O Surg Fall 2008

Front 1

Bone is?

made of?

Back 1

specialized CT,

mineralized, dynamic tissue

Front 2

bone remodeling is in accordance with?

Back 2

stress/strain

Front 3

Cortical vs. cancellous bone?

Back 3

Cortical: dense layers
Cancellous: network of trabeculae

Front 4

bone heals by?

Back 4

regeneration

Front 5

what is the best type of bone healing for implants?

Back 5

primary healing

Front 6

what is the first thing that happens after an implant is placed for bone healing?

Back 6

blood forms between implant and bone, organizes into a clot

Front 7

What does the clot turn into in bone healing?

what happens after this change?

Back 7

phagocytic cells

fibroblasts and mesenchymal cells infiltrate area

Front 8

fibroblasts and mesenchymal cells become?
form?

Back 8

osteoprogenitor cells (forming an internal, not external, callus)

Front 9

What forms after the callus? which is?

Back 9

fibrocartilaginous matrix: template for new bone (right next to implant) so that it can attach

Front 10

in spongy bone, remodeling occurs on the ?

Back 10

trabecular surfaces

Front 11

what stimulates bone remodeling?

what allows implant to withstand masticatory forces/function?

Back 11

occlusal forces

remodeling

Front 12

what are the 2 main types of implant materials?

Back 12

Pure titanium (CPT) (99.7% Ti, rest is Fe, O, N,C
Ti Alloy: 90% Ti, Al 6%, Va 4%

Front 13

What is good about pure titanium?

Back 13

1. no inflam/rxn, 2. Ti contants air, makes oxide layer immediately,

Front 14

what is downside to pure Ti

Back 14

1. must be kept sterile
2. Oxide layer attracts biomolecules
3. contamination changes Ox. layer resulting in inflammation, granulation tissue

Front 15

what is the brands of Ti alloys?

Back 15

IMTEC, Core-vent, Integral

Front 16

How is Ti alloy better than pure Ti?

Back 16

it isn't, same histologically btwn two types

Front 17

what is used to cover the surface of implants?

Back 17

1. Titanium plasma spray (TPS)
2. Hydroxyapatitic (HA) coating

Front 18

what is TPS designed to do?

Back 18

increase surface area by 6x so that there is more surface osseointegration

Front 19

hydroxyapatitic coating studies say?

Back 19

more bone deposited adjacent to HA surface, and it is earlier

Front 20

what is the implant fixture design?

Back 20

screw type that is cylindrical

Front 21

what is the purpose of the threads of the implant?

Back 21

create more surface area (essential to osseointegration)

Front 22

fixture design that is screw is designed for?

Back 22

distribute forces into bone
initial implant stabilization
precision fit, stability

Front 23

what do the studies say about screw type fixtures?

Back 23

Branemark et all says great
Boyne says noooooooo that cylindrical is same successs as screw

Front 24

what does Boyne have to say about fixtures?

Back 24

smooth, non-coated implants have inferior rate of success
depends on quality of technique!

Front 25

what about bone temp?

Back 25

at 47 C, alkaline phosphatase breaks down so prevent excessive heat to preserve vitality

Front 26

why is not overheating important besides maintaining alkaline phosphatase?

Back 26

overheating prevents osseointegration

Front 27

how do we maintain low temp?

Back 27

gentle tech,
copious irrigation
drilling tech important

Front 28

what is the max speed of the drill?

what is the max tapping procedure?

Back 28

speed: under 2000 rpm
tapping procuedures: 15-20 rpm

Front 29

What does overtightening cause?

Back 29

compression ischemia

Front 30

how long do you have to wait until fixture can handle occlusal load?

Back 30

3-4 mo in mandible
6 mo in maxilla

Front 31

what do you need to do to analyze mouth for implant?

Back 31

x-rays, clinical, assessments

Front 32

what are the important clinical procedures for assessment?

Back 32

palpate, probe,

Front 33

bone morphology classifacations are?

Back 33

a. minimal or no resorption of ridge with minimal inter-arch clearance
b. Moderate ridge resorption
c. advanced resorption
d. severe resorption
e. extremely severe, bone grafting indicated

Front 34

is category A of bone morph easy to place implants?

Back 34

difficult

Front 35

what are the bone quality classifactions?

Back 35

1. mostly compact bone
2. thich layer of cortical bone, dense core of spongy bone
3. thin layer cotrical bone, core of dense spongy bone
4. thin layer of cotrical bone, core of low-density spongy bone

Front 36

why do you want some degree of resorption (type B) for implants?

Back 36

allows for sufficient inter-arch clearance

Front 37

what classes of quality of bone are good prognosis?

Back 37

2,3 (with b,c is ideal)

Front 38

when did the new area of preprosthetic surgery begin?

who did the work?

Back 38

1980s

branemark

Front 39

what do the bone grafts do?

Back 39

enhance primary bone healing
reduces graft resorption

Front 40

what causes the compromised bone volume that needs grafting?

Back 40

extreme resorption, trauma, cleft deformities, aplasia, anodontia
oncologic defects

Front 41

how does the delayed technique differ from the immediate tech?

Back 41

delayed: greater stability, better placement
immediate: has loading, graft preservation earlier, (functional bone stimulation leads to less resorption)

Front 42

what are the types of bone graft materials?

Back 42

autogenous, allogeneic, tricalcium phosphate, HA

Front 43

what is the most compatible bone graft material for osseointegration?

why?

Back 43

autogenous

living cells connect with implant, phase 1 bone optimized,

Front 44

when is stage 2 performed for graft tech?

Back 44

6 mo

Front 45

what are the types of graft techniques?

Back 45

1. inlay
2. onlay (veneer, saddle, split/full arch)
3. interpositional

Front 46

what is an inlay graft for?

Back 46

small osseous defects inlaid with bone
for anatomic restoration of deficient bone: emergence profiling (upper incisor)
mandibular ridge deficiency

Front 47

what is teh exposure like for inlay grafts?

Back 47

high labial/ lingual based flaps

Front 48

how is an inlay site prepared?

Back 48

with tapered fissure bur

Front 49

why use inlay grafts?

Back 49

form retentive inlay seat,

Front 50

where is the graft obtained from for inlay graft?

how stabilized inlay graft?

Back 50

symphysis region

micro screw

Front 51

what is the standard implant drilling carried through to?

Back 51

graft engaging uderlying basal bone

Front 52

saddle graft is used where?

Back 52

mandibular free-end cases
for restoring anatomic height for fixtures

Front 53

what is sometimes needed for saddle grafts?

Back 53

buccal extension

Front 54

graft is contoured in saddle graft for?

Back 54

definite seat

Front 55

what is placed to hold saddle graft in place?

Back 55

fixation screws (removed at stage 2)

Front 56

can the saddle graft be used in the maxilla?

Back 56

yes

Front 57

what is veneer graft used for?

Back 57

buccal ridge repacement
when the width is less than 4mm

Front 58

how is veneer graft secured?

Back 58

with 1.5 mm screws

Front 59

what is a maxillary split graft indicated for?

Back 59

severe maxillary atrophy

Front 60

where is the bone for split graft obtained?

Back 60

corticocancellous block from iliac

Front 61

how estimate graft dimension for split graft?

Back 61

template used, graft sectioned into halves

Front 62

what is the flap like in split grafts?

Back 62

mucosal flap extended into lip

Front 63

what does a max split graft provide?

Back 63

adequate graft coverage

Front 64

how does a max split graft work?

Back 64

each graft seperately adapted, seated seperately and then rigidity fixated

Front 65

how are fixtures placed in max split graft?

Back 65

placed thru graft engaging basal bone, then graft contour finalized after fixture placement, then fixation screws removed

Front 66

how is the graft placed in max split graft?

Back 66

cancellous bone packed around graft, v-y closure advocated.

Front 67

how long until denture can be worn after max split graft?

Back 67

4-6 wks (no loading until final prosthesis delivered)

Front 68

the max full arch graft is similar to?

Back 68

split graft

Front 69

what is the max full arch graft an alternative approach to?

Back 69

atrophic maxilla

Front 70

what is the template like used for max full arch graft?

Back 70

horseshoe template used

Front 71

where does the bone come from in max full arch graft?

Back 71

iliac bone, left intact

Front 72

mandibular split graft is for?

how does the man split graft differ from the max?

Back 72

severe mandibular atrophy (<7mm bone height

same tech, graft firmly seated in 2 sep segments, fixed, fixtures placed

Front 73

what is max sinus graft for?

Back 73

b/c limited bone availability in post max, and pneumatization

Front 74

what is the min bone needed for fixture?

Back 74

8 mm

Front 75

what dictates incision in max sinus graft?

Back 75

amount of attached gingiva

Front 76

what type of incisions are available for max sinus graft with wide band of attached gingiva?

Back 76

if wide band of attached gingiva: curved incision at MG junction or
crestal incision

Front 77

what type of incisions are available for max sinus graft with narrow band of attached gingiva?

Back 77

single palatal incision

Front 78

where is the inferior osteotomy in max sinus graft?

size?

Back 78

suerior to sinus floor
1-2mm size

Front 79

what is the graft selection based on for max sinus graft?

options?

Back 79

thicness of sinus floor

if >3mm, cancellous bone placed
if < 3mm, block/cancellous bone placed

Front 80

what do the fixtures engage in max sinus graft?

Back 80

max sinus floor

Front 81

what is maxillary interpositional graft for?

Back 81

severe maxillary atrophy with horizontal/vertical discrepancies
Max. downfracture with interpositional graft

Front 82

how is teh max interpositional graft fixed?

Back 82

resorable plate

Front 83

what is Adell's study?

Back 83

124 fixtures with immediate graft with
marginal bone loss of 1.49mm after 1 yr and .1mm/yr thereafter (which is normal for nongrafted)

Front 84

individual success rate for maxilla?

mandible?

successful prosthesis provided by grafts' rate in ?

Back 84

80s

in 90s

mid to high 90s

Front 85

what are the presurgical considerations for tx planning partially edentulous pt?

Back 85

1. location of proposed implant
2. available bone
3. quality of soft tissue
4. occlusion

Front 86

What are the surgical considerations for tx planning a partially edentulous pt?

Back 86

1. need for grafting (osseous and soft tissue)
2. emergence profile
3. impant dimensions

Front 87

what are soft tissue quality considerations?

Back 87

adequate karatinized tissue
adequate thickness

Front 88

occlusion considerations for partial?

Back 88

adequate fabrication space
protection against lateral forces
laod distribution

Front 89

Indications for a surgical guide are?

Back 89

when emergence profile is critical for esthetics (anterior teeth)
if post teen need proper spacing, (no adjacent teeth

Front 90

what are teh surgical flap design condiderations for implants?

Back 90

available keratinized tissue,
location of keratinized tissue
emergence profile
importance of papilla form

Front 91

Fully edentulous mandibular flap design: adequate keratinized tissue present means use what type of flap?

Back 91

crestal incision if wide attached band
incise at junction of attached/unattached gingiva if narrow attached band

Front 92

inadequate keratinized tissue present for fully edentulous mandibular, use what type of flap?

Back 92

consider graft keratinized tissue (palatal tissue, split thickness skin)
crestal incision is appropriate

Front 93

what are the condiderations for a partially edentulous flap design?

Back 93

slightly palatal/lingual
avoid transection of papilla

Front 94

what is the edentulous maxilla flap design like?

Back 94

slightly palatal (permit visualization of osteotomy sites)
midlie and posterior releasing incisions permit access

Front 95

what are the drill speeds like?

Back 95

1200-1500 for 1-2.8 mm
900-1100 for 3.3-4mm
900 and less for 4.75 and greater
15 RPM for screw fixture insertion

Front 96

what are the flap closure techniques?

Back 96

1. interrupted
2. oversewn
3. mattress

Front 97

what are the surgical complications in implantology?

Back 97

1. dehiscence
2. infection
3. sinus perforation
4. mandibular fracture
5. nerve injury

Front 98

how avoid dehiscence?

Back 98

sutures placed in keratinzed tissue
limit denture wear

Front 99

what is tx for hediscence ?

Back 99

local tx

Front 100

how avoid infections for o surg?

Back 100

Chlorohexidine pre op
pre-op antibiotics

Front 101

how tx infections from o surg?

Back 101

aggressively

Front 102

sinus perforations in o surg are due to?

can result in?

Back 102

aggressive osteotomy

sinusitis

Front 103

most common site of man jaw break?
(jaw is usually?)

Back 103

symphysis (atrophic jaw)

Front 104

nerve injury more common in?

Back 104

posterior edentulous mandible

Front 105

how tx nerve injury?

Back 105

tx etiology (lol, what?)

Front 106

what are the complications of sinus lifts?

Back 106

membrane perforations
acute infections
chronic sinusitis