Proper treatment planning and design of implant restorations can help lessen complications and prevent implant treatment failures. We always talk about the need for team approach with the restorative dentist and the surgeon. But we also need to emphasize the importance of understanding implant complications so that we can optimize our treatment design.
To deliver an acceptable treatment, we should be aware of the problems that may arise from lack of treatment planning. Therefore knowing and understanding the complications will lead us into knowing how to avoid treatment failures.
In implant dentistry, the medical history is one of the most important and revealing aspects of patient evaluation. This is to identify potential medical problems that could prohibit a patient from receiving dental implant treatment.
1. Determine if the patient is currently under the care of a physician.
2. Determine if the patient has a history of rheumatic or congenital heart disease, angina, rheumatic fever, myocardial infarction or arrhythmia.
3. Determine if the patient has a history of diseases of the kidney, urinary tract, GI system, respiratory system, endocrine and nervous system.
4. Determine if the patient has a history of abnormal bleeding tendencies.
5. Determine if the patient has a history of allergies. Continue reading
Vital dental pulp tissue is essential for maintenance of homeostasis and long term survival of the tooth. Stem cell based regeneration with/without gene modification has a promising potential to develop as an essential approach to treat pulpitis while regenerating the pulp’s vitality. Stem cell based tissue engineering requires the interplay of three key elements:
1. progenitor cells
2. inductive morphogenetic signals
3. extracellular matrix scaffold
Patients want a pleasing smile. Esthetics is an essential part of restorative practice and therefore attention must be given to color, shape, surface texture and proportion. Tooth colored restorations have evolved and currently, metal ceramic restorations are widely accepted and commonly used extracoronal restoration.
Using auto tooth bone grafts, made from extracted tooth of patient’s own to be discarded, is possible due to the development of tooth banking procedure. Implants operation with auto tooth bone grafts are now performed more than 10,000 cases per year in Korea. Besides the clinical effectiveness, the safety of auto tooth bone graft materials should be guaranteed by the quality control (QC) and quality assurance (QA) of tooth banking procedures because the extracted teeth are sent to the facility units and deleivered back to same patient for clinical use not for the medical devices but for the medical services.
Bone loss is either bone resorption or cause by pathology is a condition that may complicate our implant management. Because the lack of adequate bone volume and dimension we may not be able to place dental implants on an ideal position which may result to prosthetic complication. Bone grafting in most cases can be valuable in creating an ideal implant site however large bony defect may require a two stage approach lengthening the time for implant rehabilitation.
Platelet-Rich Plasma Membrane – dentalimplantscostguide.org
is a portion of the patient’s own blood having been manipulated and has been enriched with platelets above the baseline levels. It was used in the OMS field as early as the 1990s. PRPs are prepared from one to a few tubes of the patient’s own blood following a strict aseptic technique. As a concentrated source of autologous platelets, PRP contains and releases through degranulation several growth factors and other cytokines that stimulate healing of bone and soft tissue to improve wound strength and initiation of callus formation.
Soft tissue shortage after oral and neck surgery is common. Split thickness skin graft and synthetic dermal graft are the gold standards for raw surface repair now. However these graft materials are not abundant, nor bio-controlled. Ex-vivo soft tissue engineering is an emerging science not only to fulfill soft tissue coverage but also to explore prosperous stem cell applications.
Periodontal disease is a complex prevalent condition that affects both young and old alike. It is characterized by redness and swelling of the gingiva which brings about the increased tendency to bleed. Advanced stages of periodontitis may also be associated with increased tooth mobility and loss. Patients suffering from this condition may complain of bleeding gums, flaring of teeth and a dull ache. The concern is that patients and even the dentists at times are completely unaware of its early presence and progression that by the time the condition is noticeable and felt, infection and severe loss of attachment has already taken place.
The checklist below is about Routine Assessment of Dental Implants.
Assess Implant Health
Soft and hard tissue
Successful Implant Debridement
Intrumentation options for the various implant suface materials
Establish Home Care Protocol
Options and considerations
Home care aids
Integrity of Prosthesis
Check 2 x per year maintenance appoinments
Check for lateral contact with articulating paper.
Include evaluation of prosthesis.
Check for fractures and cracks.
If visible, check for integrity of screws
Replace loose screws.
Place instrument under embrasures.
Apply gentle pressure.
Presence of mobility check with side to side movement.
Prosthetic mobility and component mobility.
Hard Tissue Assessment
Diagnostic, accurate radiograph
Able to see thread count
Crestal view is very important.