smoker

Question 15

what is the acceptable resoprtion per year of the bone?

Answer 15

0.2mm

Question 16

what initial cratering can you expect shortly after abutment connection ?

Answer 16

0.2-2.0mm

Question 17

what is treatment for peri-implantitis?

Answer 17

HOME CARE
! It is imperative that patients understand their role and responsibility in maintaining their implants
! Home care assessment: Review and reinforce at subsequent maintenance appointments
! Interdental brushes with nylon-coated core wire
! Soft toothbrushes (both manual and power)
! End-tuft brushes
! Gauze
! Many types of floss (e.g., plastic, braided nylon,
coated, floss with stiffened end to clean under bridges (Superfloss), dental tape, Postcare implant flossing aid
! Stannous fluoride gel and
! Chlorhexidine

SCALING AND ROOT PLANING
! Some plastic instruments are highly flexible and can be difficult to use when removing calculus from implant surfaces.
! Plastic instruments reinforced with graphite are more rigid and can be sharpened.
! Traditional stainless steel, titanium, gold-tipped instruments and traditional ultrasonic tips may scratch the implant surface, which facilitates biofilm growth
! To date, no studies have linked scratching of the implant surfaces to increased incidence of mucositis or peri-implantitis

OCCLUSAL ADJUSTMENT
! Perform occlusal examination during the implant maintenance consultation
! For fixed restorations, light centric contacts and avoidance of non-centric interference are recommended
! During the occlusion assessment, shim stock should be held only with tightly clenched teeth, to ensure avoidance of excessive occlusal loading of implants

FURTHER INTERVENTIONS
Non-Surgical
! Mechanical Debridement, supplemented with application of chlorhexidine
! Reducing plaque
! Inflammation
! Probing depth and allowing gain in clinical attachment level
! Local administration of Arestin (minocycline hydrochloride microspheres 1 mg)
! Slight improvements in clinical and microbiological
parameters for up to 12 months.
Surgical Intervention
! Resection associated with implantoplasty ! Regenerative therapy

Question 18

what should be checked prior to patient appointment for restoration try-in

Answer 18

! Prior to patient appointment:
! Restorations should be evaluated on the articulator for:
! Marginal adaptation
! Proximal and occlusal contacts
! Occlusal form
! Axial contours
! Tissue relationship/contact of pontics
! Stability of die
! Surface finish
! Porcelain shades should be verified against shade tabs
! Any gross deficiencies of any of the above should be corrected prior to patients’ appointment

Question 19

what are indications for implant overdentures (9)?

Answer 19

Compromised bone support for conventional denture
Poor neuromuscular coordination
Low tolerance of mucosal tissues for a removable
acrylic base
Parafunctional habits leading to instability of prosthesis
Active or hyperactive gag reflexes, stimulated by upper removable denture
Psychological inability to wear a removable prosthesis
Patient dissatisfaction with complete dentures and desires for more stability and comfort
Congenital or oral and maxillofacial defects that need oral rehabilitation
High prosthodontic expectations

Question 20

what are tissue-supported implant overdentures like?

Answer 20

When two prefabricated individual attachments are
utilized
The attachements provide retention for the
overdenture
Should provide maximum tissue coverage, similar to a conventional complete denture
Tissue-Implant-Supported Overdenture:
Is more implant-borne
Two implants and a resilient bar attachment assembly should be utilized
The attachment assembly and supporting implants receive most of the masticatory forces
The remainder are transferred and absorbed by the supporting tissue

Implants placed between the mandibular foramen Most common position is the canine area
Option; lateral incisors area (14 – 15 mm)
Provision for more implants posteriorly
Minimizes the hinge movement of the prosthesis

Question 21

what are fully implant-supported overdentures like?

Answer 21

An attachment assembly with 4 or more implants

The attachment assembly transfers all of the masticatory forces to the supporting implants

Question 22

what are factors that affect the decision making process?

Answer 22

Factors that affect the decision-making process:
Soreness and discomfort associated with the denture
base and its flanges
Bone quantity
Patient’s expectation for the treatment outcome
Expected oral hygiene and patient compliance
Jaw relationship
Distance between the upper and lower alveolar ridge
Expertise of the dentist and the lab technician
Patient finances

Question 23

what are basic requirements for successful overdenture (7)?

Answer 23

Stress-free fit of attachment assembly
Good oral hygiene
Biocompatibility of the chosen material
High biomechanical strength of chosen materials Functional and equilibrated occlusion
Natural looking aesthetics
Absence of interferences with normal phonetics

Question 24

what are the benefits of a surgical guide in overdentures?

Answer 24

Creates a surgical template
• Visualizes the rela7onship of the denture teeth with an7cipated implant posi7ons
• Gives the clinician and lab technician a good idea of the posi7on and final design of the bar
• Creates an index for the posi7on of the final overdenture teeth

Question 25

what is the classification of fully edentulous ridges based on bone quantity?

Answer 25

Group A
Minimum bone loss – less inter-ridge space
Average height of bone: anterior mandible >20 mm. Width: >5 mm.
Anterior maxilla: >15 mm.
Width: >5 mm.
Not a good candidate for a bar attachment assembly
Good for Hybrid prosthesis as well as overdenture with stud attachments

Group B
More bone loss – more inter-ridge space than group A Height of bone: anterior mandible bet. 15 – 20 mm. Width: >5 mm.
Anterior maxilla: approx. 12 – 15 mm.
Width: >5 mm.
Good candidate for any kind of implant overdenture
The bone quantity and inter-ridge space allow the clinician to utilize any type of attachment assembly

Group C
Severe resorption of the alveolar process – expansive inter-
ridge space
Height of bone: anterior mandible approx. 10-15 mm.
Width: almost 5 mm.
Anterior maxilla: less than 10 mm.
Width: almost 5 mm

Question 26

what is the classification of edentulous ridges based on bone quality?

Answer 26

D1: thick, compact bone
Type of bone usually can be found in the symphysis
part of the mandible
Advantages:
Provides good primary stability for the implants Expansive implant bone interface
Use of short implants is possible
Overdenture can be loaded immediately
Disadvantages:
Reduced blood supply
Difficult implant bed preparation, which can cause
overheating
Extra step of tapping the bone is required to eliminate the possibility of the pressure necrosis

D2: thick, porous, compact bone with a highly trabecular core
Type of bone can be found in the anterior and posterior portions of the mandible as well as the palatal aspect of the anterior maxilla.
Advantages:
Provides good primary stability
Easy implant bed preparation
Overdenture can be loaded immediately
Good blood supply which means shorter healing time and faster osseointegration
Disadvantages: None
(LOOKS LIKE THE BEST KIND OF BONE!)

D3: Thin, porous, compact bone surrounding a loosely structured cancellous bone
Type of bone can be found in the facial aspect of the
anterior maxilla, posterior maxilla, posterior portion of the mandible, and the remaining bone after the oeteoplasty of the D2 bone
Advantages:
Good blood supply
Disadvantages:
Possibility of unwanted widening of the osteotomy,
which can lead to poor primary stablity Reduced implant bone interface

D4: Loose, thin, cancellous bone
Type of bone can be found in the posterior maxilla, as
well as the remaining bone after the oeteoplasty of the D3 bone
Advantages: None
Disadvantages:
Poor primary stability
Reduced implant bone interface

Question 27

why use a locator?

Answer 27

Patient Satisfaction
- ! Patients can now eat more vegetables and other foods with the Locator system which can lead to an improved diet

User Friendly for the Patient
- ! The self-locating design of the Locator system is designed to allow patients
to easily seat their dentures

Flexibility

• ! Up to 40° divergence between two implants can be accommodated
• ! Denture restorations are possible even in cases of limited space inside the denture due to small vertical dimensions
• ! Retrofit Locator attachments in new or existing dentures is possible

Simple to Restore
- ! Dental professionals of all ability levels, including recent graduates, can learn to restore implant-secured dentures using Locator

Practice Builder
- ! Dental professionals can use Locator as a tool to promote value-added services to their patients

Question 28

what is the torque for an overdenture locator abutment?

Answer 28

35Ncm

Question 29

what’s different retention force for the locator?

Answer 29

5lbs, 3lbs, 1.5lbs up to 20 degrees angulation between 2 implants

also 3-4lbs, 1.5lbs, and 2.0lbs for up to 40 degrees angulation

you might want less retention force if they have trouble taking it off

Question 30

how do you pick your locator abutments heights?

Answer 30

you probably want to be about 1mm higher than
the tissue for cleaerance at most or 0.5mm clearance
from the tissue because if you’re
right at the tissue then you might irritate it so whatever
this measurement is from top of implant to highest
point of tissue then you want to add whatever you need
to get 0.5mm of clearance

measure from top of implant to the highest point of the tissue

Question 31

how many implants should you have for implant retained overdenture?

Answer 31

! Maxilla
! 4 implants minimum recommended due to soft bone type

! Mandible
! 2 – 4 implants

Question 32

what are factors influencing the design and resiliency of the attachment assembly?

Answer 32

! Shape of the arch
! Distribution of the implants in the arch
! Length of the implants and degree of implant-bone interface
! Distance between the most anterior and most posterior implants

Question 33

what are the design features of the locator overdenture attachment (7)?

Answer 33

! Self Alignment
! Dual Retention
! Pivoting Feature
! Resilient Function
! Vertical Space (shortest, only 2.27mm above tissue, allows for more acrylic and teeth)
! Abutment height selection (VARIETY)
! Buccal/Lingual – Mesial/Distal Space (it’s small, only 5.5 mm wide)

Question 34

what about buccal/lingual and mesial distal of overdenture implant placement?

Answer 34

! Buccal/Lingual – Mesial/Distal Space
! Metal housing: 5.5 mm wide
! Implant centers should be spaced 6.5 mm or more apart.

Question 35

what are factors that infleunce the flexibilituy of the bar?

Answer 35

! Length of the bar between the two implants
! Number of implants that support the bar
! Height of the bar
! Physical property of the alloy
! Magnitude of the masticatory load

Question 36

how should you place a bar?

Answer 36

The bar should be perpendicular to the line that bisects the angle formed by the two posterior mandibular arch segments

Question 37

what are two factors influencing distance between implants?

Answer 37

! Size and curvature of the mandibular arch

! Type of attachment assembly

Question 38

what should the vertical relationship of the bar and the alveolar ridge be?

Answer 38

! A wide gap of 2 mm or more between the bottom of the bar and the soft tissue will allow easy passage of saliva and food particles as well as cleaning tools

! A small gap of 1 mm or less will cause plaque and calculus accumulation

! Compression of the mucosa by the bar will cause hyperplasia of the gum

! The bar should be positioned directly above the crest of the ridge. This position makes it easy to clean the bar and fabricate the prosthesis above the bar.

! If the bar is positioned lingual to the crest of the ridge, it will interfere with the tongue space, impeding function and speech.

! If the bar is positioned labial to the crest of the ridge, it will interfere with lip support

Question 39

what is the anterior posterior distance rule for bar placement?

Answer 39

Good for determining the distal cantilever extension of the bar or distal extension of the hybrid (fixed detachable) prosthesis from the most distal implants

the cantilever distance of the bar is 1.5 times the atnerior posterior distance when measured from the most anterior implant to the posterior implant.

Question 40

why would you use an implant over just a denture?

Answer 40

bite force is greater with implant supported

prevent bone loss

Question 41

when to use screw-retained crown?

Answer 41

o Use a screw-retained crown:
• 1. Limited interarch dimension
• 2. Patient is a bruxer
• 3. Retrievability is desired

• You will be able to tell if it is screw retained or cement retained by how the post comes out of the impression, the angle

o 2 ways to know if screw retained or cement retained
• 1. If impression post indicates that it will be in the center of the planned crown
• 2. If you have more than 5mm you can do cement retained.

o Cement-retained implant restorations
• Cement entrapment leading to peri-implantitis. Contamination risk of bacterial colonization of the implant sulcus leading to perio-implant inflammatory reactions and bone resorption.