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DMD3 sem 2 > Intro to implants > Flashcards

Intro to implants Flashcards

1
Q

What are the typical problems with fixed/removable prosethetics?

A

Retention/resistance

Phonetics

Aesthetics

Stability

Micro leakage

Caries in abutments

Lateral forces

Deterioration of peridontal health around abutments

Psychological

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2
Q

How did dental implants change from when they were first invented until now?

A

First looked at in the 1950s initially made of cobalt chrome and stainless steel which sint’ very biocompatible.

Subperiosteal implants developed next. Initially very stable but lead to infections.

in 1960s and 70s Titanium was found to be very compatible with bone. Classical 2 stage surgery; first stage is placement second stage is uncovering

Andre Schroeder found a method of sectioning the bone and the titanium

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3
Q

What are the benefits of using dental implants?

A

Implant dentistry revolutionised dental treatment for patients

High survival and success rates

Conservative treatment option

Long term risk benefits were found to be in favour of dental implant use in 1978

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4
Q

What are the primary functions of bone?

A

Structural support

Calcium metabolism

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5
Q

What are the types of bone?

A

Compact bone

Spongy bone

Cancellous bone

Cortical bone

Woven bone

Lamellar bone

Bundle bone (only found around the alveolus)

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6
Q

What kind of bone is needed for implants?

A

A healthy ratio of cancellous bone to cortical bone.

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7
Q

Why is bone important as a calcium reservoir?

A

Calcium is important for maintaining pH, Nerve and muscle conduction, and heart function are all influenced by calcium levels.

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8
Q

What are the components of the bone’s molecular structure?

A

Organic bone consists of Type 1 collagen, GAG (glue), PG, Non-collagen proteins, Osteo collagen fibres, and H2O

Inorganic bone consists of hydroxyappatite, calcium carbonate, and fluoride

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9
Q

How much of bone is organic and how much is inorganic?

A 
Organic = 35%
Inorganic = 65%
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10
Q

Where do osteoblasts and osteoclasts arise from?

A

Osteoblasts = bone marrow derived mesenchymal progenitors (endosteal/periosteal origin)

Osteoclasts = bone marrow-derived haematopoietic progenitors

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11
Q

What kind of cytoplasm do osteoblasts have?

A

Basophilic cytoplasm

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12
Q

What are the functions of osteoblasts?

A

Bone building cells

Deposit bone matrix

Lay down bone in concentric circles

Phospholipid and proteo-glycan synthesis

Osteogenic cells

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13
Q

What growth factors and cytokines act on on osteoblasts to stimulate their function?

A

TGF-beta

BMP

PDGF

Insulin-like growth factor

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14
Q

What is an osteocyte?

A

Most abundant bone cell

Formed as embedded osteoblasts

Express TGF-beta

Communicate via dendrites

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15
Q

What is the function of osteoclasts?

A

Bone resorption cells

Occupy 1% of bone surfaces

Work in combination with osteoblasts and remain active for 3 weeks.

Tunnels 0.2 - 1mm deep formed by them

Ruffled border contacting the bone, villi at resorption contact and then they digest the bone via proteolytic digestion and phagocytosis

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16
Q

What do osteoclasts look like on microscope?

A

Multinucleate

Monocyte family

Have vili like projections that are important for bone resorption

Found in howship lacunae

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17
Q

What regulates osteoclast function?

A

PTH

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18
Q

How do osteoclasts get deactivated?

A

Typically degenerate via apoptosis

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19
Q

What is the bone matrix made up of?

A

Collagen fibers that are impregnated with mineral salts.

Mineral salts consist of 85% calcium phosphate, 10% calcium carbonate, 5% calcium fluoride and magnesium fluoride

Non-collagen proteins such as Bone Morphogenic Proteins

20
Q

What are the types of bone morphogenic proteins?

A

Growth factors/cytokines

TGF beta superfamily

Bone inducing cytokines BMP2, BMP7

Acid insoluble protein which bind to UD-MesenchymalCSC to get OsteoBlast differentiation

21
Q

How much resorption happens daily?

A

Approximately 0.7% of the skeleton is resorbed daily

22
Q

Where is periosteum located?

A

Outer surface of most bone but not articular surfaces.

23
Q

What are the layers of the periosteum?

A

Outer fibrous layer

Inner cellular layer

24
Q

Cells and blood vessels are related to the periosteum. What is the significance of this in dentistry?

A

Raising a mucoperiosteal flap typically causes 0.5mm bone loss.

25
Q

What dental procedures cause bone modelling?

A

Orthodontic movement

Implant placement

Sculpting and shaping after growth

26
Q

What happens during bone remodelling?

A

It is a cyclical process

No change occurs to the shape of the bone

Old bone is removed and new bone replaced it

27
Q

How does bone mass change in response to age?

A

Maxilla grows approximately 10 years after linear growth has finished

Bone mass declines after 4th decade

By 80 years bone mass is 50% less

Women lose more bone mass

28
Q

How do edentulous ridges differ between upper and lower jaw?

A

Upper jaw bone tends to be more trabecular.

Upper jaw tends to resorb quicker than lower jaw

Lower jaw bone tends to be more compact and dense

29
Q

What is osseointegration?

A

Direct connection between the bone and implant without interposed soft tissue.

30
Q

What factors are needed for successful osseointegration?

A

Design

Implant surface condition

Host bed status

Surgical technique

Loading

31
Q

What are the types of bone quality?

A

Quality 1: Very hard, very dense, may overheat, anterior mandible

Quality 2: Externally hard, Good core, Ideal for implants, and found in the premolar region

Quality 3: Thin externally, Good core, Good for implants, Maxillary incisor region

Quality 4: Very soft, very thin, found in posterior maxilla

32
Q

What does quality 1 bone consist of?

A

Homogenous compact bone

33
Q

What does quality 2 bone consist of?

A

Thick layer of compact bone around core of dense trabecular bone.

34
Q

What does quality 3 bone consist of?

A

Thin layer of cortical bone around dense trabecular bone.

35
Q

What does quality 4 bone consist of?

A

Thin layer of cortical bone around low density trabecular bone

36
Q

What are the types of implants?

A

Straight/tapered

One piece/ Two piece

TAD- Orthodontics

37
Q

What are the microscopically different implants?

A

V thread

Reverse thread

Square thread

38
Q

What is the ideal size of microscopic implant?

A

100 microns for complete bone ingrowth

39
Q

What are the types of implant surfaces?

A

TItanium machined surfaces

Titanium plasma spray surface (using plasma spray to spray titanium particles on top of the implant (good for increased surface area but has a tendancy to break off the implant surface)

Sand blasted surface

Hydroxyl apatite coated titanium surfaces

40
Q

How is the implant surface designed?

A

Coating is designed to decrease time for osseointegration

Machine surface/sand blasting/acid etching

Surfaces can add/subtract

They can affect the cytokine expression and growth factors in the bone

41
Q

What kind of surface treatments are supported by evidence in literature?

A

Current literature supports subtractive surface treatments:

Acid etching is beneficial

Sandblasting large grit

Additive surface treatments can breakdown and are unstable

42
Q

What are the stages of osseointegration?

A

Osteophillic

Osteoconductive

Osteoadaptive

43
Q

What happens in the osteophillic stage of osseointegration of implants?

A

Occurs upon insertion

Body responds to the rough surface

Clot formation occurs and cytokines are released

Vascular growth

44
Q

When does osteointegration begin to occur during the osteophillic phase?

A

Starts 1 week and lasts for a month

45
Q

What happens during the osteoconductive phase?

A

Bone cells spread along titanium and a thin layer of woven bone is formed. Bone is gradually added during this stage over 3 months until it reaches stability.

46
Q

What happens during the osteopadaptive phase?

A

Starts at 3 - 4 months

Remodelling occurs around the implant

Initial Bone to Implant Contact thickens and implants stable under the load.

47
Q

What are the types of stability of newly integrated implants?

A

Primary stability as the bone remodels

Secondary stabliity when the de novo bone forms around the implant

DMD3 sem 2 (69 decks)

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