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217 Cards in this Set
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an implant component that lies between the implant and the crown
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Abutment
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an impression taken after an abutment has been delivered clinically.
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Abutment-level impression
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the screw that clamps the abutment onto the implant.
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Abutment screw
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a prefabricated abutment that is angled from the implant body to counter inclination of implants.
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Angled abutment
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a radiopaque powder material utilized in radiographic templates to visualize diagnostic teeth.
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Barium sulfate
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flat, small implants that are inserted into a cut in the bone.
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Blade implants
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a restoration cemented on abutments
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Cemented prosthesis
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a software-assisted radiographic technique that produces an exact cross-sectional view of the mandible or maxilla.
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Computed tomography (CT scanning)
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the screw that blocks the implant entrance during the healing period after surgery.
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Cover screw
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the distance between the implant platform and the edges of the extraction socket. Usually used with reference to feasibility of immediate implant placement.
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Critical space
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an abutment that is custom-made in the laboratory.
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Custom abutment (also called UCLA abutment)
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the subgingival change in shape of the abutment and/or the crown, between the implant platform and its emergence from gingival tissues.
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Emergence profile
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an implant-to-abutment attachment that sits on top of the implant platform. A common shape is the external hexagon attachment.
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External connection
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often used to describe the screw retaining the crown of a screw-retained prosthesis. Other screws also contain gold.
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Gold screw
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a temporary abutment that is used in place of a cover screw after an implant has been inserted and removed before the restoration is placed.
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Healing abutment
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an arbitrary scale of values assigned to various radiopaque densities, when using computed tomography.
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Hounsfield numbers
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the placement of an implant at the time of tooth extraction.
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Immediate implant placement
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a technique in which implants are restored, and thus, loaded, at the time of their placement.
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Immediate loading
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a titanium device placed in the bone that replaces the root of a tooth and enables the attachment of a prosthesis.
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implant
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a method in which an impression is taken at the time of surgical placement.
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implant indexing
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an impression taken with copings that fit onto implants directly. No abutments are present.
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Implant-level impression
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A label for implants that are functional and satisfactory at the time of examination.
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Implant success
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A label for implants that are in the mouth at the time of examination, regardless of the state of the prosthesis or patient satisfaction.
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Implant survival
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– a device used when taking impressions that fits on the implant and enables the capture and duplication of the implant position onto a stone model.
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Impression coping
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an implant-to-abutment attachment that is placed inside the implant body. These are found, for example, in internal friction systems.
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Internal connection
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a system in which abutments are retained by friction against the inner walls of the implant.
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Internal friction system
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a radiographic method used to obtain cross-sectional images in which the radiographic source and film rotate around the plane of interest.
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Linear tomography
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a measurement of the forces exerted onto implants or teeth.
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Load
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irreversible microscopic changes that occur in the metal of implants and components when an excessive force is applied. Fatigue often leads to fracture.
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Mechanical fatigue
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a reversible condition characterized by gingival inflammation around implants without evidence of bone resorption.
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Mucositis
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implants that are exposed to the oral cavity on the day of placement.
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One-stage implants
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the attachment of bone to the surface of an implant
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Osseointegration
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the surgical procedure of drilling into bone.
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Osteotomy
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the placement of a multi-unit restoration onto the implant complex without resistance or distortion.
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Passive fit
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progressive bone loss and inflammatory tissue pathology that results from plaque accumulation and bacterial infiltration around implants.
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Peri-implantitis
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flat, mesh-like implants that lie on the osseous surface.
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Periosteal implants
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an impression coping that is automatically retained in the impression after removal.
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Pickup coping
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a manufactured abutment that arrives with a set collar height, taper, and/or angulation.
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Prefabricated abutment
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the clamping force that is applied by a screw between the implant and its abutment.
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Preload
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an abutment that is received as a straight cylinder with no taper or margin level. Preparation is required to set height, angulation, taper, and margins.
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Prepable abutment (also called prepable post)
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– a technique in which a provisional restoration is placed shortly after implant placement.
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Progressive loading
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an acrylic appliance worn by a patient during a radiographic analysis. It incorporates radiopaque markers to visualize diagnostic teeth and potential implant sites on the films.
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Radiographic template- can be saved and modified into a surgical guide
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a clinical procedure in which soft tissue is measured at several locations of an edentulous ridge. Measurements can be reported on a drawing or a model to estimate the width of underlying bone architecture.
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Ridge mapping
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cylinder or screw-shaped implants. They are the most common implants used today.
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Root-form implants
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an acrylic appliance worn by a patient during a computed tomography scanning that incorporates radiopaque material (ie, barium sulfate) to visualize diagnostic teeth.
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Scannographic template
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a restoration affixed on abutments or implants using screws in place of cement.
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Screw-retained prosthesis
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an augmentation technique used when the maxilla lacks sufficient vertical bone for implant placement.
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Sinus floor elevation
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implants that are joined by a bar to enable attachment to a removable prosthesis.
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Splinted implants
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an acrylic appliance used during surgery that indicates where the ideal implant placements must be for restorative purposes.
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Surgical guide
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a lightweight, soft, noncorroding metal used to make implants.
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Titanium
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the amount of turning force placed on screws at delivery.
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Torque
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an impression coping that remains on the implant complex after the impression is removed. It needs to be removed and placed onto the impression manually.
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Transfer coping
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implants that are covered by the gingival immediately after placement. A second surgery is necessary to uncover them
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Two-stage implants
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Implants are most often made of
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Titanium
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The rough surface of implants is
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Desirable for improved osseointegration
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Osseointegration means
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40% to 50% bone/implant contact
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The first event leading to osseointegration that occurs after implant placement is
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Formation of a blood clot
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Excessive force on implant crowns results in:
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Fatigue of implant components, leading to fracture
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Preload is
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Tension placed by screws to protect implant components from displacing forces
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Plaque and calculus
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Accumulate on implants similarly to teeth
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Connective tissue fibers around the implant neck are
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Parallel to the implant surface
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Peri-implantitis:
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preads rapidly to bone
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Implant survival
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Means that an implant is still present in the mouth after a period of time
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The minimum interarch space for a fixed implant-supported prosthesis is:
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7 mm
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Ridge mapping measures
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Soft tissue thickness clinically to deduce bone width
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Panoramic radiographs are useful for
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Ruling out bony pathologies and estimating bone availability
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Linear tomography
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Can deliver cross-sections in any part of the mouth
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Computed tomography
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Is the most precise radiographic technique
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Hounsfield numbers are
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Arbitrary numbers set for tissue density on computed tomograms
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Radiographic templates are
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Used to visualize diagnostic teeth
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A scannographic template is
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An aide for visualizing diagnostic teeth on a computed tomography image
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Which of the following statements about bone quality is true?
A. D4 bone is the densest bone B. D1 bone is the densest bone C. There is a direct correlation between bone density and implant survival rate D. Bone quality is determined precisely based on Hounsfield numbers |
D1 bone is the densest bone
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When selecting an implant:
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At least 1 mm of bone lingual and buccal of the implant must remain for it to survive
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Screw-retained prostheses possess the following advantages:
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Ease of retrieval
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Cemented prostheses possess the following advantages
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Ease of fabrication
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Connecting implants and teeth
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Should be avoided whenever possible, but can be performed with careful consideration
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When treatment planning edentulous cases
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The decision between a fixed or removable prosthesis depends in part upon arch shape
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Distal cantilevers on implant prostheses are
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To be avoided whenever possible and limited to short spans
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Immediate implant placement is
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The placement of an implant at the time of tooth extraction
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Immediate loading is
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The placement of a restoration at the time of implant placement
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Provisional restorations
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Should not rest on bone grafts or newly placed implants
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Bone grafting
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Works best to augment ridge width
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Gingival grafts should be performed
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Prior to fabricating the final restoration
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Implants are...
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replacement tooth roots
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implants are attached to the bone through a process called
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osseointegration
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implants are made of this metal
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titanium
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what are some advantages of having the implants threaded
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-helps transfer bitting force to surrounding bone
-enhance placement -enhance stability |
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through osseointegration about what percentage of the implant is in direct contact with the bone?
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40-50%
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whats a clinical sign if the implant is not osseointegrated?
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slight mobility
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the titanium surface must be smoothed or roughened for better bone attachment?
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roughened-blasted
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what are the events leading to osseointegration?
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-blood clot forms between bone and implant
-inflammation -fibrous mesh attaches to implant -bone cells form extracellular compenents -bone mineralization |
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over time what happens between the bone and implant with osseointegration?
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-bone continually remodels and is denser than its surrounding
-the ceramic oxide layer of the implant thickens |
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are abutments necessary with all implants?
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No, some restorations are screwed directly into the implant
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what are the 2 main categories for implants
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root-form implants
periosteal and blade implants |
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abutments for internal connections may be shaped like what
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-crown prepped toot=cemented restoration
-central hole for a screw=screw retained crowns |
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what are the stages for root-form implants?
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one-stage
two-stage |
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can two stage implants be exposed on initial implantation?
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Yes, with the use of a healing abutment
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what is a major difference between periosteal and blade implants with root-form implants
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the abutment and implant are not separable, and come as one.
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whats the purpose of torque?
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stretches the screw slightly, preventing implant components from moving. As a result, the components are protected from force injuries
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what happens if not enough torque is applied?
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will lead to loosening. If undetected clinically, loosening leads to abutment mobility, which can cause screws to bend and, ultimately, to fracture.
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too much toque leads to what?
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will cause screw distortion, which can also lead to fracture.
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preload determines what?
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whether a screw retains the crown or an abutment.
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if forces are low and remain in the elastic range of the implant and its components does mechanical fatigue occur?
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No
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can overload be detected clinically?
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no, only during maintenance, after screw loosening or the component has already fractured.
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what are the differences between implants and teeth?
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• Unlike teeth, implants lack healing capacities.
• Implants do not have a periodontal ligament. • The barrier to the oral cavity is rather different around implants, principally because of a missing connective tissue attachment. |
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Plaque accumulation and bacterial infiltration may result in
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peri-implantitis
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gingival attachment is comprised of a
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junctional epithelium (1-2 mm) and a connective tissue attachment (∼1 mm).
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blood vessels for teeth arise from the periodontium and the periosteum, though for implants, the blood vessels only arise from which?
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periosteum
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clinical signs or peri-implantitis
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more severe than periodontitis. Gingival inflammation may resemble a periodontal abscess, and suppuration and bleeding upon probing can occur.
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peri-implantitis can spread to the bone rapidly because of what
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ack of connective tissue resistance and diminished blood supply
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in peri-implantitis, once bone is loss, can it be reversed?
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no, unless bone regeneration was attempted
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reversible form of peri-implantitis
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mucositis
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In one-stage implants that have high, smooth collars, coronal bone remodels to the
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smooth/rough surface connection.
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to keep the papaillae and bone height between 2 implants at least how far apart should they be placed?
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3mm
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when does a peri-implant deep sulcus arise?
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when the implant is placed more apically than the adjacent teeth-it is stable
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In order to prevent bone remodeling downwards along the implant, displacement of the implant/abutment connection is placed where?
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towards the center of the implant
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how is the implant/abutment connection towards the center achieved?
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by creating a bevel, or by “platform switch” which consists of placing an abutment narrower than the implant platform.
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A nonfunctional implant requiring additional treatment is counted in the surviving group or success group?
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surviving
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what are some systemic conditions that need to be taken into consideration when considering implants?
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Smoking
Diabetes Osteoporosis Age Head and Neck Radiotherapy Immunocompromised Patients Psychological conditions |
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How does smoking affect implants?
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postsurgical healing is poor
peri-implantitis is more frequent |
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what type of diabetes is CI for implants?
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uncontrolled
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what should be considered for diabetics going in for implant surgery?
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prescribing antibiotics
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Is osteoporosis a CI for implants?
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no, it may be beneficial as it increases bone density around the implant
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when should implants be given to young patients and why?
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after growth is complete, as the implant will not follow the growth progression
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what is the failure rate with pts who have had radiation?
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30%
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are immunocrompromised pts CI for implants, survey says...
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NERP
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what should happen to high expectations?
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toned down because of possible dissapointment
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what are some early considerations needed in a dental evaluation for implants to be considered?
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-FMX or PANoRAM
-perio charting, and caries detection -Tx Plan should take diseases into consideration -OH must be great |
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what are the main focuses in a dental examination relevant to implant therapy?
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-Arch Shapes and Sizes
-Maximum Intercuspation, CR, and Occlusal Interferences -Anterior Guidance -Wear Facets and other parafunctional habits -Interarch relationships -Adjacent teeth -Esthetic evaluation -Diagnostic casts and wax ups |
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Interarch space needed: posterior fixed implant supported prosthesis
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7mm
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Interarch space needed: anterior fixed implant supported prosthesis
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8-10mm
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Interarch space needed: implant-retained removable prosthesis
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12mm
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for an implant, how much space is needed for the teeth that will be adjacent to the implant?
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at least 7mm
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the clinical examination includes what?
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EVALUATION OF:
-tissue health -attached gingiva -ridges |
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how much bone in a buccal lingual direction should surround the implant?
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1mm on the buccal and lingual surfaces
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They are utilized to estimate bone quantity and quality, as well as the presence of anatomic limitations (eg, mandibular nerve or maxillary sinus).
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Panoramic Radiographs
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when considering implants in the mandibular anterior region what special radiograph is ordered
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lateral cephalogram
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Things to look for in radiographic images
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-the scout view
-the tilt -the window -the window level -the window width - |
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shows how the patient was positioned on the table, and the angulations (called “tilt”) of the axial views with regard to the jaw positions. The slice thickness is also indicated, as well as the magnification ratio
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scout view
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The scanner acquires images using gray contrasts in Hounsfield units . What the clinician sees is a portion of the gray spectrum called the ...
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window
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o Level-(width/2) is the lowest Hounsfield unit within the window. All Hounsfield densities below that level are _______ on the image
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black
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o Level+(width/2) is the maximum Hounsfield unit within the window. All densities above that level are ______.
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white
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what are some advantages of reading images with software?
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-Multiple views can be seen at once,
-virtual implants may be positioned on the screen for better diagnosis. - evaluation of relative bone density -measurements of distances and angles, -localization of vital structures, -estimation of volumes. |
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Bone quality is best evaluated using what?
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CT scan
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Bone Quality: CLass I/D1
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compact bone
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Bone Quality: CLass II/D2
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cortical bone surrounding trabecular bone
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Bone Quality: CLass III/D3
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thin compact bone surrounding cancellous/trabecular bone
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Bone Quality: CLass IV/D4
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thin and spongy canellous bone
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Class IV/D4 bone quality is associated with what
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higher implant loss
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Class I/D1 is associated with what clinically
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poor blood supply
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Bone Volume Classification: A
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most intact edentulous archecture where bone volume is present in all directions
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Bone Volume Classification: D
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most atrophic
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about how much bone volume is lost in the first yr after an extraction?
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25%
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what is impossible to recover from? Loss of bone width or bone height?
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bone height
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what does a removable prosthesis do to bone resorption over time?
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increases it
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how far should the implant be in the mandibular posterior area?
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at least 2mm from the nerve
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Many implant drill systems extend 1.5-2 mm beyond the implant length (due to the shape of the drill tip). This means that the implant apex must remain at least ____ mm from the canal.
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4mm
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how much space in the BL ridge dimension should there be for an implant?
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1mm each side, so for a 4mm implant, 6mm in the BL dimension is needed
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how much space is needed on either side of the implant in a MD dimension?
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1.5mm, so for a 4mm implant, 7mm in a MD dimension is needed
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For posterior teeth, implant angulation should allow the implant's long axis to emerge from the
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center of the occlusal surface
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For anterior teeth, the angulation should allow the long axis to emerge through
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cinguli.
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in what orientation should multiple implants be placed and how far apart
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parallel when possible
3mm apart |
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In Tx planning, what must be completed before implant planning begins?
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-initial disease control phase
-periodontal problems -endodontic problems -caries control and oral hygiene instructions. |
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_______ ______ and _______are necessary for visualizing and selecting a prosthetic design. These can also be used during treatment presentation to help patients understand their condition.
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diagnostic casts and wax-ups
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what should be avoided with implants, unless its absolutely necessary?
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connecting implants with other teeth
using the implant as a cantilever |
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For edentulous cases, interarch space may be increased by opening the...
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vertical dimension of occlusion.
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implant-retained prostheses for partially edentulous cases are ______ restorations.
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fixed
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how are prosthesis attached to implants?
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screw retained-the prosthesis has a chimney where the screw is attached to
|
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Advantages of a Screw-Retained Prosthesis
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-Ease of fit-checking prior to delivery.
-Absence of subgingival cement that may remain and irritate tissues. -Ease of retrieval for maintenance and repair. |
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Advantages of a Cemented Prosthesis
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-Ease of fabrication because laboratory steps are identical to those used for a traditional prosthesis.
-Esthetics because of the absence of screw-access occlusal holes. -Metal and porcelain thickness on occlusal platforms. |
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what should be considered when considering a fixed or removable prosthesis?
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-Feasibility of placing multiple implants
-Necessity of supporting lips with a flange -Arch form -Access to implants during home care -Ease of home maintenance -Cost |
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how many implants are needed for a fixed prosthesis?
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4-if 4 cant be placed then go with a removable
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if theres ridge resorption why must a removable prosthesis needed?
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for lip support, a fixed one wont be able to provide sufficient lip support
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if implants are in a row because of a narrow arch which is better, removable or fixed?
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removable
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in a fixed prosthesis what is more preferred, porcelain or acrylic?
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porcelain, because its more durable and better esthetics
|
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repairs are easier to perform on porcelain or acrylic?
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acrylic
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whats better for resorbed ridges? porcelain or acrylic?
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acrylic
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2 ways to connect a removable prosthesis to the implant
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splinted
nonsplinted |
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joined by a bar that enables attachment to the prosthesis
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splinted removable
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how are nonsplinted implants attached to a removable prosthesis?
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by an abutment
|
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how much space is needed for splinted implants?
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12mm
|
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if 2 implants are present which is preferred? splinted or nonsplinted
|
nonsplinted
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can a denture be retrofitted for a nonsplinted implant?
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yes
|
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2 types of biotype tissues
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-thick and flat
-Thin and scalloped |
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what is the most common tissue biotype?
|
thick and flat
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_____ _______ is necessary when bone width or height is inadequate for receiving an implant.
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bone grafting
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obtaining bone height or width is more predictable?
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bone width
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how much at best can be obtained in bone height from grating
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2mm
|
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______ ____________ ________ is an augmentation technique used when there is insufficient vertical bone for implant placement in maxillary posterior areas
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Sinus floor elevation
|
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what are some sources of bone grafts
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-autogenous sources (ie, chin, hip),
-allografts (ie, demineralized freeze-dried bone allograft), -xenografts (of bovine origin), -biomaterials. |
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After tooth extraction, the ideal waiting period for placement of an implant is __ weeks.
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8
|
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Originally, it was necessary to wait up to 6 months after inserting an implant before beginning restoration. Due to improvements in implant surfaces, the waiting period has been shortened to _____ weeks for many implant systems
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6-12
|
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Two-stage implants usually require a surgical re-entry after placement in order to uncover them. There should be a waiting period of at least ___ weeks after uncovery for gingival tissues to heal. The second surgery can, in some cases, be avoided by placing a _______ ___________ at the time of implant insertion.
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6 weeks
Healing Abutment |
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Grafting procedures should be executed when?
|
as early as possible in order to evaluate their outcome and repeat an augmentation if necessary.
|
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Depending upon the case, bone grafts may be placed at the time of implant placement or _____ months prior to implantation
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4-6
|
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when can implantation and bone grafting be done at the same time?
|
if primary stability of the implant can be obtained and minimal grafting is necessary.
|
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For one-stage implants, gingival augmentation procedures should be performed
|
prior to implant placement.
|
|
For two-stage implants, gingival grafting can be done at
|
all times before the implant uncovering procedure.
|
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Once an abutment and a crown have been delivered, when can gingival augmentation be performed?
|
it is too late to recommend gingival augmentation
|
|
when can simultaneous implantation and sinus grafting are performed?
|
when bone height is sufficient to obtain primary stability but insufficient to accommodate the length of the implant.
|
|
placement of an implant at the time of extraction
|
Immediate implant placement
|
|
two main concerns when regarding immediate implant placement
|
-primary stability
-critical space |
|
immediate implant placement: primary stability
|
After extraction, the implant must engage 5 mm or more bone, either apically (such as in the case of a lateral incisor), or horizontally (such as in the case of the inter-radicular area of posterior teeth)
|
|
immediate implant placement: critical space
|
This is the distance between the implant platform and the edges of the extraction socket. It should be <2 mm.
|
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placement of a final prosthesis shortly after implant placement, typically at the same visit or within 24 hours.
|
immediate loading
|
|
similar to immediate loading, but describes the placement of a provisional restoration.
|
progressive loading
|
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implant with longest period of clinical trial
|
subperiosteal
|
|
best indicated implant for edentulous mandible
|
subperiosteal
|
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Branemark's keys to osseointegration
|
atraumtatic surgery (less than 47 deg C)
1mm bone B&L at crest no micro-movement adequate healing time (3-6 months) |
|
branemark made what kind of implants
|
endosteal
|
|
endosteal implant system
|
commercially pure Ti
screw implant 2 stage implant placement protocol using controlled surgical technique well established animal and human documentation |
|
did branemark use 1 or 2 stage implants
|
2
|
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criteria for implant success
|
immobile when tested clinically
BL less than .2mm annually following first year absence of irreversible signs and symptoms (pain etc) no radio evidence of peri-implantitis |
|
post branemark implants
|
ITI-implant
core-vent cacitek |
|
ITI-implant
|
single stage
immediate penetration into oral cavity |
|
core vent
|
titanium-aluminum alloy
controlled surgical technique with two stage design poor initial data |
|
calcitek
|
HA coated titanium
press form HA may promote earlier bone appostion? |