IMPLANT DENTISTRY EXAM BANK 1. Define osseointegration. (4 points, 1/4 2. What are the critical components of an acceptable clinical trial? (10 points) 3. Compare the masticatory performance of individuals with complete upper and lower dentures with patients using an implant assisted lower denture opposing a complete maxillary denture. (4 points) 4. Compare the masticatory performance and chewing strokes required to reach swallowing threshold of a fully dentate individual with a patient wearing upper and lower dentures. (4 points) 5. Compare the masticatory performance of Kennedy Class II patients restored with removable partial dentures vs fixed, implant supported partial dentures. (12 points) 6. Describe the difference between a resilient and a nonresilient attachment. In your answer provide a clinical example where each of the attachment types could be used. (8 points) 7. In specific situations attachments are used to connect implants to natural dentition when fabricating fixed partial dentures. Both precision and semi-precision attachments have been used. Which type is preferred and why. (4 points) 8. Patients fitted overdentures assisted by natural tooth abutments chew more effectively than patients fitted with overdentures assisted by osseointegrated implants. Why do you think this is true? (4 points) 9. List those clinical factors which are critical if a titanium screw shaped implant placed into a favorable bone site is to achieve osseointegration. (6 points, 1/2 10. Define A-P spread. When is it used? Why is it important? (6 points, 1/2 11. Osseointegrated implants used to retain and support single teeth restorations have had good success. Please discuss their use for each of the following sites and provide the following information: (1) prognosis, (2) special surgical considerations if any, (3) other prosthetic options, and (4) your recommendation. a. Maxillary central incisor site. (4 points, 1/4 b. Mandibular first bicuspid site. (4 points, 1/4 c. Mandibular first molar site. (4 points, 1/4 RFE 311 & RFE 315 1 KCS
d. Maxillary first molar site. (4 points, 1/4 12. Subperiosteal implants are reasonably successful for the first 4 to 5 years of use. However, after this period the incidence of local infections and implant failures increase dramatically. Please explain. (6 points, 1/2 13. Dental cantilevers have been incorporated into the design of many types of implant supported prostheses. Discuss the method used to determine cantilever length for the following situations: a. Six implants have placed in the maxilla and you wish to extend the restoration posteriorly with a distal cantilever. (4 points, 1/3 b. Five implants have been placed in the anterior mandible and you wish to develop a distal cantilever. (4 points, 1/3 14. Posterior quadrant of the mandible in a partially edentulous patient where have placed implants in each of the premolar positions and your considering a distal cantilever in the molar region. (4 points, 1/3 15. In the edentulous maxilla, implant assisted overlay prostheses are best suited for most patients, as compared to fixed restorations. Explain. (10 points, full 16. The success rates for the current generation of osseointegrated implants in the anterior mandible exceed 97% after 5 years. This rate of success has not been duplicated in the posterior quadrants of partially edentulous patients. Please explain. Please address both the mandible and maxilla during your discussion. (12 points, full 17. Define combination syndrome. (4 points, 1/4 18. Describe the peri-implant soft tissues histologically from the crest of the peri-implant gingiva down to area of the implant that is osseointegrated. (8 points, 1/2 19. When evaluating a patient for an implant in the maxillary anterior region, what are the clinical parameters that need to be taken into consideration. (12 points, 3/4 20. What are the most important factors to be considered if osseointegration is to be achieved consistently? (regarding preparation of bone sites and placement of implants) (10 points, 1/2 21. Describe the layers in the bone-implant interface zone of an osseointegrated titanium implant. Start from the center of the implant and proceed outward. (8 points, 1/2 RFE 311 & RFE 315 2 KCS
22. Describe the difference between a pickup type impression coping and a transfer type impression coping. Which type would you favor? Please explain. (6 points, 1/3 23. In the anterior maxilla when designing a single tooth restoration, why are ridged lap designs considered less than ideal (6 points, 1/3 24. List those factors that affect the mastication efficiency of a patient with a well made complete denture. (10 points, 1/2 25. With reference to the previous question describe how each of these is affected with the addition of two implants to the anterior mandible and the fabrication of mandibular overlay denture opposed by a maxillary complete denture. (10 points, 1/2 26. List the possible difficulties associated with cementing crowns on commercially fabricated implant abutments? (6 points, 1/3 27. List those factors which have led to a higher failure rate for osseointegrated implants used to restore the posterior quadrant of the maxilla. (8 points, 1/2 28. Success rates for implants used to restore edentulous spaces in the posterior quadrant of the mandible have been lower than those reported in the anterior mandible. Explain. (8 points, 1/2 29. Define implant assisted restoration. (4 points, 1/4 30. Define implant supported restoration. (4 points, 1/4 31. In the edentulous maxilla most patients are best fitted with implant assisted restorations. Explain. (6 points, 1/3 32. An implant assisted palateless, overlay denture is planned for this patient. Indicate the minimum number of implants you would use, the tooth positions you would favor for placement into the edentulous ridge and your reasons for selecting these positions. (6 points, 1/2 33. What is the difference between fibrous-encapsulated implants and osseointegrated implants? Which is clinically more predictable? Please explain your answer. (10 points, 1/2 34. Which of the original implant surfaces (machined, titanium plasma spray, hydroxyl apatite) resulted in the highest bone to implant contact? Does this relate to the clinical results? Explain. (8 points, 1/2 35. What are the advantages of roughening the surface of an implant by acid etching or some similar method? (6 points, 1/3 RFE 311 & RFE 315 3 KCS
36. Why is attached keratinized mucosa preferable to unattached nonkeratinized tissue around implants. (6 points, 1/2 37. Describe the biologic processes that take place associated with the bony tissues next to the surface of a titanium implant immediately following placement until complete healing has taken place. (10 points, 1/2 38. How long does this process take in humans? (2 points, 1/4 39. What strategies can be employed to avoid implant overload when restoring single molar defects in the mandible (6 points, 1/3 40. What factors determine the load carrying capacity of an implant supported prosthesis? (10 points, 1/2 41. Brunski et al (2000) has proposed a possible mechanism of implant failure associated with implant overload and bone resorption. Please describe in detail (10 points, 3/4 42. The magnitude of occlusal loads delivered to the bone through a three unit implantsupported fixed bridge restoring a posterior quadrant is controlled by many factors. What are they? Which of these are under control of the restorative dentist (12 points, 1/2 43. In edentulous patients (both maxilla and mandible) what strategies would you use to avoid implant overload when planning for and designing implant supported prostheses? (8 points, 1/2 44. When restoring an edentulous posterior quadrant of a partially edentulous patients what strategies would you use to avoid implant overload when planning for and designing an implant supported fixed partial denture. (14 points, 3/4 45. Immediate loading of osseointegrated implants is somewhat controversial. Please explain. (6 points, ¼ 46. Describe clinical situations where immediate or early loading of osseointegrated implants would be feasible. (6 points, 1/2 47. Describe some of the potential problems associated with placing implants into fresh extraction sites. (6 points, 1/2 48. Compare the bone quality and quantity of the edentulous posterior maxilla and anterior mandible with respect to their suitability as implant sites. (8 points, 1/2 49. What factors influence the implant anchorage in bone? (6 points, 1/2 RFE 311 & RFE 315 4 KCS
50. What are the advantages of implant assisted overlay dentures in the maxilla as opposed to fixed implant supported prosthesis? (8 points, 1/2 51. What are the minimum requirements for an implant supported prosthesis in the mandible with respect to number, length and arrangement? (6 points, 1/2 52. What are the minimum requirements for an implant supported prosthesis in the maxilla with respect to number, length and arrangement. (6 points 1/3 53. What factors should be taken into account when you are deciding between restoring an edentulous mandible with a fixed hybrid prosthesis vs. an implant assisted overlay denture? (10 points, 2/3 54. When restoring posterior quadrants of partially edentulous patients with osseointegrated implants, how do you minimize the buccal or lingual cantilever effect? (6 points, 1/3 55. When considering patients for implants in the edentulous mandible, describe some of the common problems that are encountered and need to be considered before embarking a specific course of treatment. (6 points 1/2 56. Name each level in a standard implant pillar, the material of which it is constructed and its purpose. (6 points 1/2 57. Explain how the UCLA abutment is different from a standard abutment. What problems it can solve. (6 points 1/2 58. Explain the difference between an implant level and an abutment level impression and describe two techniques for making the impression. (8 points 1/2 59. Describe a technique for improving the accuracy of the master impression in an edentulous patient when 4-6 implants are arranged in the anterior symphyseal region. (6 points) 1/2 60. How can labial-buccal plate deficiencies be resolved in single tooth defects in the anterior maxilla? Which of the two methods available would you prefer? Please explain. (4 points 1/2 61. Explain what is meant by an AP spread and how it is used. (4 points 1/4 62. What are the factors necessary to allow opening the palate on a maxillary implant assisted overdenture? When should you cover the palate? (6 points 1/2 63. What factors affect load distribution of an implant supported fixed partial denture designed for the posterior quadrants of the maxilla or mandible? (10 points 1/2 RFE 311 & RFE 315 5 KCS
64. What purposes are served by the use of provisional implant restorations in partially edentulous patients? (8 points 1/2 65. What factors (with respect to the anatomy of the site and surface of the implant) influence the effectiveness of implant anchorage in bone? (6 points 1/2 66. When restoring the edentulous maxilla, what are the advantages of overlay dentures over fixed prostheses? 67. When restoring an edentulous maxillary or mandibular arch with a fixed implant supported prosthesis, how is the cantilever length determined? (4 points 1/4 68. In the edentulous mandible, what factors influence the treatment choices available (fixed vs. removable)? With each factor indicate whether this factor would lead you to prefer a fixed or removable option. With each factor explain the reason for your preference. (20 points whole 69. What issues need to be considered when deciding whether or not to immediately load an implant retained prostheses? (8 points, 1/2 70. What biologic processes need to be complete before an implant is fully anchored in bone? (12 points, 1/2 71. What are the advantages of the two implant assisted overlay denture as compared to fixed prostheses when restoring the edentulous mandible? (8 points 1/2 72. When designing an implant assisted overlay denture for the mandible, what prime support areas must be engaged to absorb posterior occlusal forces? (4 points 1/4 73. When designing a two implant assisted mandibular overlay denture for a patient, where are the two most desirable implant locations? Please explain your answer. (4 points 1/2 74. Prior to processing the two implant assisted overlay denture, the clip housings are secured to the bar via Hader clips and the rest of the bar is blocked out with plaster or stone. Why? (4 points 1/3 75. What is meant by the phrase prosthetically-driven implant placement? (4 points 1/3 76. When surgically placing an implant into a bony site, what strategies are used to avoid overheating the bone? (8 points 1/2 77. List the relative medical contraindications to placing osseointegrated implants in patients with bone sites of reasonable quantity and quality. (8 points 1/2 RFE 311 & RFE 315 6 KCS
78. List the relative dental contraindications to placing osseointegrated implants in patients with bone sites of appropriate volume. (8 points- 1/2 79. What are the objectives to be accomplished at second stage surgery? (6 points 1/2 80. What impact have the changes in surface micro-architecture (acid etching etc.) had on predictability and implant anchorage as determined by reverse torque tests and histomorphometry of titanium implants? (10 points 1/2 81. Why have HA coated implants been less predictable than titanium implants? Please explain in detail. (6 points 1/3 82. What are the most common problems patients experience with their mandibular dentures that lead patients to inquire about dental implants? (6 points 1/3 83. What impact would the placement of two implants in the symphyseal region and the fabrication of an implant assisted overlay denture have on each of problems cited above? (8 points, 1/2 84. Single tooth implant restorations can be either screw retained or cement retained. Cite arguments in favor of each method. Based on your knowledge to this point, which would your prefer? Please explain. (8 points ½ 85. When using a Hader bar to retain an implant assisted overlay for the edentulous mandible, why are the two implants positioned in the cuspid region? (4 points 1/3 86. When making implant assisted overlay dentures for the mandible, why is the impression border molded? (4 points, 1/4 87. When fabricating an implant assisted overlay denture for the edentulous mandible, why does the land of the master cast have to be wider than normal? (2 points, 1/4 88. How do you decide whether to restore an edentulous mandible with a fixed or a removable prosthesis? Please explain. (12 points, 1/2 89. What are the most common problems encountered when considering implants for the edentulous mandible? Please explain why each problem you list is significant? (10 points, 2/3 90. In this patient only 4 implants can be placed in the edentulous maxilla because of pneumatized maxillary sinuses. RFE 311 & RFE 315 7 KCS
91. Indicate by drawing, where each of the implants should be positioned with respect to one another. Be specific. (4 points, 1/3 92. What type of tissue bar would you design for this patient, an implant supported, or implant assisted design? (2 points, 1/8 93. Indicate by drawing, the design of the tissue bar you would recommend. Be specific with respect to the types of attachments you would use and their position. (6 points, 1/2 94. Why do you need to border mold an impression when fabricating a palateless implant assisted overlay denture? (4 points, 1/4 95. When performing implant surgery, why is it important to use standard sterile surgical technique? (6 points, 1/3 96. What are the possible undesirable outcomes if a fixed implant supported prosthesis in an edentulous patient is designed with excessive cantilevers combined with insufficient A-P spread? (4 points, 1/4 97. During your clinical examination, when considering a patient for a single tooth implant supported restoration, it is important to evaluate the status of the adjacent teeth. What factors are important to consider before developing a definitive treatment plan? (8 points- ½ 98. Why do implant sites in the anterior maxilla in partially edentulous patients frequently need to be augmented with bone grafts? (4 points, 1/3 99. Do implants achieve the same degree of anchorage in grafted sites as in normal bone? Please explain your answer. (4 points, 1/3 100. In partially edentulous patients, why do implants in grafted bone sites do better in the anterior maxilla than they do in grafted sites in the posterior mandible? (4 points, 1/4 101. There are several ways to supplement soft tissue contour of the peri-implant gingiva around implants in the anterior maxilla. List the choices available and indicate which would be your first choice. Explain your reason. (10 points, 1/2. 102. When designing a surgical template for placement of an implant in #8 position, what landmarks or surfaces associated with the proposed definitive restoration need to be incorporated within the design of the template? (4 points, 1/4 103. What is a custom abutment? Why are custom abutments often necessary when restoring anterior maxillary teeth with implants? (8 points, 1/2 RFE 311 & RFE 315 8 KCS
104. What factors contribute to an ideal esthetic result when restoring a single tooth defect in the anterior maxilla? (6 points, 1/3 105. What anatomic factors limit the use of implants in the posterior mandible? (4 points, ¼ 106. What anatomic factors limit the use of implants in the posterior maxilla? (4 points, ¼ RFE 311 & RFE 315 9 KCS