Sweep 1

Question 1

Osseointegration:

Answer 1

The direct attachment or connection of vital osseous
tissue to the surface of an implant, without intervening
connective tissue.

Question 2

Rigid fixation –

Answer 2

Clinical term to define osseointegration

Question 3

Various steps used in surgical procedure:

Answer 3

1- Incision

2- Mucoperiosteal flap elevation

3- Preparation of a bed in the cortical and 		    spongy bone (osteoctomy)

4- Insertion of the titanium device

Question 4

Initial implant stability –

Answer 4

press-fit implant placement

Lateral displacement of bone tissue and the tight
contact at the cortical bone level.

Question 5

Surgical trauma –

Answer 5

Initiation of wound healing.

Question 6

Ultimate implant goal:

Answer 6

The implant to become “anchylotic” with the bone

The establishment of a mucosal attachment

Question 7

24 hrs healing –

Answer 7

Resorption at the cortical bone.
Woven bone formation in the spongious bone.
Blood clot formation.
Proliferation of vascular structures into newly
forming granulation tissue.

Question 8

1 week healing-

Answer 8

Reparative macrophage and undifferentiated
mesenchymal cells.
Modeling at the apical trabecular region and
at the “furcation sites” of a screw-shaped
implant.

Question 9

2 weeks healing –

Answer 9

New bone formation can be detected at

the “furcation sites” of the implant surface.

Question 10

Up to 6 weeks healing –

Answer 10

Callus formation and lamellar

compaction within woven bone.

Question 11

During healing, you see

Answer 11

Temporary decrease in implant stability
Plateau effect in implant stability after 6 weeks and
Enhanced bone formation around implant.

Question 12

“Jumping distance” concept –

Answer 12

The distance that can be filled by new bone between the implant and the remaining host bone.

Question 13

Ideal tolerable distance =

Answer 13

20-40 microm

A larger gap does not heal well.

Question 14

TPS=

Answer 14

Titanium Plasma Sprayed

Question 15

SLA=

Answer 15

Sand Blasted Acid Etched

Question 16

HA=

Answer 16

Hydroxyapatite

Question 17

TCP=

Answer 17

Tricalcium Phosphate

Question 18

Titanium is mostly used as

Answer 18

Ti-6Al-4V alloy.

Covered with a layer of titanium dioxide.

Biologically inert.

Increase in thickness with time.

Porosity increases surface area.

Question 19

Bone response is stronger to surfaces with

Answer 19

irregularity values of 1.0-1.5 microns.

Question 20

An implant should be surrounded with a minimum of

Answer 20

1 mm alveolar bone thickness.

Question 21

Minimum bone thickness between 2 implants should

be

Answer 21

3 mm (implant surface to implant surface) and

Question 22

minimum bone thickness between an implant and

a tooth should be

Answer 22

4 mm (from root surface to implant 
surface).

Question 23

Coronal part of an implant should be placed

approximately

Answer 23

5 mm apical to the adjacent CEJ.

Question 24

Obtaining maximum parallelism between

Answer 24

implants and
teeth is critical.

Implants do not have periodontal ligament and cannot
tolerate horizontal forces.

Question 25

An implant can be placed with a maximum of

Answer 25

20 angle.

Question 26

The transmucosal attachment-

Two parts:

Answer 26

Barrier epithelium
(2 mm long)
Zone of connective tissue
(1-1.5 mm high)

Collagen fiber bundles parallel
to implant surface.

Question 27

Zone that is adjacent to implant surface is rich from

Answer 27

fibroblast but poor from blood vessels.

Question 28

Zone that is in lateral direction and continuous with

the first zone has fever

Answer 28

fibroblasts but it is rich in

collagen fibers and blood vessels.

Question 29

Blood supply coming only from

Answer 29

supraperiosteal blood

vessels.

Question 30

Two stage implant placement sx=

Answer 30

submerged tech.

Question 31

One stage implant placement sx=

Answer 31

non-submerged tech.

Question 32

Microgap =

Answer 32

Micro space that exists
between implant and abutment.

It is generally located at alveolar
crest.

Question 33

Biological width concept and dental implants-

Answer 33

A biological width exists around unloaded and loaded
nonsubmerged one-part titanium implants.
It is approximately 3 mm.

Question 34

Clinical parameters used to evaluate peri-implant health:

Answer 34

1- Absence of mobility
2- Radiographic examination
3- Absence of bone loss 0.2 mm/year following the first
year
4- Absence of any pain, complain and infection
5- Functional and esthetic acceptance of implant
supported restoration by both patient and doctor
6- A success rate of 94-98% following 5 years and
90-94% following 10 years

Question 35

3 available techniques to evaluate dental implants:

Answer 35

1- Peri-implant probing
2- Existence of mobility
3- Radiographic examination

Question 36

RFA (Resonance Frequency Analysis)

Answer 36

Mechanically, the resonance frequency of an object

is strongly correlated to the boundary constrains of the structure.

Question 37

A.a is associated with LAP

Answer 37

Facultative anaerobe, nonmotile.
Virulence factors:
Leukotoxins: kills PMNs and MΦ
LPS: activates cells to produce PGs, IL-1, TNF-
Collagenases: degrades collagen fibers 
Immunosuppressive factors : 
Lymphocyte supprressing factors
Chemotactic suppressing factors 

Translocate across the JE
Invade the CT

Question 38

P. gingivalis

Answer 38

Anaerobe, nonmotile, G-. 
Virulence factors: 
Proteinases: Gingipains, Collagenases 
LPS: activates cells to produce PGs, IL-1β, TNF-α 
Inibits IL-8: ↓ chemotaxis of PMNs.

Question 39

Diagnosis of AP

Quesations to answer

Answer 39

Microbiologic diagnosis
A.a., P.g., both, neither one?
Biochemical analysis
Crevicular PGE2 levels largely increased?
IgG2 titers against A.a.?

Question 40

Major microbial virulence factors

Immunostimulatory molecules

Answer 40

LPS (endotoxin) from Gram-negative bacteria, disrupt host response
Lipoteichoic acids from Gram-positive bacteria
Gingipains (Arg-specific protease)
Formylpeptides (stimulate leukocyte chemotaxis) - chemotactic factors for phagocytic leukocyytes. They guide leukocytes to source of infection. Other surface antigens on pathogenic bacteria
Other surface antigens

Question 41

Complement system

Induces

Answer 41

bacterial lysis
Promotes phagocyte recruitment (chemotaxis)
Promotes phagocytosis by opsonization of bacteria
Helps activate mast cells, which increases vascular permeability

Question 42

Oral mucosa produces

Answer 42

anti-microbial peptides (e.g., defensins)

Question 43

Oral epithelium produces

Answer 43

pro-inflammatory cytokines

Question 44

IL-1ß and TNF-α are universal signals of

Answer 44

infection that help recruit inflammatory cells

Question 45

IL-8 attracts

Answer 45

neutrophils in the early stages of infection

Question 46

In gingival crevicular fluid and saliva – secretory IgA helpful antibody that prevents

Answer 46

certain bacteria adhering.

Question 47

Von Ebner’s glands – release

Answer 47

antimicrobial peptides (similar to histatins).

Question 48

Toll-like receptors (TLRs)

Answer 48

Major role in induction of innate immune response
Recognize conserved microbial-associated molecular patterns (including LPS, lipoteichoic acid and flagellae)
Expressed by all cells, including epithelial cells, PMNs, monocytes and macrophages
TLRs signal for cells to produce cytokines, chemokines, antimicrobial peptides, nitric oxide and eicosanoids

Question 49

Biological activities of LPS (endotoxin)

Answer 49

Complement activation
PMN activation
Macrophage activation
B-cell mitogen activity
Stimulation of bone resorption
Stimulation of prostaglandin synthesis
Induction of Tumor Necrosis Factor (TNF-α)

Question 50

Mediators of innate immunity: Cytokines

Pro-inflammatory activity:

Answer 50

IL-1β, TNF-α

Question 51

Mediators of innate immunity: Cytokines

Chemotactic activity:

Answer 51

IL-8 – neutrophil attractor.