Q6 IMPLANT MIDTERM QUESTIONS REFINED WEEKS 1-5

⭐ What anatomical component is NOT involved in osseointegration?

Keratinized gingiva

What is osseointegration?

the direct structural and functional connection between living bone and the surface of a load-bearing artificial implant

What are the two shapes of endosseous root forms?

cylindrical or screw shaped

⭐⭐⭐What is the first step in the mechanism of healing? (Initial healing event at the implant site)

Formation of a peri-implant blood clot

⭐ True or False: osteoblasts lay down a collagen matrix.

True

⭐ What bone cells deposit collagen-rich osteoid?

Osteoblasts

⭐Which bone cells resorb mineralized bone?

Osteoclasts

⭐ Around what time does the primary-to-secondary stability dip often occur? / ⭐⭐ What week has the lowest stability on the graph?

Around 4 weeks (variable)

Difference between woven and lamellar bone?

woven bone: highly cellular, low mineral content, random orientation, reaches implant surface in 6 wks

lamellar bone: highly organized, densely mineralized, forms in 18 weeks

What is the delayed loading protocol for mandible and maxilla?

Mandible: 3 months

Maxilla: 6 months

⭐ Rank the studies from least bias to most bias

Systematic review, prospective studies, retrospective studies

If it asks for more: case reports, animal and in vitro studies, expert opinion (most bias)

⭐ True or false: financial history is NOT a part of treatment planning.

False — financial considerations are part of structured implant treatment planning

⭐ What is the sequence of structured implant patient assessment?

1) Anamnesis/history →

2) examination →

3) imaging →

4) additional investigations →

5) risk assessment

⭐ Is structured patient assessment only indicated for difficult implant cases?

No, we do structured patient assessment for every implant case

⭐ What are the main goals of structured implant treatment planning?

Identify risks and options, address patient expectations and finances, obtain informed consent, and document care

⭐ When doing implants you have to take all of the following into consideration EXCEPT?

Implant brand preferences

What are the 4 decision making processes in implant treatment planning?

Patient mediated factors

Local factors

Systemic factors

Evidence-based prognosis

What are systemic ABSOLUTE contraindications of implant therapy?

Uncontrolled Diabetes, alcohol/drug abuse, unrealistic expectations

⭐ Which of the following is an absolute contraindication?

Uncontrolled Diabetes; leads to 50% of implant failures

The level of evidence indicative of absolute and relative contraindications for implant therapy due to systemic diseases is ______

low

4 recommendations for controlled diabetics undergoing implant treatment

1) increased healing time (Osstell - 70 threshold)

2) prophylactic antibiotics

3) 0.12% Chlorhexidine

4) increased implant length and width where bone permits

⭐⭐⭐ In an osteoporotic patient, what cells are targeted by bisphosphonates?

Osteoclasts

⭐ Does smoking constitute an ABSOLUTE contraindication to implant therapy?

No — smoking is a significant risk factor and a RELATIVE contraindication, but not an absolute contraindication

⭐⭐ Relative Contraindications of Implant therapy

BRUXISM

History of Radiation therapy

Immunocompromised

Smoking

Antidepressants

proton pump inhibitors

History of periodontitis

Oral and IV bisphosphonates for osteoporosis

Alcohol

Long term use of NSAIDs

⭐ Which of the following is NOT a relative contraindication

Elderly

⭐ What is NOT a systemic absolute contraindication?

Smoking

⭐ For a better prognosis, what is the timeline for the smoking cessation process?

4 weeks prior & 8 weeks post-surgery

⭐⭐⭐ What of the following are NOT recommendations for parafunction/bruxism?

Cantilever designs, Tilted teeth, narrow implants

Recommendations for implant restorations with parafunction:

wider diameter implants, functional cusp tip/fossa occlusion, wider diameter implants, no cantilevers

What is the Law of 7 for a standard 4mm implant?

-7 mm Inter-Occlusal space (5 mm Abutment, 2 mm Zirconia)

-7 mm Mesio-Distal space (1.5 + 4 + 1.5)

-7 mm Bucco-Lingual space (1.5 +4 + 1.5)

⭐ All of the following are the law of seven except?

Minimum diameter of healing abutment

The 3 F's (local factors)

Field (law of 7)

Foundation

Facial and dental esthetics

More favorable implant surface structures have led to _____

higher survival rate in Type 4 bone and a minimally invasive approach

How thick is the implant vacuum forming material?

0.02 mm

⭐ What must be fabricated before a CBCT?

Radiographic template

If the implant is in the esthetic zone what do we need?

smile design

List all the items we need before we take a CBCT in preparation for an implant treatment

a) informed consent (RBA including no tx)

b) financial discussion/approval

c) systemic review

d) panorex, PA of area

e) mounted study casts

⭐ What is the CBCT billing code for single implant, multiple implants, and full arch?

D0367

CBCT billing code for post op 3-6 months after grafting

D0367PO

⭐ What anatomical features must be traced and carefully avoided due to irreversible damage?

IA and Mandibular nerve

⭐ Whats the implant consultation code for a partially edentulous pt?

D0160I

⭐⭐ CBCT Code for PARTIALLY Edentulous patient

D0364I

⭐⭐ What is not a goal for implant SURGERY

establish the shape and size of the ridge.

⭐ What is the recommended mesio-lingual distance between an implant and the adjacent tooth?

1.5 mm

⭐ What is the recommended mesio-lingual distance between two contiguous implants?

3.0 mm between implants

⭐ What is the minimum distance between two adjacent implants?

3 mm

⭐ What is the minimum distance from an implant to an adjacent tooth?

1.5 mm

⭐ What is the critical measurement for predictability?

1.0 mm

⭐ Why would you have to reduce interproximally between adjacent teeth for an implant site?

Maximize space for surgeon

Four steps from a radiograph to a placed implant

1) from 2D to 3D

2) Acquiring the CBCT

3) reading the scan

4) digital planning

Five goals of imaging in implant dentistry

1) establish the shape and size of the ridge

2) determine the orientation of the residual alveolar ridge

3) identify the local anatomic or pathologic boundaries

4) create and visualize the result

5) create a surgical guide

3 file types of digital planning

1) DICOM (bone)

2) STL (teeth and soft tissue surface)

3) JPEG (face and smile)

What do we use PA's for regarding implants?

single implant. Contact point to contact point. Mesio-distal width of the alveolar ridge and inter-radicular distance.

⭐⭐ Which is not a goal of imaging in implant dentistry

Determine bone density

⭐⭐ All of the following are acceptable for prescribing a CBCT EXCEPT

Intraoral donor site evaluation → this IS a recommendation for CBCT

⭐⭐ Not a recommendation for CBCT

Bone density

⭐ What is not an indication for CBCT?

Bone height

⭐ Which of the following do CBCT scans NOT determine?

True bone density (CBCT grayscale values are not calibrated HU)

⭐ Can conventional CBCT grayscale values reliably measure true bone density?

No

⭐ What is the file format for CBCT

DICOM

⭐ What does DICOM stand for in implant imaging?

Digital Imaging and Communications in Medicine; CBCT file format

⭐⭐ What is the unit for CBCT this is

Voxel

⭐ What is the three dimensional unit for CBCT

Voxel

⭐ What is the unit of measurement for CBCT scans?

Voxels

⭐ What is a voxel in CBCT?

A three-dimensional volume element

⭐⭐ How do you keep radiation for a minimum in a CBCT

Small FOV

⭐⭐ Lowest cbct radiation

Lowest FOV

⭐ What technique for CBCT is used to minimize radiation to patients?

Smallest field of view (FOV) compatible with the diagnostic task

⭐ What imaging parameter should be minimized to reduce CBCT dose?

Field of view (FOV), consistent with the diagnostic task

⭐⭐ Before taking a CBCT, what do you need?

Radiographic template

⭐⭐ Occurrence of Dehiscence/fenestration in sound dentition?

20%

⭐⭐ Which of the following do you NOT need for surgical guidance?

JPEG files (intraoral and extraoral photographs)

What are the two datasets that are required for digitally guided implant surgery?

DICOM (CBCT)

STL (intraoral scan)

Once the implant surgeon approves the plan, what is the code to print the surgical guide?

D6190

⭐ What is the 3A-2B rule?

3 mm apical to the planned cervical (gingival) margin

2 mm palatal/lingual from planned buccal cervical margin

⭐ Which of the following is a component of the 3A2B rule

3mm from cervical margin in apical direction

⭐ Which anatomical structure is generally not relevant to maxillary implant site safety: sinus floor or sinus roof?

Sinus roof

⭐⭐ Picture 5 mm of bone under sinus

sinus tap and 8 mm sinus

⭐ When surgically exposing an implant for locator overdenture patients, what technique should be avoided to maintain keratinized tissue around the abutment?

Tissue punch technique

⭐ What surgical exposure method may remove keratinized tissue around locator abutments?

Tissue punch technique

⭐ Which gingival biotype is 3x more likely to experience recession?

Thin gingival phenotype

⭐ Which gingival phenotype presents a lower risk of recession when completing surgical procedures?

Thick

⭐ What tissue phenotype has a higher risk of recession?

Thin gingival phenotype

⭐⭐⭐⭐ Tissue level implants are used in all EXCEPT

Esthetic zone in non-bruxers

⭐⭐⭐Contraindication for tissue level implant? (Straumann)

Esthetic Zone (anterior region) Non-Bruxer

⭐ What type of implant is often taught for posterior sites in the Straumann system?

Tissue-level implant

⭐⭐ T/F Straumann has both bone level & tissue level implants. (T/F) For posteriors, tissue level implants are used b/c creates good emergence profile and the microgap is further away from bone compared to bone level implant

True, True

⭐⭐ What shape screw with Straumann for SOFT TISSUE?

Octagon (SynOcta) - traditional

Star-shaped TorcFit - at UOP

⭐⭐ Removable provisionals are NOT

Fully functional

⭐ Which of the following is NOT correct regarding an Essix retainer?

Fully functional provisional

⭐ Which is NOT a function of an implant provisional?

Retaining or mechanically stabilizing the implant fixture

⭐ What is the role of a provisional implant crown?

Support esthetics, speech, and soft-tissue contours; it does not mechanically retain the implant fixture

⭐⭐ Which do you use a provisional prosthesis restoration

Anterior maxillary bone level implant

⭐⭐ Loading protocol for posterior

Delayed loading with direct definitive restoration (no provisional crown).

maxilla - 6 months

mandible - 3 months

definitive restoration after osseointegration

⭐⭐ Minimum torque needed for a Straumann BLT implant before restoration.

35 Ncm

⭐⭐⭐ How do you know when you're ready for loading?

ISQ is 70 or more in both B/L and M/D directions

⭐⭐⭐ What do you use to determine implant stability?

RFA (Resonance frequency analysis)

⭐ What is resonance frequency analysis used to measure?

Implant stability, reported as an implant stability quotient (ISQ)

⭐ What device attaches to an implant for ISQ measurement?

SmartPeg

⭐ The Osstell Resonating needs to physically touch the implant. A ISQ of 60 is stable

False, False