Applied Dental Materials 2 Lecture 8 (Dental Implant Materials)

Front 1

What are three categories used to classify implants?

Back 1

implant design, implant properties, attachment mechanism

Front 2

What are 4 main implant designs?

Back 2

edosteal, subperiosteal, transosteal, epithelial

Front 3

What are the 5 properties used to rate implants?

Back 3

yield strength, elastic modulus, elongation, tensile strength, ductility

Front 4

What are the two main attachment mechanisms of implants?

Back 4

osseointegration, fibrous-integration

Front 5

Which of the 4 main implant designs us most commonly used?

Back 5

endosseous implant

Front 6

Which type of implant is embedded in the mandible or maxilla and projects through the oral mucosa on an edentulous ridge?

Back 6

endosseous implant

Front 7

True or False, endosseous implants have fewer clinical limitations

Back 7

True

(It doesn't say fewer than 'what', just fewer)

Front 8

In implants >15 years, what is the success rate of endosseous implants in the mandible and maxilla?

Back 8

>86% in mandible
>78% in maxilla

Front 9

What are the three subtypes of endosseous implants?

Back 9

root form
blade (plate) form
ramus form

Front 10

Which subtype of endosseous implant is designed to mimic the shape of tooth root for directional load and proper positioning in bone?

Back 10

root form

Front 11

What is the only type of endosseous implant that has long term clinical results published?

Back 11

root form

Front 12

What is the most commonly used implant in clinical practice? (be very specific)

Back 12

screw-threaded variety of endosseous root form implant

Front 13

True or False, root form endosseous implants are considered very technique insensitive often requiring 1 surgical stage

Back 13

FALSE, is technique sensitive and may require several surgical stages

Front 14

What types of endosseous implant (out of 3) can be used on partially edentulous patients?

Back 14

root and blade (plate) form.

ramus form is ONLY for completely edentulous, however, all 3 can be used on completely edentulous

Front 15

The following describes what kind of endosseous implant?:

in completely or partially edentulous patients, multiple-tooth replacement, used in narrow spaces, excessive bone loss, no documented success rate, not used much currently

Back 15

blade (plate) form

Front 16

A ramus frame is a type of ___ implant used for completely edentulous patients and has (perfect/no) documented success rate

Back 16

endosseous, no

Front 17

Which type of implant has the lowest success rate and what is the success % after 15 years?

Back 17

subperiosteal, 55%

Front 18

Which implant type is the least stable?

Back 18

subperiosteal

Front 19

Which type of implant involves impression-making surgical technique?

Back 19

subperiosteal

Front 20

Which type of implant has issues due to slow rejection of the implant, difficult retrievability, and excess bone loss associated with failure?

Back 20

subperiosteal

Front 21

What are the three subtypes of subperiosteal implants?

Back 21

complete
unilateral
circumferential

Front 22

Which subtype of subperiosteal implants is described below?

A. adequate and stable bone, even if atrophied, is required to support this

B. maxillary and mandibular arch locations

C. completely and partially edentulous patients

Back 22

A. complete
B. unilateral
C. circumferential

Front 23

Which type of implant is the most destructive?

Back 23

transosteal

Front 24

Which type of implant type penetrates the inferior border of the mandible and projects through the oral mucosa on the edentulous ridge. Limited to use in anterior mandible, supports tissue-borne overdentures, has high success rate?

Back 24

transosteal

Front 25

What are the three types of transosteal implants?

Back 25

staple
single pin
multiple pin

Front 26

What type of implant is no longer used?

Back 26

epithelial implant

Front 27

Which type of implant is described below?:

Inserted into oral mucosa using a simple surgical technique. Mucosa is used as attachment site for metal inserts. There are several disadvantages including very painful healing and need for continual usage of implant.

Back 27

epithelial implant

Front 28

Put the following components of an implant in ascending order from the most apical component towards the crown

abutment post
implant (fixture)
implant prosthesis
transmucosal abutment

Back 28

implant (fixture)
transmucosal abutment
abutment post
implant prosthesis

Front 29

True or false, the healing cap is placed on the EXPOSED part of the implant

Back 29

True

Front 30

Describe each of the three types of transosteal implants

1. staple
2. single pin
3. multiple pin

Back 30

1. adequate anterior bone support implant--width and height of primary concern

2. anterior mandibular arch ONLY

3. completely and partially edentulous patients

Front 31

Special (Ti/Ni/Co) burs at (high/slow) speed used in (wet/dry) environment for the handpiece are used to prepare site for implant

Back 31

Ti, slow, wet (with sterile-water coolant)

Front 32

True or False, implants can always be screwed in, but not always friction fit.

Back 32

False, the method depends on the site of placement

Front 33

You should wait several (days/months/years) before putting a load on the implant. Why?

Back 33

months, to encourage osseointegration

Front 34

True or False, despite the warning to wait several months to load an implant, some practitioners advocate immediate loading

Back 34

True

Front 35

Approximately how long should you wait between the steps for placing an implant?

Back 35

2-3 weeks

Front 36

Put these steps in order:

place crown
place abutment cap
place abutment
prepare implant site
place implant

Back 36

prepare implant site
place implant
place abutment cap
place abutment
place crown

Front 37

What type of metal shows the best osseointegration with implants?

Back 37

Ti

Front 38

What is the term for the thin zone at surface of an implant, which includes the surface oxides, protein layers, and connective tissue?

Back 38

interfacial zone

Front 39

The interfacial zone contains what three things?

Back 39

surface oxides
protein layers
connective tissue

Front 40

What is the term for the direct structural and functional connection between ordered, living bone and the surface of a load-carrying implant (100 angstroms distance)?

Back 40

osseointegration

Front 41

Osseointegration depends on what 5 things?

Back 41

composition of implant
surface characteristics
prosthesis design
care during surgery
follow-up hygiene

Front 42

The continuous integration of bone with implant material (mostly ceramics) without intervening space is called:

Back 42

biointegration

Front 43

Ti-bone is called ___

Ti-connective tissue-bone is called___

Back 43

osseointegration

fibrous-integration

Front 44

What is the term for a material that acts as a scaffold for new bone formation?

Back 44

osteoconductive material

Front 45

What is the term for a material that causes the conversion of mesenchymal cells preferentially to bone progenitor cells?

Back 45

osteoinductive material

Front 46

___ involves plasma-spraying with Ti, acid-etching, sand-blasting with alumina, to increase surface area by up to SIX times, which enhances osseointegration

Back 46

texturing

Front 47

What is the term for bombarding surface with high-energy ions to a depth of 0.1 um to form TiN surface layer, so as to reduce corrosion

Back 47

ion-implantation

Front 48

True or False, occlusal forces on a natural tooth and an implant put nearly identical pressure on the surrounding bone

Back 48

False!!! Natural teeth tend to distribute the forces via oblique fibers whereas an implant sends most of its force straight down its axis

Front 49

What are 6 big catagories of variables that affect a dental implant and which 4 include the biological response?

Back 49

(* = includes biological response)

materials
mechanics
chemical*
surface*
environment*
biology*

Front 50

The typical requirements for clinical success of an implant are:

< __mm of mobility
no radio(lucency/opacity)
bone loss (>/<) 1/3rd of implant
no infection
pt satisfaction
> __% success after __ years

Back 50

1
lucency
<
-
-
75, 5

Front 51

What is the most biocompatible and corrosion-resistant metal?

Back 51

commercially pure Ti

Front 52

cpTi has >__% Ti

Back 52

99

Front 53

cpTi has >99% Ti and < 1% of what other 4 elements?

Back 53

Fe, C, H, N

Front 54

Titanium and titanium alloys are (lightly/highly) reactive because it (reduces/oxidizes) in air, and forms a passivation layer 20-100A thick in just __ msec

Back 54

highly, oxidizes, 1

Front 55

Ti is __% less dense and has half the elastic modulus value of STEEL, yet is __ to __ times higher than bone

Back 55

40, 5, 10

Front 56

True or False, Ti-6Al-4V alloy properties are better than cpTi, but NOT as biocompatible

Back 56

True

Front 57

Elastic modulus of Ti-6Al-4V is (higher/lower) than cpTi and (higher/lower) than non-Ti alloys

Back 57

higher, lower

Front 58

True or False, the release of Ti, Al and V into the blood and saliva with Ti-6Al-4V alloys is very high, and is thus considered moderately cytotoxic

Back 58

False

blood and saliva at LOW levels, cytotoxicity is not well known

Front 59

What are the two ways to weld Titanium alloys and which is preferred?

Back 59

(* = preferred)

laser*
plasma-welding

Front 60

Fill in the elements in these two 'newer" Ti alloys

Ti-13__-13__

Ti-15__-2.8__

Back 60

Nb, Zr

Mo, Nb

Front 61

The following describes what kind of metal?

AISI 316L, 18-8/Cr-Ni

Back 61

Austenitic stainless steel

Front 62

Austenitic stainless steel has (high/low) strength and has 0.0_% C, is (brittle/ductile), is (low/high) cost, can be HEAT treated, and is used in what TWO types of implants?

Back 62

high, 5, ductile, low, subperiosteal, transosteal

Front 63

Austenitic stainless steel is NOT used because of three reasons:

Corrosion potential (due to crevice and pitting corrosion) which causes release of __, Fe, Cr, and __ ions

Creation of ___ current

allergenic potential in patients with an allergy to ___

Back 63

Ni, Mo

galvanic

Nickel

Front 64

What are the Wt% of each of these three elements in a Co-Cr-Mo alloy?

Back 64

63, 30, 5

Front 65

Co-Cr-Mo alloy contains trace amounts of what other THREE elements?

Back 65

C, Mn, Ni

Front 66

True or False, Co-Cr-Mo alloy can be cast into custom designs

Back 66

True

Front 67

Co-Cr-Mo alloy has (poor/good) corrosion resistance and (high/low) elastic modulus

Back 67

good, high

Front 68

Co-Cr-Mo alloy is the (most/least) ductile and is sensitive to casting

Back 68

least

Front 69

Initially, Co-Cr-Mo alloy was thought to have good biocompatibility but is now associated with what THREE issues?

Back 69

chronic inflammation
fibrous encapsulation
mobility

Front 70

Metal with surface coating combines the benefits of two material types: (high/low) strength of metal with coatings that (degrade/enhance) bone-implant bond and (slow/accelerate) rate of attachment to bone

Back 70

high, enhance, accelerate

Front 71

True or False, Plasma-spray/coating of TRIPHOSPHATE CALCIUM (TCP) or hydroxyapetite (HA) on Ti alloys to produce thin (50-100micrometer), uniform bioactive surface

Back 71

False,

TCP is Tricalcium phosphate, not triphosphate calcium.

All other parts of the statement are TRUE

Front 72

Commercial implants coated with HA have ranged from __% HA and 15% TCP, to __% HA

Back 72

85, 97

Front 73

What is the chemical formula for HA (hydroxyapatite)?

Back 73

Ca10(PO4)6(OH)2

(all numbers are subscripts)

Front 74

"Bioglass" is a combination of what 4 molecules?

Back 74

CaO, Na2O, P2O5, and SiO2

Front 75

True or False, HA is used for augmentation of bony defects and ridges

Back 75

True

Front 76

There was some information in the HA section but I can't tell if they mean this information for HA or a "new material" so the 'answer' slide here has that information for you

Back 76

HA is used for augmentation of bony defects and ridges; new materials use collagen matrix, available in dense or porous forms, it is difficult to keep granular form localized, low tensile strength and ductility limit its use, best used as a coating material

Front 77

Bioglass forms a (strong/weak) bond about how many micrometers thick?

Back 77

strong, 100-200

Front 78

The bonding mechanism for bioactive ceramics is as follows:

(inner/outer) region of ceramics dissolves

___-rich gel is formed

___ fibrils develop and get incorporated in calcium phosphorus gel

Calcium phosphorus surface crystallizes and (releases/locks) in collagen fibrils

Back 78

outer
silica
collagen
locks

Front 79

What are the two bioactive ceramics?

Back 79

Hydroxapatite and Bioglass

Front 80

Nonreactive ceramics include:

___crystalline alumina
single crystal alumina (_____)

Back 80

poly
sapphire

Front 81

The following describes nonreactive ceramics:

bio(active/inert)
(high/low) strength, stiffness, hardness
(poor/good) fracture toughness (esp in bending)
work best in (partial/complete) edentulous cases

Back 81

inert
high
poor
partial

Front 82

polymers and composites were used in early implants and (were/were not) successful

Back 82

were not

Front 83

polymers and composites are now sold in __ or __ form

Back 83

porous, block

Front 84

What materials can be used for augmentation, tissue attachment or as coatings?

Back 84

polymers and composites

Front 85

What are 6 elements that are considered "other" implant materials

Back 85

C, Au, Pa, Pt, Zr, W

Front 86

Rank these in order of HIGHEST to LOWEST in terms of ELASTIC MODULUS

Alumina
Steel
Bone
HA
Ti
Ti-6Al-4V
Co-Cr

Back 86

Alumina
Co-Cr
Steel
Ti-6Al-4V
Ti
HA
Bone

Front 87

Demonstration of safety and efficacy in (preliminary/advanced) biocompatibility studies ensures that only biocompatible materials are employed in human clinical trials

Back 87

preliminary

Front 88

True or False, implant materials are free to be used until efficacy is proven otherwise

Back 88

False, tests are run prior to their implementation

Front 89

At one point, many C implants were used in humans after successful tests in baboons. However, they caused problems in humans that were not present in baboons. This brings up the issue of proper testing of what?

Back 89

biocompatibility

Front 90

True or False, fluoride has been known to damage and corrode Ti implants

Back 90

True

Front 91

You should avoid using cleaning materials made of ___ on implants

Back 91

metal

Front 92

What can metal instruments potentially remove off of an implant when cleaning them?

Back 92

the surface oxides

Front 93

True or False, you should not touch the implant with fingers, gloves or any other hand instrument used in restorative dentistry

Back 93

True

Front 94

What is the term for an inflammatory pocess that causes loss of soft tissue attachment and bone erosion? It is due to microorganisms similar to those in periodontal disease.

Back 94

Peri-implantitis

Front 95

Small concentrations of fluoride are corrosive to cpTi at (high/low) pH by infiltrating and dissolving the ____ layer

Back 95

low, passivation

Front 96

fluoride corrodes cpTi at the following concentrations:

0.05% NaF below __ pH

0.1% NaF below __ pH

__% NaF below 6.2 pH

Back 96

4, 4.3, 2

Front 97

True or False, cements with fluoride in them do NOT interfere with the passivation layer like straight fluoride does

Back 97

False, it DOES!

Front 98

To clean an implant, the hygiene instrument should be __ or __ tipped.

Back 98

plastic, Teflon

Front 99

True or False, you should use heavy abrasives with rubber cup to properly clean an implant

Back 99

False, use MILD abrasive with rubber cup

Front 100

True or False, unless there is a special situation, patients can typically perform they normal oral hygiene routine

Back 100

True