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217 Cards in this Set

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