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Oral Surgery > soft tissue- Grafting > Flashcards

soft tissue- Grafting Flashcards

1
Q

bone augmentation types

A
  1. block graft
    - take block of bone from patient
    - adding volume
  2. GBR- guided bone regeneration
    - cadaver or pt. bone mixed together and putting membrane on it
    - adding volume
  3. ridge split
    - can do this if have VOLUME ALREADY
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2
Q

patient evaluation

A

importance of the dental or medical history

anything medical / patient factors that may not be aware of / contra-indications for various treatments

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3
Q

bone grafts are driven?

A

PROSTHETICALLY

have plan in mind first - restoration planned and deign and then determine if you need this

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4
Q

3 main grafing used in implant surgery

A
  1. soft tissue grafting
  2. bone augmentation
  3. sinus lift
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5
Q

stages of soft and hard tissue management

A

varies
- like may need to do soft tissue graft before bone tissue

soft tissue can be at multiple stages

hard tissue augmentation – 2 options – before or at time of placement

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6
Q

timing of hard tissue augmentation / bone graft

A
  1. BEFORE placement
  2. during

predictability of doing it once patient has the restoration is variable

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7
Q

height or width - harder to augment?

A

HEIGHT

width - easier

hardest when do not have height or width

vertical augmentation – do need to do it?? because risk of failure is higher

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8
Q

local risk factors for grafting

A
  1. previous history of graft failure
  2. scaring in the area of grafting
  3. frenums in the area to be grafted
    - Pulls tissue and can open
  4. volume and direction of grafting needed
  5. size/ span of defect
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9
Q

implication of scaring in area of graft

A

NO BLOOD SUPPLY AND WE NEED BLOOD SUPPLY FORO HEALING

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10
Q

soft and hard tissue augmentation go

A

hand in hand

- sometimes need one before the other and vise versa

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11
Q

hard area to restore with grafts

A

unilateral esthetici zone like 7 and 8 and not having to do 9 and 10

easier to do 7-11 vs the two

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12
Q

non vascularized bone grafts heal?

A

through a sequence of events
- grafts usually undergo partial necrosis - osteocytes death

followed by an inflammatory stage – existing bone is replaced with new bone by osteoblasts brought in by invading vessels

“creeping subsitution” -the slow process of vessel invasion and bony replcemetn

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13
Q

creeping subsitution”

A

in bone graft healing – the slow process of vessel invasion and bony replacement

bone that forms is of the origin (like bone graft with hip in maxilla will become maxillary bone)

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14
Q

all bone grafts we do for dental are

A

NON-vascularized

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15
Q

bone graft physiology

A
  1. clot / hematoma foramtion
  2. process of inflamamtion
  3. revascularization
  4. osteoconduction
  5. osteoinduciton
  6. osteogenesis
  7. remodeling
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16
Q

rate of revascularization in cancellous bone?

A

faster – b/c more architecture

occurs RAPIDLY AND COMPLETELY due to its open architecture that allows easy invasion of blood vessels

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17
Q

revascularization of cortical bone

A

SLOW AND INCOMPLETELY

  • due to its dense lamellar structure
  • vessels must penetrate along haversian and volkmann’s canal

remodels less

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18
Q

inlay vs onlay

A

inlay – inside bone

onlay - on top of bone

  • so depending on vessels coming from beneath vs coming from within and around in inlay
  • need the vascularization

INTERPOSITION/ INLAY – maintained violume and preserved significantly better than onlay grafts

19
Q

interpiosition graft aka

A

inlay

20
Q

BEST GRAFTING MATERIAL

A

EMBRIOLOGIC ORIGIN
- from the skull

  • gets remodeled less
21
Q

rigid fixation

A

use of rigid fixation in fracture repair results in primary bone healing

the effect of rigid fixation on bone grafts results in bone graft survival, greater bony union, increased primary bone healing and rapid re-vascularization by virtue of graft IMMOBILITY

dont want graft to move
- if have movement - wont get the re-vascularization and may get fibrous tissue in area / scarring- not good

22
Q

graft orientation

A

cancellous – against bone

bone grafts had better survival when their cancelloous surfaces contacted the bone even though grafts with cancellous surfaces facing soft tissue revascularized sooner

cortical - against the periosteium

23
Q

recipient site

A

grafts placed in avascular bed do NOT survivie well

other factors at the recipient site include prior irridation, infection, and tissue scarring

24
Q

best grafts are

A

from head and mixture of cancellous and cortical

cancellous –> revascularization

cortical –> to resist resorption

25
Q

sites block grafts often taken from

A
  1. chin
  2. ramus
  3. body of mandible
  4. hip
  5. calvarium
    - best option
    - used more for trauma
26
Q

hip vs chin and ramus

A

we get more volume from the hip

27
Q

technique often used

A

uses ultra-sonic and chisel

28
Q

most comfortable (for patient) area to take bone from

A

ramus

- can take and cut into multiple pieces

29
Q

fixate the bone grafts with

A

screws - score it and primary closure

30
Q

rigid fixation for

A

vascularization – idealy 2 screws

31
Q

4 maor things need for bone graft

A
  1. rigid fixation
  2. good adaption of the graft
    - one of the most important things – may need to shave recipient side or the graft
  3. passive soft tissue closure
  4. 4-6 months of healing
    - want remodeling to occur - before place implant
32
Q

soft tissue closure?

A

need to SCORE the periosteum to allow soft tissue to expand

33
Q

graft blood upply dependent on

A

vascularization from the recipient side

34
Q

ridge split - general

A

taking the bone we have and making it WIDER

use of an ultra-sonic machine to make cuts

  • use chisel to lift up a little and spread it apart
35
Q

____ needs to be longer than what your splitting with ridge split

A

IMPLANT

FOR PRIMARY STABILITY

works because bone is wider at bottom and opposite with the implant

need the width of bone where you place the implant

36
Q

Guided bone regeneration

A

membrane to exlcude soft tissue from going in

healing is coming from the bone underneath the membrane

37
Q

most predictable cases when doing guided bone regeneration

A

when there is adjacent bone around

so works well when have 3 wall defect (not as well when 1 wall defect)

38
Q

when have 3 wall defect use?

A

guided bone regeneration

healing starts from those walls!

most remodeling occurs on buccal because thinner

39
Q

healing of guided regeneration

A

same
allow about 6 months healing

from bone within
membrane excludes the periosteum

40
Q

approaches to sinus augmentation

A
  1. crestal approach

2. lateral window approach

41
Q

prerequisite for one stage implant placement and sinus lift

A

4-5 mm of bone HEIGHT

42
Q

external sinus lift healing?

A

6-9 months then implant placement

43
Q

if have less than 5 mm (residual height of bone) of bone height and sinus lift?

A

have to do external sinus lift - wait 6-9 months then implant placement

44
Q

options if residual bone height is greater than 5 mm with sinus lift / external sinus lift

A
  1. simultaneous / immediate implant placement with sinus lift
  2. external sinus lift
    - wait 6-9 months for healing
    - implant placementn

Oral Surgery (26 decks)

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