Dr. Terrell's Implant Lecture

Implanted titanium oculars into rabbit leg bones in _______

1952

Treated the first human patient in ________

1965

Presented a two-stage threaded titanium root-form implant (the genesis of Nobel Biocare) in ________

1978

Responsible for viewing the direct contact of implants and bone at the resolution of the light microscope

Branemark, 1969

Saw functional ankylosis, no intervening layer of connective tissue

Schroeder, 1976

Discovered that the soft tissue reaction to a foreign body is rejection, solution, resorption, or fibrous encapsulation.

In bone, the body attempts to exclude the foreign material through demarcation (if immobile) or fibrous encapsulation (if mobile)

Donath, 1992

Discovered that micromotion of the implant more than 50-100 µm may lead to fibrous encapsulation

Lundgren, 1995

Osseointegration

____ hour(s): Coagulum

_____ day(s): Fibroblast-like cells (mesenchymal cells) surrounded by vasculature

_____ week(s): A provisional matrix with areas of woven

bone to include in contact with the implant

2, 4, 1

_________ osteogenesis occurs when there is de novo bone formation on the implant surface.

_________ osteogenesis occurs when the formation of new bone occurs on the surfaces of existing peri-implant bone.

Contact, Distance

_______ and _________ (______) are responsible for the studies on contact and distance osteogenesis.

Osborn, Newesley

After ____ week(s) of osseointegration, intense new bone formation is occurring, and the thread area shows resorption/remodeling.

2

After ____ weeks of osseointegration, there is marked new bone formation from the cut bone and implant surfaces, and the thread area shows intense bone remodeling.

4

At ____ weeks of osseointegration, the chamber is filled with bone (woven,

parallel-fiber, and lamellar).

6

At ___ - ____ weeks of osseointegration, there are marked signs of remodeling.

8, 12

Remodeling of native bone in contact with the implant occurs from weeks ___ to ____.

This occurs at approximately ____% bone to implant

contact (Araujo, 2018)

1, 4, 60

According to Raghavendra's Curve, the critical time frame for implant healing is ___ - ___ weeks.

2, 3

It takes ___ weeks before secondary stability overtakes primary stability.

4

Excessive heat causes necrosis of bone

2 days = _______

1-5 weeks = __________

6-8 weeks = Bone resorption with ______ _______

Hyperemia, Hemostasis, Revascularization

Effects of Heat

1. ____ ºC for 1 minute: no significant disturbance

in regeneration

2. ____ ℃ for 1 minute: significant effect on the

regeneration process

44, 47

Natural Teeth:

1. Supracrestal attached tissues: JE and CT

2. Attachment of junctional epithelium via hemidesmosomes

3. Insertion of connective tissue into _________

4. Collagen fibers are oriented ___________ to the tooth

5. Inflammatory infiltrate does not spread to the bone, but is

separated from it by noninflamed connective tissue

6. The _____ serves as vascular supply and suspension system for

occlusal loads

Cementum, Perpendicular, PDL

Implants:

1. Peri-implant mucosa: JE and CT

2. Attachment of junctional epithelium via hemidesmosomes

3. No connective tissue insertion

4. Collagen fibers originating at the alveolar crest oriented

________ to the implant surface - creates a cuff-like barrier

5. Inflammatory infiltrate in peri-implantitis lesions is in

direct contact with the alveolar bone and can extend to

the alveolar bone marrow spaces

6. Implant is ______ susceptible to trauma

Parallel, More

________ ______ ______ is characterized by bone loss around an implant, primarily in the first year after it is transmucosal (crestal remodeling), that

occurs regardless of functional loading.

Marginal Bone Loss

According to Adell (1981), there is ____ mm of vertical bone loss in the first year, and ___ mm annually after

1.5, 0.1

According to Tarnow (2000), there is _____ mm to ____ mm lateral bone loss circumferentially.

1.34, 1.4

Peri-Implant Bone Thickness:

1. A bone thickness of ≥ ____ mm resulted in decreased bone loss and in some cases, bone apposition

2. Implants with ______ buccal bone are more prone to major dimensional changes

1.8, Thin

Recommended Categories of Bone Thickness:

Thick PBT = < __ mm

Thin PBT = ≥ ___ mm

2, 2

Placement Parameters:

1. Buccal bone thickness of ≥ ____ mm

2. Tooth to implant distance of at least ____ mm (or only ___ mm with platform switching)

3. Implant-to-Implant distance of ___ mm

4. Depth of placement ____ mm below the facial free gingival margin

5. Emergence angle < ____º and a straight or concave profile

6. Proximity to IAN and mental foramen ≥ ___ mm.

1.8, 1.5, 1, 3, 3, 30, 2

________ _______ is a techique that shifts the microgap (implant-abutment interface) away from bone to implant contact.

Platform Switching

For platform switching, _________ placement with ______ soft tissue height was the most significant in reducing marginal bone loss.

Supracrestal, tall

Increasing (diameter/length) has a larger effect on decreasing crestal bone stress.

Diameter

_____ is the type of bone with the greatest stress at the crest.

D4

Torque:

Forces ≥ ____ Ncm are usually used for immediate loading

Forces ≥ ___ Ncm reduce micromotion and do not appear to damage bone

30, 50

Primary stability is desirable, but the absence of _________ is what

facilitates osseointegration.

Micromotion

True or False: More torque = less micromotion

True

_______ is the placement of healing abutment, provisional, or restoration

_________ ________ is the placement of restoration in occlusion/function

Loading, Functional Loading

Loading:

______ stage: Implant loaded at placement

_______ stage: implant submerged under tissue for healing with a

subsequent phase 2 for uncovering and loading

One, Two

Loading times:

Immediate: within ____ week(s)

Early loading: ___ week(s) to _____ month(s) after placement

Conventional loading: >_____ month(s) after loading

1, 1, 2, 2