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Implant > Wound Healing And Anatomical Considerations For Implants > Flashcards

Wound Healing And Anatomical Considerations For Implants Flashcards

1
Q

Who discovered that when pure titanium comes into direct contact with the living bone tissues, the two form a permanent adhesion (osseointegration)

A

Professor Per-Ingvar Branemark - father of modern day implantology

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2
Q

Types of implant healing

A

Fiber integration
Fibo osseous integration
Osteo integration

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3
Q

Fibro osseous integration

A

-Tissue to implant contact with dense collagenous tissue between the implant and bone
-initially good successor ate but extremely poor long term success
-failure by todays standards
-soft tissue contact with implant

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4
Q

Osseointegration

A

Direct connection between living bone and load bearing endosseous implants at the light microscopic level

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5
Q

Repair

A

Results in tissues that are structurally and functionally different form their pre injury sites

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6
Q

Regeneration

A

Results in tissues that are structurally and functionally similar to their preinjured site

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7
Q

GTR

A

Guided tissue regeneration
In periodontal defects include furcation of new bone, cementum, and PDL (around tooth)

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8
Q

GBR

A

Guided bone generation
On bone

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9
Q

Stages of bone healing

A

Phase 1= inflammatory phase
Phase 2= proliferation phase
Phase 3= maturation phase

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10
Q

Phase 1- inflammatory phase Days

A

1-10

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11
Q

Things that happen in phase 1 (inflammatory phase)

A

Platelet aggregation and activation
Clotting cascade activation
Nonspecific cellular inflammatory response
Specific inflammatory response
Macrophages mediated inflammation

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12
Q

Phase II proliferative phase days

A

3-42

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13
Q

What happens during phase II (proliferative phase)

A

Neovascularization on the clot
Differentiation, proliferation and activation of cells (fibroblasts —> osteoblasts, osteoclasts)
Production of immature connective tissue matrix (Granulation tissue)

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14
Q

Phase III (maturation phase) days

A

After day 28

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15
Q

What happens during the phase III (maturation)?

A

Remodeling of the immature connective tissue matrix with coupled resorption/depostion of bone
Physiologic bone resorption

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16
Q

Bone modeling

A

When bone resorption and bone formation occur on separate surfaces
Formation and resorption are not coupled
Causes change in bone shape
Ex. Ortho forces

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17
Q

Bone remodeling

A

Replacement of old tissue by new bone tissue
Formation and resorption are coupled at same site
No changes in shape
Normally: implant site healing

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18
Q

Junctional epithelium

A

Attaches to implant surface by basal lamina and hemidesmosmes (same as teeth)

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19
Q

Connective tissue attachment

A

Fibers parallel to implant surface
No direct attachment to implant surface
20nm amorphous glycoproteins layer between CT and implant

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20
Q

Biological width

A

Peri implant biological width is similar to width around natural teeth and serves similar protective barrier functions
THE WIDTH IS LARGER THAN BIOLOGICAL WIDTH AROUND TEETH DUE TO LONGER JUNCTIONAL EPITHELIUM
Peri-implant CT fibers are generally parallel to the implant surface, tight adhesive attachment to the implant surface

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21
Q

Why is it important to have maintenance of the soft tissue seal (junctional epithelium, CT)?

A

Prevent peri implant mucus it is and peri implantitis
Bacterial can pass through easier on an implant surface than on a tooth surface

22
Q

Marginal inflation —» ________ —-> per implant bone loss ——-> ________ —-> eventual implant loss

A

Apical spread ; peri implanttitis

23
Q

How is the tissue interface around the implant similar/different to tooth?

A

Has junctional epithelium and CT but no PDL
Weak attachment

24
Q

Does inflammation spread faster from soft tissue to implant or soft tissue or tooth?

A

SOFT TISSUE TO IMPLANT

25
Q

Peri implant sulcus

A

Microbes more pathogenic

26
Q

Factors that affect healing

A

Surgical technique
Pt selection
Oral hygiene
Bone density
Site selection

27
Q

Surgical technique

A

Frictional heat= temp threshold is 47 degrees C
Greater = failure to achieve ossoeintegration = thermal injury
Necrosis of bone

28
Q

How can you reduce heat

A

Gentle surgical technique, using sequential drills, use sharp drills, copious irrigation, use drills at recommended RPM

29
Q

Drilling sequence for osteotomy

A

Small to large

30
Q

Surgical technique two methods

A

Delicate soft tissue manipulation - maintain periosteal integrity and keratin end tissue and soft tissue biotype
Periosteum - has blood vessels and local osteoblasts, important for bone healing

31
Q

Compression necrosis

A

Drilling into dense bone - compression of trabecular marrow space, lost blood supply, necrosis
Dependent on - high insertion torque and high bone density type

32
Q

D1 bone density

A

Oak/maple wood

33
Q

D2 bone density

A

White pine or spruce wood

34
Q

D3 bone density

A

Balsa wood

35
Q

D4 bone density

A

Styrofoam

36
Q

Cortical bone density

A

Mandible > Maxilla

37
Q

Most dense

A

Mandibular anterior - less blood supply

38
Q

Least dense

A

Maxillary posterior
Poor quality
Soft bone but good blood supply

39
Q

Anterior vs posterior cancellous

A

Anterior = more
Posterior= less

40
Q

Rough surface implants

A

Majority of implants today
Increase roughness (surface treated, HA coats, plasma sprayed, sand blasted
Increase SA, cellular attachment, primary stability, bone implant contact, success rate

41
Q

Machined surfaces

A

Smooth surface
More bone loss than rough
Decrease primary stability, less success, not used anymore

42
Q

Primary stability

A

At time of implant
Decrease over time - 1st osteoclastic activity followed by osteoblastic response
Osseointegration and healing occurs —> secondary stability (1-2 weeks)
Most important during placement
Micro movement of implant is the most common cause of implant failure (fibrous encapsulation)

43
Q

Mylohyoid ridge

A

Careful palpation —> concavity below the ridge anteriorly (sublingual fossa), posteriorly (submandibular fossa)
Implants in post mandible high risk entering submandibular fossa ( highly vasuclarized) —> hemorrhage
Can be life threatening

44
Q

Inferior alveolar nerve and mental foramen

A

Minimum 2 mm safe distance between implant and nerve
Canal is surrounded by cortical bone —> however, tactile feedback cannot be relied on
No substitutes for radiometrics, pre, intra, post operative PAs super important
When in doubt CBCT

45
Q

Anterior loop of Ian

A

Majority of cases —> anterior loop is present
Average loop dimensions: 3 mm
PLACE IMPLANT AT LEAST 5 MM ANTERIOR TO THE LOOP - distance from implant surface to foramen not the osteotomy

46
Q

Mental foramen

A

Differs in horizontal and vertical plane
2mm distance between implant apex and foramen
When in doubt, can surgically locate the foramen

47
Q

Lingual nerve

A

75% times
3 mm apical to the crest of the 3rd molar and 2mm from the lingual cortical plate in the flap
Avoid lingual vertical incisions

48
Q

Nasopalatine foramen and canal

A

Contains nasopalatine nerve and sphenopalatine artery
Could be at site of implant placement
Complete degranulation of canal —> place implant —> graft the canal

49
Q

Greater palatine foramen and artery

A

Greater palatine artery foramen - near 3rd molar
When harvesting tissue graft- careful reflection to prevent hemorrhage

50
Q

Maxillary sinus pneumatization

A

Need sinus lift either lateral wall or osteotomy mediated

Implant (10 decks)

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