IMPLANTS

QUESTION ONE
Osseointegration implies :

A. The process of inserting implants in bone B.Integration of the bone and implant with fibrous tissue between then C. At least some direct contact of living bone and the surface of the impact at the light microscopic level of magnification D. None of the above Answer - C

Definitions
Glossary of Prosthodontic Terms-8 The apparent direct attachment or connection of osseous tissue to an inert, alloplastic material without intervening connective tissue.

American Academy of Implant Dentistry (AAID) Osseointegration is an exact relation between normal and remodeled bone and an implant surface without interposition of non-bone or connective tissue.

Branemark Osseointegration is the direct structural and functional connection between the ordered lining bone and the surface of the load carrying implant. Schroeder (1976)- Clinical Definition Ankylosis of the implant bone interface

Fibro-osseous integration
Fibro-osseous integration refers to a presence of

connective tissue between the implant and bone.

Theory of osseointegration
According to Branemark a direct bone to implant

attachment is possible, if the implant is allowed to heal undisturbed.

QUESTION TWO
The force applied to the implant to check its

mobility is approximately:a. 1000 gms b. 400 gms c. 250 gms d. 500 gms ANSWER -d

classification
Epiosteal

Endosteal

Transosteal

Epiosteal implant
Dental implant structure that covers almost the entire

crestal surface of the maxillary and mandibular residual alveolar bone under the soft tissue periosteum.Eg- Subperiosteal implant
It is a dental implant that receives its primary bone

support by resting on the bone.new bone will grow around the implant

Subperiosteal implant
Covers the almost entire crestal surface of maxillary &

mandibular residual alveolar ridge.

Four to six posts protruding out through gingiva and

on to which the complete denture will be attached.

Endosteal Implant
Extends into the basal bone for support
It transects only one cortical plate Two types Root form Plate form

Endosteal Implant

Used over a vertical column of bone

Available in four forms cylindrical, press fit, screw root, combination

They are used for horizontal column of bone which is flat and narrow facial lingual direction

Transosteal implants
A dental implant that penetrates

both cortical plates and passes through entire thickness of the alveolar bone

Parts of an implant Prosthetic screw

Prosthetic abutment
Crest module

Body

Body or fixture
apex

QUESTION THREE
The superstructure may be retained on the

abutment (implant case) by the following methods except. a) Through screws b) Through cementation c) Through adhesives. d) Through an attachment device Answer- c

QUESTION FOUR
Endosteal impant can be:

A. B. C. D.

Root form implant only Plate form implant only Can be either root from or plate from Combination of both

Answer- C

QUESTION FIVE
The transfer coping in an implant is used: A. To position an analog in the impress inserted in: B. To transfer the position of the implant in the mouth to the cast C. To gain exact implant positioning D. All of the above
Answer - D

QUESTION SIX
In case of endosseous implant: A. A seal between implant surface and soft tissue is not required B. A permucosal seal of the soft tissue at the implant surface is very essential C. Whether the seal is established or not it does not really make a difference to the success D. None of the above
Answer- B

CRITERIA FOR SUCCESS OF OSSEOINTEGRATION

Schnitman and Schulman, 1979

Mobility less than 1mm in any direction Radiologically observed radiolucency graded but no success

criterion defined
Bone loss no greater than one third of the vertical height of

the bone
Gingival inflammation amenable to treatment; absence of

symptoms and infection, absence of damage to adjacent teeth, absence of paresthesia and anesthesia or violation of

the mandibular canal, maxillary sinus, or floor of the nasal

passage
Functional service for 5 years in 75% of patients

Albrektsson, Zarb, Worthington, and Erickson, 1986

Individual unattached implant that is immobile

when tested clinically

Radiograph that does not demonstrate evidence of

peri-implant radiolucency
Bone loss that is less than 0.2 mm annually after

the implants first year of service

 Individual implant performance that is

characterized by an absence of persistent and/or irreversible signs and symptoms of pain, infections, necropathies, paresthesia, or violation of the mandibular canal
In context of criteria mentioned, a success rate of

85% at the end of a 5-year observation period and 80% at the end of a 10-year observation as a minimum criterion for success

Implant stability
When an implant is placed surgically, initial stability or

primary stability is a function of the bone quality, implant deign and surgical technique.
Implant placed in the dense cortical bone should have

higher initial stability than in a weak cancellous bone

 During the osseointegration healing and maturation process

, the initial stability changes with increases in bone- to implant contact and osseous remodeling.
It is unknown however what precisely constitutes adequate

stability to warrant proceeding with restoration

Rigid fixation

Absence of observed clinical mobility. First clinical criterion to be evaluated.

A healthy implant moves less than 73microns appears as

zero clinical mobility . The goal for root form implants should be rigid fixation and IM status 0

QUESTION SEVEN
Lack oosseointegration can be due to : A. Premature loading of the implant system B. Placing the implant with too much pressure C. Overheating the bone during preparation D. All of the above

Answer- D

QUESTION EIGHT
While inserting an implant a gap is observed between the implant and the prepared site the implant will most probably: A. Fail B. Be a success C. The gap does not affect the success of the implant D. All of the above
Answer - A

1) Horizontal mobility beyond 0.5mm or any clinically observed vertical movement under <500g force 2) rapid progressive bone loss regardless of the stress reduction and peri implant therapy 3) Pain during function or on percussion 4) Dull sound on percussion

Signs and symptoms of implant failure

5) Continued exudation inspite of surgical attempts at correction

6) Generalized radiolucency around an implant 7) >1/2 of the surrounding bone is lost 8) SLEEPERS -Implants inserted in poor position making them useless for prosthetic support 9) Pocket depth of 5mm and increasing 10) Bleeding on probing(BOP) Index of 2 or above

QUESTION NINE
Which of these is an indication for implant

placement? A. Inability to wear a removable or complete denture B. Unfavourable number and location of natural tooth abutments C. Single tooth loss which would necessitate preparation of undamaged teeth for fpd D. Any of the above

Answer -D

QUESTION TEN
Which of the following types of bone represents

the worst option for implant placement? A. Type I B. Type II C. Type III D. Type IV Answer - D

Bone
An assessment of the characterstics of the recepient osseous site is criticle as the bone quality and quantity are the two of the most important factors that determine the fixture longevity

Available bone
Width Height Length

Angulation
Crown height/implant body ratio

 Height
Measured from the crest of the ridge to the

opposing landmark. 8-12mm height Bone height determines the crown height ,esthetics Bone augmentation

Width
Width is measured between the facial and lingual

plates at the crest

 Length
Mesiodistal length of the available bone in the edentulous area

Angulation
Depend upon the width and density of the bone

Crown height
Its measured from the occlusal plane to the crest of the ridge
It acts as a vertical cantilever

Division of available bone Division A

Dimensions >5mm width >12mm heigth

>7mm length
<300 angulation <15mm crown heigth

 Advantages of Division A
Greatest surface area Improved stress distribution Designed for variable bone density

Greatest range of prosthetic options

Less fracture of implant and components More esthetic conditions Less abutment screw loosening

 Division B

2.5 to 5mm wide(B+ 4-5mm, B- 2.5-4mm) >12mm height >6mm length <20 degree angulation <15mm crown height

Division C

O-2.5mm width <12mm height >30 degree angulation >15 mm crown height

Division D
Severe atrophy Basal bone loss Flat maxilla and pencil thin mandible >20 mm crown height

 Lekholm and Zarb

Quality 1: composed of homogenous compact bone. Quality 2: thick layer of compact bone surrounding a core of dense trabecular bone. Quality 3: thin layer of cortical bone surrounding dense trabecular bone of favorable strength. Quality 4: thin layer of cortical bone surrounding a core of low density trabecular bone

Misch

D1: Dense cortical bone D2: Thick dense to porous cortical bone on crest and course trabecular bone within. D3: Thin porous cortical bone on crest and fine trabecular bone within. D4: Fine trabecular bone

QUESTION ELEVEN
Bone loss to what degree will lead to continued problems because the bone and soft tissues will not predictably reosseointegrate? A. Greater than 0.5-1.0 mm B. Greater than 1-2 mm C. Greater than 2-3 mm D. Greater than 3-4 mm
Answer - B

Failing and failed implants

Failing Implant Failed Implant

Definition- Failure process is in early stages and is reversible Clinical features Progessive Marginal Bone loss(Saucerization) absence of mobility peri implant infection (peri implantitis

Failure process has reached the irreversible state Marginal bone loss reaching the apical 1/3 of implant mobility Thin peri fixtural radiolucency

QUESTION TWELVE
Implants placed in the maxilla fail because of all of the following except one: A. Poor bone quality. B. Rapid resorption of bone height and width. C. Off - axis forces. D. Poorly trabeculated bone.
Answer- C

QUESTION THIRTEEN
Results of several studies show that the effective dose of radiation with the New CT imaging machine is A. Significantly lower than traditional CT imaging. B. Significantly higher than traditional CT imaging. C. Equal to that associated with traditional CT imaging. D. Not detectable
Answer - A

D1: More than 1250 Hounsfield unit D2: 850 1250 Hounsfield unit D3: 350-850 Hounsfield unit D4: 150-350 Hounsfield unit

QUESTION FOURTEEN
A permucosal seal in case of a dental implant is a. Possible b. Absolutely impossible as tissues will not stick to implant surface c. Not necessary at all d. None of the above Answer - a

QUESTION FIFTEEN
Distance between the implant and periodontal ligament of the adjacent teeth is a. 2mm b. 1mm c. 3mm d. 0.5 mm
Answer- C

QUESTION SIXTEEN
Ideal site for implant placement in a completely edentulous mandible is a. 1st Molar region bilaterally b. Retro molar pad area because its resistant to resorption. c. Buccal shelf area because its most suited for loading
d. Mandibular interforaminal region. Answer- D

QUESTION SEVENTEEN
The New CT imaging 3G software can deliver high quality images for user-defined templates, available in all of the following ways except one: A. On paper. B. On film. C. In digital form. D. As Selenium plates
Answer- D

QUESTION EIGHTEEN
Important diagnostic tool for achieving accurate implant angulation is a. Diagnostic Template b. Wax- up (Diagnostic) c. Mounted casts d. Surgical Template
Answer - d

QUESTION NINETEEN
Following are the signs and symptoms of failure of an implant except. a. Severe radiopacity around the implant. b. Bone loss around implant c. Pain during percussion d. Horizontal mobility > 0.5 mm.
Answer- a

QUESTION TWENTY
The most common types of implant in use today are: A. Subperiosteal implant B. Transosteal implant C. Endosteal implants D. All of the above.
Answer- c

QUESTION TWENTY ONE

Anatomical problem associated with edentulismis : A. Width of supporting bone
B. C. D. Height of supporting bone Thinning of mucosa and sensitivity or abrasion All of the above

QUESTION TWENTY TWO

RP-5 in implantology is aA. Removable prosthesis completely supported by implants / teeth. B. Removable prosthesis combining implant and soft tissue support. C. Fixed prosthesis replacing natural crowns and portions of soft tissue. D. Removable prosthesis that restores anatomic crowns and portions of root of natural tooth.

Prosthodontic treatment classification

FP-1
FP-2 FP-3 RP-4 RP-5

 FP1 Fixed prosthesis that replaces only the crown

 FP-2 - Fixed prosthesis :replaces the crown and a portion

of the root

 FP3 Fixed prosthesis : replacing missing crowns and

gingival color and portion of the edentulous site

 RP4 Removable prosthesis: Overdenture supported

completely by implants

 RP5 Removable prosthesis : overdenture supported by

soft tissue and implant