DD - Perio from pg - 151

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Questions and Answers

What is the purpose of allowing a 2 mm margin of safety between the osteotomy and any vital structure?

To avoid contacting vital structures during implant placement (correct)

To compensate for implant angulation

To ensure primary stability of the implant

To select the type of abutment

Why may implants have deeper probing depths than natural teeth?

Because of the type of material used for the implant

Because of the length of the abutment used

Because of the location of the implant in the mouth

Due to the connective tissue interface with the abutment (correct)

What is the term for the interface between epithelial cells and titanium?

Hemidesmosomes

Basal lamina

Both a and b (correct)

Junctional epithelial attachment

What is the primary objective at surgical placement of the implant?

Primary stability Signup and view all the answers

What is the term used to describe the attachment level calculated from a landmark beside the CEJ?

Relative attachment level Signup and view all the answers

Why are plastic probes used?

To avoid scratching of titanium components Signup and view all the answers

What is the purpose of the abutment?

To provide adequate retention Signup and view all the answers

What is the consequence of having less than 3 mm of bone between adjacent implants?

Bone loss and esthetic consequences Signup and view all the answers

What is the term used to describe the space between the occlusal aspect of the implant and the opposing occlusion?

Restorative space Signup and view all the answers

Why is a smooth surface not protective against damage from cleaning with metal instruments?

Because the surface does not provide protection against damage Signup and view all the answers

Why might cephalometric radiographs be used in orthodontic treatment planning?

To predict how a patient's jaw and surrounding bone will be affected by orthodontic treatment Signup and view all the answers

Why should the implant location be planned to be at least 5 mm anterior to the mental foramen?

To avoid nerve damage Signup and view all the answers

What is the purpose of a 'radiographic stent' or guide?

To identify proposed implant sites in the radiograph Signup and view all the answers

What can happen to an implant that was surgically placed with primary stability but rotates in the osteotomy at the time of second-stage surgery?

It can be salvaged by replacing the cover screw and allowing the site to heal for an additional 3 months Signup and view all the answers

What is bone sounding used for?

To determine the height and shape of the bone surrounding a tooth with an intrabony defect Signup and view all the answers

What is a common issue with probing depths around implants?

They can be difficult to measure due to the size and access limitations of implant restorations Signup and view all the answers

Why might placement of the abutment even with the surrounding tissue cause tissue to grow over the abutment?

Because the tissue is prone to growing over the abutment Signup and view all the answers

What is a limitation of mouth opening ability on the part of the patient?

That it can preclude placement of an implant due to the inability to accommodate the hand-piece and drills Signup and view all the answers

What can be used to assess soft tissue health around implants?

Both A and B Signup and view all the answers

What is a possible consequence of deeper probing depths around an implant?

A more pathogenic flora Signup and view all the answers

What characteristic of a patient's gingiva is associated with a lower chance of recession and 'show through' of the implant?

Thick periodontal biotype Signup and view all the answers

Why do implants not move in response to orthodontic forces?

Because they do not have a periodontal ligament Signup and view all the answers

What is the purpose of direct palpation of the bone contours in the area of the planned implant?

To judge for adequate bone volume Signup and view all the answers

What is the advantage of cross-sectional imaging over two-dimensional radiography?

It provides more detailed information Signup and view all the answers

What is the term for the phenomenon that develops over time, allowing patients to sense the position of their implants in the bone?

Osseoperception Signup and view all the answers

Why are certain types of implants conveniently placed for anchorage on a temporary basis?

To facilitate orthodontic treatment Signup and view all the answers

What is the significance of a low smile line in relation to implant placement?

It is more acceptable to the patient due to limited visibility Signup and view all the answers

What is particularly important to explore during the assessment of the prospective implant patient?

The lingual contours of the mandible and possible concavities Signup and view all the answers

What is the main concern with the abutment-to-implant interface being located at or below the bone crest?

Increased bone loss or remodeling Signup and view all the answers

What is the minimum distance recommended between adjacent implants to prevent or limit bone loss?

3 mm Signup and view all the answers

What can occur if adjacent implants are too close together and one of them develops peri-implantitis?

Bone loss on the adjacent implant Signup and view all the answers

What is the term used to describe the unesthetic open space between two adjacent implants?

Black triangle Signup and view all the answers

How much soft tissue height can be expected to form between two implants?

2, 3, or 4 mm Signup and view all the answers

How much bone should remain between an implant and a natural tooth?

1.5 mm Signup and view all the answers

What initiates the process of immediate inflammation?

Resident leukocytes Signup and view all the answers

What is the purpose of the dense zone of connective tissue between the epithelial attachment and the marginal bone?

To take up the greatest amount of space vertically for adequate abutment length Signup and view all the answers

What characterizes the acute stage of inflammation?

Influx of neutrophils Signup and view all the answers

Why are plastic curettes recommended for titanium surfaces on implants and abutments?

Because they are less likely to scratch the surface Signup and view all the answers

What is the term used to describe the observable alterations in tissues associated with changes in vascular permeability and dilation?

Inflammation Signup and view all the answers

What type of ultrasonic tips should be avoided on titanium surfaces?

Metal tips Signup and view all the answers

What type of cells control all three stages of inflammation?

Leukocytes Signup and view all the answers

What is the recommended interval for implant maintenance appointments?

Every 3 months Signup and view all the answers

What is peri-implantitis?

A reaction to plaque around implants Signup and view all the answers

What is a contraindication to implant treatment?

Systemic health conditions that impair healing Signup and view all the answers

What is the purpose of platform switching?

To decrease the amount of bone remodeling and bone loss Signup and view all the answers

Why is smoking a concern for dental implant treatment?

Because it increases the risk of implant failure Signup and view all the answers

What type of mouth rinses can be used safely on implants and other titanium surfaces?

Both chlorhexidine and phenolic compound mouth rinses Signup and view all the answers

What is the reaction of tissues surrounding an implant to plaque similar to?

The reaction of tissues surrounding teeth to plaque Signup and view all the answers

Which type of immune response involves cells that are present from birth?

Innate immune response Signup and view all the answers

What is the primary function of mast cells in inflammation?

To release histamine and serotonin Signup and view all the answers

What is the term for the process by which white blood cells squeeze between endothelial cells and migrate into the extravascular space?

Diapedesis Signup and view all the answers

Which type of white blood cells are the first to arrive at the site of injury during acute inflammation?

Neutrophils Signup and view all the answers

What is the term for the process by which white blood cells engulf and digest foreign particles?

Phagocytosis Signup and view all the answers

What is the term for the binding of complement proteins to microbes and injured tissue?

Opsonization Signup and view all the answers

Which cells are considered part of the specific immune response and develop antigen-specific responses throughout life?

T cells, B cells, and plasma cells Signup and view all the answers

What is the term for the movement of white blood cells towards the site of injury or infection in response to chemotactic agents?

Chemotaxis Signup and view all the answers

What is the term for the brief period of localized vasoconstriction that occurs immediately following tissue injury?

Vasoconstriction Signup and view all the answers

Which type of cells arise from a lymphoid progenitor cell in the bone marrow?

T cells, B cells, and natural killer cells Signup and view all the answers

What is the primary function of mast cells in the body?

To participate in immediate inflammation and allergic responses Signup and view all the answers

Which type of cells are responsible for antigen processing and presentation to cells of the specific immune response?

Peripheral dendritic cells Signup and view all the answers

What is the characteristic of T cells that recognizes diverse antigens?

Low-affinity transmembrane complex Signup and view all the answers

What is the primary function of macrophages in chronic inflammation?

To engulf and neutralize foreign antigens Signup and view all the answers

Which type of cells are responsible for producing antibodies in chronic inflammation?

B cells Signup and view all the answers

What is the characteristic of chronic inflammation?

Slow onset and persistent symptoms Signup and view all the answers

What is the role of lymphocytes in chronic inflammation?

To orchestrate the chronic immune response with macrophages Signup and view all the answers

What is the result of the interaction between macrophages and lymphocytes in chronic inflammation?

Mutual activation of macrophages and lymphocytes Signup and view all the answers

What type of cells are eosinophils often found in?

Sites of parasitic infection or allergic responses Signup and view all the answers

What is the outcome of chronic inflammation?

Tissue destruction and fibrosis Signup and view all the answers

Study Notes

Implant Placement and Surgical Considerations

A low smile line indicates that the gingival-restorative interface is not visible when smiling, making esthetic compromises more acceptable.
A thick periodontal biotype means thicker, denser gingiva, less prone to recession, and less likely to show implant or abutment.
Implants do not respond to orthodontic forces due to the lack of a periodontal ligament.
Certain implants can be used for temporary anchorage during orthodontic treatment.

Assessment of Implant Patients

Direct palpation of bone contours is essential to judge adequate bone volume.
Cross-sectional imaging is superior to 2D radiography and is the standard of care.
Limitations of mouth opening ability may preclude implant placement.

Treatment Planning

Cephalometric radiographs help predict jaw and bone growth patterns.
When planning mandibular implant locations, the inferior alveolar nerve's path must be considered.
The implant location should be at least 5 mm anterior to the mental foramen.
The osteotomy preparation should end 2 mm away from vital structures.

Implant Design and Abutment Selection

Two-stage systems involve initial placement, primary closure, and secondary exposure of the abutment.
One-stage systems place the implant with the abutment exposed to the oral cavity.
Abutment selection is critical, and the ideal type is determined during treatment planning.
Abutments can be used to compensate for implant angulation and provide adequate retention.

Implant Maintenance and Complications

Probing depths are generally deeper around implants than natural teeth.
Changes in attachment level around an implant indicate peri-implantitis.
Implant surfaces can be damaged by metal instruments, and cleaning should be done with plastic instruments.
Plaque forms on rough surfaces, but not smooth surfaces.
Epithelial attachment on a roughened surface is identical to a natural tooth.

Patient Considerations

Advanced patient age is not a contraindication to implant treatment.
Any condition that impairs the patient's ability to heal should be considered a contraindication.
Serious psychiatric conditions, such as psychoses, are contraindications.
Smoking is not a contraindication, but failure rates are higher.

Platform Switching

Combining an abutment of a particular diameter with a non-matching diameter implant reduces bone remodeling and bone loss.
This combination is advantageous, but different designs have typical patterns of bone remodeling.

Bone Remodeling and Adjacent Implants

A minimum of 3 mm of bone should remain between adjacent implants.
If the implants are closer than 3 mm, bone loss is likely.
Oral hygiene efforts are compromised if implants are too close together.
Maintaining or creating an esthetic papilla between adjacent implants is a major challenge.

Inflammation

Inflammation is an observable alteration in tissues associated with changes in vascular permeability and dilation.
The three stages of inflammation are immediate, acute, and chronic.
Leukocytes, such as mast cells, peripheral dendritic cells, neutrophils, and monocytes/macrophages, play a crucial role in inflammation.### Leukocyte Migration
Leukocytes squeeze between contracted endothelial cells and migrate into the extravascular space through a process called diapedesis.
Once in tissue, leukocytes are attracted by activated complement and begin to migrate to the site of injury or infection.

Chemotaxis

Leukocytes (specifically PMs) have surface receptors for chemotactic agents (e.g. C5a, TNF, IL-8, LTB4, IL-1, IFN-γ).
These receptors cause leukocytes to move in the direction of increasing concentrations of the chemotactic substance.

Phagocytosis

When leukocytes (specifically PMs) arrive at the site of tissue injury or microbial invasion, they become active and begin engulfing bacteria, forming a phagosome.
The phagosome combines with lysosomal granules to form a phagolysosome, where digestion of the engulfed particle occurs.

Immune System Cells

All cells of the immune system originate from a hematopoietic stem cell in the bone marrow, which gives rise to two major lineages: myeloid and lymphoid progenitor cells.
These progenitors give rise to myeloid cells (monocytes, macrophages, dendritic cells, megakaryocytes, and granulocytes) and lymphoid cells (T cells, B cells, and natural killer cells).

Cell Receptors

Cells possess receptors, which are molecules on the cell surface that enable the cell to interact with other molecules or cells.
Receptors reflect and dictate the function of cells.

Mast Cells

Mast cells are important in immediate inflammation (anaphylaxis and allergic responses).
They possess receptors for complement components (C3a and C5a) and receptors for the Fc portion of antibody molecules IgE and IgG.

Dermal Dendrocytes (Histiocytes)

Dermal dendrocytes are distributed near blood vessels and possess receptors for the complement component C3a, participating in immediate inflammation.

Peripheral Dendritic Cells (DCs)

Peripheral DCs are leukocytes with dendrites and are important in antigen processing and presentation to cells of the specific immune response.

Neutrophils and Monocytes/Macrophages

Neutrophils and monocytes/macrophages are phagocytic leukocytes.
Neutrophils are the predominant leukocyte in blood and are suited for rapid responses.
Monocytes are referred to as macrophages when they leave the blood and present antigen to T cells.

Lymphocytes

The three main types of lymphocytes are distinguished based on their receptors for antigens: T lymphocytes, B lymphocytes, and natural killer (NK) cells.
T cells recognize diverse antigens using a low-affinity transmembranous complex, the T-cell antigen receptor (TCR).
B cells recognize diverse antigens using the B-cell antigen receptor (BCR).
Natural killer (NK) cells recognize and kill certain tumor and virally infected cells.

Chronic Inflammation

Chronic inflammation is characterized by a slow onset and persists for weeks or more.
The main cells involved in chronic inflammation are macrophages and lymphocytes.
Macrophages and lymphocytes are interdependent, with the activation of one stimulating the actions of the other.

Cells Involved in Chronic Inflammation

Macrophages: circulate as monocytes, reach the site of injury within 24 to 48 hours, and transform into activated macrophages.
T cells: antigen-activated, release macrophage-activating cytokines.
B cells: terminally differentiated, produce antibodies.
Plasma cells: produce antibodies.
Eosinophils: found especially at sites of parasitic infection or allergic (IgE-mediated) sites.

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This quiz covers the importance of smile line and periodontal biotype in restorative dentistry. It discusses how a low smile line and thick periodontal biotype affect the esthetic outcome of restorative procedures.

DD - Perio from pg - 151 - 200

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