L14- Digital Dentistry

Question 1

why CBCT?

Answer 1

evaluates the bone profile, volume and architecture

identifies important structures

avoid snafus?

Question 2

implant placement methods without CBCT?

Answer 2

freehand

acrylic guide

implant guiding system

thermoplastic template

use of pilot drills?

Question 3

adhere to hard and soft tissue criteria

Answer 3

HARD TISSUE – 2 MM OF L ABIAL OR BUCCAL BONE

SOFT TISSUE 2MM OF KERATINIZED TISSUE

HAVE TO KNOW THIS

Question 4

___ mm of labial r buccal bone

Answer 4

2mm hard tissue !!!

Question 5

___ mm of ____ tissue needed

Answer 5

2 mm of KERATINIZED tissue

soft tissue !!!

Question 6

bio basis for the soft and hard tissue criteria?

bio width?

Answer 6

requires a minimum of 2.04 mm of sound tooth structure ABOVE the osseous crest
sulcular - .69
junctional epi attachment -.97
CAT - connective tissue attahment = 1.07

approx. 3 mm of soft tissue in the apico-coronal dimension

Question 7

connective tissue provides? junctional?

Answer 7

mechanical protection

mechanial barrier

and the junctional is the biological barrier

make up the biological width

Question 8

compare the periodontal and perimplant soft tissue
what do they both have?
what lacks in the implant side?

Answer 8

both have

1. oral epithelium
2. sulcular epithelium
3. junctional epithelium

IMPLANT

1. • NO CONNECTIVE TISSUE ATTACHMENT
     - HAS CONNECTIVE TISSUE ZONE
     - hypovascular / hypocellular CT zone
2. hypovascular
   - less blood supply because no supply from pdl

Question 9

key difference in implant and not

Answer 9

blood supply

natural

• many sources of blood supply
  1. soft tissue
  2. bone
  3. from PDL

implant
1. no PDL blood supply ***

Question 10

connective ___ in implant

Answer 10

connective tissue ZONE but NO CT attachment

Question 11

connective tissue attachemnt in implants

Answer 11

NO

but there is junctional epithelium

Question 12

cellular zone adjacent to the implant

Answer 12

hypovascular - hypocellular CT zone adjacent to implant

Question 13

what is 3D guided implant surgery ***

Answer 13

does not matter method but start CROWN DOWN APPROACH

Question 14

placing implant where bone is?

Answer 14

not necessarily we practiec prosthetically driven implant placement

so if graft you do it

Question 15

epithlium with implant

Answer 15

still have oral epithelium and sulcular epithelium with junctional epithelium

no connective tissue attachment and no PDL

Question 16

guided surgery work up

Answer 16

1. 3D scan and digital impression
2. crown down virtually
3. integrate and plan the case
4. fabricate the stent of your choice

Question 17

implant placement method we use with CBCT

Answer 17

cerec guide 2

Question 18

classic guide?

Answer 18

completely guided

when place pilot – everything goes through this key whole

Question 19

method to use for first time

Answer 19

classic guide

Question 20

optiguide radiogrpah?

Answer 20

no radiogrpahic guide

uses the cerec galileos integration with CBCT

Question 21

fully guided systems

Answer 21

1. classic method

2. optiguide

Question 22

no radiographic guide with

Answer 22

optiguide with CGI and cerec guide 2

Question 23

more details on cerec guide 2

+ additional requirement

Answer 23

requirement is the milling unit

no models necessary - so no alginate impressions

no radiographic guide required

Question 24

cerec guide 2 fully guided?

Answer 24

NO

optical scan becomes the surgical guide

Question 25

hard and soft tissue defect
how do we treat?
especially if patient on bisphosphonates?

Answer 25

avoid ridge augmentation

serum CTX

free gingival graft - 3 months

then placement

Question 26

MRONJ

Answer 26

medically 
related 
osteo 
necrosis of the 
jaw

Question 27

serum CTX test

Answer 27

higher number you get – represents osteoclastic activity

HIGHER NUMBER IS BETTER

Question 28

high risk CTX levels

moderate

low

Answer 28

high risk is CTX lower than 100 pg/ml

moderate risk is CTX from 100-150 pg/ml

minimal risk is CTX over 150 pg/ml

Question 29

his opinion on hard and soft tissue grafting

Answer 29

he likes soft tissue first

Question 30

YOMI

Answer 30

robotic assisted surgery

Question 31

mechanical barrier is

why important?

Answer 31

the connective tissue
- acts to protect against bacteria - infectoins, etc
junctional epithelium is bio barrier

Question 32

guided surgery work up

basic 4 steps

Answer 32

1. 3D scan and digital impression
2. crown design virtually
3. integrate and plan the case
4. fabricate the stent of your choice

Question 33

classic guide uses

Answer 33

radiographic guide

Question 34

T/F optiguide uses a radiographic guide

Answer 34

false – it does not

Question 35

2 requirements for guided surgery

Answer 35

need cbct scanner and cerec acquisition

Question 36

additional requirement for cerec guide 2

Answer 36

milling unit
so need the CBCT
cerec aquisition and a milling unit

• no rx guide

Question 37

impressions for cerec guide 2

Answer 37

no models necessary

so no alginate impressions

no radiographic guide required

Question 38

if no radiographic guide ?

Answer 38

the optical scan you take becomes the surgical guide

Question 39

how long he waits after soft tissue graft

Answer 39

3 months

Question 40

platalet rich fibrin

Answer 40

next generation of platalet concentration

so we can get good clot