The surgical aspects of implant treatment Flashcards

1
Q

What preoperative preparations do we need to make before implant surgery

A
  1. Proper diagnostics
  2. Treatment plan
    3Pt explanation, warnings and informed consent
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2
Q

How do we carry out asepsis of the implant site

A
  1. Chlorohexidine mouth rinse pre op
  2. Skin preperation
  3. Isolation of surgical field with barrier draping
  4. Protection of patient and staff from cross infection
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3
Q

What are the stages of traditional implant surgery 1st stage

A
  1. Asepsis
  2. LA
  3. Incision
  4. Flap reflection
  5. Bone preparation
  6. Positional guide
  7. Enlarging osteotomy site
  8. Placement, torque and primary stability
  9. Cover screw placement, wound closure and temporisation
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4
Q

What do we mean by bone preparation

A

Getting through the soft tissue remnants to the bone

Cresting a flatten or scallop ridge crest

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5
Q

Talk through atraumatic implant site preparation

A
  1. Low speeds/ high torque
  2. Sharp graduated drills
  3. Efficient cooling/ evacuation of debris
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6
Q

What can happen if don’t have adequate cooling during bone preparation

A

If temperature reaches above 47 degrees fro 1 min bone necrosis will occur

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7
Q

What are the 4 different bone types called

A

I
II
III
IV

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8
Q

Describe bone quality I

A

Homogenous cortical bone

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9
Q

Describe bone quality II

A

Thick cortical bone with marrow centre

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10
Q

Describe bone quality III

A

Thin cortical bone with dense trabecular bone of good strength

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11
Q

Describe bone quality IV

A

Very thin cortical bone with low density trabecular bone of poor strength

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12
Q

Name the 3 positions we need to consider when placing our implant

A
  1. Mesio distal
  2. bucco palatally
  3. Apico coronally
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13
Q

What post operative considerations need to be made after implant surgery

A
  1. Avoid disturbing the surgical site
  2. Avoid alcohol, smoking and vigorous exercise
  3. Antibiotics
  4. Analgesics
  5. Cholorhexidine mouth rinse
  6. Ice pack
  7. Keep wel hydrated
  8. Balanced soft diet
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14
Q

After the first stage of implanted surgery is completed what do we wait for

A

For the bone and implant to integrate

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15
Q

Talk through the steps of the 2nd stage of implant surgery

A
  1. Simple crest incisor
  2. Reflection of soft tissues
  3. Removal of cover screw
  4. Check bone
  5. Placement of healing abutment
  6. Soft tissue sculpting
  7. Placement of sutures
  8. Allow soft toss healing for 4 weeks
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16
Q

If we find soft tissue is lacking interdentally between multiple implants what can we do

A

Implant exposure using rotation finger flaps

17
Q

what are rotational finger flaps called

A

Palacci flaps

18
Q

How do we create palace flaps

A
  1. Create a crystal incision
  2. Reflect flap to buccal
  3. Connect healing abutments
  4. Semi lunar incisors from distal of implant
  5. Rotate mini finger flaps medial into internal space and suture
19
Q

What do we space on the implant after the second stage

A

A provisional crown fro 3 months to allow soft tissue remodelling

20
Q

What do we mean by immediate placement of implants

A

Implants placed in to extraction sockets

21
Q

What do we mean by delayed/ early placement of implants

A

Implants placed in to extraction sockets 6-8 weeks post extraction

22
Q

What do we mean by delayed/ late placement of implants

A

Implant placed more than 3 months post extraction

23
Q

What considerations do we need to make before immediate placement of implants

A
  1. Bone quality and quantity
  2. Integrity of buccal plate
  3. Implant to bone gap
  4. Primary stability
  5. Infection
  6. Soft tissue biotype
  7. Temporisation
24
Q

How do we carry out immediate implant placement

A
  1. Careful removal of tooth
  2. Assess bone
  3. Use pilot drill to establish orientation of implant
  4. Protection of buccal plate of bone
  5. Prepare site Using direction indicator and surgical guide
  6. Implant placement
  7. Graft material between implant and socket wall
  8. Placement of healing abutment
25
Q

How do we carry out delayed immediate implant placement

A
  1. Extract teeth
  2. Soft tissue healing over 6 weeks
  3. Flap reflection
  4. Contour down bone
  5. Implant placement with surgical guide
    6.
26
Q

List the different techniques we can use to augment deficient ridges

A
  1. Ridge expansion
  2. Guided bone regeneration
  3. Block only grafts
  4. Maxillary sinus grafts
  5. Combination procedures
27
Q

What is ridge expansion

A

mechanically pushing out the buccal plate of bone to create space for an implant rather than drilling a hole for the implant

28
Q

How do we carry out guided bone regeneration

A
  1. use a choral to remove bone chips from surrounding bone
  2. Decorticate the bone a chisel or bur
  3. Place bone chips over the implant site and adjacent area to augment deficient site
  4. Biomaterials can be used further augment the site and protect autogenous bone chips for resorption
  5. Collagen membrane is placed over the area
29
Q

Why is a collagen membrane placed over there area following guided bone regernation

A

To protect the soft tissues in growth

30
Q

Where can ewe harvest block bone cells fro a block only graft

A

The mental region

31
Q

Name a technique we can use to carry out maxillary sinus graft

A

Lateral windows technique

32
Q

Talk though the lateral window technique

A
  1. Use large particles of bovine bone granules mixed with bone chips and blood to graft the sinus floor
  2. Porcine collagen membrane is placed over the lateral window and stabilised with titanium tacks prior to closure
  3. 6 months needed for healing before implant placed