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Intro to Implants > Osseointegration > Flashcards

Osseointegration Flashcards

1
Q

A direct structure and functional connection between ordered, living bone and the surface of a load-carrying implant:

A

osseointegration

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2
Q

List the 6 key factors for successful implant osseointegration:

A
  1. BIOCOMPATIBLITY of the implant material
  2. Macroscopic and microscopic nature of the IMPLANT SURFACE
  3. The status of the implant bed in both a HEALTH (non-infected) and a MORPHOLOGIC (bone quality) context
  4. The surgical TECHNIQUE
  5. The undisturbed HEALING PHASE
  6. The subsequent PROSTHETIC DESIGN and the long term LOADING PHASE
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3
Q

CP:

A

Commercially pure

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4
Q

Why do we use CP titanium and titanium alloys? (5)

A
  1. Low weight high strength/weight ratio
  2. Low modulus of elasticity
  3. Excellent corrosion resistance
  4. Excellent biocompatibility
  5. Easy shaping and finishing
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5
Q

What is the most frequently used titanium alloy for implants?

A

Titanium-6 Aluminum-4 Vanadium

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6
Q

List the composition of Titanium-6 Aluminum-4 Vanadium:

A
  • 90% titanium
  • 6% aluminum
  • 4% vanadium
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7
Q

What does the 6% aluminum in Titanium-6 Aluminum-4 Vanadium contribute?

A

decreases the specific weight and improves the elastic modulus

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8
Q

What does the 4% Vanadium in Titanium-6 Aluminum-4 Vanadium contribute?

A

Decreases thermal conductivity and increases the hardness

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9
Q

Tenacious oxides in air or oxygenated solution:

A

Titanium oxide layer

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10
Q

The titanium oxide layer promotes:

A

adhesion of osteogenic cells

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11
Q

Surface topography influences:

A

osteoblasts morphology

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12
Q

List the different categories of surface topography: (4)

A
  1. Smooth
  2. Minimally rough
  3. Moderately rough
  4. Rough
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13
Q

According to the study, _____ and ____ surfaces showed weaker bone responses than with ____ surface

A

smooth & minimally rough; rough

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14
Q

According to the study, _____ surfaces showed stronger bone responses than rough in some studies

A

moderately rough

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15
Q

Surface topography influences bone response at the:

A

micrometer level

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16
Q

List some examples of how we can modify the surface:

A
  1. machines
  2. plasma-spray
  3. titanium-spray
  4. sandblasted & acid-etched
  5. RBM (resorbable blast media with calcium phosphate)
  6. zirconia ceramic
  7. hydroxyapatite coatings
  8. lasers
  9. nano-structured surfaces
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17
Q

Surface treatment that includes etching with strong acids to increase the surface roughness and surface area of titanium implants:

A

Acid-etched

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18
Q

Surface treatment that includes an electrochemical process to thicken and brought the titanium oxide layer on the surface of implants:

A

Anodized

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19
Q

Surface treatment that includes particles being projected through a nozzle at a high velocity onto the implant.

Can be done with various materials such as titanium dioxide, aluminum dioxide, and hydroxyapatite (HA)

A

Blasted

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20
Q

Surface treatment that includes implants undergoing a blasting process and afterwards the surface is washed non-etching acid or etched with strong acids:

A

Blasted and acid-washed/ etched

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21
Q

Surface treatment that includes an osteoconductive material that has the ability to form a strong bond between the bone and the implant:

A

Hydroxapatite (HA)

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22
Q

Surface treatment that includes high-intensity pulses of a laser beam strike to a protective layer that coats the metallic surface. As a result the implants demonstrate a honeycomb pattern with small pores:

A

Laser ablation

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23
Q

Surface treatment that includes powdery forms of titanium that are injected into a plasma torch at elevated temperatures:

A

Plasma-sprayed

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24
Q

A greater surface roughness increases the potential for:

A

biomechanical interlocking

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25
Q

Rougher implant surfaces have a higher percentage of ________ & also a higher _____ than machined surfaces

A

bone implant contact; torque removal

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26
Q

The chemical composition of bone is ___% inorganic and ___% organic

A

70% inorganic; 30% organic

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27
Q

What comprises the inorganic component of bone?

A

Crystalline salts (primarily HA)

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28
Q

What comprises the organic component of bone?

A
  • Type 1 collage (90-95%)
  • Non-collagenous proteins
  • Proteoglycans
  • Growth factors
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29
Q

What cells can be found in bone?

A
  1. pre-osteoblast
  2. osteoblast
  3. osteoclast
  4. osteocytes
  5. monocytes
  6. macrophages
  7. endothelial cells
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30
Q

Active osteoblasts deposit:

A

osteoid matrix

31
Q

The 3 Davis’ Concepts:

A
  1. Bone is synthesized by only on cell- osteoblast
  2. Bone grows only by apposition
  3. Bone matrix mineralizes and has no inherent capacity to “grow”
32
Q

De novo bone formation that occurs on the surfaces of old bone in the peri-implant site

A

Distance osteogenesis

33
Q

In DISTANCE osteogenesis, the bone surfaces provide a population of ____ that lay lay down a new matrix that encroaches on the implant

A

osteogenic cells

34
Q

In _____ osteogenesis new bone is NOT forming on the implant, but the latter does become surrounded by bone

A

Distance osteogenesis

35
Q

Results in bone approximating the implant:

A

distance osteogenesis

36
Q

No bone is present on the surface of the implant upon implantation:

A

Contact osteogenesis

37
Q

In CONTACT osteogenesis, new bone forms first on the ______ and has to become colonized by ____ before bone matrix formation can begin

A

implant surface; bone cells

38
Q

Bone is formed for the first time at the appropriate site by differentiating osteogenic cells:

A

Contact osteogenesis

39
Q

Results in bone apposition to the implant surface:

A

Contact osteogenesis

40
Q

Results in bone approximating the implant:

Results in bone apposition to the implant surface:

A

Distance osteogenesis

Contact osteogenesis

41
Q

2 hours after implant installation, the threads are in contact with the bone leading to:

A

mechanical anchorage

42
Q

2 hours after implant installation, the primary stability is through:

A

Mechanical stability

43
Q

2 hours after implant installation, the void between the pitch and body of the implant can be described as:

A

a well defined wound chamber

44
Q

2 hours after implant installation, the blood clot is characterized by:

A
  1. erythrocytes
  2. neutrophils
  3. monocytes/macrophages in a network of fibrin
  4. leukocytes
45
Q

2 hours after implant installation, the blood clot characterized by erythrocytes, neutrophils, monocytes/macrophages in a network of fibrin + leukocytes are engaged in:

A

wound cleaning process

46
Q

Following implant installation, the blood clot is replaced with ____ 4 days after

A

Primitive granulation tissue

47
Q

The primitive granulation tissue that replaces the blood clot 4 days after implant installation, contains:

A
  1. mesenchymal cells
  2. matrix components
  3. newly formed vascular structures
48
Q

The primitive granulation tissue that replaces the blood clot 4 days after implant installation, contains mesenchymal cells, matrix components and newly formed vascular structures which is evidence of:

A

angiogenesis

49
Q

In the early events of osseointegration, the ____ has been established

A

provisional connective tissue matrix

50
Q

What type of surface is characterized by the following events?

4 days after implant installation, in the proximal region, an early granulation tissue has formed, whilst the region close to the device, large numbers of erythrocytes remain:

A

Rough surface

51
Q

What type of surface is characterized by the following events?

4 days after implant installation, in the area close to the parent bone, the clot has been penetrated by vascular structures surrounded by fibroblast-like cells, whereas in the areas close to the surface of the device, large numbers of erythrocytes, polymorphonuclear leukocytes and macrophages remain:

A

Machined surface

52
Q

Osseointegration: Bone Remodeling at 1 week:

____ in the wound chambers rich in vascular structures and mesenchymal cells

A

Provisional connective tissue

53
Q

Osseointegration: Bone Remodeling at 1 week:

A relatively small number of _____ was still present

A

Inflammatory cells

54
Q

Osseointegration: Bone Remodeling at 1 week:

A _____ was seen in the provisional CT that surrounded the blood vessels

A

cell-rich immature bone (woven bone)

55
Q

Osseointegration: Bone Remodeling at 1 week:

______ occurred in the center of the chamber as well as discrete locations that apparently were in direct contact with the surface of the titanium device. “_____”

A

woven bone formation; “Contact Osteogenesis”

56
Q

Osseointegration: Bone Remodeling at 1 week:

_____ was not observed on polished implant surfaces at this stage

A

Contact osteogenesis

57
Q

According to the human bone model, the healing period was:

A

6 weeks

58
Q

The original Branemark’s protocol recommended strict adherence to surgical and prosthodontic technique and a “non-disturbed” healing period of:

A

3-6 months

59
Q

What follows the original Branemark’s protocol of a “non-disturbed” healing period of 3-6 months?

A

an abutment and superstructure prosthesis are fabricated and attached to an implant fixture

60
Q

Today, clinicians have 3 loading options which include:

A
  1. immediate loading
  2. early loading
  3. delayed loading
61
Q

Loading technique in which the prosthesis is connected to the implant fixture within the first 48hrs

A

Immediate loading

62
Q

Loading technique in which the prosthesis is connected to the implant fixture after the first 48 hours but prior to 3 months:

A

Early loading

63
Q

Loading technique in which the prosthesis is connected to the implant fixture after the initial 3 months

A

Delayed loading

64
Q

Immediate loading time:
Early loading time:
Delayed loading time:

A

Within 48 hours
After 48 hrs - 3 months
After 3 months

65
Q

T/F: According the study, immediate implant loading may impose a greater risk for implant failure when compared to conventional loading although the survival rates were high for both groups

A

True

66
Q

By connecting the implants with the ___ we limit the micro-movements and therefore ensure the osteointegration process:

A

acrylic restoration

67
Q

What is the ideal insertion torque for immediate loading?

A

Greater than 35 Ncm

68
Q

Osteotomy can be prepared using: (3)

A
  1. sequential drilling
  2. blunt osteotome
  3. piezosurgery
69
Q

What was the most beneficial form of osteotomy preparation?

A

Piezosurgery (leaves a cleaner cavity for implant placement with very few osseous debris)

70
Q

Can be defined as the measurement of the resistance that the implant encounters during its advancement in the apical direct by means of a rotating movement on its axis:

A

Insertion torque

71
Q

The insertion torque is measurement in:

A

Ncm (Newton Centimeters)

72
Q

According to the study, Is there an optimal insertion torque for osseointegration to occur around unloaded implants?

A

No significant differences were observed in the way bone heals around high versus low insertion torque

73
Q
A

Intro to Implants (8 decks)

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