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revision Flashcards

1
Q

tooth-implant prosthesis:
ADV:
DISADV:

A

ADV:

  • cheaper
  • more tx options
  • cantilever elimination
  • ADDITIONAL SUPPORT FOR THE TOTAL LOAD ON THE DENTITION

DISADV:

  • risk of osseointegration failure
  • risk of marginal bone loss
  • more periodontal and prosthodontic complications
  • more need for repair and maintenance
  • INTRUSION OF TEETH
  • risk of excessive stress on implant
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2
Q

most common biological complications of tooth to implant prosthesis:

A 
periapical lesions and caries
but also:
-tooth fractures
-fistulas
-loss of osseointegration
-periodontal pathology
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3
Q

most common technical complications of tooth to implant prosthesis:

A 
porcelain occlusal fracture and screw loosening
but also:
-retention loss
-cement failure
-screw fracture
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4
Q

intrusion of teeth - percentage:

A

0 - 5.2%

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5
Q

rigid connection or non-rigid connection between teeth and implants?

A

rigid connection

bc the non-rigid have more technical complications

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6
Q

which is better; tooth-implant prosthesis or implant-implant prosthesis?

A

implant-implant prosthesis is better

bc of increased no of biological and technical complications with implant-tooth prosthesis

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7
Q

diagnostic phase planning for implant placement includes:

A 
no of implants
position of implants
angulation of implants
dimension needed
design of finalized prosthetic rehabilitation
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8
Q

surgical guide use:

A
  • for desired implant position and angulation
  • for abutment dimension and angulation
  • if there is a need for soft/hard tissue augmentation before or during implant placement
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9
Q

distance needed between two implants placed:

A

3 mm space

bc we want space for OH, otherwise it will fail

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10
Q

pink porcelain use:

A

high lip line - used only for aesthetics

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11
Q

technical complications of implant supported FPDs:

A
  • veneer fractures -> most common
  • screw loosening
  • abutments/screw fracture
  • implants fracture
  • occlusal restoration loss
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12
Q

solution for a two rooted or three rooted tooth extraction:

A

sectioning

for a less traumatic procedure

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13
Q

what will be missing from the extraction site once a tooth is removed?

A

PDL

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14
Q

alveolar bone morphology depends on:

A

tooth size
tooth shape
events occurring during tooth eruption
erupted teeth inclination

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15
Q

alveolar bone morphology of long and narrow teeth:

A

more delicate alveolar process, in particular in the frontals, a thin, fenestrated buccal bone plate

so with thin biotype and long narrow teeth there is a thin or non-existent buccal plate

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16
Q

where would we see an impact of a thin or non-existent buccal plate?

A

in:
orthodontic movements
periodontitis
recessions

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17
Q

what do we expect to have when we have subgingival restoration margins in a thin biotype?

A

recessions

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18
Q

what do we expect to have when we have subgingival restoration margins in a thick biotype?

A

inflammation

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19
Q

attachment apparatus components:

A

periodontal ligaments
cement
alveolar bone

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20
Q

what will happened to the bone when there are multiple tooth extractions and then subsequent restoration with RPDs?

A

reduced size of ridge in both horizontal and vertical dimension

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21
Q

bone resorption depends on:

A
  • thin or thick biotype
  • pressure on the area
  • why you lost teeth (caries or perio)
  • original dimension (height and width)
  • > thin bone plate (<1 mm wide) lose more dimension than plates > 1 mm wide
  • not the same for everyone
  • same resorption process for both single and multiple teeth being extracted
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22
Q

bone reduction percentages in 3m and 12m after tooth extraction:

A

3m: 30%
12m: 50%

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23
Q

clinical ramifications concerning prosthetic rehabilitation after teeth being extracted:

A

implants - bone augmentation
bridge - space b/w pontic/bridge?

complaints for:

anteriors: aesthetics
posteriors: food impaction

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24
Q

factors that will influence changes in the bone after tooth extraction:

A
  • traumatic injuries (ex: during extraction or after an accident)
  • tooth related diseases (ex: periodontitis or apical periodontitis)
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25
Q

classification of residual jaw shape:

A

In groups A and B, substantial amounts of the ridge still remain
In groups C, D, and E, only minute amounts of hard tissue remain

A and B: can place a full mouth denture or implants
Vs
C, D, E: problems with placing a denture or implant

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26
Q

4 different groups of jawbone quality:

A

Quality 1 to 4: less cortical bone, more bundle bone present

Quality 1: thick and resistant bone – very good for dentures, not very good for implants – there is no proper blood supply to the area so you might have problems with osseointegration
Vs
Quality 4: it is so soft so there is no primary stability so when you are placing an implant you might need to stop before placing the correct size, there is a lot of bleeding upon working

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27
Q

clinical ramifications of tooth extraction:

4 pictures

A 
thin or thick bony plate
small (incisor) or big (molar) socket
bone augmentation needed
implant placement
food impaction problems
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28
Q

What do we expect to see when removing a tooth?

A

Bone resorption and then soft tissue follows

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29
Q

When you have resorption occurring, and you want to replace a missing tooth with a prosthesis, what are your concerns?

A
  • resorption of buccal bone
  • adjacent teeth recession leading to root exposure and sensitivity
  • aesthetics
  • food impaction
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30
Q

When would be the optimal time to plan the restorative treatment of a patient?

A

Prior to teeth extraction

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31
Q

which has less traumatic change after extraction?

  • lower anteriors
  • lower molars
  • upper anteriors
  • upper molars
A

-lower anteriors

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32
Q

post extraction healing stages:

A
  • epithelial cells (fastest cells) proliferation
  • keratinization covering extraction site
  • bone cells (osteoclasts, osteoblasts) multiplication (so bone builds up in the socket)
  • resorption (a little, especially on the buccal plate)
  • bone and soft tissue loss
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33
Q

type 1 implant placement:

A

-immediate placement after extraction

  • ADV: 1 surgery, less tx time, less visits (patient friendly bc you do it in 1 go), bone augmentation favorable
  • DISADV: high risk procedure, need experience, inadequate soft tissue, aesthetical problems
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34
Q

type 2 implant placement:

A
  • when the socket is covered with mucosa
  • best solution
  • after 4-8w before socket coverage with soft tissue
  • ADV: good aesthetics and predictable, less tx time, favorable bone augmentation procedure, allows pathology resolution
  • DISADV: 2 surgeries, not easy (the least no of disadv), more tx time than type 1, socket wall resorption
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35
Q

type 3 implant placement:

A
  • when bone fill is required within the extraction socket
  • after 10-16w
  • ex: after big tooth extraction or huge defect (ex: periapical lesion, periodontitis, tooth fracture, huge bone loss)
  • ADV: favorable bone augmentation procedure, allows pathology resolution, easier to manage mucosa during flap elevation
  • DISADV: 2 surgeries, more tx time, additional resorption
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36
Q

type 4 implant placement:

A
  • everything is completely healed
  • when the patient asks for it or for financial reasons
  • after 4m or 6-12m
  • ADV: complete healing, allows pathology resolution, only minor additional change of the ridge may occur
  • DISADV: 2 surgeries, more tx time, might require complicated bone augmentation procedures
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37
Q

flap closure methods:

A

1st approach: requires primary wound closure which leads to submerged healing

2nd approach: allows for a transmucosal position of implant/healing cap which leads to transmucosal healing
-> If its not that big bone augmentation, then you go to the transmucosal healing

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38
Q

In which clinical situation you would prefer to have healing and then bone? What would you see in your initial radiograph?

A

after big tooth extraction or huge defect (ex: periapical lesion, periodontitis, tooth fracture, huge bone loss)

so it’s better to wait a little bit longer

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39
Q

aspects evaluated during tx planning phase:

A
  • overall tx objective
  • tooth location in oral cavity (aesthetic zone or not)
  • bone and soft tissue anatomy at the site
  • adaptive changes of alveolar process following tooth extraction
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40
Q

which factors differentiate someone from having periodontitis or not?

A

susceptibility

genetics

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41
Q

risk factors for periodontitis:

A

smoking

uncontrolled diabetes

42
Q

clinical parameters that should be noted before placing an implant:

A
  • OH habits
  • plaque score – very important
  • presence of BoP (should be less than 20%)
  • periodontal probing depth
  • soft tissue levels
  • thick and thin gingival biotypes (thick is preferred)
  • restorative conditions of adjacent teeth
  • edentulous regions (horizontal or vertical defects)
43
Q

panoramic indications:

A

partially dentate

edentulous patient

44
Q

CBCT indications:

A
  • when clinical examinations or conventional radiography have failed to adequately identify the relevant anatomic boundaries or the absence of pathology
  • can provide additional information and help minimize the risk of damage to important anatomic structures
  • requirement for a more extensive augmentation procedure
  • implant positioning improvement with the use of radiographic templates and surgical guides
45
Q

Esthetics:
Patient is influenced by:

Clinician is influenced by:

A 
Patient is influenced by their:
•self-perception
•social environment
•media
•dental history

Clinician is influenced by:
•current dental knowledge
•experience
•available medical checklists – evidence based

46
Q

What would be a method for the patient to visualize the final esthetic result before treatment begins?

A

Mock-up

47
Q

Which alternative tx modalities are available to replace a tooth in the esthetic zone?

SOS

If you have a patient that is 16-year-old (boy/girl) – what would you exclude?

A
  • Conventional FPD comprising cantilever units
  • Adhesive, RBB (cantilever)
  • Conventional RPDs
  • Tooth-supported overdentures
  • Orthodontic therapy
  • Implant-supported prostheses
  • Combinations of the above

implants

48
Q

How can orthodontic treatment be used to enhance the final esthetic result in a patient with missing teeth in the anterior zone?

A
  • With forced eruptions
  • Changing the distribution pattern of the edentulous spaces by turning a neighboring two-unit space into two one-unit spaces
  • The temporary implant may serve as anchorage
49
Q

In which cases an implant supported solution is preferred?

A
  • unrestored, healthy neighboring teeth
  • overly prepared teeth or compromised risky abutments
  • diastemata
50
Q

options of provisional prosthesis following tooth extraction prior to implant placement:

A
  • Acrylic RPD
  • Essix provisional splint (removable prosthesis)
  • Resin-bonded pontics or bridge (Maryland)
51
Q

Acrylic RPD:
ADV:
DISADV:

A

ADV:
•Simple to construct
•Cheap
•Easy to adjust and fit

DISADV:
•May apply too much pressure to the healing site
•Not comfortable
•Aesthetically might not be that good for patients

52
Q

Essix provisional splint (removable prosthesis):
ADV:
DISADV:

A

ADV:
•Doesn’t apply pressure on the healing site
•Protects the underlying soft tissue and implant during healing phase
•Can be used in cases of limited interocclusal space or in deep anterior overbite

DISADV:
•Unable to mold the surrounding soft tissue
•Lack of patient compliance can cause rapid occlusal wear from the vacuum form material

53
Q

Resin-bonded pontics or bridge (Maryland):

A

ADV:
•More comfortable from a functional and phonetic point of view
•More esthetic
-Better option than removable, because you don’t have anything moving around and pushing the tissue, you have something that is stable; bonded and is aesthetically good

DISADV:
•Their removal and rebonding after the surgical intervention requires more time and work from the dentist

54
Q

peri-implant health =

A
  • absence of clinical signs of inflammation (ex: swelling, redness)
  • absence of bleeding/suppuration on gentle probing
  • no increase in probing depth compared to previous examinations
  • no bone loss
55
Q

peri-implant mucositis =

A
  • bleeding and/or suppuration on gentle probing

* no bone loss

56
Q

When you have bone loss for the first time then it is:

  • peri-mucositis
  • peri-implantitis
A

peri-implantitis

57
Q

When you have increased PPD then it is:

  • peri-mucositis
  • peri-implantitis
A

-peri-implantitis

58
Q

let’s say you see a patient for the first time and the implant area has bleeding on probing, suppuration and bone loss. What would you characterize it?

  • peri-mucositis
  • peri-implantitis
A

-peri-implantitis

59
Q

if it is your own patient, and you have multiple radiographs in a sequence where the bone level is the same (stable) and all of a sudden you have BoP, but you don’t have PPD (more than what you had before) then probably it will be:

  • peri-mucositis
  • peri-implantitis
A

-peri-mucositis

60
Q

Is peri-implant mucositis a reversible disease?

A

Yes, because there is no bone loss. (It is like gingivitis – inflammation of soft tissue)

61
Q

What is the aetiology of peri-mucositis?

A

Plaque (remove plaque then -> reversed)

62
Q

peri-implantitis =

A

= a plaque-associated pathological condition that occurs in tissues around dental implants
Characteristics:
•bleeding and/or suppuration on gentle probing
•increased probing depth compared to previous examinations - probing depths of ≥ 6 mm (subgingivally)
•bone loss - bone levels ≥ 3 mm apical of the most coronal portion of the intra-osseous part of the implant

63
Q

What is the difference in disease progression between periodontitis and peri-implantitis?

A

peri-implantitis -> faster than in periodontitis and occurs in a non-linear and accelerating pattern

Due to micro-rough surface of implant, which is paradise for bacteria to stick to, difficult for us to clean, so accelerated progression

64
Q

risk factors for peri-implantitis:

A
  • patients with poor plaque control who do not attend regular maintenance therapy
  • rough surface
  • uncontrolled diabetes
  • bad OH
  • smoking
  • history of severe periodontal disease (the main risk factor is)
65
Q

the difference between severe perio disease and others are:

A

genetics

66
Q

most common complications regarding tooth supported single crowns:

A
  • post-cementation endodontic therapy (3%) - first
  • porcelain fracture (3%)
  • loss of retention (2%)
  • periodontal disease (0.6%)
  • caries (0.4%)
67
Q

most common complications regarding tooth supported FPDs:

A
  • caries (18% abutments; 8% prostheses)
  • need for endodontic treatment (11% abutments; 7% prostheses)
  • loss of retention (7%)
  • esthetics (6%)
  • periodontal disease (4%)
  • tooth fracture (3%)
  • prosthesis fracture (2%)
  • porcelain veneer fracture (2%)
68
Q

complications regarding implant supported restorations:

these do not apply:

A

Pulpal complications, periodontal disease (for here would be peri-implantitis) and caries

69
Q

Would you recommend a tooth supported restoration to a periodontal patient?

A

yes but OH and maintenance are important

70
Q

Would you recommend an RPD to a periodontal patient? What would be your risks and most important factors to consider?

A

not the ideal option, but you can

OH and more recalls are important

risk for technical complications such as loss of retention, loss due to abutment fracture and material complications

71
Q

use of non-vital teeth as abutments:

A

increased loss of retention

fracture of teeth and cores

72
Q

Objectives of perio tx:

A

Maintain, improve and preserve dentition, periodontium, implants and peri-implant tissues

73
Q

Portion of collagen fibers penetrating into cementum and bone:

A

Sharpey fibers

74
Q

In which disease you still have sharpey fibers intact in sockets? What would be the tx?

A

Acute perio abscess

AB and instrumentation of the pocket

-in periodontitis you don’t have them

75
Q

Is periodontitis a consequence of gingivitis?

A

Not always

76
Q

Is periodontitis linear?

A

No, it is a non-linear disease with bursts and rests

77
Q

If you stop brushing, gingival inflammation will occur when?

A

Might start in 10 days but in 21 days definitely you will have

78
Q

Describe the gingiva

A 
Reddish
Swollen interdental papilla
Gingival recession
No stippling of the gingiva
Reduced scalloped outline
79
Q

Medications causing gingival enlargement:

A

Anti-seizure - Phenytoin
Immunosuppressant - Cyclosporine A
Calcium channcel blocker - nifedipine

80
Q

Necrotizing ulcerative periodontitis characteristics:

A 
Loss of interdental papillae!
Plaque
Redness
Swelling
Bleeding
81
Q

What induces necrotizing ulcerative periodontitis?

A

Malnutrition
Stress
Smoking
Bad OH

82
Q

How can you treat necrotizing ulcerative periodontitis?

A

Antibiotics
Hydrogen peroxide mouthwash
debridement

83
Q

Single periodontal abscess can be found when?

A
  • incomplete calculus removal or forcing calculus deeper in the socket
  • after perio surgery
  • after perio tx
  • after systemic antibiotic tx
  • due to recurrent disease
  • foreign body impaction
84
Q

Multiple periodontal abscess occurs when?

A

Uncontrolled diabetes mellitus

Impairment of immune system

85
Q

What would you ask to see if the DB is controlled?

A

Hb1Ac levels -> less than 7

86
Q

Tx for abscess:

acute:
Vs
chronic:

A

acute abscess:

  • AB and then
  • LA
  • scaling and root planning
  • OHI

chronic abscess:

  • LA
  • scaling and root planning
  • drainage if needed
  • OHI
87
Q

Which is worse?

  • Endo-perio lesion
  • Perio-endo lesion
A

Perio-endo lesion bc it reaches the apex and infects the pulp - doubtful prognosis

Endo-perio:
Necrotic tooth
Accessory canals spread of infection
Deep Pocket depths

88
Q

Non-surgical tx steps:

A 
OHI
Plaque disclosing agents
Smoking sensation if needed
Anesthesia
Scaling and root planning
Re-evaluation (after 3w then 6w)
Check if surgery is needed
89
Q

Major risk factor of periodontitis:

A

Smoking

90
Q

First evaluation appointment steps after non-surgerical tx:

A
  • Check plaque reduction with plaque disclosing tablets
  • Do perio chat (PPD, furcation, plaque, mobility, BoP, recessions)
  • OHI
91
Q

Red complex bacteria:

A

P gingivalia
T forsythia
T denticola

92
Q

common reasons of implant loss:

A
  • excessive or premature loading
  • > excess forces leading to osseointegration failure
  • trauma from surgeries
  • > inflammation leading to osseointegration failure
  • cement retention
  • > excess cement leading to overflood of bacteria etc
  • dentist
  • infection/contamination
93
Q

When do we observe the majority of implant loss occurring and why?

A

before functional loading

  • didn’t follow the protocol
  • iatrogenic factor
  • soft bone
  • no implant-bone contact
94
Q

What is the min thickness of bone necessary to prevent bone dehiscence around an implant?

A

min 1 mm thickness of B plate

95
Q

risk factors for implant loss:

A
  • bone type IV
  • smoking
  • parafunctional habits
  • radiation therapy
  • occlusal loading
  • history of periodontal disease
96
Q

how would you treat a malpositioned implant?

A

if not visible: nothing
if visible: repeat - go minimally invasive as possible, augment soft tissue minimally, don’t touch the crown, do a more apical flap and place soft graft, then pray otherwise refer

97
Q

malpositioned implant =

A

= an implant placed in a position that creates restorative and biomechanical challenges

98
Q

reasons for placing an implant with poor prosthetic angulation:

A
  • bone deficiency
  • GBR wasn’t performed
  • no surgical guides
  • lack of skill to make GBR
  • not correct tx planning
99
Q

complications of placing an implant with poor prosthetic angulation:

A
  • prosthetic complications
  • screw loosening
  • decementation
  • aesthetic problems
  • difficulty in OH and biologic complications
100
Q

how to prevent malpositioning of an implant:

A
  • proper tx plan
  • skills
  • augmentation procedures with the use of biomaterials, autografts or allografts
101
Q

Aa =

A

= aggregatibacter actinomycetemcomitans

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