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Questions and Answers
What is the primary aim of developing titanium implants with modified surface properties?
What is the primary aim of developing titanium implants with modified surface properties?
Moderately rough, hydrophobic surfaces promote faster osseointegration compared to hydrophilic surfaces.
Moderately rough, hydrophobic surfaces promote faster osseointegration compared to hydrophilic surfaces.
False
What impact do the surface properties of implants have on cells?
What impact do the surface properties of implants have on cells?
They influence binding capacity of fibrin, adhesion, proliferation, and differentiation of cells.
Moderately rough, __________ surfaces promote faster osseointegration.
Moderately rough, __________ surfaces promote faster osseointegration.
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Match the following surface properties with their effects:
Match the following surface properties with their effects:
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Which type of surface chemistry is associated with eliciting a macrophage phenotype that reduces inflammation?
Which type of surface chemistry is associated with eliciting a macrophage phenotype that reduces inflammation?
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After 4 weeks of healing, osseointegration outcomes of rough and smooth surfaces are significantly different.
After 4 weeks of healing, osseointegration outcomes of rough and smooth surfaces are significantly different.
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What does titanium surface topography influence regarding platelets?
What does titanium surface topography influence regarding platelets?
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What initiates the healing process of a deep narrow three-wall intrabony defect after surgery?
What initiates the healing process of a deep narrow three-wall intrabony defect after surgery?
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Epithelium from the wound margins migrates at a rate of about 2 mm a day.
Epithelium from the wound margins migrates at a rate of about 2 mm a day.
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What is the first critical area to which treatment is applied for regeneration and new attachment?
What is the first critical area to which treatment is applied for regeneration and new attachment?
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By the ____ day after surgery, osteogenic activity appears near the budding capillaries.
By the ____ day after surgery, osteogenic activity appears near the budding capillaries.
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What is used to remove all granulation tissue and residual fibers attached to the bone during the preparation for regeneration?
What is used to remove all granulation tissue and residual fibers attached to the bone during the preparation for regeneration?
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Match the following stages of wound healing with their descriptions:
Match the following stages of wound healing with their descriptions:
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Calcification continues in the wound healing process for several weeks.
Calcification continues in the wound healing process for several weeks.
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The socket is filled with woven and _______ bone by two months.
The socket is filled with woven and _______ bone by two months.
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What is the primary concern regarding the membrane during GBR procedures?
What is the primary concern regarding the membrane during GBR procedures?
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Using non-resorbable pins is one of the suggested methods for maximizing membrane stability during GBR.
Using non-resorbable pins is one of the suggested methods for maximizing membrane stability during GBR.
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What were the membranes indicated to be tucked under during the procedure?
What were the membranes indicated to be tucked under during the procedure?
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A successful GBR emphasizes the importance of __________ for space provision.
A successful GBR emphasizes the importance of __________ for space provision.
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Match the following stabilization methods with their descriptions:
Match the following stabilization methods with their descriptions:
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Which combination was used with the e-PTFE membrane to reduce defect width?
Which combination was used with the e-PTFE membrane to reduce defect width?
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Resorbable membranes are emphasized as the only option for GBR.
Resorbable membranes are emphasized as the only option for GBR.
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What should be maintained during GBR to ensure its success?
What should be maintained during GBR to ensure its success?
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What is a significant drawback of non-resorbable membranes?
What is a significant drawback of non-resorbable membranes?
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The degradation products of collagen membranes can harm the regeneration process.
The degradation products of collagen membranes can harm the regeneration process.
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What is the process through which autologous bone grafts are incorporated into surrounding bone?
What is the process through which autologous bone grafts are incorporated into surrounding bone?
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An ideal membrane should gradually __________ over time.
An ideal membrane should gradually __________ over time.
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Match each type of barrier with its property:
Match each type of barrier with its property:
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What are typical properties associated with collagen membranes?
What are typical properties associated with collagen membranes?
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The resorption rate of a grafting material is unaffected by its physical and chemical properties.
The resorption rate of a grafting material is unaffected by its physical and chemical properties.
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The degradation pattern of a collagen membrane at 30 days showed it was significantly reduced in __________.
The degradation pattern of a collagen membrane at 30 days showed it was significantly reduced in __________.
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What is the primary purpose of applying bone grafts?
What is the primary purpose of applying bone grafts?
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Bone grafts help prevent membrane collapse beneath them.
Bone grafts help prevent membrane collapse beneath them.
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What are the four classifications of bone graft materials according to their origin?
What are the four classifications of bone graft materials according to their origin?
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An ideal bone replacement graft should have properties like ________, ________, and ________.
An ideal bone replacement graft should have properties like ________, ________, and ________.
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Match the following terms with their definitions:
Match the following terms with their definitions:
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Which property is NOT considered a part of an ideal bone replacement graft?
Which property is NOT considered a part of an ideal bone replacement graft?
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Bone grafts can only be made from autologous sources.
Bone grafts can only be made from autologous sources.
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What percentage reduction in the total width of the graft was observed after six months?
What percentage reduction in the total width of the graft was observed after six months?
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What condition may lead clinicians to consider a longer healing period for implant osseointegration?
What condition may lead clinicians to consider a longer healing period for implant osseointegration?
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A diagnosis of osteopenia is an absolute contraindication to dental implants.
A diagnosis of osteopenia is an absolute contraindication to dental implants.
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What percentage prevalence of peri-implantitis is typically seen in pristine sites?
What percentage prevalence of peri-implantitis is typically seen in pristine sites?
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Regular supportive care and close monitoring are essential to prevent and manage _______ diseases in both pristine and regenerated sites.
Regular supportive care and close monitoring are essential to prevent and manage _______ diseases in both pristine and regenerated sites.
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Match the following complications with their descriptions:
Match the following complications with their descriptions:
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Which factors may negatively impact large bone reconstructions in osteoporotic patients?
Which factors may negatively impact large bone reconstructions in osteoporotic patients?
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The incidence of peri-implantitis in regenerated sites is significantly different from pristine sites.
The incidence of peri-implantitis in regenerated sites is significantly different from pristine sites.
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In what situation is there a higher risk of larger peri-implantitis lesions?
In what situation is there a higher risk of larger peri-implantitis lesions?
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Study Notes
Implantlogy Program (Basic Implantology) - Semester 2
- Course taught by Ass.Prof.Dr. Marwa Mohammed Tawfiq
- Associate professor of Oral medicine and periodontology
- Beni-suef university
Periodontal Regeneration
- The reproduction or reconstitution of lost or injured parts of the tooth supporting structures to restore form and function
- The process involves restoring lost tissues during periodontal disease, including structures like alveolar bone, cementum, and periodontal ligament
- It's a complex process with diseased periodontium, cells, scaffolds, and signaling molecules requiring blood supply
- Periodontal repair involves healing by long junctional epithelium without completely restoring architectural function or form.
Regenerative Periodontal Therapy
- Aims to reproduce or reconstitute lost or injured parts of the tooth supporting structures
- This process is critical to restoring the form and function of the lost structures, supporting tissues during periodontal disease
- Regrowth of cementum, alveolar bone and periodontal ligament is part of treating periodontal disease
Reattachment
- The reunion of epithelial and connective tissue with a root surface surgically or mechanically separated
- New attachment may involve epithelial adhesion or connective tissue adaptation or include new cementum
- This typically happens when the attachment has been lost due to disease progression
Classification of Periodontal Pockets
- Gingival sulcus (shallow pocket)
- Free gingiva
- Attached gingiva
- Free gingival groove
- Mucogingival junction
- Alveolar mucosa
- Gingival pocket
- Suprabony periodontal pocket
- Intrabony periodontal pocket
- Classification based on the position of the pocket base relative to the underlying bone
- 3-wall, 2-wall, combination, and 1-wall defects
Types of Periodontal Pockets
- Pockets can involve 1, 2, or more tooth surfaces
- They can be different depths and types on the same tooth surface
- Pockets can be spiral, originating on one tooth surface and twisting around to involve multiple surfaces
- This is most often the case in furcation areas
Horizontal vs. Intrabony Bone Loss
- Horizontal bone loss occurs when the bone loss is parallel to a line drawn from the cementoenamel junction (CEJ) of one tooth to the CEJ of an adjacent tooth
- This is a common pattern of bone loss seen in periodontal disease
- Intrabony pockets are pockets where the base of the pocket lies below the level of the adjacent alveolar bone
- This is indicated by more rapid bone resorption
Healing of Three-Wall Intrabony Defects
- Blood clot fills the defect immediately after surgery
- The clot and surrounding tissues contain growth factors, proteins, and molecules necessary for normal wound healing
- Organization of the clot occurs several days later with increased blood vessels and granulation tissue formation
- Epithelial cells from the wound margins begin to migrate across the clot
- Osteogenic activity appears around the developing capillaries by the 21st day
- The socket is filled with bone by 2 months with continuing calcification
- Bone fill is visible on radiographs by 6 months
Preparation for Regeneration and Attachment
- Three critical areas of treatment for regeneration and attachment:
- Granulation tissue of the defect
- The root surface
- The underlying bone
- Removal of bacterial deposits, calculus, and endotoxins on the cementum surface
- Demineralization of the root surface to expose dentin collagen
- Decortification involving the formation of small holes in the bone
Periodontal Regeneration Procedures
- Grafting procedures
- Guided tissue regeneration (GTR)
- Root conditioning and biomodification
- Biologic mediators for periodontal regeneration (e.g., Emdogain)
- Combination of the above procedures
Grafting Materials
- Osteoinductive: induce bone formation in surrounding soft tissues through growth factors
- Osteoconductive: provide a scaffold for the formation of new bone
- Osteoneutral: serve only as space fillers
- Different types of grafts based on origin (autogenous, allogenic, xenogenic, alloplastic) and substitutes (e.g., bone substitutes)
Selection of Graft Material Criteria
- Osteoinductive potential
- Osteoconductivity
- Accessibility
- Availability
- Safety and biological compatibility
- No risk of disease transmission (e.g., AIDS, viruses)
Guided Tissue Regeneration (GTR)
- Aims to regenerate lost periodontal structures (i.e., cementum, periodontal ligament, and alveolar bone)
- Involves cell and tissue repopulation of periodontal wounds
- Repair involving connective tissue adhesion and long junctional epithelium formation
Barriers in GTR
- Exclusion of epithelial and gingival connective tissue cells from the periodontal defect
- Membranes maintain space between defect and barrier for regenerative cells from periodontal ligament
- Barriers stabilize clots
Indications for GTR
- Intra-bony defects
- Furcations
- Gingival recession
- Alveolar ridge augmentation
Biocompatible Barrier Membranes
- Should be biocompatible to avoid immune response
- Material should act as a barrier to prevent undesirable cell types
- Must create space for tissue ingrowth from the periodontal ligament to the root surface
Technique for GTR
- Surgical initiations : Sulcular incisions
- Removal of all granulation tissue
- Debridement of root surfaces
- Shape membrane to cover defect, extending at least 3mm beyond defect margins
- Fixation with sutures and chlorhexidine gluconate rinse (at least 4 weeks)
- Systemic antibiotics during and after surgery
- Removal of non-resorbable membranes after 4-6 weeks
Causes of GTR Failure
- Surgical technique (improper incision placement, excessive loss of marginal tissue, trauma, etc)
- Post-surgical factors (plaque recolonization, mechanical insult, loss of wound stability, etc)
- Barrier-dependent factors (inadequate barrier adaptation, non-sterile technique, premature barrier exposure, etc)
Contraindications for GTR
- Class II furcations
- Horizontal bone loss
- Patient's health, compliance, and tooth mobility
- Any medication or conditions that might hinder proper healing
Types of Barrier Membranes
- Non-absorbable: Last longer but require a second procedure for removal
- Bio-absorbable: Avoids second surgery, but absorption can take weeks to months
Root Surface Conditioning Materials
- Tetracycline
- Citric acid
Biological Mediators for Periodontal Regeneration
- Growth and differentiation factors (e.g., PDGF, IGF, FGF)
- Mediators of bone metabolism (e.g., BMPs)
- Attachment factors (e.g., fibronectin)
- Extracellular matrix proteins (e.g., enamel matrix proteins)
Bone Regeneration in Implant Dentistry
- Dental implants are widely used for missing teeth restoration
- The need to regenerate alveolar bone in certain situations for implant success
- Bone regeneration procedures can improve stability, predictability, and long-term success of implant treatments
Factors Affecting GBR outcomes
- Patient-related: Compliance, history of periodontitis, smoking
- Biomaterials-related: Barrier/graft properties, clinical handling, resorption pattern, bioactivity
- Surgery-related: Healing protocol, surgical complications
- Implant-related: Implant surface
- Prosthetic-related: Loading protocol, abutment characteristics
Principles of GTR
- Aiming at regeneration of lost periodontal structures (cementum, PDL, and alveolar bone)
- Selective repopulation of periodontal wounds
The Biology of Bone Regeneration
- Cell recruitment: recruitment of osteoprogenitor cells for the start of the process
- Matrix deposition: blood clot provides a scaffolding for the growth of cells through the wound area
- Signaling pathways: signaling pathways, such as BMP and VEGF, regulate the differentiation of osteoprogenitor cells
The Impact of Surgery-Related Factors
- Submerged vs Non-submerged healing protocols
- Surgical complications: soft tissue dehiscence, membrane exposure, infections, leading to decreased quality and stability
Molecular Mechanisms of Bone Formation
- Hydrophilic and moderately rough surfaces promote early bone formation and favorable immune response
- Complex signaling pathways regulate cell proliferation, osteogenesis (bone formation) and angiogenesis to achieve bone regeneration
The Impact of Biomaterials
- Importance of barrier membranes (and bone grafts / substitutes)
- Properties of various materials: Their impact on bone regeneration, space maintenance, and stability of the procedure
The Impact of Prosthetic Factors
- Implant loading timing (immediate, early, conventional)
- Abutment characteristics: Design and properties influence peri-implant tissue stability and maintenance of regenerated bone
Patient-Related Factors
- Periodontitis history, systemic conditions (diabetes, osteoporosis), smoking
History of Periodontitis, Compliance, and Oral Hygiene
- Thorough assessment of oral conditions required
- Development of an individual oral healthcare plan
- Coaching patients on proper oral hygiene
- Professional plaque removal
Systemic Conditions and Smoking
- Underlying medical conditions can negatively affect bone and soft tissue healing during regeneration
- Smoking is detrimental to wound healing, increasing the risk of complications and implant failure
Diabetes Mellitus
- Diabetes is linked to complications (bone disease/osteopathy) during implant placement, potentially affecting peri-implant bone formation and mineralization
- This may also lead to negative impacts on bone regeneration quality.
Considerations in Osteoporosis
- Osteoporosis affects bone quality in the jaw and may correlate with reduced bone density/increased cortical porosity
- Patients with osteoporosis are at higher risk for complications during implant procedures, so the clinician should extend healing time
- A diagnosis of osteopenia or osteoporosis may not prevent implant placement today
Risks of Peri-Implantitis
- Prevalence of peri-implantitis (inflammation around implants) may vary based on initial implant location
- It is important to monitor peri-implant diseases for both pristine and regenerated sites
Future Directions in Bone Regeneration
- Tissue engineering approaches integrating cells, biomaterials, and signaling pathways can revolutionize treatment methods
- Personalized approaches will utilize proteomics and transcriptomics to create customized treatments, improving outcomes,
Considerations for GBR Success
- Space maintenance is crucial
- Bioactivity, stability, and appropriate grafting materials play a role in GBR outcomes
- Clinical success requires monitoring
- A variety of strategies support ideal stability in GBR outcomes
References
- Includes listed authors, publication titles, and publication years. (Note: these need to be filled using the supplied references)
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Description
Explore the crucial role of surface properties in titanium implants, focusing on how modifications can enhance osseointegration and influence cellular responses. This quiz delves into the effects of surface roughness and hydrophobicity on healing outcomes.
