Implant Rehabilitation of Reconstructed Mandible

In Asia, oral tumors or cancers are common due to its population and additional predisposing factors such as betel nut chewing. Patients suffering from benign and maligant tumours of the mandible commonly require resection of the involved alveolusmor mandibular segmant. Reconstruction of the mandible is considered important for the restoration of facial esthetics, speech and dental occlusion.

The methods of mandibular reconstrcution have undergone considerable improvement by stereomodel and computer planning, making the restoration of the mandibular contour a reliable technique. The choice of bone grafts has gradually shifted from non-vascularized to vascularized bone flaps due to their low infection risk. The challenge now rest in the restoration of dental occlusion, which is generally accepted to be best with dental implant supported prostheses.
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Understanding Implant Complications

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.
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Medical History

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

Korea Tooth Bank

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.
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3-Dimensional Bone Grafting

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.
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Platelet-Rich Plasma Membrane

Platelet-Rich Plasma Membrane - dentalimplantscostguide.org

Platelet-Rich Plasma Membrane – dentalimplantscostguide.org

Platelet-rich plasma 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.
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Soft Tissue Graft

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.
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Dental Implant Routine Assesments

The checklist below is about Routine Assessment of Dental Implants.

Assess Implant Health
Soft and hard tissue
Occlusion

Successful Implant Debridement
Intrumentation options for the various implant suface materials

Establish Home Care Protocol
Options and considerations
Home care aids

Routine Assesments
Occlusion
Integrity of Prosthesis
Mobility
Soft Tissue
Hard Tissue
Home care

Occlusion Assessment
Check 2 x per year maintenance appoinments
Check for lateral contact with articulating paper.
Include evaluation of prosthesis.

Prosthesis Assessment
Check for fractures and cracks.
If visible, check for integrity of screws
Replace loose screws.

Mobility Assessment
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.
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Zirconia Dental Implants

Titanium dental implants have been used very successfully for the last four decades. Implants have evolved in shape, size, design and materials. However with the popularity and widespread use of titanium and titanium alloys as dental implant materials, there has been a steady increase in patients having an immediate and in most cases developing delayed sensitivity to their dental implants.

For the last twenty years a variety of alternative materials have been utilized but with limited success in dentistry. Continue reading

Dentin Graft in Implant Dentistry

Dentin graft is the advanced clinical concept based on materials science. We achieved the first autograft of demineralized dentin matrix (DDM) for the sinus graft in 2002. The bone inducing property of rabbit dentin was discovered in 1967 by Urist’s Group. However most dental doctors still don’t know the important evidences of dentin matrix. Biorecycle of patient own teeth is an attractive unique technique.

Dentin and bone are almost similar in chemical components. They consist of collagen (18%), non-collagenous proteins (2%), HAp (70%) and body fluid (10%) in weight volume. The matrix is a repository of BMPs, TGF-B, IGF and bFGF.
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