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Module 8 > Oral Surgery > Flashcards

Oral Surgery Flashcards

Topics Covered: Management of Cysts of the jaw, Guidelines and Indications for Implants, Patient Assessment for Implants, Implant Surgeryy

1
Q

What is a cyst?

A

A pathological cavity containing fluid or semi-fluid contents which hasn’t formed as a result of pus accumulation

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2
Q

Where do cysts most commonly occur and why?

A

Jaw

Because there are epithelial remnants left in the jaws from tooth development from the dental lamina and epithelial remnants left around the face from the fusion of the embryonic arches that form the face.

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3
Q

What are cysts often lined with?

A

Epithelium

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4
Q

What is the most frequent jaw cyst?

A

Radicular cyst

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5
Q

What is the most frequent non-odontogenic jaw cyst?

A

Nasopalatine duct cyst

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6
Q

Which type of teeth are radicular cysts associated with?

A

Non-vital teeth

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7
Q

What is the most common location for radicular cysts?

A

Anterior maxilla

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8
Q

Which type of epithelial remnants form radicular cysts?

A

The debris of Malassez from the Root Sheath of Hertwig

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9
Q

Which teeth are paradental cysts frequently associated with?

A

Impacted third molars

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10
Q

Which type of epithelial remnants form Dentigerous cysts?

A

Reduced enamel epithelium

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11
Q

Where is a common site for odontogenic keratocysts?

A

Angle of mandible

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12
Q

What type of pressure occurs on the adjacent bone during cyst expansion?

A

Hydrostatic pressure

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13
Q

During cyst expansion what does hydrostatic pressure on the adjacent bone result in?

A

Osteoclastic bone resorption

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14
Q

Are cysts symptomatic?

A

Cysts are usually asymptomatic unless the cyst expansion is so large that the overlying cortex and mucosa have been breached and bacteria has entered through the sinus into the cyst cavity resulting in infection.

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15
Q

What signs would indicate the presence of a cyst?

A
  1. Radiographic finding
  2. Bony expansion (eggshell crackling - bone so thin that it breaks on palpation), fluctuant swelling (no bone), or firm/hard swelling (extra bone formation to wall off hydrostatic pressure).
  3. Missing teeth
  4. Carious, discoloured or fractured teeth
  5. Tilted, displaced teeth
  6. Discharge/sinus
  7. Hollow percussion note
  8. Pathological fracture
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16
Q

What symptoms would indicate the presence of a cyst?

A
  1. Loose teeth
  2. Mental hypoesthesia
  3. Pain and swelling if secondarily infected
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17
Q

What investigations may be carried out when investigating pathology associated with teeth?

A
  1. Sensibility/sensitivity testing of teeth in area
  2. Radiology:
    - PAs or DPT (if sizeable cyst-like radiolucency)
    - CBCT if necessary
  3. Aspiration of cyst contents
  4. Biopsy
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18
Q

If on aspiration of a cyst, the contents are clear with small crystals/sparkles in it, what is the lesion likely to be?

A

Inflammatory radicular cyst

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19
Q

If on aspiration the contents of the cyst are blood-filled and appear as though they have come from an intra-alveolar vascular lesion, then what path of management would you follow?

A

Avoid surgical approach
Take 3D imaging

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20
Q

A what stage can you definitely call a cyst a cyst?

A

When the nature has been confirmed by pathology.

You must refer to it as a cyst-like radiolucency until this confirmation is made.

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21
Q

List the 3 aims of management of a cyst?

A
  1. Eradicate pathology
  2. Minimise surgical damage
  3. Restore function quickly
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22
Q

List the 6 treatment options available for managing a cyst?

A
  1. Marsupilisation
  2. Enucleation
  3. Marsupilisation + Enucleation
  4. Enucleation + Curettage/Excision
  5. En bloc Resection - jaw continuity maintained
  6. Partial resection - jaw continuity lost
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23
Q

Which treatment option is the first line treatment for cyst management?

A

Enucleation

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24
Q

What does enucleation of a cyst involve?

A

The complete removal of the cyst lining.

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25
Q

What must you consider before selecting enucleation or marsupilisation as your choice of treatment for cyst management?

A
  1. The type of cyst
  2. The size of the cyst (i.e. potential for iatrogenic damage to associated nerves, teeth, sinus, or floor of nose)
  3. The patient’s general medical status (i.e. fitness for GA)
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26
Q

What might be used in conjunction with the enucleation of a cyst if you wish to preserve involved teeth?

A

Peri-radicular surgery

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27
Q

What are the 2 methods of closure following enucleation?

A
  1. Primary closure
    - complete closure of the defect
  2. Secondary closure
    - by packing the defect and replacing subsequent packs until granulation tissue forms from the base to the top of the defect
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28
Q

In what cases might enucleation be contraindicated?

A

If the cyst is:
- large
- involving a number of vital teeth
- in a difficult anatomical site
- involving a potentially useful unerupted tooth.

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29
Q

Outline the procedure carried out for the enucleation of a cyst:

A
  1. Plan the incision of the flap so that it doesn’t directly rest over the osteotomy (bone removal) site created to get access to the cyst
  2. Raise flap
  3. Remove overlying buccal bone to gain access to the cyst
  4. Using a curette lift out the cyst lining off from the bone (curettage)
  5. Once cyst lining has been removed, suture the flap back where it belongs - sutures sit distantly from osteotomy site, resting on the crest of the bone
  6. Defect left will gradually feel with blood, this blood will initially liquify and be replaced by granulation tissue that will eventually be replaced by bone (this healing process takes several months)
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30
Q

My is it important to eliminate the defect that is left after enucleation of a cyst?

A
  1. To reduce reactionary haemorrhage
  2. To reduce post-op infection
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31
Q

How do you eliminate the defect that is left after enucleation of a cyst?

A
  1. Can place a vacuum drain which sucks down the overlying mucosa
    - this minimises the size of the dead space preventing reactionary haemorrhage by reducing the volume of blood clot that fills up the space
  2. Procedures to collapse cavity walls (known as saucerisation)
    - for soft tissue cysts
    - this involves intentionally taking away more bone to create a saucer shape to allow the mucosa to collapse down over the cavity.
  3. Use of biological and other materials to fill the space to facilitate bony infill:
    - Autograft - patients own bone
    - Allograft - bone from another human
    - Xenograft - bone from another species
  4. Use layered soft tissue closure
    - suture layers (e.g. muscle) into the area
    - not a common technique
  5. Secondary intention (packing)
    - older technique, not encouraged
    - pack the defect with anti-septic dressing to encourage healing by secondary intention
    - long drawn out process, involves several visits to replace packs, can be uncomfortable for the patient
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32
Q

What are the advantages and disadvantages of enucleation?

A

Advantages:
- Complete removal for tissue for histological examination
- Cavity heals without complications

Disadvantages:
- Potential for infection
- Potential for incomplete removal of lining
- Potential for damage to adjacent teeth or antrum
- Potential for weakening of bone

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33
Q

What is the treatment of choice for the management of an eruption cyst involving potentially useful teeth?

A

Marsupilisation

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34
Q

What does marsupilisation of cyst involve?

A

The creation of a window in the cyst lining, suturing the flap to the remaining lining to allow shrinkage of the lesion which may become self-cleansing or be subsequently removed.

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35
Q

Outline the procedure carried out for the marsupilisation of a cyst?

A
  1. Plan your flap margins to line up directly over the osteotomy (bone removal) site
  2. Raise the mucoperiosteal flap and gain access to underlying bone for osteotomy- have inferior and superior aspects to the flap
  3. Remove cyst
  4. Deliberately aim to achieve closure by secondary intention. Use acrylic bung to act as a stopper in the orifice of the cavity to prevent food/debris trapping as the area is not easily cleanable
  5. Over time layers of bone will form from the base of the cavity and eventually fill up the defect
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36
Q

What are the advantages and disadvantages of marsupilisation of a cyst?

A

Advantages:
- Avoids pathological fracture
- Treatment for medically compromised patients
- Avoids damage to adjacent structures
- Allows potentially useful teeth to erupt (mostly maxillary incisors and canines).

Disadvantages:
- Orifice closes and cyst reforms
- May be left with a defect in the alveolus
- Repeat visits required
- Manual dexterity and compliance
- Complete lining not available for histology

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36
Q

What is the difference between marsupilisation and decompression of a cyst?

A

Marsupilisation - involves a bung
Decompression - involves a drain

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37
Q

List these cysts in order of most frequently occurring to least frequently occurring:

  • paradental cyst
  • gingival/lateral periodontal cyst
  • dentigerous cyst
  • other non-odontogenic cysts
  • radicular cyst
  • keratocyst
  • nasopalatine cyst
A
  1. Radicular cyst - 60-75%
  2. Dentigerous cyst - 10-15%
  3. Keratocyst - 5-10%
  4. Nasopalatine cyst - 5-10% (non-epithelialised)
  5. Paradental cyst - 3-5%
  6. Other non-odontogenic cysts - 1% (non-epithelialised)
  7. Gingival/lateral periodontal cyst - <1%
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38
Q

Name 2 cysts that are associated with vital teeth:

A
  1. Gingival cysts
  2. Lateral periodontal cysts
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39
Q

Name a type of cyst that is associated with non-vital teeth:

A

Radicular cysts

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40
Q

What % of radicular cysts can be residual?

A

20%

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41
Q

What are dentigerous also known as?

A

Follicular cysts

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42
Q

How would you treat an apical or lateral radicular cyst?

A

Enucleation and extraction of associated tooth or apicectomy following RCT

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43
Q

How would you treat a residual radicular cyst?

A

Enucleation and marsupilisation

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44
Q

How do dentigerous cysts form?

A

They are formed by reduced enamel epithelium which results in a lining over the crown of the tooth.

These proliferate and form a dentigerous cyst.

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45
Q

Where is a dentigerous cyst always attached?

A

At the ACJ

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46
Q

How would you treat a dentigerous cyst?

A
  1. Enucleation and removal of the associated tooth - treatment of choice if the tooth is non-functional (e.g. wisdom tooth).
  2. Marsupilisation if the unerupted tooth is potentially functional and can be aligned spontaneously/orthodontically (e.g. maxillary canines).
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47
Q

When would you used marsupilisation?

A
  1. In the case of a large cyst
  2. When there is a functionally useful aesthetic tooth.
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48
Q

How do you differentiate a chronic cyst from an acute cyst?

A

Radiographically if there is loss of lamina dura then it is likely to be acute

Radiographically if the lamina dura is well-defined it is likely to be chronic

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49
Q

Where are OKCs commonly found?

A

Angle of the mandible

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50
Q

What are OKCs formed by?

A

Remnants of the Dental Lamina

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51
Q

What direction do OKCs grow in?

A

Anteroposterior direction

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52
Q

Why is there a high recurrence rate with OKCs?

A

Due to their daughter/satellite cysts making complete removal difficult

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53
Q

What are the treatment options for OKCs?

A
  1. Enucleation
    - ensure removal of an intact lining to reduce recurrence and tooth removal
  2. Curettage of bony cavity
    (some people use Carnoy’s solution or cryotherapy however little evidence base to back this up)
  3. Long-term radiographic follow up required
  4. Previously used to be treated like a tumour by use of en bloc resection
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54
Q

What syndrome presents as multiple keratocysts?

A

Multiple basal cell naevoid syndrome (Gorlin Syndrome)

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55
Q

List features of Multiple Basal Cell Naevoid Syndrome (Gorlin Syndrome):

A
  1. Multiple basal cell carcinomas of the skin
  2. Multiple odontogenic keratocysts
  3. Rib and vertebrae anomalies
  4. Intracranial calcification
  5. Skeletal abnormalities
    - bifid ribs
    - kyphoscoliosis
    - early calcification of falx cerebri (diagnosed with AP radiograph)
  6. Distinct facies
    - frontal and temporoparietal bossing
    - hypertelorism (wide space between eyes)
    - mandibular prognathism
  7. 3 or more palmar (palms of hands) or plantar (soles of feet) pits
  8. Prominent supra-orbital ridges
  9. First-degree relative with the condition
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56
Q

Are lateral periodontal cysts associated with vital teeth or non-vital teeth?

A

They are associated with vital teeth

*Do not mix this up with lateral radicular cysts as these are associated with non-vital teeth!!

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57
Q

What is the treatment for lateral periodontal cysts?

A

Enucleation - ensure to establish vitality of adjacent teeth prior to surgery

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58
Q

What is the treatment for gingival cysts?

A

Enucleation - however most of the time you can simply excise the cyst with overlying mucosa as access is usually relatively straightforward.

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59
Q

What type of cysts are nasopalatine duct cyst and nasolabial cyst?

A

These cysts are epithelial non-odontogenic (fissure) cysts

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60
Q

What forms a nasopalatine duct cyst and nasolabial cyst?

A

These types of cysts are formed by the remnants of the fusion of the embryonic arches that form the face.

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61
Q

What is the treatment for a nasolabial cyst?

A

Marsupilisation once raised an incision in the nasolabial fold and dissected out the cyst

62
Q

What other causes of cyst-like radiolucencies are there other than cysts?

A
  1. Staphne’s idiopathic bone cyst (not true cyst)
  2. Aneurysmal bone cyst (not true cyst)
  3. Solitary (haemorrhagic) bone cyst (not true cyst)
  4. Ameloblastoma
63
Q

What is Staphne’s idiopathic bone cyst?

A

Ectopic salivary tissue in concavity in the medial aspect of the mandible, usually below the level of the IAN.

**NOT A CYST!

64
Q

How do you treat Staphne’s bone cyst?

A

No active treatment required as not pathological.

65
Q

What is an aneurysmal bone cyst?

A

Mass of blood-filled spaces with scattered giant cells

**Not actually a cyst!!

66
Q

How do you treat an aneurysmal bone cyst?

A

Establish diagnosis by biopsy - raise flap, osteotomy into defect, curettage of contents to send for biopsy (this also therapeutic as it encourages healing)

67
Q

What causes a solitary (haemorrhagic) bone cyst?

A

Caused by bleed within the bone - can be traumatic or non-traumatic cause

68
Q

How do you treat a solitary (haemorrhagic) bone cyst?

A

Resolves spontaneously

69
Q

How does a solitary (haemorrhagic) bone cyst appear radiographically?

A

Large radiolucency arching up between the roots of the teeth - scalloping appearance

70
Q

What is an ameloblastoma?

A

Most common Odontogenic tumour

Essentially benign but can be locally aggressive and invasive but doesn’t commonly metastasise

71
Q

What are the 3 subtypes of ameloblastoma?

A
  1. Luminal
  2. Intraluminal
  3. Mural
72
Q

What does an ameloblastoma arise from?

A

From tooth-forming structures

73
Q

How do ameloblastomas appear radiographically?

A
  • Uni or multilocular radiolucency
  • Defined or diffuse edged
  • Usually displaces adjacent structures (tilting of teeth)
  • Often in the mandible
74
Q

What type of ameloblastoma is neoplastic?

A

Adenoid ameloblastoma

75
Q

In the UK, what % of adults are edentulous?

A

6%

76
Q

What problems can occur with implants?

A
  1. Poor maintenance:
    - Peri-implantitis
    - Peri-implant mucositis
  2. Nerve damage:
    - Inappropriate placement
77
Q

What is a dental implant?

A

A prosthetic device of alloplastic material (usually metal) implanted into the oral tissues beneath the mucosa and/or periosteal layer, and/or within bone to provide retention and support for a fixed or a removable prosthesis.

78
Q

What are the indications for dental implants?

A
  1. To replace lost tooth or teeth:
  2. Well motivated compliant patient
  3. Well-maintained dentition free of caries and periodontally sound
  4. Systemically well
  5. Non-smoker for at least 3 months
    - can do blood tests to check for nicotine
  6. Not immunocompromised
  7. No bruxism or parafunctional habits
  8. No impaired wound healing
79
Q

How long do you need to be a non-smoker before committing to implant treatment?

A

For a minimum of 3 months (includes nicotine vapes)

80
Q

What is the % failure rate of dental implant treatment in patients who are smokers compared to non-smokers?

A

Implants placed in smokers have a 140.2% higher risk of failure than implants placed in non-smokers

Up to 10% of implants fail in smokers

81
Q

What are the contraindications for dental implants?

A
  1. Age
    - Wouldn’t treat if patient <18 years due to growth
  2. Medical health
    - Poorly controlled diabetes (HbA1c >8)
    - Bisphosphonate treatment
    - Psychiatric and mental health issues
    - Other conditions such as blood disorders, immunodeficiency, alcohol/drug abuse, bone disorders and epilepsy
    - Tobacco use
    - Poor dental health
82
Q

Who can get implants on the NHS?

A
  1. Pts with congenital, inherited conditions that have lead then to missing teeth, tooth loss or malformed teeth
  2. Patients with traumatic events leading to tooth loss
  3. Patients with surgical interventions resulting in tooth and tissue loss - e.g. H&N cancer and non-malignant pathology
  4. Pts with congenital or acquired conditions with extra-oral defects of, for example, eyes or ears.
  5. Pts who are edentulous in either one jaw or both in whom repeated conventional denture treatment options have been unsuccessful
  6. Pts with severe oral mucosal disorders and those with severe xerostomia where conventional prosthetic treatment is not possible and/or the provision of conventional treatment would be detrimental to the mucosal disorder
  7. Pts who do not have suitable existing teeth that can be used for anchorage to facilitate ortho treatment.
83
Q

Which implant system is frequently used in tayside?

A

Straumann implant system

84
Q

What are the requirements of an implant material?

A

Has to:
- be safe
- be biocompatible (biological, biomechanical and morphological)
- be MRI-safe
- produce good image compatibility

85
Q

What must you consider when placing implants?

A

Do not apply excessive force

Make sure maximum loading on them doesn’t exceed physiological norms

Loading should be directed primarily axial down the long axis of the implant (as the bone resists this loading the best)

86
Q

What host factors affect osseointegration of implants?

A
  1. Bone density
  2. Bone volume and bone implant surface area
  3. Parafunctional habits
87
Q

What implant factors affect osseointegration of implants?

A
  1. Implant macro design
  2. Chemical composition and biocompatibility
  3. Hydrophilicity
  4. Surface treatment and coatings
  5. Implant tilting, prosthetic passive fit, cantilever, crown height, occlusal table, loading time
88
Q

What happens to the Straumann implants in DDH prior to placement to help improve osseointegration?

A

They are sandblasted and acid-etched

89
Q

What are the advantages of modifying the surface of implants?

A
  1. Greater amounts of bone to implant contact
  2. More rapid integration with bone tissue
  3. Higher removal torque values
90
Q

Which 2 metals can be used as implants?

A

Titanium
Zirconium

91
Q

Why is titanium and zirconium safe to use as an implant material?

A

As they do not inhibit the growth of osteoblasts

92
Q

How successful are titanium implants over 8 years (give %) ?

A
  • 96.7% survival
  • 93.3% successful
93
Q

How successful are titanium implants over 10 years (give %) ?

A
  • 99.2% survival
  • 96.4% success
94
Q

What factors must be assessed when planning for implant placement?

A
  1. OH, compliance and motivation
  2. Pt medical factors
    - fitness
    - meds
    - radiation tx
    - growth
  3. Site-related factors
    - perio status
    - access
    - pathology near implant site
    - previous surgeries at site
  4. Surgical complexity
    - timing of implant
    - simultaneous or staged grafting procedures
    - number of implants
  5. Anatomical factors
    - bone
    - soft tissue
    - site
    - adjacent teeth
    - aesthetic risk
95
Q

Why is good oral hygiene really important following implant placement?

A

As poor OH can lead to recession, which can lead to implant exposure.

As the implant surface has been treated it has a rough surface which can very easily harbour bacteria that is impossible to clean.

The bacterial load can lead to further recession and exposure of the threads, ultimately resulting in peri-implantitis.

96
Q

Which medications must you be wary of when assessing a patient for implants?

A
  1. Any medications that can result in MRONJ:
    - Bisphosphonates
    - RANKL inhibitors
    - Anti-angiogenic drugs
  2. Steroids
    - impact on wound healing (particularly bone healing)
97
Q

Why is it important to consider if the pt has had H&N radiation treatment when assessing them for implants?

A

As it is a relative contraindication to tx due to the risk of ORN

Note that it is NOT a complete contraindication though as there is evidence to suggest that if the pt. has had <50 grades total dose of radiotherapy to a target area then the risk of ORN is reduced.

Must always warn the patient of the risk of ORN in the consent procedure!!

98
Q

What age would make a patient unsuitable for implants?

A

If they’re <18 years old

99
Q

What factors might make access more difficult when placing implants?

A
  1. Posterior implant placement
  2. Limited mouth opening
  3. TMD
100
Q

What pathology may be present near an implant site?

A
  1. Perio pathology
  2. Gingival pathology
  3. Cysts
101
Q

Why is it important to note whether the patient has had previous surgeries at the site where you wish to place an implant?

A
  1. As there may be less bone in the area to allow healing
  2. Scarring can make it difficult to raise a flap
102
Q

When is an immediate implant placed?

A

Straight after the extraction

103
Q

When is a delayed immediate implant placed?

A

6-8 weeks following extraction

104
Q

When is a delayed implant placed?

A

> 12 weeks - 6 months after extraction

105
Q

What tool can be used to assess surgical complexity of an implant case?

A

ITi tool

106
Q

What bone volume is needed horizontally and vertically for the placement of a straumann implant?

A

Horizontally - 7mm
Vertically - 8-10mm

107
Q

Describe an ideal soft tissue quality, thickness and biotype for the placement of a implant:

A

Thick keratinised biotype

108
Q

Which vital anatomical structures must you be vary about when placing implants?

A

Maxillary sinus, IAC, mental foramen

109
Q

What may you need to carry out prior to implant placement in anterior teeth to facilitate aesthetics?

A

Bone graft/soft tissue graft

110
Q

What anatomical factors about bone must you assess before implant placement?

A
  1. bone volume
  2. bone quantity
  3. bone quality/anatomy
111
Q

In elder patients what must you consider when placing an upper implant?

A

That often elder patients may have pneumatisation of the maxillary antrum (an enlarged antrum), and therefore there may be a lack of alveolar bone height for implant placement.

112
Q

Why is it important to do 3D imaging prior to implant placement to check for feeder blood vessels?

A

As feeder blood vessels can cause enhanced bleeding during the implant placement procedure.

113
Q

What bone anatomy can often be seen in an edentulous mandible that can make it more difficult to place implants?

A

A knife edge ridge

114
Q

Why are clinical photographs important for implant planning?

A

As they provide information about:
- Resting and smiling lip lines
- Position of midlines
- Recession and loss of papillary tips
- Occlusion

115
Q

Why are radiographs important for implant planning?

A

As they provide information about:
- The antrum
- The IAC
- Bone height

3D imaging can be utilised to assist planning of the position and angulation of the implants.

116
Q

Why must you ensure not to impinge on the mental foramen or the IAC during implant placement?

A

As could lead to permanent altered sensation in the patients lower lip.

117
Q

What is the minimal distance of bone required from the implant shoulder to the adjacent tooth at bone level?

A

1.5mm

118
Q

What is the width at the shoulder of a Straumann standard platform implant?

A

4.1mm

119
Q

What is the minimum distance of bone required between the necks of 2 adjacent teeth (with an Straumann standard platform implant placed between)?

A

7.1mm

120
Q

When there are implants adjacent to one another, what is the minimum distance of bone required between the 2 implant shoulders?

A

3mm

(This equates to 7mm between the centre of each implant)

121
Q

What can be done to change the bone levels?

A

Recontouring:
- Knife edge ridges
- Mandibular tori
- Undercuts - onlay graft or particulate graft

Large bone volume lacking:
- Onlay grafts
- Inter-positional grafts
- PRF sticky bone

Sinus lift techniques

122
Q

What are the benefits of using a mixture of an autogenous bone graft and a xenograft when augmenting an area prior to implant placement?

A

Xenograft has a stabilising effect on the autograft.

The autograft already contains osteoblasts and bone morphogenic proteins - able to produce bone straight away.

It heals in a shorter time frame (~4 months)

123
Q

What are the 2 different types of implant?

A
  1. Tissue level implants
  2. Bone level implants
124
Q

What is the main difference between the placement of tissue level implants compared to bone level implants?

A

Tissue level implants are placed as a 1 stage surgical technique.

Whereas, bone level implants are placed as a 2 stage surgical technique.

125
Q

For both tissue level implants and bone level implants, where must the endosseous part of the implant sit?

A

Within the alveolar bone, flush with the alveolus

126
Q

For tissue level implants where does the polished transmucosal collar sit?

A

Above the level of the alveolus

127
Q

When would you use tissue level implants?

A

Used under dentures

128
Q

When would you use bone level implants?

A

For aesthetic purposes - ie. anywhere in the aesthetic zone.

129
Q

What mathematical model analysis is used to test the transfer of implant load to surrounding bone?

A

Finite Element Analysis (FEV)

130
Q

What is the transfer of implant load affected by?

A
  1. Implant body shape
  2. Implant collar shape
  3. Threads - shape, pitch, height
131
Q

Which implant shape (parallel or tapered) provides a better transfer of load from the metal implant to surrounding bone?

A

Tapered provides better transfer of load

132
Q

Which implant threads are useful for transferring primarily occlusal loads to surrounding bone?

A

Triangular compacting threads.

133
Q

List 4 advantages of using Grade 4 Ti-6Al-4V alloy as your material choice for implants?

A
  1. Very high mechanical strength
  2. Reduced heat conduction (from metal implant to bone) by 50% compared to pure titanium
  3. Doubled corrosion resistance compared to pure titanium
  4. Better fracture resistance
134
Q

List 2 ideal aims of an implant design?

A
  1. A design that maximises the transfer of load (primarily occlusal to surrounding bone)
  2. A design that avoids stress of the bone around the neck of the implant - as overloading could lead to peri-implant bone loss
135
Q

What does implant success depend on?

A
  1. Implant design
  2. Material used
  3. Quality/quantity of bone
136
Q

What implant material superseded the Type 4 Titanium alloy and why?

A

Roxolid

  • As it has a higher tensile strength than the grade 4 alloy
  • Preserves bone
  • Has a greater flexibility with smaller implants
137
Q

What % of zirconium and titanium is present in the Roxolid alloy?

A

15% zirconium
85% titanium

138
Q

What are the advantages of pure ceramic implants?

A

High performance - 97.5% survival and success rates after 3 years

Higher fatigue strength than grade 4 titanium implants

White coloured (better aesthetic results)

139
Q

Which forces are well managed with implants and which forces aren’t well-managed with implants?

A

Best manage compressive forces - vertical forces

Don’t manage tensile (tilting) or shearing (rotatory) forces well.

140
Q

What range of compressive force can a dental implant manage in the molar region?

A

380-880N

141
Q

What range of compressive force can a dental implant manage in the incisor region?

A

<220N

142
Q

What lateral/shearing forces can a dental implant manage?

A

20N

143
Q

What factors influence failure of an implant?

A
  1. Biological factors
    - overloading
    - insufficient quality/quantity of bone
    - poor vascularity
  2. Mechanical factors
    - breakage of abutments, screws, or implant itself
144
Q

When would you use immediate implant placement?

A

When there is good quality bone and good bone volume

145
Q

What is immediate delayed implant placement?

A

Placement when there is early soft tissue healing at 4-8 weeks post extraction

146
Q

What is delayed implant placement?

A

Placement when there is partial bone healing - 3-4 months post extraction

147
Q

What is elective implant placement and when is this used?

A

Placement when there is full bone healing >4 months, happens with edentulous arches

148
Q

How long would you usually wait before loading the implant?

A

Usually wait 8-12 weeks before loading the implant however evidence shows that early light loads are beneficial for bone healing

149
Q

What are the complications that can occur with implants?

A
  1. Wound breakdown
  2. Infection
  3. Early loss
  4. Mucositis
  5. Peri-implantitis
150
Q

According to Buser et al.(1997) and Cochran et al. (2002) what is the success criteria for an implant?

A
  1. Absence of clinically detectable implant mobility
  2. Absence of pain or any subjective sensation
  3. Absence of recurrent peri-implant infection
  4. Absence of continuous radiolucency around the implant at the 12 week time point
151
Q

What is the 10 year survival rate of implants according to the meta-analysis study by Derek Richards et al.?

A

93.2%

152
Q

What is failure of implants often due to?

A

Failure to osseointegrate:
- lost
-mobile
- shows peri-implant bone loss (>1mm in first year and >0.2mm after)

153
Q
A

Module 8 (6 decks)

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