OS Final Flashcards by A G

One of the best advances in dentistry in the last fifty years; significantly advances restorative options

Implants

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Direct connection between living bone and the load bearing endosseous implant at the light microscopic level

Osseointegration

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What are the 4 successful requirements for implants?

Biocompatible material
Precise adaptation
Atraumatic surgery
Stable healing phase

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What is involved in the soft tissue to implant relationship?

Thick vs thin biotype
JE attachment

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Can be caused by improper loading of the
implant

Bone resorption around implant

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Often due to premature loading and/or repeated overloading

Bone resorption around implant

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What is vertical and/or horizontal bone loss most often caused by?

Occlusal trauma

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Prosthetic design as well as __________ of the implant relative to the loading axis of forces is crucial to know and understand

position

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T/F: Do not connect implants to natural teeth

True

(recipe for failure)

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What are the 4 absolute contraindications of implants?

Cardiovascular
Acute illness
Uncontrolled metabolic disease
Pregnant patient

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What are the following relative contraindications associated with?

Abnormal bone metabolism
Poor oral hygiene
Previous radiation
Smoking
Osteoporosis
Fibrous Dysplasia
Osteomyelitis
Florid Osseous Dysplasia
Periodontal disease
Bisphosphonates (PO vs IV)
Expectations
Motivation

Implants

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What is the failure rate of implants in pts that smoke?

2-3x the failure rate

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Which radiograph is the gold standard for planning implants?

CBCT

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When evaluating the implant site, what 3 things do you look at?

Bone
Anatomical variations
Normal anatomy

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When evaluating the implant site, what are the 3 most important things when looking at bone?

Quality (type I-IV)
Quantity (height, width)
Position

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Atraumatic extraction helps minimize what?

Bone loss

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Bone grafting with GTR

Socket preservation

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When are implants placed after ext?

4-6 months after ext

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When placing implants, soft tissue _________ needs to be carefully evaluated and managed

biotype

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Inadequate soft tissue can make the implant look unnatural or lead to _________

failure

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When placing implants, soft tissue _____________ should be address well before final restoration

augmentation

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What is placed at the time of implant placement?

Healing collar

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Flat and typically placed at the time of surgery
for a two-stage implant

Cover screw

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At the time of uncovering or at time of the implant placement, what can be placed for soft tissue management?

Healing collar

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What is placed for posterior teeth but can be used for anterior teeth if the patient already has an esthetic appliance?

Healing collar

What are typically used for anterior teeth so a temporary crown/restoration can be fabricated?

Temporary anterior abutments

Very few implants fail at which time period?

Uncovering

At which time period will an implant fail due to the following reasons? Failure of primary stability Postop infection Pressure from prosthetic device Wound healing Over heating bone at time of placement

Uncovering

Implant fails during the first 18 months after restoration/uncovery

Early failure

At which time period will an implant fail due to the following reasons? Excessive biomechanical forces Compromise periodontal issues Poor oral hygiene Smoking (increases failure rate by 2-3x)

Early failure (first 18 months after restoration/uncovery)

Implant fails more than 18 months after prosthetic restoration

Late failure

At which time period will an implant fail due to the following reasons? Idiopathic Leftover cement that can cause significant and rapid bone loss and poor OH Excessive biomechanical forces Compromise periodontal issues Poor oral hygiene Smoking (increases failure rate by 2-3x)

Late failure (more than 18 months after restoration)

What can be done for failing implants?

Implant salvage

Mechanical and chemical debridement/cleansing followed by bone grafting, membrane placement, and tension free closure

Implant salvage

Which procedure? Surgical exposure Careful and meticulous mechanical debridement Chemical debridement Bone graft with/without membrane and/or primary closure

Implant salvage

When are immediate implant placements indicated?

Tooth is not infected No significant bone loss at time of ext Must be able to engage at least 4mm of stable bone

What are the following considered? Bone block grafting and/or sinus lift augmentation Alveolar distraction LeForte I Osteotomy with sinus and anterior maxillary grafting Zygomatic Implants Ridge Split Individual Patient Solution (IPS) Craniofacial Implants

Advanced technique for implant placement

Indicated with minimal maxillary bone and/or patient is unwilling to undergo large sinus lifts, or LeForte I bone graft augmentation

Zygomatic implants

When are the following advanced techniques used for implant placement? Bone block graft Trans-mandibular Implant/Mandibular Staple Nerve repositioning

Atrophic mandible

What are the following examples of? FDDB (free dried demineralized bone) Bovine bone Hydroxyapatite Bioactive glass/ceramics

Bone graft in bottle

What are the following advantages associated with? Readily accessible No 2nd surgical site Unlimited supply Done in office

Bone graft in bottle

What are the following disadvantages associated with? Pt acceptance Possible transmission of disease Biologic activity questionable from batch to batch Quality of grafted bone

Bone graft in bottle

What are the following advantages associated with? Can grow bone No 2nd surgical site "Tissue engineering"

BMP

What are the following disadvantages associated with? Expensive Learning curve (unpredictable as to amount generated) How does bone know when to stop growing?

BMP

What are the 2 types of sinus lifts?

Direct Indirect

A tooth that fails to erupt into the dental arch within the expected time frame

Impacted tooth

What are the 5 causes of impacted teeth?

Adjacent teeth Dense bone Excessive soft tissue Cysts Tumors

T/F: Impacted teeth can be retained for life if not surgically removed, but they can lead to issues

True

What is the frequency of tooth impaction?

Mandibular 3rds > Maxillary 3rds > Maxillary canines > Mandibular premolars

What are the 3 classification systems for impacted mandibular 3rds?

Angulation Pell and Gregory (1) and (2)

Which classification system for impacted mandibular 3rds? Long axis of the 3rd molar as related to the long axis of the 2nd molar

Angulation

Which type of angulation? (impacted mandibular 3rds classification) Most common Least difficult to remove

Mesio-angular impaction

Which type of angulation? (impacted mandibular 3rds classification) 2nd most common Long axis of 3rd molar is parallel to 2nd molar

Vertical impaction

Which type of angulation? (impacted mandibular 3rds classification) Uncommon Most difficult to remove

Disto-angular impaction

Which type of angulation? (impacted mandibular 3rds classification) 3% of all impactions

Horizontal impaction

Which classification system for impacted mandibular 3rds? Classes 1, 2, and 3 Ramus

Pell and Gregory (1)

Which classification system for impacted mandibular 3rds? Based on the amount of impacted tooth covered with bone of the mandibular ramus

Pell and Gregory (1) - classes 1, 2, and 3 ramus

Which type of Pell and Gregory classification? (impacted mandibular 3rds classification) M-D diameter completely anterior to ramus

Class 1 ramus

Which type of Pell and Gregory classification? (impacted mandibular 3rds classification) 1/2 of crown covered by ramus

Class 2 ramus

Which type of Pell and Gregory classification? (impacted mandibular 3rds classification) Completely embedded within ramus

Class 3 ramus

Which classification system for impacted mandibular 3rds? Class A, B, C

Pell and Gregory (2)

Which classification system for impacted mandibular 3rds? Another system suggested by Pell and Gregory which used vertical position relative to occlusal plane

Pell and Gregory (2) - Class A, B, C

Which type of Pell and Gregory classification? (impacted mandibular 3rds classification) Level or nearly level with occlusal surface of 2nd molar

Class A

Which type of Pell and Gregory classification? (impacted mandibular 3rds classification) Btwn occlusal surface and CEJ

Class B

Which type of Pell and Gregory classification? (impacted mandibular 3rds classification) Below level of CEJ

Class C

Angulation terms similar but with different implications with regards to _________

difficulty

Pell and Gregory A, B, and C Classification system is used to describe _______

depth

What are the 2 classification systems for impacted maxillary 3rds?

Angulation Pell and Gregory

Which classification system for impacted maxillary 3rds? Term is similar to impacted mandibular 3rds, but with different implications with regards to difficulty

Angulation

Which classification system for impacted maxillary 3rds? Used to describe depth

Pell and Gregory - Class A, B, C

Which type of angulation? (impacted maxillary 3rds classification) 63% occurence

Vertical impaction

Which type of angulation? (impacted maxillary 3rds classification) 25% occurence

Disto-angular impaction

Which type of angulation? (impacted maxillary 3rds classification) 12% occurence Most difficult to remove

Mesio-angular impaction

In general, surgical removal of impacted teeth is indicated ______ problems arise

before

Technical difficulty and morbidity related to extractions increases with _____

age

T/F: You should wait to take out impacted teeth until symptoms arise

FALSE

Removal of third molars before age ____ results in better healing (bone height and attached tissue) and long-term regeneration of the periodontium

Removal of completely bony impacted third molar in patient older than _____ should be considered only if specific pathology exists

What are the indications associated with? Prevention of odontogenic cysts/tumors Prevention of mandibular fracture Facilitation of orthodontic treatment Impacted tooth under a prosthesis Treatment of pain of unknown origin Prevention of root resorption Prevention of pericoronitis Prevention of perio Prevention of caries Inflammation +/- infection Chances of decreased bone distal to 2nd molar

Ext 3rd molars

What is the #1 reason for removal of 3rd molars?

Pericoronitis

What are the following contraindications associated with? Extreme age Compromised medical status Possible damage to surrounding anatomic structures (lingual nerve, IAN, bone) Suspect radiographic findings

Ext 3rd molars

What are the following associated with? Diversion of the canal Darkening of the root Bifid root tip Narrowing of the root(s) Deflection of the root Narrowing of the canal

Suspect radiographic findings

How do you surgically remove impacted teeth?

Soft tissue flap for adequate exposure Remove bone Section tooth Elevate sectioned tooth Irrigation & closure

What do you use to remove bone on the mandible?

High speed/torque surgical handpiece

What do you use to remove bone on the maxilla?

Monobevel osteotome or handpiece

What bur do you use to section teeth?

Fissure bur

What is the mandibular incision design?

Envelope flap from mesial of 1st molar to DB line angle of 2nd molar DB/facial release

When removing impacted 3rd molars, flap design is based on a ________ approach with avoidance of the ________ nerve

buccal; lingual

When is the most discomfort expected following impacted 3rd molar surgery?

First 24-72 hrs (should start to feel better every day after that)

What is the max amount of time expected for swelling and trismus following impacted 3rd molar surgery?

48-72 hrs

For each day of swelling, how many days does it take to resolve following impacted 3rd molar surgery?

3 days

Swelling should be _____ and _____. Hard, hot and red indicates _______. Remove suture, loosen flap for drainage, antibiotics

soft; cool; infection

T/F: Pain and swelling after 48-72 hrs or failure to improve requires investigation

True

What should you be thinking if your pt has long term trismus following 3rd molar ext?

Deep seated infection

After 3 dressings, it is no longer a "dry socket," but possible _________

osteomyelitis

Paresthesia that is not __________ requires referral for nerve repair eval

changing

What are the following complications associated with? Swelling, bruising, stiffness of jaws Hemorrhage Dry Socket (alveolar osteitis) 1-3.5% Infection Nerve Injuries Periodontal defects Damage to Adjacent teeth, restorations Injury to maxillary sinus/tuberosity Mandibular fracture TMD

3rd molar exts

The risk of dry socket increases with what 2 things?

Increasing age Smoking

There is a _____x likelihood of a complication if the patient having 3rd molars removed at over 25 years of age with generalized increasing risk with age through age 65

1.5

Benefit must __________ the risk

outweigh

T/F: In older pts, it is better to let sleeping dogs lie and remove 3rd molars only if symptomatic or with evidence of developing pathology

True

An advantage to early removal of 3rd molars is reduced possible injury to _________

2nd molars

An advantage to early removal of 3rd molars is that the roots are not fully formed, which results in fewer root _______ and nerve injuries. The bone is also softer and more elastic, allowing for better _________.

fractures; healing

An advantage to early removal of 3rd molars is lower incidence of surgical ___________

morbidity

An advantage to early removal of 3rd molars is less anesthetic risk and economic __________

convenience

What are the 3 alternatives to 3rd molar ext?

Manage medically (antibiotics, pain meds, peridex) Operculectomy Coronectomy

When is the ideal time to take out 3rd molars?

When there is radiographic evidence of furcation

T/F: Prior to age 18, presence of 3rd molars alone is indication for removal

True

By age 27, the risk/benefit of 3rd molar removal is approximately _______

equal

Treatment based on signs and symptoms is appropriate. For true __________________, there should be a clear indication for removal

complete bony impaction (CBI)

Beware of the __________ patient….they are not generally straight forward cases and patient management can be difficult

pediatric

Beware of the __________ patients… brittle bone does not give and teeth tend to shatter and require surgical removal

elderly

What are the following complications associated with? Increased Postoperative Pain Alveolar Osteitis (Dry Socket) Hemorrhage Oroantral Communication Paresthesia (IAN/Lingual) Damage to adjacent structures TMJ pain Fracture Retained bone fragment/tooth MRONJ

Extractions

T/F: It is never ok for a pt to find out about your complication from anyone but you

True

Inform the patient of possible complications ________ the procedure

before

What are the 4 components of informed consent?

Risks (generic and specific) Benefits Alternative tx (including no tx) Documentation

What are the 6 steps to follow if a patient returns to your clinic after an ext?

1. Review notes 2. Listen to pt 3. Exam 4. Diagnose 5. Explain 6. Treat

What are the 7 things that should be on your differential diagnosis of post-op OMFS pain?

Normal post-op pain Infection Dry socket Buccal plate fracture Peri-cementitis of teeth adjacent to ext site Retained root / pathology Additional tooth/teeth pain

What are the following symptoms associated with? Fever (subjective—pt reports fever—ask for specifics) Pain Drainage Bad taste Malodorous Swelling Lethargy

Infection

What are the following signs associated with? Exam may reveal tenderness, erythema, edema, purulence, fever

Infection

What are the following symptoms associated with? Pain that typically begins post-operative day 3-4 after initial improvement

Alveolar osteitis (dry socket)

What are the following symptoms associated with? Loss of portion of blood clot (or all of it) with resultant exposed bone

Alveolar osteitis (dry socket)

What are the following symptoms associated with? Self-limiting process Painful NOT an infection

Alveolar osteitis (dry socket)

How do you treat alveolar osteitis (dry socket)?

Gentle irrigation Pack w/ dressing (eugenol)

T/F: NEVER use a regular highspeed handpiece for surgical procedures

True

Your #1 friend to treat bleeding is always ________ __________

direct pressure

Which sinuses are present at birth?

Maxillary Ethmoid

What is the volume of the maxillary sinus?

15 mL

Sinusitis is still acute up to ____ months

Viral sinus infections often resolve in ____ days

What do you do if there's a root tip in the maxillary sinus?

Verify with x-ray Let pt know Removal is usually indicated

Do not _______ the sinus if you think there is an OA communication

probe

If the OA communication is 2-6mm big, how do you fix it?

Figure 8 suture Sinus precautions

If the OA communication is 7mm or bigger, how do you fix it?

Close w/ flap procedure

What are the following symptoms associated with? Halitosis Oral & sinus drainage Bad taste Pain

OA communication

When is OA communication best managed?

At time of ext

What are the post-op instructions following OA communication?

No smoking No nose blowing Open mouth sneezing Decongestants as needed

OS Final Flashcards

(137 cards)