AL Advanced proth

  1. Maxillary denture is loose
    • Lack or incorrect posterior palatal seal
    • Short on hamular notches
    • Dry mouth
    • Posterior border too short or thin
    • Inaccurate denture base
    • Short labial flange or excessive notch for frenum
    • Inadequate clearance for labial frenum
    • Improper clearance for buccal frenum
  2. Maxillary denture drops when the patient opens wide
    • Posterior borders too thick
    • Posterior borders too long
    • Interference with the coronoid process by distobuccal flange
  3. Maxillary denture loosens while patient speaks
    • Inadequate posterior palatal seal
    • Interference with coronoid process
    • Posterior border too long or too thick
    • Short labial flange or excessive notch for frenum
  4. Maxillary denture loosens at different times of the day
    • Heavy secretion of mucinous saliva from palatal salivary glands
    • Periods of dry mouth due to alcoholism, radiation, medication or disease
    • Sjögren's syndrome
  5. Mandibular denture is loose
    • Over extension of base
    • Under extension of base
    • Thickness in lingual border in molar area
    • Lack of neuromuscular control
    • Posterior teeth set too lingual-crowding tongue
    • Dry mouth
  6. Neutral Zone
    • • The neutral zone is the potential space in the oral cavity where the forces between the lips and cheeks on one side and the tongue on the other side are equal and balanced.
    • • The teeth when developing are guided in to this space during childhood.
    • • When prosthesis are inserted or teeth are arranged they must conform to this space.
    • • When prosthesis or teeth that are set outside this zone they will cause discomfort, cheek or tongue biting and instability of the dentures.
  7. One or both dentures loosens when eating
    • Teeth are set too far buccal to crest of ridge
    • Occlusal plane higher than retromolar pads
    • Occlusal interferences
    • Inadequate neuromuscular control
  8. Excesive salivation
    • Strangeness of new denture, will subside
    • Can lead to swelling of the sublingual gland area if the lingual flanges are obstructing the opening of the ducts
  9. Sore on areas
    • Excessive pressure areas
    • • Over extensions
    • • Errors in occlusion
    • • Insufficient relief over undercuts
  10. Non-specific pain
    • • Pressure over zygomatic process
    • • Distobuccal border of denture base too wide
  11. Cheek biting
    • Insufficient clearance of the denture bases distal to the last tooth
    • • Insufficient horizontal overlap of posterior teeth
    • Sharp buccal cusps
    • • Teeth extend too far posteriorly
  12. Burning sensation of the upper lip/ nose
    Impingement of the nasopalatine nerves
  13. Tingling or pain in the lower lip
    Pressure over mental foramen
  14. Sore throat
    • Over extension and ulceration of soft palate
    • Overextension beyond hamular notch:
    • distobuccal of maxillary and
    • distolingual of mandibular
  15. Gagging
    • • Posterior border of the maxillary denture too long or thick
    • • Distolingual flange of the mandibular denture too long or thick
    • • Maxillary occlusal plane too low
    • • Mandibular teeth set too far lingual
    • • Excessive increase in the vertical dimension
  16. Difficulty speaking
    • • History of corrected speech problems as a child
    • • Improper arrangement of maxillary anterior teeth
  17. Whistle on "s" sound
    • • Maxillary anterior teeth set too far labial
    • • Insufficient base material on lingual of maxillary anterior teeth
    • • Posterior teeth set too far lingual
    • • Posterior denture base is too thick
  18. "S" sound like "sh"
    • • Maxillary anterior teeth set too far lingual
    • • Excessive base material on lingual of maxillary anterior teeth
    • • Posterior denture base is too thin, air escapes
    • from lateral borders of the tongue
  19. Palatal erythema
    • This happens in longer term wear:
    • Excessive and long wear of dentures
  20. Patient comes to you complaining of crusting and infection involving
    the lip and commissures . On examination you find that he has deep
    fissures at the corners of the mouth and he is wearing complete
    maxillary and mandibular dentures. The possible cause of this
    condition is related to:
    • A reduced interarch distance
    • Candidiasis
  21. 1. Loss of bone from the anterior part of the maxillary ridge
    2. Overgrowth of the tuberosities
    3. Papillary hyperplasia in the hard palate
    4. Extrusion of the lower anterior teeth
    5. Excessive resorption of posterior mandible
    Kelly's combination syndrome
  22. Flabby Ridge
    Excessive Forces
    Loss of bone from the anterior part of the maxillary ridge
  23. Use of denture adhesive and trauma may lead to
    Papillary hyperplasia in the hard palate
  24. What causes extrusion of the lower anterior teeth?
    Lack of posterior occlusion
  25. What causes Excessive resorption of posterior mandible
    Cause: Lack of lower RPD wear
  26. Partially edentulous mandible
    typically Kennedy class I
    Completely edentulous maxilla
    Combination Syndrome
  27. Resorption in anterior maxilla is caused by excessive, damaging forces. It may lead to
    • • Dislodgment of the maxillary denture
    • • Pressure on anterior nasal spine in severe cases
    • • Numbness or pain in the anterior maxilla as a result of pressure on incisive nerve
    • • Poor esthetics and lack of lip support
  28. Prevention to become a Combination Syndrome
    • Prevention of further bone loss
    • Restoration of Posterior Occlusion
  29. What is the pre treatment of the combination syndrome
    • Tuberosities reduction
    • Treatment of papillary hyperplasia
    • Flabby ridge reduction in the anterior maxilla
  30. What is the predictibility of success for
    1.Prevention of further bone loss
    2. Restoration of posterior occlusion
    • 1 is good
    • 2 is only Ok if the etiology is not addressed therefore the treatment will be compromised
  31. How to  prevent further bone loss?
    • • Placement of implant fixtures “sleepers”
    • • Augmentation and implant placement
  32. How to restor posterior occlusion?
    • Provide well made, retentive and stable prosthesis:
    • • Retentive prosthesis:
    • Border molded maxillary and mandibular
    • Retentive claps /components on lower partials
  33. According to Lekholm and Zarb, there are 4 types of bones. Which are the worst for implant placement and Why?
    • Type 1 is too solid (cortical bone) with not enough bone cell to osseointegrate.Type 4 also in not good because it is very trabecular. (low implant to cortical bone ratio)
    • Type 2 and 3 are more ideal
  34. At what level should be the top portion of the implant ideally?
    • At the bone level.
    • A tissue level implant is more prone to bone resorption due to more biomechanical forces and also is more plaque retentive
  35. Where is type 1 and type 4 bone usually located?
    • Type 1 in lower anterior between the metal foramens
    • Type 4 usually located in the posterior maxilla ( the most trabecualr bone)
  36. Some of the golden rule measurements for implants are between them, to adjacent teeth and kind of tissue
    • Between implants 3 mm
    • distance to adjacent teeth 2 mm
    • Keratinized gingiva is prefered
  37. What is the drilling technique to place an implant?
    • In and out motion
    • Don't stop motor
    • Drill to desire depth:
    • → bur is 1.5 mm longer than desire depth
    • → implant is 1 mm longer than desired depth
  38. When placing implants what is the meaning of tripodization?
    • tripodization means not to place 3 implants in the same straight line but placing one of the implants offline. That will allow a better distributions of the biomechanical forces (like a tripode table)
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  39. After how many uses a drill should be replaced and why?
    After 20 to 30 or when is dull; because a dull drill will need more force to be applied leading to more heat, more friction and more cell death (leading cause of surgery related implant failure)
  40. When placing a 3,5mm implants, what is the drilling sequence protocol?
    • 1. A precision drill (optional) to start
    • 2. A 2.0 mm Drill with tip Tapered
    • 3. A direction indicator has to be used at this point to check the angulation of the hole in relationship with adjacent teeth(single implant) or with other direction indicators (multiple implants). If something has to be changed, the precision drill can be used to redirect the angulation.
    • 4. A 3.5mm Tapered drill
    • 5. Check againg with the direction indicator.
    • 6. In a normal bone the implant can be placed at this point
    • 7. In a very dense bone two more drill should be used to create the threats for the implant
  41. Drill sequence protocol for a 4.3 mm implant
    • 1. A precision drill (optional) to start
    • 2. A 2.0 mm Drill with tip Tapered
    • 3. A direction indicator has to be used at this point to check the angulation of the hole in relationship with adjacent teeth(single implant) or with other direction indicators (multiple implants). If something has to be changed, the precision drill can be used to redirect the angulation.
    • 4. A 3.5mm Tapered drill
    • 5. A 4.3mm Tapered drill
    • 6. Check again with the direction indicator.
    • 7. In a normal bone, the implant can be placed at this point
    • 8. In a very dense bone two more drill should be used to create the threats for the implant

    Basically is the same protocol as a 3.5mm but one more drill is added
  42. What is a flapless flap procedure?
    • Is a computer guided surgery that will be using a stent to place the implant without exposing the bone.
    • It requires a lot of computer assisted planning.
  43. What is the maximum RPM of the handpiece when drilling into the bone?
    • 800 Revolution Per Minute should be the maximum
    • Also it should irrigate saline solution.
  44. What is the maximum RPM of the handpiece when inserting the implant?
    • Use irrigation
    • 25 rpm max
    • 20-40 Ncm max (low torque)

    if implant doesn't sit, remove and use dense bone drill (the one with the threats)
  45. When manually adjusting and tightening the implant, what is the Ncm (torque)?
    35-45 Ncm of final torque.

    manually tighten until it reached the final depth
  46. How to judge what is a good time to wait for a phase II implant surgery?
    • Based on the type of bone.
    • A type 3 (more trabecular(back of maxilla)) should take more time (+- 6 month)when compared to
    • a type 2 (more dense(lower anterior)) +- 4 months
  47. Consideration for the phase II of implant surgery
    • Flap design: either an incision (90% of the time) or a punch (like an incisional biopsy)
    • Remove bone overgrowth: sometimes there is a very good healing and some bone may be covering the implant which have to be removed
    • Remove cover screw
    • Connect healing abutment
  48. Consideration after placing implants in bruxer patients
    Always place a night guard after implants placement
  49. What are the most common implant complications?
    • 1. Loosening of overdenture retention 30%
    • 2. Implant loss in irradiated maxilla 25%
    • 3. Hemorrhage-related surgical complication 24%
    • 4. Resin-veneers fracture on complete arch FPD 22%
    • 5. Implant loss with maxillary overdenture 19%
  50. Implant complication is classified in 1. Non-critical 2. Moderately critical and 3. Critical. What does the problem require? How to fix it?
    • Does not require surgical intervention
    • May not require removal of the restoration
    • to fix it:
    • Occlusal adjustment, cleaning of the excess cement
    • Replacement of the screw access hole filing, re-cementation of the restoration
    • Repair of the restoration
    • Replacement of retentive plastic males on locaters
    • Re-tighten locater or retaining screw
  51. Implant complication is classified in 1. Non-critical 2. Moderately critical and 3. Critical. What does the problem require? How to fix it?
    Moderately Critical
    • May or may not require surgical intervention
    • May require removal of restoration, abutment or framework
    • Requires replacement of the restoration
    • To fix it:
    • Early cleaning of the excess cement
    • Removal/replacement of the abutment/ retainer screw
    • Replacement of restoration due to poor fit/ esthetics
    • Replacement of broken restoration/ framework/ restorative material
    • May restore miss positioned/ miss angulated implants
  52. Implant complication is classified in 1. Non-critical 2. Moderately critical and 3. Critical. What does the problem require? How to fix it?
    • Require surgical intervention
    • Require replacement of restoration, abutment or framework
    • Require implant replacement/ removal
    • IAN damage (face a lawsuit)

    • to fix it:
    • Late cleaning of excess cement
    • May not replace broken abutment or framework
    • May not restore miss positioned/miss angulated implants
    • Removal of broken/ failed implant
    • Surgical treatment of a damage nervejQuery110108074723293820061_1487364062869?????
  53. What are the consequences of late cleaning of excess cement?
    • constant discomfort
    • bleeding on probing
    • probing depth 8-10 mm
  54. After what dosage osteoradionecrosis develop?
    55 Gy (gray)

    decreased collagen formation and wound healing due to hypovascularity
  55. What is the risk associated with the use of Bisphosphonates?
    Major rosk factor for Osteonecrosis.
  56. A prosthesis used to close congenital or acquired tissue opening, primarily of the hard palat and/or contiguous alveolar structures?
    • Obturator (GPT-8)
    • It can be:
    • Immediate surgical obtirator ISO
    • Interim Obturator INO
    • Definitive Prosthesis DP
  57. What is a palatal incompetency and how to treat it?
    • Abnormal velo-pharigeal closure
    • due to CVA, head injuries or neurologic diseases
    • Normal velopharingeal structures

    Treatment: Palatal lift prothesis
  58. What is a palatal insufficiency and how to treat it?
    • Inadequate length of hard and soft tissue
    • Normal movement of the remaining tissue
    • Congenital and acquire soft palate defects 

    Treatment: Speech bulb
  59. When is a palatal augmentation prosthesis used?
    In patients who undergo a tongue recection to improve speech
  60. What is the biologic width?
    • 2.04mm
    • Connective tissue 1.07mm
    • Epithelial attachment 0.97mm
  61. Considerations about the permucosal seal or transgingival area
    • Is the interface between the implant and the tissue around it. (Important to achieve a succesful dental implant)
    • There is no cementum
    • There is no connective tissue
  62. Which is the most desirable tissue around implant?
    • Keratinized tissue because it is immobile. 
    • However if there is no KT available the impplant can still work if properly maintained
  63. How long should you wait after the crown lengthening procedure before taking a final impression?
    4 to 6 weeks. That is what usually takes to the biologic with to reestablish.
  64. How the use of a wide implant can cause gingival recession?
    Because it may weaken the buccal plate exposing it.

    avoid this by using a narrower implant or by placing it more palatal
  65. Compare standard diameter implant SDI with wide diameter implant WDI regarding recession recorded around the implant
    • SDI recession about 0.5mm
    • WDI recession about 1 to 1.5mm

    • also 50% of the SDI implants showed signs of recession
    • 90% of WDI showed signs of recession
  66. What is the protocol to maintain or increase width of Keratinized mucosa arround impplants?
    • Free gingival grafts
    • Apically positioned flap during stage II surgery (defect)
    • Gingivectomy during stage II surgery (excess)
  67. What is dehiscence around implant?
    Is a defect exposing part of the axial surface (including the coronal aspect) while maintaining sufficient bone volume around all remaining implant surfaces
  68. What is the difference between a surgically driven implant and a restorative driven implant?
    • Surgically driven implant: places the implant where the bone is.
    • Restorative...: places it in a position that will allow a proper restauration

    note: even if there is enough bone to place the implant, the pt may need bone augmentation to place the implant in the right position
  69. Collagen fiber differences between implant and tooth?
    • Implant: parallel collagen fibers and non-attached
    • Tooth: perpendicular and in a functional arrangement
  70. Inflammatory process affecting the tissue around an osseointegrated implant in function, resulting in loss of supporting bone

    • Plaque is the primary etiologic factor.
    • It is perpetuated by bacterial infection and by excessive biomechanical forces
  71. How to diagnose peri-implantitis?
    • Probing depth changes
    • Radiographs
    • Mobility
    • Suppuration
    • Visual exam: plaque and calculus. Swelling. Bleeding. Tissue changes like color, contour and consistency.
  72. Peri-implantitis in partial vs complete edentulism
    Partially edentulous are at greater risk because natural teeth harbor more pathogenic peri-implant microflora vs fully edentulous
  73. When does implant failure occurs?
    when the implant moves.

    There are some instruments that measure implant stability like Periotest and Resonance Frequency Analysis
  74. Criteria for implant success
    • it is immobile
    • no prei-implant radiolucency
    • bone loss is less than 0.2mm a year
    • no pain, discomfort or infection related to implant
    • the implant allows the placement of a restoration

    note: there is a 85% success rate for 5 years post restorative preiod and 80% for 10 years post restorative
  75. The coronal portion of the implant achieves a normal bone-to-implant interface but a clinically symptomatic PARL develops shortly after the implant insertion
    Retrograde Peri-implantitis
  76. Soft tissue aberration w/o loss of supporting bone and clinically stable
    Ailing implant
  77. May demonstrate bone loss with pocketing, BOP, purulence and irrespect of therapy
    Failing Implant
  78. Clinically mobile and dull sound when percussed. Peri-implant RL evident on x-rays
    Failed implant
  79. Treatment of the ailing and failing implant
    • Chemotherapeutic agents: 0.12% chlorhexidine, hydrogen peroxide, tetracycline, citric acid.
    • Repair:
    • Reflect the tissue, degranulate the defect
    • Detoxify implant
    • Graft with BRG, barrier membrane
    • Leave the repaired implant out of function and "covered" for 10 to 12 weeks
  80. Clinical role for implant maintenence
    • Check pt every 3-4 month
    • check for 85% plaque control
    • X-rays every 12-18 month
    • Repair implant if necessary: degranulate, detoxify, and graft
    • Document all procedures and data
  81. Summary of periodontal aspect of implants
    • KT is not essential but highly desirable
    • Implant patient is a periodontal patient
    • Peri-implantitis is similar to periodontitis
  82. What is the strength hierarchy of all ceramic crown?
    • 1. Zirconia: Procera(1650 MPa), Lava (1475 MPa), Vita(1270 MPa)
    • 2. Fine grane Alumina: Procera (700 MPa0
    • 3. Glass infiltrated Alumina: InCeram (550 MPa)
    • 4. Porcelain/Glass ceramic: Mark II (110 MPa) Empress (160 MPa), Empress II (420 MPa)  E.Max (520 MPa)

    Note: The stronger the ceramic the less esthetic (less translucent)
  83. When treating a patient with a double layer (bilayer anterior restoration) ceramic crown, when should alumina core be used and when zirconia core should be used?
    • Alumina is more translucent, it will provide a more natural color of the tooth
    • Zirconia is more opaque but is indicated to mask a discolored (stained) tooth
  84. All ceramic indications
    • Anterior teeth with sufficient clinical crown height (including first premolar)
    • Highly aesthetic areas within the smile zone
    • Occlusion that allows sufficient reduction w/o compromising retentive elements
  85. Indications for crowns, bridges and laminates (veneers) based on aesthetic and strength of all-ceramic materials.
    • Crowns: Alumina / Zirconia- pressed
    • Bridges: Zirconia (very strong)
    • Laminates: Alumina (very translucent)
  86. Indications for Procera - Alumina (678 MPa)
    • Anterior single crowns
    • More translucent teeth
    • Warmer chroma
    • Lower value
  87. Indications for Procera - Zirconia (1121 MPa)
    • Posterior single crown
    • Bridges
    • Masking abilities
    • More opaque teeth
    • Less chroma
    • High value
  88. Considerations for the preparation of all ceramic crowwns
    • Chamfer margins: at the gingival level or 0.5mm subgingival 
    • Sufficient reduction: 1.5 to 2.0 mm occlusal/incisal reduction
    • Rounded preparation: this will allow a better image scanning for the cad/cam machine. (Today's reason)

    A sharp angle is a point of weakness in the ceramic and it will lead to chipping and propagation of cracks. (old reason)
  89. What is the most common cause of gingival irritation when placing an all ceramic crown?
    Excessive cement
  90. Reduction guide examples
    • Silicone/ putty index: index of wax up
    • Alternative reduction guides:
    • Provisional
    • Vacuum formed matrix
  91. #1 Nerb failure and #1 QA problem for anterior restauration is
    lack of occlusal reduction
  92. When does zirconia do a lot of damage to the opposing restoration?
    When it is adjusted and Not polished afterward. 

    By itself, if well constructed, polished and in a normal occlusion the wearing properties are similar to enamel
  93. The supra-structure of the crown, as they are baked shrinks. How much?
    20% of shrinkage.
  94. In a RCT tooth can zirconia be used?
    • Yes. IF:
    • The core of the tooth structure is intact
    • If minimal core build up is required
  95. In a tooth with RCT and Post and core build up can an all ceramic restoration be used?
    No. A PFM crown is the preferred one to be used
  96. Why does the industry is moving from bilayer ceramic into monolitic layer ceramic?
    The mayority of the problems occurs in the veneering porcelain layer (all the chipping)
  97. In an all porcelain bridge what is the minimum height of the connection (joints) between the units?
    At least 4mm.

    It has to be checked with the index
  98. Clinical complications in fixed prosthodontic
    All ceramic restorations have the least amount of complications
  99. Name the 8 steps in CAD/CAM guided surgery workflow *
    • 1.Clinic diagnostic
    • 2. Interim denture that will become the
    • 3. Radiographic guide
    • 4. Digitization with CBCT scan
    • 5. Diagnostic and treatment plan in the 3-D software
    • 6. Fabrication of surgical guide
    • 7. Guided surgery
    • 8. Restoration
  100. What software is used to define implant position(s) from a clinical, anatomical, and prosthetic perspective by combining  tooth setup with the Pt anatomy
    Nobel Clinician software

    it is the 5th step in the CAD/CAM guided surgery workflow. The 3D diagnositc and treatment planning
  101. Some of the advantages of CAD/CAM fabrication of titanium frameworks are
    • Elimination of distortion
    • Better fit
    • Fewer fabrication steps
    • Biocompatibility
    • Low cost
    • Titanium frameworks are more accurate than cast frameworks because there is no heat involved. Meaning there is no expansion, shrinkage and distortion
  102. What are some clinical methods to assess framework fit in the implant fit prosthesis?
    • Sheffield test (single screw test) combined with radiographic evaluation is very efficiant
    • Also visual inspection
    • Finger pressure
    • Disclosing materials
  103. What is the single screw test?
    • Sheffield test used for long spam framework.
    • A single screw is placed in the distal abutment and if it does not create a vertical gap on the other end of the framework then it is considered to have an acceptable fit

    If something comes up, the framework have to be sectioned and then soldered
  104. What is a sterolithography?
    It produces a 3D model (like a 3D printer) using a computer controlled laser to cure a photosensitive resin, layer by layer to create the 3D part
  105. NobelGuide advantages
    • Virtual treatment planning
    • Prosthetic based
    • Precision flapless surgical technique
    • Less chair time for the patient
    • Immediate function
  106. NobelGuide disadvantages
    • All bone augmentation surgeries must be done before the computer-guided surgeries
    • Instrumentation length limit number and placement position
    • May have higher lab bill
    • Higher cost to the patient
Card Set
AL Advanced proth
Remount, Dowel, Immediate denture, relining and rebasing, perio of implants, QA, post insertion problems, combination syndrome, oseointegration, maxillofacial prosthesis, cad-cam zirconia, implants complications, cad-cam implats