Clinical Cases in Implant Dentistry E-Book

• Herausgeber: John Wiley & Sons
• Kategorie: Fachliteratur
• Serie: Clinical Cases (Dentistry)
• Sprache: Englisch

Seitenzahl: 1020

Veröffentlichungsjahr: 2016

Beschreibung

Clinical Cases in Implant Dentistry presents 49 actual clinical cases, accompanied by academic commentary, that question and educate the reader about essential topics in implant dentistry, encompassing diagnosis, surgical site preparation and placement, restoration, and maintenance of dental implants.  

• Unique case-based format supports problem-based learning
• Promotes independent learning through self-assessment and critical thinking
• Highly illustrated with full-color clinical cases
• Covers all essential topics within implant dentistry

Leseprobe

Clinical Cases in

Implant Dentistry

Edited by

Nadeem Karimbux, DMD, MMSc

Professor of PeriodontologyAssociate DeanAcademic AffairsTufts University School of Dental MedicineBoston, MAUSA

and

Hans-Peter Weber, DMD, DrMedDent

Professor and ChairDepartment of ProsthodonticsTufts University School of Dental MedicineBoston, MAUSA

This edition first published 2017 © 2017 by John Wiley & Sons, Inc.

Editorial offices:1606 Golden Aspen Drive, Suites 103 and 104, Ames, Iowa 50010, USA The Atrium, Southern Gate, Chichester, West Sussex, PO19 8SQ, UK 9600 Garsington Road, Oxford, OX4 2DQ, UK

For details of our global editorial offices, for customer services and for information about how to apply for permission to reuse the copyright material in this book please see our website at www.wiley.com/wiley-blackwell.

Authorization to photocopy items for internal or personal use, or the internal or personal use of specific clients, is granted by Blackwell Publishing, provided that the base fee is paid directly to the Copyright Clearance Center, 222 Rosewood Drive, Danvers, MA 01923. For those organizations that have been granted a photocopy license by CCC, a separate system of payments has been arranged. The fee codes for users of the Transactional Reporting Service are ISBN-13: 978-1-1187-0214-7/2017

Designations used by companies to distinguish their products are often claimed as trademarks. All brand names and product names used in this book are trade names, service marks, trademarks or registered trademarks of their respective owners. The publisher is not associated with any product or vendor mentioned in this book.

The contents of this work are intended to further general scientific research, understanding, and discussion only and are not intended and should not be relied upon as recommending or promoting a specific method, diagnosis, or treatment by health science practitioners for any particular patient. The publisher and the author make no representations or warranties with respect to the accuracy or completeness of the contents of this work and specifically disclaim all warranties, including without limitation any implied warranties of fitness for a particular purpose. In view of ongoing research, equipment modifications, changes in governmental regulations, and the constant flow of information relating to the use of medicines, equipment, and devices, the reader is urged to review and evaluate the information provided in the package insert or instructions for each medicine, equipment, or device for, among other things, any changes in the instructions or indication of usage and for added warnings and precautions. Readers should consult with a specialist where appropriate. The fact that an organization or Website is referred to in this work as a citation and/or a potential source of further information does not mean that the author or the publisher endorses the information the organization or Website may provide or recommendations it may make. Further, readers should be aware that Internet Websites listed in this work may have changed or disappeared between when this work was written and when it is read. No warranty may be created or extended by any promotional statements for this work. Neither the publisher nor the author shall be liable for any damages arising herefrom.

Library of Congress Cataloging-in-Publication Data

Names: Karimbux, Nadeem, editor. | Weber, Hans Peter, 1950- editor.Title: Clinical cases in implant dentistry / edited by Nadeem Karimbux and Hans-Peter Weber.Other titles: Clinical cases (Ames, Iowa)Description: Ames, Iowa : John Wiley & Sons, Inc., 2017. | Series: Clinical cases | Includes bibliographical references and index.Identifiers: LCCN 2016036137 (print) | LCCN 2016037395 (ebook) | ISBN 9781118702147 (paper) | ISBN 9781119019930 (pdf) | ISBN 9781119019923 (epub)Subjects: | MESH: Dental Implantation | Dental Prosthesis Design | Case ReportsClassification: LCC RK667.I45 (print) | LCC RK667.I45 (ebook) | NLM WU 640 | DDC 617.6/93–dc23LC record available at https://lccn.loc.gov/2016036137

A catalogue record for this book is available from the British Library.

Wiley also publishes its books in a variety of electronic formats. Some content that appears in print may not be available in electronic books.

Cover image: top middle – courtesy of Do-Gyoon Kim

CONTENTS

Contributors

Preface

Acknowledgments

Chapter 1 Examination and Diagnosis

Case 1 Clinical Examination

Satheesh Elangovan

Case 2 Medical Considerations

Ioannis Karoussis and Pinelopi Pani

Case 3 Implant Stability

Marcelo Freire, Samuel Lee, and Kwang Bum Park

Case 4 Oclussal/Anatomical Considerations

Hamasat Gheddaf Dam and Rumpa Ganguly

Case 5 Radiographic Interpretation and Diagnosis

Aruna Ramesh and Rumpa Ganguly

Chapter 2 Implant Design

Case 1 Regular Platform Implant Case

Mariam Margvelashvili and Jacinto Cano Peyro

Case 2 Wide-Diameter Implants

Hans-Peter Weber and Hadi Gholami

Case 3 Special Surfaces

Suheil M. Boutros

Case 4 Narrow-Diameter Implant

Sung Min Chi

Case 5 Short Implants

Chun-Teh Lee, Chin-Wei Jeff Wang, Rainier A. Urdaneta, and Sung-Kiang Chuang

Case 6 Platform Switching

Samuel Lee, Sergio Herrera, and Kwang Bum Park

Chapter 3 Prosthetic Design

Case 1 Abutment Design

Christopher A. Barwacz

Case 2 Screw-Retained Implant Restorations

Luis Del Castillo, Maria E. Gonzalez, and Jacinto Cano-Peyro

Case 3 Choice of Restorative Materials

Sonja Mansour

Chapter 4 Soft Tissue Management

Case 1 Free Gingival Grafts

Daniel Kuan-te Ho

Case 2 Subepithelial Connective Tissue Graft

Luca Gobbato, Gustavo Avila-Ortiz, and Fabio Mazzocco

Case 3 Vestibuloplasty and Frenectomy

Daniel Kuan-te Ho, Luca Gobbato, and Luigi Minenna

Chapter 5 Ridge Site Preparation

Case 1 Xenograft Membrane: Porcine Derived

Mohammed Alasqah and Zuhair S. Natto

Case 2 Guided Bone Regeneration

Satheesh Elangovan

Case 3 Growth Factors

Daniel Kuan-te Ho and David Minjoon Kim

Case 4 Alveolar Ridge Preservation: Allograft

Gustavo Avila-Ortiz, Mitchell Gubler, Christina Nicholas, and Christopher Barwacz

Case 5 Alveolar Ridge Preservation: Alloplast

Waeil Elmisalati, Wichaya Wisitrasameewong, and Emilio Arguello

Case 6 Alveolar Ridge Preservation: Xenograft

Waeil Elmisalati, Wichaya Wisitrasameewong, and Emilio Arguello

Case 7 Guided Bone Regeneration: Non-Resorbable Membrane

Yong Hur, Hsiang-Yun Huang, Teresa Chanting Sun, and Yumi Ogata

Case 8 Ridge Split and Expansion

Samuel Koo and Hans-Peter Weber

Chapter 6 Sinus Site Preparation

Case 1 Lateral Window Technique

Yumi Ogata, Irina Dragan, Lucrezia Paterno Holtzman, and Yong Hur

Case 2 Internal Sinus Lift: Osteotome

Samuel Lee, Adrian Mora, and Kwang Bum Park

Case 3 Internal Sinus Lift: Other Techniques

Samuel Lee, Adrian Mora, and Kwang Bum Park

Chapter 7 Implant Placement

Case 1 One Stage/Two Stage Placement

Rory O’Neill and Pinelopi Pani

Case 2 Immediate Placement

Samuel Koo, Marcelo Freire, and Hidetada Moroi

Case 3 Delayed Placement: Site Development

Y. Natalie Jeong and Carlos Parra

Case 4 Submerged Implant Placement and Provisional

Hans-Peter Weber and Hadi Gholami

Chapter 8 Restoration

Case 1 Single-Tooth Implants: Posterior

Hans-Peter Weber and Hadi Gholami

Case 2 Anterior Implant Restoration

Gianluca Paniz and Luca Gobbato

Case 3 Full-Mouth Rehabilitation

Gianluca Paniz, Eriberto Bressan, and Diego Lops

Case 4 Implant-Supported Mandibular Overdentures

Michael Butera

Case 5 Immediate Provisionalization (Temporization)

Panos Papaspyridakos and Chun-Jung Chen

Case 6 Immediate Loading

Panos Papaspyridakos and Chun-Jung Chen

Chapter 9 Special Interdisciplinary Considerations

Case 1 Implants for Periodontally Compromised Patients

Marcelo Freire, Karim El Kholy, and Mindy Sugmin Gil

Case 2 Dental Implants in an Orthodontic Case

Chin-wei Jeff Wang, Seyed Hossein Bassir, Nadeem Karimbux, and Lauren Manning

Case 3 Patients with Systemic Disease (A Genetic Disorder)

Abdullah Al Farraj Aldosari and Mohammed Alasqah

Case 4 The Use of Dental Implants in the Child/Adolescent

Seyed Hossein Bassir, Nadeem Karimbux, and Zameera Fida

Chapter 10 Peri-implantitis: Diagnosis, Treatment, and Prevention

Case 1 Ailing and Failing Implants

Seyed Hossein Bassir and Nadeem Karimbux

Case 2 Patient’s Plaque Control Around Implants

Lorenzo Mordini, Carlos Parra, Tannaz Shapurian, and Paul A. Levi, Jr.

Case 3 Professional Plaque Control Around Implants

Carlos Parra, Lorenzo Mordini, Tannaz Shapurian, and Paul A. Levi, Jr.

Case 4 Locally Delivered Drug Agents

Federico Ausenda, Francesca Bonino, Tannaz Shapurian, and Paul A. Levi, Jr.

Case 5 Systemic Antibiotics

Zuhair S. Natto, Shatha Alharthi, Tannaz Shapurian, and Paul A. Levi, Jr.

Case 6 Surgical Management of Peri-implantitis

Yumi Ogata, Zuhair S. Natto, Minh Bui, and Yong Hur

Case 7 Removal/Replacement of Failed Implants

Samuel S. Lee, Paulina Acosta, and Rustam DeVitre

Index

Eula

CONTRIBUTORS

Paulina Acosta

Private PracticeTijuana, Baja, CA, USA

Mohammed N. Alasqah

Periodontist and Esthetic Dentistry Assistant Professor Department of Preventive Dental Sciences College of Dentistry Prince Sattam Bin Abdulaziz University Al Kharj, Saudi Arabia

Abdullah Al Farraj Aldosari

Director of Dental Implant and Osseointegration Research ChairAssociate Professor and Consultant of Prosthodontics and ImplantologyDepartment of Prosthetic ScienceCollege of Dentistry King Saud University Riyadh, Saudi Arabia

Shatha Alharthi

Advanced Graduate ResidentDepartment of Periodontology School of Dental MedicineTufts UniversityBoston, MA, USA

Emilio Arguello

Clinical InstructorDivision of Periodontology Department of Oral Medicine, Infection, and Immunity Harvard University School of Dental MedicineBoston, MA, USA

Federico Ausenda

Advanced Graduate ResidentDepartment of PeriodontologyTufts University School of Dental MedicineBoston, MA, USA

Gustavo Avila-Ortiz

Assistant ProfessorDepartment of PeriodonticsUniversity of Iowa, College of DentistryIowa City, IA, USA

Christopher A. Barwacz

Assistant ProfessorDepartment of Family DentistryUniversity of Iowa, College of DentistryIowa City, IA, USA

Seyed Hossein Bassir

Division of PeriodontologyDepartment of Oral Medicine, Infection and ImmunityHarvard School of Dental MedicineBoston, MA USA

Francesca Bonino

Advanced Standing Student for Internationally Trained DentistsHenry M. Goldman School of Dental MedicineBoston UniversityBoston, MA, USA

Suheil M. Boutros

Private practice limited to periodontics and dental implantsGrand Blanc, MI, USA;Visiting Assistant ProfessorDepartment of Periodontics and Oral Medicine The University of MichiganAnn Arbor, MI, USA

Eriberto Bressan

Professor Department of NeuroscienceUniversity of PadovaPadova, Italy

Minh Bui

DMD Candidate Department of Diagnosis & Health PromotionTufts University School of Dental MedicineBoston, MA, USA

Michael Butera

ProsthodontistPrivate PracticeBoston, MA, USA

Jacinto Cano-Peyro

Periodontist, Private Practice Marbella, Spain;Visiting Professor, Department of Restorative DentistryComplutense University of MadridMadrid, Spain

Chun-Jung Chen

Instructor in PeriodonticsDepartment of DentistryChi Mei Medical CenterTainan, Taiwan

Sung Mean Chi

ProsthodontistPrivate PracticeStow, OH, USA

Sung-Kiang Chuang

Associate Professor in Oral and Maxillofacial SurgeryMassachusetts General Hospital and Harvard School of Dental MedicineBoston, MA, USA

Luis Del Castillo

Clinical Assistant ProfessorDepartment of ProsthodonticsTufts University School of Dental MedicineBoston, MA, USA

Rustam DeVitre

Director of AlumniTufts University School of Dental MedicineBoston, MA, USA;Private PracticeBoston, MA, USA

Irina Dragan

Department of PeriodontologyTufts University School of Dental MedicineBoston, MA, USA

Satheesh Elangovan

Associate ProfessorDepartment of PeriodonticsThe University of Iowa College of DentistryIowa City, IA, USA

Karim El Kholy

Advanced Graduate ResidentDivision of PeriodonticsDepartment of Oral Medicine, Infection, and ImmunityHarvard School of Dental MedicineBoston, MA, USA

Waeil Elmisalati

Clinical Assistant Professor of PeriodontologyUniversity of New England College of Dental MedicinePortland, ME, USA

Zameera Fida

Associate in Pediatric DentistryBoston Children’s HospitalBoston, MA, USA

Marcelo Freire

Advanced Graduate Resident Division of Periodontology, Oral Medicine, Infection and ImmunityHarvard School of Dental MedicineBoston, MA, USA

Rumpa Ganguly

Assistant Professor and Division HeadOral and Maxillofacial RadiologyDepartment of Diagnostic SciencesTufts University School of Dental MedicineBoston, MA, USA

Hamasat Gheddaf Dam

Adjunct Assistant Professor in ProsthodonticsTufts University School of Dental MedicinePrivate PracticeBoston, MA, USA

Hadi Gholami

Research FellowDepartment of ProsthodonticsTufts University School of Dental MedicineBoston, MA, USA

Mindy Sugmin Gil

Visiting Postgraduate Research FellowDepartment of Oral Medicine, Infection, and ImmunityHarvard School of Dental MedicineBoston, MA, USA

Luca Gobbato

Clinical InstructorDepartment of Oral Medicine, Infection and ImmunityDivision of PeriodonticsHarvard University School of Dental MedicineBoston, MA, USA

Maria E. Gonzalez

Clinical Assistant ProfessorDivision of Operative DentistryComprehensive Care DepartmentTufts University School of Dental MedicineBoston, MA, USA

Mitchell Gubler

Advanced Graduate ResidentDepartment of PeriodonticsUniversity of Iowa College of DentistryIowa City, IA, USA

Sergio Herrera

Post Graduate ResidentInternational Academy of Dental ImplantologySan Diego, CA, USA

Daniel Kuan-te Ho

Assistant ProfessorDepartment of PeriodonticsSchool of DentistryUniversity of Texas Health Science Center at HoustonHouston, TX, USA

Hsiang-Yun Huang

Private PracticeTaipei, Taiwan;Clinical InstructorSchool of DentistryNational Defense Medical CenterTaipei, Taiwan

Yong Hur

Assistant Professor Department of PeriodontologyTufts University School of Dental MedicineBoston, MA, USA

Y. Natalie Jeong

Assistant ProfessorDepartment of PeriodontologyTufts University School of Dental MedicineBoston, MA, USA

Nadeem Karimbux

Division of PeriodontologyDepartment of Oral Medicine, Infection and ImmunityHarvard School of Dental MedicineBoston, MA, USA;Professor of Periodontology Department of PeriodontologyTufts University School of Dental MedicineBoston, MA, USA

Ioannis Karoussis

Assistant Professor of Periodontology Dental SchoolUniversity of AthensAthens, Greece

David Minjoon Kim

Associate ProfessorDirector, Postdoctoral PeriodontologyDirector, Continuing EducationDivision of PeriodontologyDepartment of Oral Medicine, Infection & ImmunityHarvard School of Dental MedicineBoston, MA, USA

Samuel Koo

Assistant ProfessorDepartment of PeriodontologyTufts University School of Dental MedicineBoston, MA, USA

Chun-Teh Lee

Post-Doctoral Fellow in PeriodontologyHarvard School of Dental MedicineBoston, MA, USA

Samuel Lee

Director of International Academy of Dental ImplantologySan Diego, CA, USA

Paul A. Levi, Jr.

Associate Clinical ProfessorDepartment of PeriodontologyTufts University School of Dental MedicineBoston, MA, USA

Diego Lops

Assistant Professor in Periodontology and Implant DentistryUniversity of MilanMilan, Italy

Lauren Manning

Assistant ProfessorOregon Health & Science UniversityPortland, OR, USA

Sonja Mansour

Assistant ProfessorDepartment of ProsthodonticsInstitute for Dental and Craniofacial SciencesCharitéBerlin, Germany

Mariam Margvelashvili

Postdoctoral FellowDepartment of ProsthodonticsTufts University School of Dental MedicineBoston, MA, USA

Fabio Mazzocco

Visiting ProfessorDepartment of Implantology at PadovaUniversity of Dental MedicinePadova, Italy

Luigi Minenna

Research Centre for the Study of Periodontal and Peri-Implant Diseases Department of PeriodontologySchool of Dentistry University of FerraraFerrara, Italy

Adrian Mora

Post Graduate ResidentInternational Academy of Dental ImplantologySan Diego, CA, USA

Lorenzo Mordini

Advanced Graduate ResidentDepartment of PeriodontologyTufts University School of Dental MedicineBoston, MA, USA

Hidetada Moroi

Assistant Clinical ProfessorDepartment of PeriodontologyTufts University School of Dental MedicineBoston, MA, USA

Zuhair S. Natto

Visiting Assistant Professor Department of PeriodontologyTufts University School of Dental MedicineBoston, MA, USA;Assistant ProfessorDepartment of Dental Public HealthSchool of Dentistry, King Abdulaziz UniversityJeddah, Saudi Arabia

Christina Nicholas

Department of Anthropology and Dows Institute for Dental ResearchThe University of Iowa College of DentistryIowa City, IA, USA

Yumi Ogata

Board DiplomateAmerican Board of PeriodontologyAssistant Professor Department of PeriodontologyTufts University School of Dental MedicineBoston, MA, USA

Rory O’Neill

Associate Clinical ProfessorDepartment of PeriodontologyTufts University School of Dental MedicineBoston, MA, USA;Clinical Professor of DentistryRoseman UniversityCollege of Dental MedicineHenderson, NV, USA

Pinelopi Pani

Advanced Graduate ResidentDepartment of Periodontology Tufts University School of Dental MedicineBoston, MA, USA

Gianluca Paniz

Visiting ProfessorDepartment of Implantology at PadovaUniversity of Dental MedicinePadova, Italy

Panos Papaspyridakos

Assistant Professor of Postgraduate ProsthodonticsDepartment of ProsthodonticsTufts University School of Dental MedicineBoston, MA, USA

Kwang Bum Park

DirectorMIR Dental HospitalDaegu, South Korea

Carlos Parra

Department of PeriodonticsTexas A & M University College of DentistryDallas, TX, USA

Lucrezia Paterno Holtzman

Department of PeriodontologyTufts University School of Dental MedicineBoston, MA, USA

Aruna Ramesh

Diplomate, ABOMRAssociate Professor and Interim ChairDepartment of Diagnostic SciencesDivision of Oral and Maxillofacial RadiologyTufts University School of Dental MedicineBoston, MA, USA

Tannaz Shapurian

Associate Clinical ProfessorDepartment of PeriodontologyTufts University School of Dental MedicineBoston, MA, USA

Teresa Chanting Sun

Department of PeriodontologyTufts University School of Dental MedicineBoston, MA, USA

Rainier A. Urdaneta

ProsthodontistPrivate PracticeImplant Dentistry CentreJamaica Plain, MA, USA

Jeff Chin-Wei Wang

Clinical Assistant ProfessorDepartment of Periodontics and Oral MedicineUniversity of Michigan School of DentistryAnn Arbor, MI, USA

Hans-Peter Weber

ProfessorDepartment of Prosthodontics Tufts University School of Dental MedicineBoston, MA, USA

Wichaya Wisitrasameewong

Post-Doctoral FellowDivision of PeriodontologyDepartment of Oral Medicine, Infection and Immunity Harvard School of Dental MedicineBoston, MA, USA

PREFACE

We are excited to present 49 Clinical Cases in Implant Dentistry. The cases have been authored by invited clinicians and residents that have diverse training and different backgrounds. Each case presents a real patient scenario with the appropriate clinical and radiographic information. The cases convey the steps involved with diagnosis, treatment planning and treatment covering both the surgical and restorative aspects.

Although each chapter is presented under certain thematic headings, we realize that many aspects of each case and each discussion cross over to areas covered in other chapters/cases. There is also redundancy in topics discussed/presented since each author was presenting their own cases with self-generated study questions/discussions. It is this diversity of clinical viewpoints and reviews of the literature that we believe will give our readers the best overview of the multiple challenges, topics and reviews of the literature presented by the cases.

Each case and the discussions and literature presented should be treated and appreciated with this in mind. We hope that you use the cases and information supplied to add to your clinical expertise in the areas presented, and as a review for potential clinical and board exams!

Hans-Peter WeberNadeem Karimbux

ACKNOWLEDGMENTS

A special thanks to my spouse and children (Hema Ramachandran and Naavin and Tarin Karimbux) for putting up with all my “lap-top” time processing chapters and manuscripts as a part of my academic pursuits.

NK

My gratitude goes to my spouse Cheryl for supporting me throughout my career and generously accepting the fact that projects like this book are not possible without spending personal time at home on them.

HPW

An acknowledgment is extended to all the residents at Harvard and Tufts University Schools of Dental Medicine. We learn from you every day as you grow in your pursuit of clinical knowledge and skills. A special thanks to the faculty for their commitment to our students and for contributing to the chapters in this book.

NK, HPW

1

Examination and Diagnosis

Case 1: Clinical Examination

Satheesh Elangovan

Case 2: Medical Considerations

Ioannis Karoussis and Pinelopi Pani

Case 3: Implant Stability

Marcelo Freire, Samuel Lee, and Kwang Bum Park

Case 4: Oclussal/Anatomical Considerations

Hamasat Gheddaf Dam and Rumpa Ganguly

Case 5: Radiographic Interpretation and Diagnosis

Aruna Ramesh and Rumpa Ganguly

Case 1

Clinical Examination 

CASE STORY

A 39-year-old Caucasian male who had just moved in from another city presented to our clinic with a chief complaint of “I lost my lower molar tooth and I need a fixed replacement.” Five months before this visit the patient had acute pain on mastication in tooth #30. Periodontal examination revealed a localized 7 mm pocket depth on the distal of tooth #30. The Slooth test was positive and there was severe pain on percussion of the lingual cusps. This led his previous dentist to suspect vertical root fracture of tooth #30. Exploratory flap surgery was performed, which revealed a fracture extending all the way to the middle of the root. The tooth was extracted in the same visit and the socket was grafted with bone allografts and covered with resorbable collagen membrane. When he presented to our clinic, it was 5 months since the time of extraction and ridge preservation. The patient reported that he was getting regular dental care, including periodontal maintenance, from his previous dentist.

LEARNING GOALS AND OBJECTIVES

To be able to understand the necessary elements in the examination and documentation portion of dental implant therapy

To be able to understand the several diagnostic tools available for comprehensive evaluation and implant treatment planning

To understand the importance of systemic, periodontal, and esthetic evaluation in dental implant therapy

Medical History

The patient when presented was a well-controlled type II diabetic. His last glycated hemoglobin was 6.2, measured a month before his initial visit. He was taking metformin 1000 mg per day. Other than diabetes, the patient did not present with any other relevant medication condition, allergies, or any untoward incidents during his previous dental visits.

Review of Systems

Vital signs

Blood pressure: 120/77 mmHg

Pulse rate: 76 beats/min (regular)

Respiration: 14 breaths/min

Social History

The patient did not smoke but he reported that he was a social consumer of alcohol.

Extraoral Examination

No significant findings were noted. The patient had no masses or swelling, and the temporomandibular joint was within normal limits. No facial asymmetry was noted, and lymph nodes assessment yielded normal results.

Intraoral Examination

Oral cancer screening was negative.

Soft tissue exam, including his buccal mucosa, tongue, and floor of the mouth, was within normal limits.

Periodontal examination revealed pocket depths in the range 2–3 mm (

Figure 1

).

Color, contour, and consistency of gingiva was within normal limits, with localized erythema of marginal gingiva in the lingual of mandibular anterior areas.

Figure 1: Probing pocket depth measurements during the initial visit.

Figure 2: Initial presentation (facial view).

Oral hygiene was good when he presented to the clinic (

Figures 2

,

3

, and

4

).

Localized areas of dental plaque-induced gingival inflammation were noted.

Slight supragingival calculus was noted in the mandibular lingual areas.

Dental caries, both primary and recurrent, was noted in a few teeth.

The ridge in the site #30 healed adequately, which revealed a slight buccal deficiency (

Figure 5

).

Figure 3: Initial presentation (right lateral view).

Figure 4: Initial presentation (left lateral view).

Figure 5: Initial presentation (occlusal view).

On palpation, the ridge width was found to be adequate to place a standard diameter implant (to replace the molar tooth), without the need for additional bone grafting.

No exaggerated lingual concavity was noted in the area.

Normal thickness and width of keratinized mucosa was noted (

Figure 3

).

No occlusal disharmony was noted, and there was adequate mesio-distal and apico-coronal space for the future implant crown (

Figure 3

).

Occlusion

There were no occlusal discrepancies or interferences noted (Figures 2, 3, and 4).

Radiographic Examination

A full mouth radiographic series was ordered. (See Figure 6 for patient’s periapical radiograph of the area of interest before extraction of #30 and after extraction and ridge preservation.) The postextraction radiograph revealed radiographic bone fill of the #30 socket. The crestal bone level was well maintained. Normal bone levels in the adjacent teeth were noted. The inferior alveolar canal was not visible in any of the three radiographs.

Diagnosis

American Academy of Periodontology diagnosis of plaque-induced gingivitis with acquired mucogingival deformities and conditions on edentulous ridges was made.

Treatment Plan

The treatment plan for this patient consisted of disease control therapy that included oral prophylaxis and oral hygiene instructions to address gingival inflammation. This was followed by implant placement. After an adequate time for osseointegration (4 months), the implant was restored.

Figure 6: Periapical radiographs: (A) pre-extraction; (B) postextraction; (C) postimplant placement.

Examination and Documental Visit

The patient when presented to our clinic had already lost tooth #30, which had been extracted 5 months previously. The healing at the extraction site was found to be satisfactory. Systemically, the patient was a diabetic but with good glycemic control and was a nonsmoker. Periodontal examination revealed healthy periodontium with localized areas of mild gingivitis. His part dental history revealed that he was a compliant patient and was on a regular dental maintenance schedule. Occlusal analysis revealed no occlusal disharmonies. These factors together made him a good candidate for dental implant therapy.

The site-specific clinical and radiographic evaluation revealed enough bucco-lingual width and mesiodistal and apico-coronal space for both the placement and the restoration of the implant. The inferior alveolar canal was not in the vicinity of the planned implant site. For these reasons, additional imaging analysis such as cone beam computed tomography (CBCT) was not planned. Impressions were taken during this initial visit that were utilized for doing diagnostic wax-up and for making a surgical guide. Extraoral and intraoral clinical photographs were taken during this visit for patient education and communication with the restoring dentist. Once the treatment plan was finalized, the patient was educated about the dental implant and the treatment sequence. This was followed by implant placement on a separate day using a surgical guide and a drilling sequence recommended by the implant manufacturer.

Self-Study Questions

(Answers located at the end of the case)

A. Why is systemic evaluation important in a dental implant patient?

B. Is the success rate of dental implants different in smoker versus nonsmoker?

C. How important is periodontal evaluation before planning for dental implants?

D. What are the site-specific assessments that need to be done prior to placing implants?

E. What are the components of esthetic evaluation for planning implants in the esthetic zone?

F. What are the anatomical landmarks that have to be examined carefully that may influence treatment execution?

G. What are the presurgical adjunctive evaluations required on a case-by-case basis?

H. How are ridge deformities classified?

References

1. Chen H, Liu N, Xu X, et al. Smoking, radiotherapy, diabetes and osteoporosis as risk factors for dental implant failure: a meta-analysis.

PLoS One

2013;8(8):e71955.

2. Oates TW, Huynh-Ba G, Vargas A, et al. A critical review of diabetes, glycemic control, and dental implant therapy.

Clin Oral Implants Res

2013;24(2):117–127.

3. Johnson GK, Hill M. Cigarette smoking and the periodontal patient.

J Periodontol

2004;75(2):196–209.

4. Heitz-Mayfield LJ, Huynh-Ba G. History of treated periodontitis and smoking as risks for implant therapy.

Int J Oral Maxillofac Implants

2009;24(Suppl):39–68.

5. Safii SH, Palmer RM, Wilson RF. Risk of implant failure and marginal bone loss in subjects with a history of periodontitis: a systematic review and meta-analysis.

Clin Implant Dent Relat Res

2010;12(3):165–174.

6. Heitz-Mayfield LJ. Peri-implant diseases: diagnosis and risk indicators.

J Clin Periodontol

2008;35(8 Suppl):292–304.

7. Lin GH, Chan HL, Wang HL. The significance of keratinized mucosa on implant health: a systematic review.

J Periodontol

2013;84:1755–1767.

8. Weber HP, Buser D, Belser UC. Examination of the candidate for implant therapy. In: Lindhe J, Lang NP, Karring T (eds),

Clinical Periodontology and Implant Dentistry

, 5th edn. Oxford: Wiley-Blackwell; 2008, pp 587–599.

9. Benavides E, Rios HF, Ganz SD, et al. Use of cone beam computed tomography in implant dentistry: the International Congress of Oral Implantologists consensus report.

Implant Dent

2012;21(2):78–86.

10. Handelsman M. Surgical guidelines for dental implant placement.

Br Dent J

2006;201(3):139–152.

11. Seibert JS. Reconstruction of deformed partially edentulous ridges using full thickness onlay grafts: part I – technique and wound healing.

Compend Contin Educ Dent

1983;4:437–453.

Answers to Self-Study Questions

A. There are several factors that influence the success rate of dental implants. Systemic factors are one among them and have a strong influence in the outcome of dental implants. Any systemic condition that has the influence to alter the bone turnover or wound healing process has to be carefully considered. It is clear from a well-conducted recent systematic review that smoking and radiotherapy (before or after implant placement) are associated with a higher (35% and 70% respectively) risk of implant failure [1]. With regard to other medical conditions, such as diabetes, it is becoming clearer that poor glycemic control is not an absolute contraindication for implant therapy provided that appropriate accommodation for delays in implant integration are considered [2]. Other commonly encountered systemic conditions that may modify the treatment plan include uncontrolled hypertension, intake of anticoagulants, patients on bisphosphonate therapy, or patients with psychiatric conditions. In select cases, getting clearance from the patient’s physician is required. Therefore, it is extremely important that a thorough systemic evaluation be completed prior to planning for dental implants.

B. It has been shown that smoking affects periodontium by more than one mechanism [3]. Smoking was shown to negatively influence the oral microbial profile, suppress the immune system, and alter the microvascular environment, leading to disrupted healing [3]. Smokers have a two times higher risk for dental implant failure than nonsmokers do [1]. Apart from the lower success rate of implants in smokers, the incidence of peri-implantitis (a condition synonymous with periodontitis around natural tooth) is also shown to be high in smokers compared with nonsmokers [3,4]. Though smoking is not an absolute contraindication for dental implant therapy, explaining the higher risk for implant failure to the patients who are current smokers is the responsibility of the clinician.

C. Doing a thorough periodontal examination prior to implant therapy is as important as doing a systemic evaluation of the patient as this allows the clinician to obtain information on the patient’s current periodontal disease status, oral hygiene status, and mucogingival parameters, such as the level of frenal attachments, width of keratinized mucosa, and vestibular depth. A moderate level of evidence suggests that patients with a history of periodontitis (especially the aggressive form of the disease) are at a higher risk for implant failure and marginal bone loss [5]. Poor oral hygiene is considered to be another important risk factor for dental implant failure [6]. Certain mucogingival conditions, such as low vestibule or high frenal attachments, may necessitate a soft tissue procedure in addition to implant placement. There is emerging evidence that lack of keratinized mucosa around dental implants is associated with more plaque buildup, inflammation, and mucosal recession [7]. Therefore, a thorough periodontal examination will guide the clinician to modify the treatment approach based on the periodontal findings.

D. For placing implants of standard diameter and length, having adequate bone volume both buccopalatally/-lingually and apico-coronally is a prerequisite. Therefore, site-specific examination, including evaluating for height and width of the bone, should be performed. This is accomplished by digital palpation of the area and by imaging techniques (described in question G). As a general rule, for a 4 mm diameter implant, at the level of the bone crest there should be at least 7 mm of mesiodistal space and buccolingual bone thickness to safely place the implant without encroaching on adjacent anatomical structures or without encountering bony dehiscence. It is a general guideline that there should be at least 1.5 mm distance between the implant and the adjacent tooth and 3 mm space between two implants placed adjacently. It is also important to make sure that there is sufficient distance from the proposed implant platform to the opposing teeth for restoring the implant with proper sized abutment and crown.

E. The esthetic analysis of an implant patient should include the following elements [8]:

patient’s smile line (high, medium, and low) and course of gingival line assessment;

gingival phenotype (thick or thin) assessment;

examination of tooth size and space distribution;

examination of the shape of anatomical tooth crowns;

examination of the length to width ratio of clinical crowns;

examination of the hard and soft tissue anatomy of the site;

interproximal bone heights (from radiographs);

occlusal assessment (overjet and overbite).

F. In the maxilla, if the proposed implant site is in close vicinity to maxillary sinuses, nasal cavities, and the nasopalatine canal, those sites should be carefully evaluated to avoid encroaching on these structures while placing the implant. In the mandible, knowing the buccolingual and apicocoronal location of the inferior alveolar canal within the bony housing and the extent of lingual concavity of the mandible are important. This is usually accomplished by taking a CBCT of the area of interest. It is a general rule to maintain a safety distance of at least 2 mm between the implant and inferior alveolar canal (to account for radiographic distortions). In some instances, neurovascular bundles can be seen exiting lingual of the anterior mandible near the midline. Any trauma to these vessels may lead to severe hemorrhage in the sublingual area that can be life threatening.

G. Apart from a clinical oral examination that includes periodontal evaluation, in select cases adjunctive diagnostic assessments such as imaging, diagnostic wax-up, and clinical photographs are required to aid in diagnosis and/or treatment planning. Imaging typically includes periapical radiographs, bitewing radiographs, panoramic radiographs, or CBCT. CBCT is more advantageous than radiographs as it gives three-dimensional information of the proposed treatment site. It also allows the clinician to accurately determine the proximity of vital anatomic structures [9]. Doing a diagnostic wax-up allows the clinician to determine the need for additional implant site preparation, help with patient education, and for making surgical guides [10]. Clinical photographs are useful diagnostic aids, especially in anterior esthetic cases to document the patient’s smile and also to discuss the case with peers.

H. There are several classifications that exist to categorize ridge deformities, but the most commonly used one is the classification proposed by Seibert in 1983 [11]. This classification was originally proposed in the context of soft tissue augmentation, but it has been adapted and is widely used in the context of implant site preparation.

The three classes of ridge deformities according to Seibert are:

class I – buccolingual/-palatal resorption;

class II – apico-coronal resorption;

class III – combination of buccolingual/-palatal and apico-coronal resorption.

Case 2

Medical Considerations

CASE STORY

A 70-year-old Caucasian male presented with a chief complaint of “I am missing my back teeth and I have difficulty in eating normally.” The patient lost teeth #2–#5, #12–#15, #18, #19, #26, and #28–#31 several years ago due to severe periodontal disease. The third molars were impacted and removed at a very young age. The patient had a maxillary and mandibular interim partial denture fabricated before proceeding with a fixed solution, which he was wearing irregularly (Figures 1 and 2). The patient visited his dentist regularly for uninterrupted dental care to maintain the remaining teeth and reported that he brushed twice per day and flossed at least once a day. He had two class V composite restorations in teeth #20 and #21 buccally and a composite restoration in the incisal edge of #8.

Figure 1: Pre-op presentation (facial view).

Figure 2: Pre-op presentation (occlusal view).

LEARNING GOALS AND OBJECTIVES

To be able to understand which medical conditions may increase the risk of implant treatment failure or complications

To understand the impact that medications might have on implant treatment

To understand the absolute medical contraindications to dental implant treatment

To understand that individualized medical control should be established prior to implant therapy

Medical History

At the time of treatment the patient presented with type II diabetes, controlled with medications (metformin). His last glycated hemoglobin (HbA1c) level was 6.7%, measured a few weeks before his initial exam. His fasting blood sugar was 120 mg/dL in the last physical exam. The patient was also hypertensive, controlled with medications (hydrochlorothiazide, doxazosin methylate, benazepril). In addition, he had hypercholesterolemia that was controlled with medication (simvastatin). Last, he suffered from a knee injury 4 years prior to his initial visit, which resulted in a blood clot formation that traveled to the lungs. The patient had surgery on his knee and has been taking Coumadin since then. The patient’s last international normalized ratio (INR) was 2.3. The patient’s body mass index was 33.9, which put him in the obese category. The patient denied having any known drug allergies.

Review of Systems

Vital signs

Blood pressure: 135/70 mmHg

Pulse rate: 85 beats/min (regular)

Respiration: 16 breaths/min

Social History

The patient had no history of smoking or alcohol consumption at the time of treatment.

Extraoral Examination

There was no clinical pathology noted on extraoral examination. The patient had no masses or swelling. The temporomandibular joints were stable, functional, and comfortable. There was no facial asymmetry noted, and his lymph nodes were normal on palpation.

Intraoral Examination

Oral cancer screening was negative.

Soft tissue exam, including his tongue and floor of the mouth and fauces, showed no clinical pathology.

Periodontal examination revealed pocket depths in the range 1–3 mm (

Figure 3

).

Localized areas of slight gingival inflammation were noted.

The color, size, shape, and consistency of the gingiva were normal. The keratinized tissue was firm and stippled.

Generalized moderate with localized severe attachment loss and generalized recession were noted.

An aberrant maxillary and mandibular bilateral labial frenum was also noted, which was extending also to the edentulous posterior areas.

Figure 3: Periodontal chart. Probing pocket depth measurements during the initial visit.

Localized plaque was found around the teeth, resulting in a plaque-free index of 90%.

Evaluation of the alveolar ridge in the edentulous areas revealed both horizontal and vertical resorption of bone (Seibert class III).

Class V composite restorations in teeth #20 and #21 buccally and a composite restoration in the incisal edge of #8 were also noted.

Occlusion

An overjet of 3.5 mm and overbite of 4 mm were noted. Angle’s molar classification could not be determined due to loss of these teeth. Canine classification could only be determined on the left side, which was class II. Signs of secondary occlusal trauma (worn dentition, mobility, fremitus) were also noted. Functional analysis of the occlusion revealed anterior guidance during protrusion and canine guidance during lateral extrusion movements.

Radiographic Examination

A panoramic and a full mouth radiographic series was ordered (Figure 4). Radiographic examination revealed generalized moderate horizontal bone loss. There was also vertical loss of bone noted in the edentulous areas. A cone beam computed tomography scan was also ordered for better evaluation of the edentulous areas. The height of bone between the crestal bone and maxillary right sinus, in the position of the future implant, as indicated by the radiographic stent, was 4.95 mm and the height of bone between the crestal bone and maxillary left sinus was 8 mm. The height of bone between the crestal bone and the inferior alveolar nerve canal was 12 mm bilaterally. The distance from the right mental foramen was 10 mm (Figure 5). The buccal–lingual width seemed adequate in all indicated positions for placement of dental implants.

Figure 4: Panoramic and full mouth radiograph.

A round, well-circumscribed radiopacity with well-defined borders was noted in the maxillary right sinus. The lesion occupied a big area of the right maxillary sinus space. Slight sinus membrane thickening was noted in the maxillary left sinus (Figure 5).

Figure 5: Cone beam computed tomography scan.

Figure 6: Implant placement.

Figure 7: Implants placed.

Diagnosis

A diagnosis of generalized moderate and localized severe chronic periodontitis with mucogingival deformities and conditions around teeth (facial, lingual, and interproximal recession and aberrant frenum), mucogingival deformities and conditions on the edentulous ridges (horizontal and vertical ridge deficiency in all edentulous areas and aberrant frenum), and occlusal trauma (secondary) was made. Additional diagnosis of partial edentulism with Kennedy class I in the maxilla and Kennedy class I (mod 2) in the mandible was made.

Treatment Plan

Interdisciplinary consultation along with diagnostic casts and wax-up led to different treatment plan options. Financial limitations also played a role in the final decision. The treatment plan for this patient consisted of an initial phase therapy that included oral prophylaxis and oral hygiene instructions to address gingival inflammation. This was followed by implant placements #3 and #5 with external sinus elevation, implants #12 and #14 with internal sinus elevation, and implants in locations #19, #26, and #30 (Figures 6 and 7). After adequate time for osseointegration (6–8 months in the maxilla, 4 months in the mandible), the implants were restored.

Treatment

Prior to any treatment, primary care physician and ear, nose, and throat (ENT) consultations were obtained. The primary care physician recommended that the patient should stop warfarin treatment 5 days prior to surgery and start using Lovenox (low molecular weight heparin) until 24 h prior to surgery. The patient should restart warfarin and Lovenox 24 h after surgery until his INR ≥2.0, when Lovenox should be discontinued.

The ENT report stated that patient had a benign asymptomatic mucous retention cyst in the maxillary right sinus and a slight membrane thickening in the maxillary left sinus. Neither condition would interfere with the implant surgery or sinus elevation procedure. In the case of membrane perforation, though, the procedure should be stopped, no implants or bone grafts should be placed, and the patient should be referred to the ENT doctor for cyst removal and sinus treatment.

After the initial phase therapy, the patient presented for implant placement. Implant placement took place in three visits (Figures 6 and 7).

Implant placement and restoration will not be described in this chapter, since these topics will be addressed in later chapters.

Discussion

In this case, the primary concern was the patient’s past and current medical history. The patient was being treated for several systemic diseased that he controlled with specific medication. These factors should be taken into consideration prior to any surgical implant treatment to minimize any possible complications and optimize implant therapy outcome.

In medically healthy patients, the success rates of some dental implant systems are reported to be between 90 and 95% at 10 years. Dental implants may fail, however, due to a lack of osseointegration during early healing, or when in function due to breakage, or infection of the peri-implant tissues leading to loss of implant support. The long-term outcome of implant therapy can be affected by local factors or systemic diseases or other compromising factors. In fact, it has been suggested that some local and systemic factors could represent contraindications to dental implants treatment [1,2].

The impact of health risks on the outcome of implant therapy is unclear, since there are few if any randomized controlled trials evaluating health status as a risk indicator [1]. Certain conditions, such as uncontrolled diabetes, bleeding disorders, a weakened/suppressed immune system, or cognitive problems, which interfere with postoperative care, increase the risk of implant failure. There is still, however, a lack of high-quality substantiated evidence to confirm all the associations [1,2]. Therefore, proper patient selection is important to increase the likelihood of implant therapy success.

It is important to realize that the degree of disease control may be far more important than the nature of the systemic disorder itself, and individualized medical management should be obtained prior to implant therapy, since in many of these patients the quality of life and functional benefits of dental implants may outweigh any risks [1]. In patients with systemic conditions, it is critical to outweigh the cost–benefit considerations with the patient’s quality of life and life expectancy, and it is very important to undertake the implant surgical procedures with strict asepsis, minimal trauma, and avoiding stress and excessive hemorrhage. Equally essential in these patients is to ensure proper maintenance therapy with optimal standards of oral hygiene, without smoking, and with avoidance of any other risk factors that may affect the outcome of dental implants [1,2].

Self-Study Questions

(Answers located at the end of the case)

A. What is the impact of systemic diseases and/or medications used to treat systemic diseases on the success of implant therapy?

B. What are the contraindications of dental implants in medically compromised patients?

C. Which medical/systemic diseases have a high risk associated with implant success and what is the level of association with lack of osseointegration, peri-implant bone loss, and/or implant failure?

D. Which medical/systemic diseases have a significant risk associated with implant success and what is the level of association with lack of osseointegration, peri-implant bone loss, and/or implant failure?

E. Which medical/systemic diseases have a relative risk associated with implant success and what is the level of association with lack of osseointegration, peri-implant bone loss, and/or implant failure?

F. Which other medical/systemic diseases have an increased risk associated with implant success and what is the level of association with lack of osseointegration, peri-implant bone loss, and/or implant failure?

G. Which medical/systemic conditions are considered to be absolute contraindications for implant therapy?

H. Which medication may affect osseointegration?

References

1. Diz P, Scully C, Sanz M. Dental implants in the medically compromised patient.

J Dent

2013;41:195–206.

2. Gómez-de Diego R, Mang-de la Rosa M, Romero-Pérez MJ, et al. Indications and contraindications of dental implants in medically compromised patients: update.

Med Oral Patol Oral Cir Bucal

2014;19(5):e483–e489.

3. Bornstein MM, Cionca N, Mombelli A. Systemic conditions and treatments as risks for implant therapy.

Int J Oral Maxillofac Implants

2009;24(Suppl):12–27.

4. Clementini M, Rossetti PHO, Penarrocha D, et al. Systemic risk factors for peri-implant bone loss: a systematic review and meta-analysis.

Int J Oral Maxillofac Surg

2014;43:323–334.

5. Berglundh T, Lindhe J, Ericsson I, et al. The soft tissue barrier at implants and teeth.

Clin Oral Implants Res

1991;2:81–90.

6. Sanz M, Alendaz J, Lazaro P, et al. Histopathologic characteristics of peri-implant soft tissues in Brånemark implants with 2 distinct clinical and radiographic patterns.

Clin Oral Implants Res

1991;2:128–134.

7. Quirynen M, Van Steenberghe D. Bacterial colonization of the internal part of two stage implants: an in vivo study.

Clin Oral Implants Res

1993;4:158–161.

8. Hermann JS, Cochran DL, Nummicoski PV, et al. Crestal bone changes around titanium implants: a radiographic evaluation of unloaded nonsubmerged and submerged implants in the canine mandible.

J Periodontol

1997;68:1117–1130.

9. Jansen VK, Conrads G, Richter EJ. Microbial leakage and marginal fit of the implant abutment interface.

Int J Oral Maxillofac Implants

1997;12:527–540.

10. De Souza JGO, Pereira Neto ARL, et al. Impact of local and systemic factors on additional peri-implant bone loss.

Quintessence Int

2013;44:415–424.

11. Albrektsson T, Isidor F. Consensus report of session IV. In: Lang NP, Karring, T (eds),

Proceedings of the 1st European Workshop on Periodontology

. London: Quintessence; 1994, pp 365–369.

12. Wennström J, Palmer R. Consensus report session 3: clinical trials. In: Lang NP, Karring T, Lindhe J (eds),

Proceedings of the 3rd European Workshop on Periodontology. Implant Dentistry

. Berlin: Quintessence; 1999, pp 255–259.

13. Fransson C, Lekholm U, Jemt T, Berglundh T. Prevalence of subjects with progressive bone loss at implants.

Clin Oral Implants Res

2005;16:440–446.

14. Meijer GJ, Cune MS. Surgical dilemmas. Medical restrictions and risk factors.

Ned Tijdschr Tandheelkd

2008;115:643–651 (in Dutch).

15. Bornstein MM, Cionca N, Mombelli A. Systemic conditions and treatments as risks for implant therapy.

Int J Oral Maxillofac Implants

2009;24(Suppl):12–27.

16. American Society of Anesthesiologists. New classification of physical status.

Anesthesiology

1963;24:111.

17. Maloney WJ Weinberg MA. Implementation of the American Society of Anesthesiologists physical status classification system in periodontal practice.

J Periodontol

2008;79:1124–1126.

18. Smith RA, Berger R, Dodson TB. Risk factors associated with dental implants in healthy and medically compromised patients.

Int J Oral Maxillofac Implants

1992;7:367–372.

19. Van Steenberghe D, Quirinen M, Molly L, Jacobs R. Impact of systemic diseases and medication on osseointegration.

Periodontol

2000 2003;33:163–171.

20. Blanchaert RH. Implants in the medically challenged patient.

Dent Clin North Am

1998;42:35–45.

21. Sugerman PB, Barber MT. Patient selection for endosseous dental implants: oral and systemic considerations.

Int J Oral Maxillofac Implants

2002;17:191–201.

22. Hwang D, Wang HL. Medical contraindications to implant therapy: part I: absolute contraindications.

Implant Dent

2006;15:353–360.

23. Hwang D, Wang HL. Medical contraindications to implant therapy: part II: relative contraindications.

Implant Dent

2007;16:13–23.

24. Buser D, von Arx T, ten Bruggenkate CM, Weingart D. Basic surgical principles with ITI implants.

Clin Oral Implants Res

2000;11(Suppl):59–68.

25. Sugerman PB, Barber MT. Patient selection for endosseous dental implants: oral and systemic considerations.

Int J Oral Maxillofac Implants

2002;17:191–201.

26. Mombelli A, Cionca N. Systemic diseases affecting osseointegration therapy.

Clin Oral Implants Res

2006;17(Suppl):97–103.

27. Krennmair G, Seemann R, Piehslinger E. Dental implants in patients with rheumatoid arthritis: clinical outcome and peri-implant findings.

J Clin Periodontol

2010;37:928–936.

28. Weinlander M, Krennmair G, Piehslinger E. Implant prosthodontic rehabilitation of patients with rheumatic disorders: a case series report.

Int J Prosthodont

2010;23:22–28.

29. Friberg B, Sennerby L, Roos J, Lekholm U. Identification of bone quality in conjunction with insertion of titanium implants: a pilot study in jaw autopsy specimens.

Clin Oral Implants Res

1995;6:213–219.

30. Jaffin RA, Berman CL. The excessive loss of Branemark fixtures in type IV bone: a 5-year analysis.

J Periodontol

1991;62:2–4.

31. Sakakura CE, Marcantonio Jr E, Wenzel A, Scaf G. Influence of cyclosporin A on quality of bone around integrated dental implants: a radiographic study in rabbits.

Clin Oral Implants Res

2007;18:34–39.

32. Heckmann SM, Heckmann JG, Linke JJ, et al. Implant therapy following liver transplantation: clinical and microbiological results after 10 years.

J Periodontol

2004;75:909–913.

33. Gu L, Yu YC. Clinical outcome of dental implants placed in liver transplant recipients after 3 years: a case series.

Transplant Proc

2011;43:2678–2682.

34. Gu L, Wang Q, Yu YC. Eleven dental implants placed in a liver transplantation patient: a case report and 5-year clinical evaluation.

Chin Med J (Engl)

2011;124:472–475.

35. Dijakiewicz M, Wojtowicz A, Dijakiewicz J, et al. Is implanto-prosthodontic treatment available for haemodialysis patients?

Nephrol Dial Transplant

2007;22:2722–2724.

36. Porter SR, Scully C, Luker J. Complications of dental surgery in persons with HIV disease.

Oral Surg Oral Med Oral Pathol

1993;75:165–167.

37. Scully C, Watt-Smith P, Dios P, Giangrande PLF. Complications in HIV-infected and non-HIV-infected hemophiliacs and other patients after oral surgery.

Int J Oral Maxillofac Surg

2002;31:634–640.

38. Oliveira MA, Gallottini M, Pallos D, et al. The success of endosseous implants in human immunodeficiency virus-positive patients receiving antiretroviral therapy: a pilot study.

J Am Dent Assoc

2011;142:1010–1016.

39. Koo S, König Jr B, Mizusaki CI, et al. Effects of alcohol consumption on osseointegration of titanium implants in rabbits.

Implant Dent

2004;13:232–237.

40. Marchini L, de Deco CP, Marchini AP, et al. Negative effects of alcohol intake and estrogen deficiency combination on osseointegration in a rat model.

J Oral Implantol

2011;37(6):633–639.

41. Galindo-Moreno P, Fauri M, Avila-Ortiz G, et al. Influence of alcohol and tobacco habits on peri-implant marginal bone loss: a prospective study.

Clin Oral Implants Res

2005;16:579–586.

42. Alissa R, Oliver R. Influence of prognostic risk indicators on osseointegrated dental implant failure: a matched case–control analysis.

J Oral Implantol

2011;38:51–61.

43. Linsen SS, Martini M, Stark H. Long-term results of endosteal implants following radical oral cancer surgery with and without adjuvant radiation therapy.

Clin Implant Dent Relat Res

2012;14:250–258.

44. Harrison JS, Stratemann S, Redding SW. Dental implants for patients who have had radiation treatment for head and neck cancer.

Special Care Dent

2003;23:223–229.

45. Javed F, Al-Hezaimi K, Al-Rasheed A, et al. Implant survival rate after oral cancer therapy: a review.

Oral Oncol

2010;46:854–859.

46. Landes CA, Kovacs AF. Comparison of early telescope loading of non-submerged ITI implants in irradiated and non-irradiated oral cancer patients.

Clin Oral Implants Res

2006;17:367–374.

47. Granström G. Radiotherapy, osseointegration and hyperbaric oxygen therapy.

Periodontology 2000

2003;33:145–162.

48. Coulthard P, Patel S, Grusovin GM, et al. Hyperbaric oxygen therapy for irradiated patients who require dental implants: a Cochrane review of randomised clinical trials.

Eur J Oral Implantol

2008;1:105–110.

49. Esposito M, Grusovin MG, Patel S, et al. Interventions for replacing missing teeth: hyperbaric oxygen therapy for irradiated patients who require dental implants.

Cochrane Database Syst Rev

2008;(1):CD003603.

50. Verdonck HW, Meijer GJ, Laurin T, et al. Implant stability during osseointegration in irradiated and non-irradiated minipig alveolar bone: an experimental study.

Clin Oral Implants Res.

2008;19:201–206.

51. Michaeli E, Weinberg I, Nahlieli O. Dental implants in the diabetic patient: systemic and rehabilitative considerations.

Quintessence Int

2009;40:639–645.

52. McCracken M, Lemons JE, Rahemtulla F, et al. Bone response to titanium alloy implants placed in diabetic rats.

Int J Oral Maxillofac Implants

2000;15:345–354.

53. Fiorellini JP, Nevins ML, Norkin A, et al. The effect of insulin therapy on osseointegration in a diabetic rat model.

Clin Oral Implants Res

1999;10:362–368.

54. Morris HF, Ochi S, Winkler S. Implant survival in patients with type 2 diabetes: placement to 36 months.

Ann Periodontol

2000;5:157–165.

55. Alsaadi G, Quirynen M, Komárek A, van Steenberghe D. Impact of local and systemic factors on the incidence of late oral implant loss.

Clin Oral Implants Res

2008;19:670–676.

56. Dowell S, Oates TW, Robinson M. Implant success in people with type 2 diabetes mellitus with varying glycemic control: a pilot study.

J Am Dent Assoc

2007;138:355–361.

57. Anner R, Grossmann Y, Anner Y, Levin L. Smoking, diabetes mellitus, periodontitis, and supportive periodontal treatment as factors associated with dental implant survival: a long-term retrospective evaluation of patients followed for up to 10 years.

Implant Dent

2010;19:57–64.

58. Turkyilmaz I. One-year clinical outcome of dental implants placed in patients with type 2 diabetes mellitus: a case series.

Implant Dent

2010;19:323–329.

59. Oates TW, Dowell S, Robinson M, McMahan CA. Glycemic control and implant stabilization in type 2 diabetes mellitus.

J Dent Res

2009;88:367–371.

60. Javed F, Romanos GE. Impact of diabetes mellitus and glycemic control on the osseointegration of dental implants: a systematic literature review.

J Periodontol

2009;80:1719–1730.

61. Tawil G, Younan R, Azar P, Sleilati G. Conventional and advanced implant treatment in the type II diabetic patient: surgical protocol and long-term clinical results.

Int J Oral Maxillofac Implants

2008;23:744–752.

62. Beikler T, Flemmig TF. Implants in the medically compromised patient.

Crit Rev Oral Biol Med

2003;14:305–316.

63. Gornitsky M, Hammouda W, Rosen H. Rehabilitation of a hemophiliac with implants: a medical perspective and case report.

J Oral Maxillofac Surg

2005;63:592–597.

64. Scully C.

Medical Problems in Dentistry

, 6th edn. London: Elsevier; 2010.

65. Madrid C, Sanz M. What influence do anticoagulants have on oral implant therapy? A systematic review.

Clin Oral Implants Res

2009;20:96–106.

66. Bacci C, Berengo M, Favero L, Zanon E. Safety of dental implant surgery in patients undergoing anticoagulation therapy: a prospective case–control study.

Clin Oral Implants Res

2011;22:151–156.

67. Hong CH, Napeñas JJ, Brennan MT, et al. Frequency of bleeding following invasive dental procedures in patients on low-molecular-weight heparin therapy.

J Oral Maxillofac Surg

2010;68:975–979.

68. Napeñas JJ, Hong CH, Brennan MT, et al. The frequency of bleeding complications after invasive dental treatment in patients receiving single and dual antiplatelet therapy.

J Am Dent Assoc

2009;140:690–695.

69. Glaser DL, Kaplan FS. Osteporosis. Definition and clinical presentation.

Spine

1997;22(24, Suppl):12S–16S.

70. Glösel B, Kuchler U, Watzek G, Gruber R. Review of dental implant rat research models simulating osteoporosis or diabetes.

Int J Oral Maxillofac Implants

2010;25:516–524.

71. Blomqvist JE, Alberius P, Isaksson S, et al. Factors in implant integration failure after bone grafting: an osteometric and endocrinologic matched analysis.

Int J Oral Maxillofac Surg

1996;25:63–68.

72. Alsaadi G, Quirynen M, Komarek A, van Steenberghe D. Impact of local and systemic factors on the incidence of oral implant failures, up to abutment connection.

J Clin Periodontol

2007;34:610–617.

73. Slagter KW, Raghoebar GM, Vissink A. Osteoporosis and edentulous jaws.

Int J Prosthodont

2008;21:19–26.

74. Dvorak G, Arnhart C, Heuberer S, et al. Peri-implantitis and late implant failures in postmenopausal women: a cross-sectional study.

J Clin Periodontol

2011;38:950–955.

75. Friberg B, Ekestubbe A, Mellström D, Sennerby L. Brånemark implants and osteoporosis: a clinical exploratory study.

Clin Implant Dent Relat Res

2001;3:50–56.

76. Sheper HJ, Brand HS. Oral aspects of Crohn’s disease.

Int Dent J

2002;52:163–172.

77. Alsaadi G, Quirynen M, Michilis K, et al. Impact of local and systemic factors on the incidence of failures up to abutment connection with modified surface oral implants.

J Clin Periodontol

2008;35:51–57.

78. Alsaadi G, Quirynen M, Komarek A, van Steenberghe D. Impact of local and systemic factors on the incidence of late oral implant loss.

Clin Oral Implants Res

2008;19:670–676.

79. Khadivi V, Anderson J, Zarb GA. Cardiovascular disease and treatment outcomes with osseointegration surgery.

J Prosthet Dent

1999;81:533–536.

80. Van Steenberghe D, Jacobs R, Desnyder M, et al. The relative impact of local and endogenous patient-related factors on implant failure up to the abutment stage.

Clin Oral Implants Res

2002;13:617–622.

81. Bayes J. Asymptomatic smokers: ASA I or II?

Anesthesiology

1982;56(1):76.

82. Wilson Jr TG, Nunn M. The relationship between the interleukin-1 periodontal genotype and implant loss. Initial data.

J Periodontol

1999;70:724–729.

83. Bain CA, Moy PK. The association between the failure of dental implants and cigarette smoking.

Int J Oral Maxillofac Implants

1993;8:609–615.

84. De Bruyn H, Collaert B. The effect of smoking on early implant failure.

Clin Oral Implants Res

1994;5:260–264.

85. Lambert PM, Morris HF, Ochi S. The influence of smoking on 3-year clinical success of osseointegrated dental implants.

Ann Periodontol

2000;5:79–89.

86. Weyant RJ. Characteristics associated with the loss and peri-implant tissue health of endosseous dental implants.

Int J Oral Maxillofac Implants

1994;9:95–102.

87. Minsk L, Polson AM, Weisgold A, et al. Outcome failures of endosseous implants from a clinical training center.

Compend Contin Educ Dent

1996;17:848–850.

88. Kumar A, Jaffin RA, Berman C. The effect of smoking on achieving osseointegration of surface-modified implants: a clinical report.

Int J Oral Maxillofac Implants

2002;17:816–819.

89. Sverzut AT, Stabile GA, de Moraes M, et al. The influence of tobacco on early dental implant failure.

J Oral Maxillofac Surg

2008;66:1004–1009.

90. Bain CA, Weng D, Meltzer A, et al. A meta-analysis evaluating the risk for implant failure in patients who smoke.

Compend Contin Educ Dent

2002;23:695–699.

91. Itthagarun A, King NM. Ectodermal dysplasia: a review and case report.

Quintessence Int

1997;28:595–602.

92. Candel-Marti ME, Ata-Ali J, Peñarrocha-Oltra D, et al. Dental implants in patients with oral mucosal alterations: an update.

Med Oral Patol Oral Cir Bucal

2011;16:e787–e793.

93. Sweeney IP, Ferguson JW, Heggie AA, Lucas JO. Treatment outcomes for adolescent ectodermal dysplasia patients treated with dental implants.

Int J Paediatr Dent

2005;15:241–248.

94. Bergendal B, Ekman A, Nilsson P. Implant failure in young children with ectodermal dysplasia: a retrospective evaluation of use and outcome of dental implant treatment in children in Sweden.

Int J Oral Maxillofac Implants

2008;23:520–524.

95. Guckes AD, Scurria MS, King TS, et al. Prospective clinical trial of dental implants in persons with ectodermal dysplasia.

J Prosthet Dent

2002;88:21–29.

96. Percinoto C, Vieira AE, Barbieri CM, et al. Use of dental implants in children: a literature review.

Quintessence Int

2001;32:381–383.

97. Scully C, Carrozzo M. Oral mucosal disease: lichen planus.

Br J Oral Maxillofac Surg

2008;46:15–21.

98. Hernandez G, Lopez-Pintor RM, Arriba L, et al. Implant treatment in patients with oral lichen planus: a prospective-controlled study.

Clin Oral Implants Res

2012;23:726–732.

99. Czerninski R, Eliezer M, Wilensky A, Soskolne A. Oral lichen planus and dental implants – a retrospective study.

Clin Implant Dent Relat Res

2013;15(2):234–242.

100. Wolff K, Johnson RA, Suurmond D.

Fitzpatrick’s Color Atlas & Synopsis of Clinical Dermatology

, 5th edn. New York: McGraw Hill; 2006, pp 398–402.

101. Jensen J, Sindet-Pedersen S. Osseointegrated implants for prosthetic reconstruction in a patient with scleroderma: report of a case.

J Oral Maxillofac Surg

1990:48:739–741.

102. Langer Y, Cradash HS, Tal H. Use of dental implants in the treatment of patients with scleroderma: a clinical report.

J Prosthet Dent

1992:68(6):873–875.

103. Patel K, Welfare R, Coonae HS. The provision of dental implants and a fixed prosthesis in the treatment of a patient with scleroderma: a clinical report.

J Prosthet Dent

1998;79:611–612.

104. Haas SE. Implant supported, long span fixed partial denture for a scleroderma patient: a clinical report.

J Prosthet Dent

2002;87:136–139.

105. Öczakir CS, Balmer S, Mericske-Stern R. Implant prosthodontic treatment for special care patients: a case series study.

Int J Prosthodont

2005;18:383–389.

106. Ekfeldt A. Early experience of implant-supported prostheses in patients with neurologic disabilities.

Int J Prosthodont

2005;18:132–138.

107. Addy L, Korszun A, Jagger RG. Dental implant treatment for patients with psychiatric disorders.

Eur J Prosthodont Restor Dent

2006;14:90–92.

108. Cune MS, Strooker H, Van der Reijden WA, et al. Dental implants in persons with severe epilepsy and multiple disabilities: a long-term retrospective study.

Int J Oral Maxillofac Implants

2009;24:534–540.

109. Delaleu N, Jonsson R, Koller MM. Sjögren’s syndrome.

Eur J Oral Sci

2005;113:101–113.

110. Mathews SA, Kuien BT, Scofield RG. Oral manifestations of Sjögren’s syndrome.

J Dent Res

2008;87:308–318.

111. Isidor F, Brondum K, Hansen HJ, et al. Outcome of treatment with implant-retained dental prosthesis in patients with Sjögren syndrome.

Int J Oral Maxillofac Implants

1999;14:736–743.

112. Attard NJ, Zarb GA. A study of dental implants in medically treated hypothyroid patients.

Clin Implant Dent Relat Res

2002;4:220–231.

113. Carabello B. Valvular heart disease. In: Goldman L, Ausiello D (eds),

Cecil Textbook of Medicine

, 22nd edn. St. Louis, MO: Saunders; 2004, pp 439–442.

114. Chambers H. Infective endocarditis. In: Goldman L, Ausiello D (eds),

Cecil Textbook of Medicine

, 22nd edn. St. Louis, MO: Saunders; 2004, pp 1795–1796.

115. Proceedings of the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy: evidence-based guidelines. Chest 2004;126:172S–696S.

116. Drews RE. Critical issues in hematology: anemia, thrombocytopenia, coagulopathy, and blood product transfusions in critically ill patients.

Clin Chest Med

2003;24:607–622.

117. Jolly DE. Interpreting the clinical laboratory.

J Calif Dent Assoc

1995;23:32–40.

118. Mealey BL. Periodontal implications: medically compromised patients.

Ann Periodontol

1996;1:256–321

119. Karr RA, Kramer DC, Toth BB. Dental implants and chemotherapy complications.

J Prosthet Dent

1992;67:683–687.

120. Steiner M, Windchy A, Gould AR, et al. Effects of chemotherapy in patients with dental implants.

J Oral Implantol

1995;21:142–147.

121. Kennedy J. Alcohol use disorders. In: Jacobson J (ed.),

Psychiatric Secrets

, 2nd edn. Philadelphia, PA: Hanley & Belfus; 2001, p 103.

122. Fu E, Hsieh YD, Nieh S, et al. Effects of cyclosporin A on alveolar bone: an experimental study in the rat.

J Periodontol

1999;70:189–194.

123. Wu X, Al-Abedalla K, Rastikerdar E, et al. Selective serotonin reuptake inhibitors and the risk of osseointegrated implant failure: a cohort study.

J Dent Res

2014;93(11):1054–1061.

124. Ferlito S, Liardo C, Puzzo S. Bisphosphonates and dental implants: a case report and a brief review of literature.

Minerva Stomatol

2011;60:75–81.

125. Flichy-Fernández AJ, Balaguer-Martínez J, Peñarrocha-Diago M, Bagán JV. Bisphosphonates and dental implants: current problems.

Med Oral Patol Oral Cir Bucal

2009;14:E355–E360.

126. Wang HL, Weber D, McCauley LK. Effect of long-term oral bisphosphonates on implant wound healing: literature review and a case report.

J Periodontol

2007;78:584–594.

127. Lazarovici TS, Yahalom R, Taicher S, et al. Bisphosphonate-related osteonecrosis of the jaw associated with dental implants.

J Oral Maxillofac Surg

2010;68:790–796.

128. Jacobsen C, Metzler P, Rössle M, et al. Osteopathology induced by bisphosphonates and dental implants: clinical observations.

Clin Oral Investig

2013;17(1):167–175.