Term
| What is the key to not getting yourself into trouble when dealing with implant cases? |
|
Definition
| to respect the biology (the way the bone heals, the way the jaw moves in space). Everything else (technology) will change but biology doesn’t. |
|
|
Term
| What are the questions you must consider when treatment planning an implant patient? |
|
Definition
Medical evaluation
Are there risk factors at the patient level (smoking)?
What are the contraindications (never ever)?
Relative contraindications (at treatment plan and doctor's discretion)?
Can a patient be to old or to young for dental implant treatment?
Should this be part of the risk/benefit informed consent (must talk with the patient, not just sign a paper)? |
|
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Term
| Can a patient be too old or too young for dental implant treatment? |
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Definition
Not too old-can be too sick
Can be too young-needs to be done growing. Teeth have a PDL, as jaw bone grows, PDL moves with tooth. Implants are like an ankylosed tooth, they’re not going to move. Men often grow until 21-22, women 18. Women can get implants at a younger age |
|
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Term
| How can tell if a patient is done growing? |
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Definition
lateral ceph exray
measures angles and growth of jaw-take it 6 mo apart and if there’s no difference than we know that growth has ceased and it’s safe to place implant) |
|
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Term
| What are the importances of medical evaluation? |
|
Definition
Older segment of the population
Systemic medical conditions tend to be cumulative
Deleterious habits (i.e. smoking, bruxism) tend to congregate
Can the patient be treated in an out-patient dental setting (due to medical or psychological)? |
|
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Term
| What is the medical risk factor that we encounter the most? |
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Definition
Endocrine disorders (diabetes, hyper- \hypothyroidism)
-known side effect of poor wound healing in poorly controlled diabetes |
|
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Term
medical contraindication or relative contraindication
Radiation treatment to the region
Sepsis
Severe medical fragility
Excessive alcohol or substance abuse
Moderate smoking (≥ 10 cigarettes/day)
Psychophobias
Well-controlled systemic disease (Diabetes mellitus, Hypothyroidism)
Osteoporosis |
|
Definition
Radiation treatment to the region - contraindication
Sepsis - contraindication
Severe medical fragility - contraindication
Excessive alcohol or substance abuse - contraindication
Moderate smoking (≥ 10 cigarettes/day) - relative
Psychophobias - contraindication
Well-controlled systemic disease (Diabetes mellitus, Hypothyroidism) - relative
Osteoporosis - relative |
|
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Term
| Why is diabetes a potential risk for dental impacts? |
|
Definition
AGE modified changes to host factors
Impaired host response
Decreased collagen metabolism (won't see same turnover for resorption/absorption of bone)
Increased susceptibility to infection
Compromised wound healing
Changes in periodontal vasculature
in Host Inflammatory State |
|
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Term
Is there a lot of date on long term success of osteoporosis and dental implants?
What should you try to do when placing an implant and what should you advise the patients on? |
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Definition
Limited data on long term success (Could be a risk factor)
May be beneficial in preserving bone
Advise patients on diet, exercise, have patient see their physician |
|
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Term
Smokers are on average ___ times more likely to lose teeth than nonsmokers
Smokers are on average ___ times more likely to lose implants than nonsmokers |
|
Definition
Smokers are on average 2.6 times more likely to lose teeth than nonsmokers
Smokers are on average 5 times more likely to lose implants than nonsmokers (NO PDL!!!) |
|
|
Term
| If we assume a 90% success rate for implants in nonsmokers, what percentage of implants will fail in smokers? |
|
Definition
|
|
Term
| List the ASA classifications from I to E and which ones do we want to see in the dental office? |
|
Definition
Class I: Healthy patient
Class II: Mid-to-moderate systemic disease
Class III: Severe systemic disturbance
Class IV: Severe life-threatening systemic disorder
Class V: Moribund patient who is not expected to survive
Class E (subclass): Emergency procedure
We want Class I or II |
|
|
Term
State if the following patient factors influence implant success:
smoking
cardiovascular disease
diabetes
osteoporosis
bisphosphonates |
|
Definition
Smoking-Yes
Cardiovascular Disease-No evidence
Diabetes-Possibly via increased infection and altered wound healing; Evidence of delayed healing in moderate to poorly controlled type 2 DM patients
Osteoporosis-Unsure; Alters bone density/bone turnover
Bisphosphonates-Unsure; Low doses may improve success |
|
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Term
Why do you need to measure bone volume?
How many mm do you actually need? |
|
Definition
to look at bone height away from anatomical structures (inferior alveolar nerve and mental foramen in mandible, maxillary sinuses in maxilla)
more than 10mm because of the bevel |
|
|
Term
| If you place a 3 mm implant, how much space would you need between the narrowest space? |
|
Definition
| 6mm (1.5mm circumferentially) |
|
|
Term
If the buccal or lingual plate thinner/tend to lose more bone?
What image do we use to see the bone? |
|
Definition
buccal plate
tomography (3D) |
|
|
Term
| When extracting maxillary teeth what risk must we tell patients of? |
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Definition
|
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Term
| Do we have the option to add more bone in the maxillary or mandible? |
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Definition
| In the max we have the option to add bone, we don’t have that option in the mandible without moving the nerve out of the way |
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Term
| ________ and ________ of bone affect the angulation/location of implant placement, prosthetic design and long-term success of the implant |
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Definition
|
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Term
| A minimum of ___mm of bone is needed buccally and lingually to maintain viability at placement. |
|
Definition
|
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Term
| What are the anatomical changes related to edentulism |
|
Definition
Decreased height and width of supporting and basal bone
Increased prominence of the mylohyoid ridge and superior genial tubercles
Increased prominence of the mandibular canal
Relative prominence of the mylohyoid and buccinator muscles
Relative increase in the size of the tongue
Decrease in the quantity and quality of the attached keratinized gingiva |
|
|
Term
| Do implants have a higher survival in the max or mand? |
|
Definition
| Why implants have higher survival in mandible (more cortical, more dense) and than maxilla (more cancellous |
|
|
Term
What part of the mouth has the highest survival of implant?
lowest survival? |
|
Definition
Anterior mandible-highest survival
Posterior maxilla-lowest survival |
|
|
Term
Identify the type of bone:
A thick layer of cortical bone surrounds a dense core of trabecular bone?
A thin layer of cortical bone surrounds a core of low-density trabecular bone
A thin layer of cortical bone surrounds a dense core of trabecular bone
Almost entirely homogenous cortical bone |
|
Definition
II
IV (posterior maxilla)
III
I (anterior mandible) |
|
|
Term
| What are indications (4) for implant assisted prosthesis? |
|
Definition
Replacement of lost hard tissue
Replacement of lost soft tissue
Presence of unfavorable ridge morphology
Expressed desire for removable prosthesis
(Because of the tongue, mandibular denture doesn’t fit like a maxillary denture, especially as mandible atrophies
-not the same as fixed prosthesis, still implant and tissue supported) |
|
|
Term
| What are indications (4) for implant supported fixed restorations? |
|
Definition
Unfavorable number and location of potential abutments in the residual dentition
Avoid need to involve neighboring teeth as abutments
Alleviate the need to use teeth with questionable prognosis as abutments for fixed restorations
Maintain bone volume after extraction |
|
|
Term
| What is stabilized on the remaining dentition and provides accurate information for the placement of the implant in the required prosthodonitic position? |
|
Definition
|
|
Term
Survival or success:
Implant still in function in the oral cavity |
|
Definition
| survival (just says it's present and patient is chewing on it) |
|
|
Term
survival or success:
implant meets certain success criteria |
|
Definition
| success (how stable implant is) |
|
|
Term
After the 1st year of loading, how much bone are you allowed to lose according to the Albrektsson criteria?
How much are you allowed to lose after the 1 year of loading? |
|
Definition
1 mm
<0.2 mm/year vertical bone loss |
|
|
Term
| What are the (5) Albrektsson Criteria for Implant Success |
|
Definition
Individual Unattached Implant is Immobile
No Radiographic Evidence of Peri-Implant Radiolucency
< 0.2mm/year Vertical Bone Loss after 1 year of Loading
No signs or symptoms, such as pain, infections, neuropathies, parasthesia or violation of the mandibular canal
At 5 years a minimum of 85% and at 10 years a minimum of 80% overall success rate |
|
|
Term
True or false:
Implant success (97.4% overall) has been demonstrated over 10 years with low complications for adjacent teeth. |
|
Definition
|
|
Term
| What are 3 reasons for early failure of implants? |
|
Definition
surgical technique (e.g. necrosis from overheating)
premature loading
poor bone quality/infection |
|
|
Term
| What are 3 reason for late failure of implants? |
|
Definition
Infection
Prosthetic Overload
Plaque induced peri-implantitis |
|
|
Term
True or false:
Patients with chronic periodontitis have similar implant success rates as implants placed in patients without periodontitis1 |
|
Definition
True
These are patients who have had perio treatment and maintenance |
|
|
Term
True or false:
Implants placed in fresh extraction sockets and those in areas of regenerated bone have similar success rates as implants placed at other sites |
|
Definition
True
esthetic success if very different in many cases |
|
|
Term
True or false:
Roughened surface implants had lower success rates than smooth surface implants in areas with low bone density |
|
Definition
False
Roughened surface implants had higher success rates than smooth surface implants in areas with low bone density |
|
|
Term
True or false:
One stage implant systems have equivalent levels of success as two-stage systems up to two years. |
|
Definition
|
|
Term
What is the associated bone loss around an implant?
What is the infection of around the implant mucosa? |
|
Definition
periimplantitis
periimplant mucositis (no pdl=no gingiva) |
|
|
Term
| What can periodontal disease (similar microflora as pin periodontitis) around dental implants cause? |
|
Definition
Can lead to peri-implant bone loss
Ultimately can lead to implant loss |
|
|
Term
| Do implants have a periodontium? |
|
Definition
| no (can't get host cells) |
|
|
Term
| What type of connective tissue is present around implant interface? |
|
Definition
| Thick band of fibrous collagen oriented in a circumferential manner (scar tissue), very different from hemidesmosal attachment |
|
|
Term
| __________of an implant indicates complete lack of osseointegration and the implant should be removed. |
|
Definition
|
|
Term
True or false:
Mobility is useful for early diagnosis of peri-implant diseases. |
|
Definition
False
Mobility of an implant indicates complete lack of osseointegration and the implant should be removed.
Mobility is therefore not useful for early diagnosis of peri-implant diseases. |
|
|
Term
| The presence of _____ is the result of infection and an inflammatory lesion |
|
Definition
|
|
Term
| What can suppuration cause? |
|
Definition
|
|
Term
| What is all involved in the biologic width around implants? |
|
Definition
Sulcus depth
Junctional Epithelium
Connective tissue |
|
|
Term
| The abutment implant gap is in what type of implants systems? |
|
Definition
|
|
Term
| What and where is the gap between the implant and the abutment (allows bacteria to get in)? |
|
Definition
abutment implant gap (Abutment connection to the submerged implant)
at or below the alveolar crest (Biologic width) |
|
|
Term
| What are the signs of a failing implant? |
|
Definition
Chronic pain
Mobility
Bone loss around the implant that persists or progresses after appropriate treatment
Advanced peri-implantitis (poor crown:root ratio) |
|
|
Term
| If an implant causes chronic pain, mobility, peri-implantitis, and bone loss, what should you do? |
|
Definition
|
|
Term
| Is there greater attached bone loss around dental implants or teeth? |
|
Definition
| implants (positive correlation was found between both IL-1 and TNFalpha and attached bone loss) |
|
|
Term
| What is the likelihood of gentlemen over 35 that smoke having periodontal disease? |
|
Definition
|
|
Term
| What are the possible treatment planning options for a fractured tooth? |
|
Definition
No Treatment
RPD
Extraction and fixed partial denture
RCT and Single Tooth Crown
Dental Implant |
|
|
Term
True or false:
Teeth should be replaced because of tooth movement. |
|
Definition
False
The real reason we replace these teeth is bc patients don’t like to be missing teeth. Psychological problem. |
|
|
Term
| What is the average success rate of FPD? |
|
Definition
|
|
Term
| Most post-operative problems after FPD resolved within 2 months with the exception of __________ and ___________. |
|
Definition
| food impaction and smiling |
|
|
Term
True or false:
implant supported crown was regarded higher than resin bonded FPD in patient satisfaction |
|
Definition
false
Resin bonded FPDs and ISC were approximately the same with regards to patient satisfaction |
|
|
Term
True or false:
ISC required more appointments, but long-term overall economic cost lower than FPD |
|
Definition
|
|
Term
What is the average survival rate of primary root canal treatment (not retreatment)?
What is the average success rate after 6+ years? |
|
Definition
|
|
Term
| What is the implant supported crown long term success and survival? |
|
Definition
Avg Survival: 97%
Avg Success: 95%
6+ years |
|
|
Term
| What is not indicative to implant supported crown survival/success? |
|
Definition
| Extremely high surgical and survival success not always indicative of esthetic success, usually caused by gingival margin discrepancies (mainly by dentists) |
|
|
Term
| What all is taken into account when referring to success of an implant supported restoration? |
|
Definition
|
|
Term
| What all must you consider when looking at overall patient health adequate for implant placement? |
|
Definition
Smoking
Diabetes
Psychoses
Dental phobias |
|
|
Term
| What all must you consider when looking at patient-specific intramural findings? |
|
Definition
Plaque control
Occlusal forces
Caries rate
Xerostomia
Periodontitis |
|
|
Term
| When assessing the site of a fractured tooth, what is the overall patient treatment pal? |
|
Definition
Temporization plan
Other treatment(s) to be rendered
Periodontal Health |
|
|
Term
| What are the two biotypes of soft tissue quality, quantity, and morphology? |
|
Definition
Thick
Think-More prone to recession, gingival showthrough, more difficult to treat |
|
|
Term
| Why is the bone greater on the buccal aspect? |
|
Definition
More delicate
Limited blood supply
More prone to trauma |
|
|
Term
| What all is involved in a successful ridge preservation? |
|
Definition
Minimal trauma to buccal of facial bone
Continuation of a blood supply
Atraumatic extraction
Guidance of the hard and soft tissue healing with temporary replacement |
|
|
Term
| What all can you do to develop a bony site? |
|
Definition
Ridge augmentation
Sinus elevation by adding bone
Nerve relocation
Guided bone regeneration after ext
Distraction |
|
|
Term
Is a FPD or an implant quicker?
Is the cost more or less than implant |
|
Definition
FPD (implant-have to wait for the biology)
about the same |
|
|
Term
What is usually the patient resistance to root canals?
Is there more or less pain involved with root canals compared to implants? |
|
Definition
due to psychosocial reasons
about the same pain |
|
|
Term
| When converting an extraction socket to a well developed implant site what do we want to do? |
|
Definition
We want to preserve the bone and soft tissue
(ridge preservation procedure) |
|
|
Term
| How much buccal and lingual bone is lost following a tooth extraction? |
|
Definition
|
|
Term
| What are the 2 phases of bone loss following a tooth extraction? |
|
Definition
Phase 1: Bundle bone resorbed and replaced with woven bone
Phase 2: Resorption from the outer surfaces |
|
|
Term
| Can you change a patient's biotype? |
|
Definition
| yes, with soft tissue site development |
|
|
Term
| Why must you take a post-operative radiograph? |
|
Definition
| to make sure there is no excess cement left over/post iatrogenic plaque retentive factors |
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