Glossary

An endosseous distractor, also known as an intraosseous distractor, is a distraction device placed into the edentulous ridge and/or basal bone of the maxilla or mandible used in distraction osteogenesis. Distraction osteogenesis is a process whereby a short bone is made into a longer one through a slow separation process. This process involves surgically cutting a bone then placing a distractor between the two new pieces. The distractor slowly and gently pulls the bone apart, allowing for the growth of new bone in between the existing pieces, thereby creating a longer bone out of what was originally a shorter one. Though the process sounds uncomfortable, osteogenesis is not painful. An endosseous distractor and distraction osteogenesis is used to correct a variety of craniofacial syndromes and is often used for treating children and teenagers. The type of distractor used and the length of time it is required depends upon the syndrome being treated.

An endosseous implant, or an endodontic endosseous implant, is a type of endosteal implant that is meant to mimic the natural root of a tooth by using a vertical column of bone to anchor the dental implant hardware. Endosseous implants are surgically placed inside the natural jawbone and allowed to heal before placing the artificial tooth or crown on the implant hardware. Since children under the age of 16 are still developing and the shape, size, and density of their jawbone is still changing, endosseous implants are typically only recommended for patients over the age of 16 to 18, depending on individual dental practice policies. Implants of this variety are also not recommended for diabetic patients who don’t have good control over their blood sugar due to the increased risk for infection and poor healing. Endosseous implant patients should have good quality and quantity of bone with no surgical contraindications.

An endosseous ramus frame implant, or ramus implant, is a blade form, full-arch, endosseous implant set into both rami and the symphyseal area of the mandible. It is constructed with a horizontal connecting bar that sits along the gingival tissues, creating a U-shaped design when viewed from the occlusal. The tripodal design of the ramus implant provides stability for mandibular dentures and is used as an option when the mandible has significant atrophy. An endosseous ramus frame implant is one of several types of endosseous implants and serves as a stable platform to which lower dentures can be affixed. It is especially useful for patients who have thin, deteriorated, or atrophied lower mandibles. Ramus implants have a high success rate with devices still in place several years after the initial placement. Endosseous ramus frame implants are also relatively easy to place as they come prefabricated and can be adjusted to fit the patient’s unique oral structure.

The endosteum is the tissue lining the medullary cavity of bone. It is composed of a single layer of osteoprogenitor cells and a small amount of connective tissue. In dentistry and oral surgery, the endosteum is generally where an implant is placed prior to a patient receiving a prosthesis. An endosteal implant is placed in the bone of the jaw and acts as a new artificial root which will anchor the restoration. For some patients, an alveolar bone graft or other type of bone graft is required to build up the area before the endosteal implant can be placed. Following the implant surgery, healing and osseointegration must occur prior to the dental prosthesis being affixed. Though endosteal implants can come in several different materials, titanium is most frequently used due to its strength, durability, corrosion-resistance, and biocompatibility. Endosteal implants are available either as screw-type (or cylinder) or blade. 

An envelope flap is a flap that is elevated from a horizontal linear incision, parallel to the free gingival margin, with no vertical incision. It may be either sulcular or submarginal. The envelope flap has been found to create less inflammation following a procedure than other similar types of flaps, such as the triangular. Though other factors of the triangular and envelope flaps are almost the same, the envelope flap is often recommended since it produces less inflammation. The envelope flap gets its name partly due to the method used to close the flap following surgical procedures. The ends of the gingival flaps are positioned and folded against the surface of the roots and then folded like an envelope. The envelope flaps are then held together by sutures or another closing technique. A dressing may also be applied following the flap closing to hold them in place and allow further healing to ensue.

Epithelial attachment refers to the mechanism of attachment of the junctional epithelium to a tooth or dental implant, i.e., hemidesmosomes. The cells of the epithelium at this attachment point are non-keratinized and form a collar around the tooth around the cemento-enamel junction. The cells themselves are formed from reduced enamel epithelium. Issues regarding epithelial attachment may arise in the case of injury or disease to the tooth or surrounding tissues. Depending on the severity of the injury or disease, epithelial attachment will begin to develop again within three days with more substantial healing noticeable after seven days. Epithelial attachment is also important in implant dentistry as the implant is placed where the site of epithelial attachment takes place. Hemidesmosomal epithelium creates a barrier that aids in tissue healing around the implant. With proper oral care, it can also assist with the long-term success of the implant by preventing bacteria from destroying the surrounding tissues.

Epithelialization refers to the healing process that takes place by the growth of epithelium over connective tissue. When an oral surgery takes place such as bone grafting or implant placement, the epithelium that covers the gums is cut in order to provide access to the underlying tissues. Once the surgical procedure is complete, healing of the tissues and epithelium is required to prevent infection and to increase the chances of the procedure’s success. As the underlying tissues begin to heal and new growth of the cells takes place to seal the incision, the epithelium also begins to repair itself and new growth and cell division occurs. When healing is complete, a new layer of epithelium has formed over the procedure site. The length of time required for epithelialization to take place may partially depend on factors such as the patient’s oral hygiene, the presence of any pre-existing health conditions or infections, and the type of procedure performed.

The epithelium is a type of tissue that lines the intraoral mucosal surfaces, extends into the sulcus, and adheres to a dental implant or tooth. Epithelium is classified both by its shape and by its layer pattern. Three different epithelial cell shapes exist: squamous, cuboidal, and columnar. Three different types of epithelial layers also exist: simple, stratified, and pseudostratified. By combining both the cell shape and the type of layer pattern, the epithelium of different parts of the body may be identified. The epithelium lining the mucosal surfaces of the mouth is stratified squamous epithelium. The epithelium in the mouth can further be classified as either keratinized or nonkeratinized. Examples of oral structures which consist of nonkeratinized squamous epithelia include the inner portion of the lips, the floor of the mouth, and the soft palate. Keratinized squamous epithelia may be observed in the hard palate, gingiva, and certain parts of dorsal tongue surface.

An eposteal implant is a device that receives its primary bone support by means of resting upon the bone itself. Though most practitioners prefer endosteal implants, in which the implant is placed in the bone, the eposteal implant may still be used in cases of extreme bone resorption or high risk of bone resorption. Since substantial bone is required in order to place an endosteal implant, some patients may require a bone grafting procedure prior to receiving the implant. However, some patients are at higher risk for bone resorption due to other underlying factors and are not good candidates for grafting and endosteal implants. Though the eposteal implant method is mostly considered outdated, it does still have applications for patients in this resorption risk category. To secure an eposteal implant, it is attached to the jawbone rather than being drilled and placed inside the bone to act as a root replacement.

Erbium-doped yttrium aluminum garnet, also known as an Er-YAG-laser, is a solid-state laser containing an Er-YAG crystal which emits a wavelength of 2940 nanometers. It is mainly used in bone surgery. There are two different types of erbium lasers: the ER-YAG-laser and the Er-Cr-YSGG laser. The two types differ in wavelength and water absorption however, their function and benefits are almost identical. In oral and dental applications, the Er-YAG-laser has been approved by the FDA for many different procedures. Its use has many benefits including a reduced need for local anesthesia, minimal negative effects or trauma to the surrounding tissues, and excellent rates of healing and recovery following its use. In addition, the laser has been shown to almost completely eliminate the smear layer while also disinfecting the dentin and enamel. The laser is approved for use in procedures such as biopsies, gingival contouring, periodontal and pre-prosthetic procedures, and frenectomies.