Implant Final

Front 1

defined as standard of care when an edentulous space is bounded by virgin teeth.

Back 1

implants

Front 2

important responsibilities of the general dentists in regards to implants

Back 2

• General dental offices should be prepared to identify implant candidates and refer them to the surgical specialist for evaluation.

• They may also perform restorations after the implants have been placed.

• The dentist should participate in treatment planning meetings held after the surgical evaluation. These should involve the general dentist and surgeon (and possibly others involved in treating the case) and typically involve planning treatment and making recommendations.

Front 3

Recommended Inventory Items for general dentists

Back 3

• Abutments in various sizes
• Drivers and torque control devices for attaching abutments to implants
• Impression copings, abutment analogs, and implant analogs for taking impressions
• Prefabricated temporization “caps” for protection of abutments between visits
• Prefabricated crown forms for custom temporization

Front 4

_______ are always required for implant treatment planning, and a _______ including natural teeth is particularly useful.

Back 4

model(s)

Front 5

what things should be documented about the patient in relation to the implant material?

Back 5

-abutment type, as well as its dimensions, on the day of placement.

-The impression type also needs to be noted, along with the type of temporization utilized.

-permanent restoration type is documented on the day of delivery.

-the restoration is screw-retained, the catalog number of the screw must be recorded as well.

Front 6

While many details have to be taken into account in order to set a patient's fee, the fee can be broken down into three main components:

Back 6

-fixed costs
-variable costs
-necessary profit

Front 7

The overhead, or fixed per hour cost to practice, that covers the treatment time.

Back 7

fixed costs

Front 8

Costs, such as laboratory fees and implant components, that may be different for each case.

Back 8

variable costs

Front 9

This covers the cost of reimbursing the doctor, services that do not generate sufficient profit to cover overhead, and increases in overhead that will occur over time.

Back 9

necessary profit

Front 10

To analyze overhead:

Back 10

• Add twelve months of operating expenses and capitol expenditures.
• Subtract the annual lab expense.
• Divide by the number of hours the practice worked.

Front 11

• Be aware that it is possible to refund a portion of a fee if the estimate turns out to be too _____, but it is impossible to ask for an increase if the estimate is too ______. The original estimate must include all potential eventualities.

Back 11

high
low

Front 12

• An _______ __________of financing can aid patients with implant affordability, as well as provide the office with more assurance that fees will be paid.

Back 12

outside source

Front 13

• One of the most significant advantages of implants over other treatments is their ability to preserve ______.

Back 13

bone

Front 14

_________ and __________ cannot address the bone loss that results from missing teeth.

Back 14

bridges
dentures

Front 15

• Healthy tooth structure often has to be removed from adjacent teeth.
• Bone loss may leave a concavity in the gums.
• Additional treatment often required to maintain function and appearance.
• Potential for uncementation.
• Potential for recurrent decay and need for root-canal treatment.
• Potential for fractured teeth.

Back 15

bridges

Front 16

• Accelerated bone loss due to pressure from the removable appliance.
• Need for regular relines and adjustments as bone melts away.
• Decreased chewing efficiency due to appliance movement.
• Potential for decreased production of an enzyme in the saliva, leading to improper digestion of carbohydrates.
• Potential for harmful mobility of abutment teeth.
• Potential for recurrent decay on abutment teeth.
• Potential for loss of abutment teeth and need to remake or repair partial denture.

Back 16

partial dentures

Front 17

• Accelerated bone loss due to pressure from the movable appliance.
• Need for regular relines and adjustments as bone melts away.
• Often results in sore spots, with potential for chronic irritation.
• Significantly reduced chewing efficiency.
• Potential for decreased production of an enzyme in the saliva, leading to improper digestion of carbohydrates.
• Probable speech alterations.
• Probable chronic yeast infection.
• Possible increase in the appearance of wrinkles and premature aging.
• Potential for psychosocial problems with loss of self-confidence.

Back 17

full dentures

Front 18

• Implants often represent a larger initial investment and involve a more complex treatment sequence than conventional methods.
• However, in comparison with conventional methods, implants have a significant number of advantages.

Back 18

dental implants

Front 19

• _______-supported replacement teeth are the only solution with the ability to preserve bone and maintain the shape of the face.

Back 19

implant

Front 20

Implant ________ is key to long-term success of the implant prosthesis.

Back 20

maintenance

Front 21

suggested sequence in maintenance of implants

Back 21

• Instruction on the day of prosthesis delivery. Show the patient how to use an array of home care devices, explaining that the number of tools will decrease as he or she demonstrates proficiency.
• Check oral hygiene within one week. Adjust devices and techniques as necessary.
• Review oral hygiene in 1-2 weeks. Adjust devices and techniques as necessary.
• Review oral hygiene in 1 month. Adjust devices and techniques as necessary.
• Schedule future visits as often as needed.

Front 22

Maintenance visits are as critical with implants as they are with teeth. And as with teeth, maintenance visits for implant patients involve ________, _________, and _______evaluations, as well as probing and scaling.

Back 22

systemic, clinical, and radiographic

Front 23

The review of the patient's medical and dental history should proceed as it would for a patient with natural dentition. With implant patients, however, it is important to pay particular attention to the following elements:

Back 23

-impaired dexterity
-stress
-medication causing xerostomia
-

Front 24

• While the presence of _______ __________ is not necessary for long-term maintenance of tissues, it is recommended for surgical management, as well as patient comfort. In some cases, gingival grafts may be appropriate.

Back 24

attached gingiva

Front 25

It is important to examine the prosthesis thoroughly. This involves assessing (4 things)

Back 25

mobility, checking screws, evaluating attachments, and examining porcelain restorations, if necessary.

Front 26

• To detect _______, place an explorer or scaler under the embrasures and apply gentle pressure in the buccolingual direction, as well as slight tension in the apicocoronal direction.

Back 26

mobility

-• All implant-supported prostheses must be stable.

Front 27

• When mobility is present, assume that it originates at the prosthetic or component level, rather than from the _____itself.

Back 27

implant

Front 28

• If the prosthesis is mobile and there is no separation between the prosthesis and the abutment, this is a sign of loosening or fracture of the _________ _______.

Back 28

abutment screw

Front 29

• Any _________ must immediately be evaluated by the restorative dentist

Back 29

mobility

Front 30

• If screws can be seen, gentle movement with a probe or an explorer will allow you to detect unscrewing or possible fracture. At least once a year, an appropriate _______ should be used to verify tightening.

Back 30

screwdriver

Front 31

• If you find a loose screw, do not ______ it, but replace it with a new one. The intimate adaptation between the screw and the implant has been lost and some small distortions in the screw may be present.

Back 31

retighten

Front 32

• Note that in the presence of periosteal or blade implants, as well as some root-form implants that contain the abutment, any loosening is due to loss of _____________ or _________ of the implant itself. It must be reported to the restorative doctor immediately.

Back 32

osseointegration
fracture

Front 33

• it is expected that attachment parts of removable prostheses must be replaced regularly because of .

Back 33

wear

Front 34

• If proper osseointegration has occurred, the implant should be entirely _________.

Back 34

immobile

Front 35

• If any implant mobility is present, the implant has _______ and must be __________.

Back 35

failed
removed

Front 36

• Although probing may aid in detecting inflammation, there is little evidence that probing measurement is ________ relevant.

Back 36

clinically

Front 37

when probing, a _____ probe should be used

Back 37

nylon

Front 38

main goal in probing

Back 38

• The main aim should be to detect inflammatory changes in tissue, rather than to measure pocket depth.

Front 39

• Normal sulcus depth may be ______ than around healthy teeth due to the presence of a subgingival abutment/implant or crown/implant connection.

Back 39

greater

Front 40

• ___________ radiographs are recommended to assess crestal bone levels.

Back 40

Annual

Front 41

• Bone levels should be assessed on the _____ and _______ surfaces of implants.

Back 41

mesial and distal

Front 42

• Note that due to routine bone remodeling, normal peri-implant bone level is expected to be at the _______ thread when using two-stage screw-type implants.

Back 42

first

Front 43

For other types, the bone level should be approximately _____ mm from the implant platform.

Back 43

2

Front 44

• A horizontal ______ line at the abutment level is most probably due to screw-loosening and separation of elements. This may happen between the abutment and the implant or between the prosthesis and the abutment.

Back 44

dark

Front 45

• Although stainless steel scalers is generally the most effective material for removing calculus, it cannot be used with implants, because it _______ titanium and leaves a nidus for plaque retention.

Back 45

scratches

Front 46

• Implant scalers may be made of

Back 46

nylon, graphite, or gold-plating

Front 47

reversible condition analogous to gingivitis.

Back 47

mucositis

Front 48

more serious condition that can lead to bone loss.

Back 48

peri-implantitis

Front 49

gingival inflammation around implants without evidence of bone resorption.

Back 49

mucositis

Front 50

• If mucositis caused by abutment loosening goes undetected, it can result in

Back 50

peri-implantitis.

Front 51

• Most often, however, mucositis results from __________ loosening.

Back 51

abutment

-The loosening of the abutment enables bacterial infiltration.

Front 52

recognized by radiographic or clinical evidence of bone loss.

Back 52

• Peri-implantitis

Front 53

• Treatment of __________ involves inflammation control and modification of the exposed implant surface.

Back 53

peri-implantitis

Front 54

• Metal tools, such as interproximal brushes with a stainless-steel core wire, must be avoided because they could damage the ________.

Back 54

titanium

Front 55

• The use of ___________ is recommended around any implant-supported bridge, crown, or bar.

Back 55

super-floss or floss-threaders

-• Instruct the patient to wrap super-floss 360 degrees around the implant and polish using both horizontal and vertical motions.

Front 56

General steps in the restoration procedure

Back 56

taking impressions, selecting and preparing abutments, fabricating a crown or prosthesis, abutment delivery, and prosthesis delivery.

Front 57

• Taking an _________ is the first step in producing a stone model that indicates the positioning of implants and/or abutments in the patient's mouth.

Back 57

impression

Front 58

• It often requires impression _________, devices that facilitate the duplication of implant positions on the model.

Back 58

copings

Front 59

• Impressions may be taken at what 2 levels

Back 59

the implant level or the abutment level.

Front 60

• Implant-level impressions involve placing an implant ________, a device that mimics the implant on the stone model.

Back 60

analog

Front 61

• Abutment-level impressions involve the placement of an abutment ______, a device that mimics the abutment

Back 61

analog

Front 62

• Internal friction abutments require abutment delivery ______ to impression.

Back 62

prior

Front 63

comparison between implant-level and abutment-level impressions

Back 63

Front 64

• Implant-level impressions are similar for ____ prosthesis types.

Back 64

all

Front 65

• There are two main types of impression copings that may be used –

Back 65

transfer type and pickup type.

Front 66

remain on the implant complex after the impression is removed and need to be placed into the impression manually.

Back 66

o Transfer copings

Front 67

o are automatically retained in the impression after removal. This usually requires the manipulation of a long screw that is not present in transfer copings.

Back 67

Pickup copings

Front 68

copings provide a more precise impression

Back 68

pickup

-because the copings do not need to be positioned manually in the impression. However, impressions are fairly accurate with both methods.

Front 69

• Pickup copings require

Back 69

adequate access and interarch space

-Thus, in posterior areas, where access and interarch space are limited, transfer copings are more convenient

Front 70

after the impression is taken on a transfer coping what must be done next?

Back 70

• Attach an implant analog to the coping and push the assemblage into the impression until the coping's original position is found. Transfer copings are designed to fit into the impression in only one position.

Front 71

what must be done for multiple implants?

Back 71

pickup copings should be splinted whenever possible. This relates the copings rigidly and increases accuracy.

Front 72

what must be done for a pickup coping when poured with stone

Back 72

• If a pickup coping was utilized, remember to remove the screw prior to separating the model.

Front 73

when selecting abutments what must be considered?

Back 73

-case type
-implant diameter
-intra-arch space
-interarch space
-angulation
-gingival margins
-subgingival contours

Front 74

term used to describe the precise insertion of a bridge into its full position without resistance.

Back 74

passive fit

Front 75

When delivering multiple abutments, a _____ _______ can help to orient the abutments, saving valuable chairside time.

Back 75

resin key

Front 76

Question 31: Characteristics of implant-level impressions are:
A. Coping placement is easy because of visibility
B. Custom abutments are not available
C. Abutments must be selected in the mouth
D. Abutments can be selected in the laboratory

Back 76

D. Abutments can be selected in the laboratory

Front 77

Question 32: Transfer-type impression copings:
A. Require a hole in the impression tray
B. Are easier to utilize than pick-up copings
C. Remain on the implant when the impression
D. Should be utilized in the anterior part of the mouth only

Back 77

C. Remain on the implant when the impression

Front 78

Question 33: Pick-up type impression copings:
A. Need no modification of the impression tray
B. Remain in the impression when removed
C. Are always more precise than transfer copings
D. Are particularly useful in the posterior part of the mouth

Back 78

B. Remain in the impression when removed

Front 79

Question 34: To verify that abutments and crowns are engaging external connection systems:
A. Tactile sense is satisfactory
B. A radiograph alone is satisfactory
C. No check is necessary
D. A combination of clinical and radiographic checks are recommended

Back 79

D. A combination of clinical and radiographic checks are recommended

Front 80

Question 35: For crowns in the esthetic zone, soft tissue support:
A. Can be created in the abutment only
B. Can be created in the crown only
C. Can be created in the abutment and the crown
D. Can only be achieved with screw-retained crowns

Back 80

C. Can be created in the abutment and the crown

Front 81

Question 36: Implant indexing is:
A. A radiographic technique
B. A method of impression-taking at the time of surgical placement
C. A method of recording gingival tissues
D. A diagnostic method of determining ideal implant position

Back 81

B. A method of impression-taking at the time of surgical placement

Front 82

Question 37: Passive fit is:
A. The placement of an abutment without resistance
B. The placement of a single crown without resistance
C. The delivery of a screw without resistance until the last quarter turn
D. The placement of a bridge without resistance

Back 82

D. The placement of a bridge without resistance

Front 83

Question 38: Testing if screws can turn without resistance until the last quarter turn is:
A. Useful for verifying proper fit in multi-unit restorations
B. Only useful for implant bars
C. Only useful for single restorations
D. Useless in most clinical cases

Back 83

A. Useful for verifying proper fit in multi-unit restorations

Front 84

Question 39: After delivery of a screw-retained bridge:
A. It is important to close the screw access hole immediately with a permanent material
B. It is recommended to block the screw access hole with a temporary material
C. It is recommended to take measures so that screws will not need to be retightened at a later time
D. It is recommended to remove the bridge and reposition it at a later time

Back 84

B. It is recommended to block the screw access hole with a temporary material

Front 85

Question 40: For removable prostheses:
A. The male attachment is usually part of the denture
B. The attachment components do not have to be replaced
C. The female component may need replacement during maintenance
D. Screws are not accessible

Back 85

C. The female component may need replacement during maintenance

Front 86

Question 41: When using a two-stage implant, radiographic bone level is expected to be:
A. At the top of the abutment
B. Flush with the implant head
C. At the level of the first thread
D. 4-5 mm apical to the implant head

Back 86

C. At the level of the first thread

Front 87

Question 42: Mobility of an implant-supported crown generally means:
A. Failure of the implant
B. Occlusal traumatism
C. Normal flexing of abutments
D. Loosening of an implant component

Back 87

D. Loosening of an implant component

Front 88

Question 43: Clinical inflammation around a single restored implant, associated with pain or pressure, but no radiographic bone loss, is most likely due to:
A. Implant failure
B. Peri-implantitis
C. Fracture of a component
D. Loosening of a component

Back 88

D. Loosening of a component

Front 89

Question 44: If an implant has been placed apically, a 7 mm peri-implant probing shows no sign of inflammation, and there is no radiographic change and no bleeding, this probably indicates:
A. Normal functioning
B. Peri-implantitis
C. Implant failure
D. Component failure

Back 89

A. Normal functioning

Front 90

Question 45: At a maintenance visit, an implant-retained bar is found to be mobile at one extremity. The following should be undertaken:
A. Place a watch in the records and reevaluate at the next visit
B. Refer for implant removal
C. Tighten the probable loose screw
D. Verify that the screw is loose and place a new one

Back 90

D. Verify that the screw is loose and place a new one

Front 91

Question 46: When observing a routine radiograph for an implant patient, you see a horizontal dark line between the implant and what seems to be the abutment. This is probably:
A. Normal
B. A sign of component loosening
C. A sign of peri-implantitis
D. A sign of implant failure

Back 91

B. A sign of component loosening

Front 92

Question 47: Maintenance instrumentation for implants:
A. Is identical to instrumentation used on teeth
B. Should be plastic only
C. Is not necessary
D. Must not be made of stainless steel

Back 92

D. Must not be made of stainless steel

Front 93

Question 48: If a patient has removable dentures, what generally needs to be done at yearly visits?
A. A change of abutment screws
B. A change of female attachments
C. A reline of dentures
D. A change of abutments

Back 93

B. A change of female attachments

Front 94

Question 49: Which of the following should be recommended to patients for home care?
A. Implant brushes
B. Any interproximal brush
C. Oral rinses only
D. Superfloss or yarn

Back 94

D. Superfloss or yarn

Front 95

Question 50: Oral hygiene instructions for implants:
A. Are identical to instructions for teeth
B. Should include specific wrap-around techniques
C. Should specify staying away from implant surfaces
D. Should be reserved for fixed restorations

Back 95

B. Should include specific wrap-around techniques