76 Questions
What is the clinical term used to describe epithelial desquamation, erythema, erosions, and/or vesiculobullous lesions of the gingiva?
Desquamative gingivitis
What is the most common age range of patients with primary herpetic gingivostomatitis?
6 months to 6 years
What is the term used to describe any deviation from the normal anatomic relationship between the gingival margin and the mucogingival junction?
Mucogingival defect
What is the goal of therapy for oral lichen planus?
To affect resolution of the erosive or ulcerative forms
What is the characteristic of skin lesions in lichen planus?
Pruritic, purple to brown papules
What is a characteristic of patients with a thin gingival biotype?
More susceptible to gingival recession
What is the treatment for primary herpetic gingivostomatitis?
Rest, antipyretics, and analgesics
What is the characteristic of the reticular form of lichen planus in the oral cavity?
White striae or plaque-like
What is a complication of mucogingival defects?
Root surface exposure
What is the term used to describe an impression made in a tray with no access hole cut over the implant?
Closed tray impression
What is the purpose of radiographic verification before making an impression?
To verify the proper seating of the abutments
What is the advantage of an open-tray impression over a closed-tray impression?
It allows for easier access to the abutment retention screw
What is the term for the amount of force or torque applied to the screw?
Preload
What is the purpose of the access hole in the crown?
To provide a pathway for the abutment retention screw
What is the term for an impression made of the already seated abutment without the use of an impression coping?
Direct impression of the abutment
Why is the impression coping removed from the mouth and joined to an implant analogue?
To create an indirect transfer impression
What is the purpose of the implant analogue?
To represent the implant in the impression material
In two-stage implant systems, what is the first-stage surgery?
Placement of the implant in the bone
What is the term for an impression made with the impression coping already attached to the abutment by a retaining screw?
Pick-up impression
Why is the master impression important?
It accurately relates the implants and/or abutments to each other, the opposing occlusion, and adjacent teeth
What is the purpose of countersinking the implant osteotomy?
To prepare the bone for a particular implant shape
What is the term for the process of creating a spiral groove on the wall of the osteotomy?
Tapping
Why are burs used at relatively slow speeds during drilling?
To prevent overheating of the bone
What is the term for the surface quality or surface alteration of an implant?
Microstructure
What is the purpose of the epithelial attachment to titanium?
To form a sulcular epithelium
What is the term for the zone of connective tissue present between the junctional epithelium and the bone?
Connective tissue zone
Why are screw-shaped implants more likely to be stable?
Because they engage the walls of the osteotomy
What is the term for the overall design of an implant?
Implant geometry
What is the purpose of a trephine drill?
To cut down the sides of the implant and release it from the bone
What is the purpose of water or saline irrigation during drilling?
To cool the burs and the bone during drilling
What is the term used to describe an implant that is covered with soft tissue and left unused in the bone?
Sleeping implant
What is the purpose of antirotational elements in implant dentistry?
To prevent rotation of the attached abutment or the restoration
What is the term for the distance between the epithelial attachment and the crestal bone around the implant?
1 to 1.5mm
Why is the CEJ not used as a landmark for determining attachment level on implants?
Because the implant does not have a CEJ
What is the condition required for an implant to be considered successfully placed?
Primary stability of the implant
What can prevent the formation of osseointegration during drilling procedures?
Excessive heat
What is the purpose of using plastic probes instead of metal probes for probing depths around implants?
To reduce the risk of bacterial contamination
What is the purpose of guided tissue regeneration techniques?
To augment bone in edentulous areas
What is the term used to describe the space between the abutment and the implant?
Microgap
What is the significance of the precision fit between the abutment and the implant?
It influences how much movement will occur between the parts
What type of bone graft material is bovine bone classified as?
Xenograft
How does the closeness of the fit of the components affect bacterial contamination?
It reduces the risk of bacterial contamination
What is the purpose of orthodontic tooth movement in site development?
To create space for implants by bringing bone volume occlusally with the tooth
What is the purpose of an antirotational element?
To prevent rotation of the abutment
What is the rate of bone loss expected over time after the initial bone remodeling phase?
0.02 mm per year
What is the term used to describe the forces that are not within the long axis of the implant?
Off-axis loading
What type of antirotational element has a permanent extension from the implant that fits into a receptacle in the abutment?
External antirotational element
What type of restorations do not require antirotational features to prevent them from rotating on the abutment?
Multiunit restorations
Why is excessive cantilevering of an implant-borne prosthesis a concern?
It results in excessive occlusal force on the implant
What happens if an implant is mobile?
It can be extracted fairly easily
What is the purpose of using a screw tap in dense bone during implant placement?
To allow for more passive implant placement requiring less pressure
Why is radiographic verification important during implant placement?
To ensure the implant is placed in the correct location
What can occur if the osteotomy is too small for the implant diameter?
The implant will not go to depth or seat completely
What is a characteristic of an implant with partial loss of osseointegration?
Stability
What is the significance of radiographic confirmation of implant malposition?
It is a sign of implant failure, especially with persistent pain, infection, or paresthesia
What is the expected success rate of implants today?
Greater than 80% to 85%
Why is it important to verify the proper mating of the components after final torque is applied?
To ensure that the components are joined together completely
What is the consequence of a non-passive fit of the prosthesis?
Implant failure
What is the purpose of taking radiographs during the surgical procedure?
To judge whether the proper depth or anatomic location has been achieved
What is the significance of a peri-implant radiolucency?
Bone is not in contact with the implant, suggesting loss of osseointegration
What is the term used to describe an absence of one or more papillae, creating an esthetic concern?
Black triangled disease
What type of bone is initially laid down at the bone-implant interface after implant placement?
Woven bone
What is the purpose of roughened-implant surfaces, such as those created by sandblasting and acid etching?
To encourage and accelerate bone formation
What is a characteristic of implants?
They are ankylosed structures
What is the result of not considering the growth of the individual when placing implants?
The implant may prevent normal development of the jaws
What is the function of the oxide layer on titanium implants?
It is biologically inert and prevents host tissue access
What is the conversion of woven bone to?
Lamellar bone
What is the structure comprised of hemidesmosomes and a basal lamina that attaches to titanium?
Junctional epithelium
What is a risk factor for periodontitis?
Diabetes
What influences susceptibility to oral health complications in patients with diabetes?
Degree of glycemic control
What is a factor associated with increased risk of periodontal disease in patients with diabetes?
Impaired connective tissue metabolism
What may influence the metabolic state of the diabetic patient, reducing glycemic control?
A rise in proinflammatory cytokines
What may improve glycemic control in patients with diabetes?
Periodontal therapy
What is the normal range for hemoglobin A1c levels?
Less than 6%
What is a characteristic of necrotizing gingivitis?
Interdental gingival necrosis
What may be a systemic symptom of necrotizing gingivitis?
Lymphadenopathy
Study Notes
Diabetes and Periodontitis
- Diabetes is a risk factor for periodontitis, with increased prevalence and severity of attachment loss and bone loss in adults with diabetes.
- Glycemic control influences susceptibility to oral health complications.
Risk Factors for Periodontal Disease in Diabetes Patients
- Impaired connective tissue metabolism and bone healing
- High glucose levels in gingival crevicular fluid hindering wound healing
- Microvascular changes
- Changes in collagen synthesis and maturation
Hemoglobin A1c (HbA1c) Test
- Measures average amount of glucose in the blood over the last 2 to 3 months
- Evaluates the percentage of glycosylated hemoglobin in the blood
- Normal range: less than 6%
Necrotizing Periodontal Diseases
- Necrotizing gingivitis
- Interdental gingival necrosis, gingival pain and erythema, bleeding with little provocation, and a fetid odor
- Predisposing factors: stress, smoking, poor oral hygiene, nutritional deficiencies, and immunosuppression
- Necrotizing periodontitis
- Necrotizing stomatitis
Mucogingival Defects
- Deviation from the normal anatomic relationship between the gingival margin and the mucogingival junction (MGJ)
- Clinical presentation: gingival recession, minimal or absent keratinized gingiva, and probing depths that extend beyond the MGJ
- Causes: local factors, mechanical trauma to the tissue, and toothbrush trauma
Impression Techniques
- Closed tray impression
- Impression coping remains in the mouth, attached to the implant or abutment
- Also called an indirect transfer impression technique
- Open tray impression (pick-up impression)
- Impression coping is already attached to the abutment by a retaining screw
- Used with divergent implants
- Also called a pick-up impression
Abutment Retaining Screw
- Tightened to a specified torque to minimize the possibility of future loosening of the screw or components
- Torque force applied to a screw is called preload
- Implant manufacturers provide recommended torque values for their particular components, materials, and design
Implant Dentistry
- Two-stage implant systems (two-piece or submerged systems)
- First-stage surgery: placement of the implant in the bone
- Second-stage surgery: uncovering the implant, making sure there is access to it, and placing an abutment
- One-stage systems (one-piece or nonsubmerged systems)
- Implant is left partially or completely exposed at the time of surgical placement, and the second-stage surgery is avoided
- Osteotomy preparation: special bur is activated and inserted into the occlusal end of the osteotomy to increase the diameter of the opening slightly or to otherwise shape it
- Countersinking: creation of a spiral groove on the wall of the osteotomy to receive and guide the threads on the side of the implant during surgical placement
Implant Design and Shape
- Produced in several categories: blades and root form implants
- Root form implants: straight cylinder or tapered screw design having threads
- Microstructure of the implant: surface quality or surface alteration (e.g., machined, polished, or roughened)
Implant Abutment Junction
- Important from an engineering and biological standpoint
- Precision fit, internal or external connection, and anti-rotational elements are part of this junction and require close manufacturing tolerances
- Minimizing bacterial contamination at this site influences how stable the bone will remain over time### Bone Grafting and Implant Placement
- Bone grafting can be combined with autograft, allograft, or fabricated bone substitutes like tricalcium phosphate or hydroxyapatite.
- Orthodontic tooth movement can create space for implants and increase bone volume at the site.
Antirotational Elements
- Antirotational elements prevent abutment screw loosening and are classified as "external" or "internal".
- External type has a permanent extension from the implant that fits into a receptacle in the abutment.
- Internal type has the extension as part of the abutment that fits into a receptacle in the implant.
Implant Placement and Verification
- Radiographic verification is desirable to ensure correct anatomic placement of the implant and separation from vital structures.
- Radiographs can be taken during surgery to judge proper depth or anatomic location.
- Verification of proper mating of components is necessary after final torque application.
Osteotomy Preparation
- Osteotomy must be prepared with precision to fit the implant being used.
- The overall implant shape and bone quality dictate osteotomy preparation.
- Tapping may be required for screw-shaped implants in dense bone.
Implant Success and Failure
- Success rates are generally higher than 80% to 85%, with 95% and higher being expected.
- Implant mobility indicates loss of osseointegration and failure.
- Peri-implant radiolucency suggests loss of osseointegration.
- Persistent pain, infection, or paresthesia indicate implant failure.
Osseointegration
- Osseointegration means direct bone-to-implant contact with no intervening periodontal ligament or tissue.
- Titanium is biologically inert and prevents host tissue access directly to titanium.
- Woven bone is laid down at the bone-implant interface within weeks of placement, later converting to lamellar bone.
Implant Characteristics
- Implants are essentially ankylosed structures and do not erupt or move physiologically within bone.
- Implants may prevent normal development of the jaws if placed before growth completion.
This quiz explores the relationship between diabetes and periodontitis, including the increased risk and severity of attachment loss and bone loss. It also covers the factors that influence this risk, such as glycemic control and microvascular changes.
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