Quick Reference to Dental Implant Surgery E-Book

Mohamed A. Maksoud

• Herausgeber: John Wiley & Sons
• Kategorie: Fachliteratur
• Sprache: Englisch

Seitenzahl: 134

Veröffentlichungsjahr: 2017

Beschreibung

Quick Reference to Dental Implant Surgery offers busy practitioners quick access to all the essential information needed for successful dental implant surgery--from case selection to radiographic examination, scrub-in to post-operative care. * How-to information in a concise, spiral-bound, quick-access format * Concrete guidelines for common scenarios before, during, and after surgery * Numerous charts, tables, checklists, and callouts * An abundance of stunning, full-color photographs illustrating key points covered * Text boxes containing clinical recommendations to help facilitate quick navigation/li>

Leseprobe

Quick Reference to Dental Implant Surgery

Mohamed A. Maksoud

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

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Library of Congress Cataloging-in-Publication Data

Names: Maksoud, Mohamed A., author.

Title: Quick reference to dental implant surgery / by Mohamed A. Maksoud.

Description: Hoboken, NJ : Wiley, 2017. | Includes bibliographical references and index. |

Identifiers: LCCN 2017018828 (print) | LCCN 2017019356 (ebook) | ISBN 9781119290131 (pdf) | ISBN 9781119290162 (epub) | ISBN 9781119290124 (pbk.)

Subjects: | MESH: Dental Implantation–methods | Dental Implants

Classification: LCC RK667.I45 (ebook) | LCC RK667.I45 (print) | NLM WU 640 | DDC 617.6/93–dc23

LC record available at https://lccn.loc.gov/2017018828

Cover image: © alexmit/123RF Cover design by Wiley

To my parents, I know you would be proud of me today. To my wife, thank you for being my best friend.

CONTENTS

About the Author

Preface and Introduction

1: Case Selection and Diagnosis

Part A: Medical Consideration in Implant Dentistry

Part B: Radiographic Examination and Imaging Modalities

2

–

4

Part C: Surgical Stents

5

–

7

References

2: Surgical Principles and Protocols

Part A: Scrubbing and Gowning

1

Part B: Surgical Report

Part C: Commonly Used Medications in Implant Dentistry

References

3: Surgical Treatment

Part A: Immediate Implants

Part B: Sinus Augmentation

Part C: Ridge Augmentation

Part D: Extraction Socket Preservation

Part E: Suture Materials

6

References

4: Corrective Implant Surgery

Part A: Clinical Recommendations for the Prevention and Treatment of Peri-implant Disease

1

Part B: Peri-implantitis Treatment Recommendations

2,3

References

5: Errors and Complications

Part A: Diagnosis of Complications

1

Part B: Surgical Errors

Part C: Prosthetic Errors

Part D: The Checklist

References

6: Communication

Part A: Sample Consents

Part B: Sample Surgical Report

Part C: Sample Postoperative Instructions and How to Clean Implants

Part D: Sample Patient Letters

Part E: Sample Letters to Physicians

Part F: Sample Letters to Referring Dentists

Index

EULA

List of Illustrations

Chapter 1

Figure 1.1

Surgical stent with teeth and occlusal access hole.

Figure 1.2

Surgical stent with clear occlusal access and no teeth.

Figure 1.3

Surgical stent with teeth and barium coated.

Figure 1.4

Surgical stent clear with sleeves.

Figure 1.5

Surgical stent clear with no lingual flange.

Figure 1.6

Surgical stent clear fully edentulous.

Figure 1.7

Surgical stent on the opposite arch with pins.

Chapter 3

Figure 3.1

Clinical photo of fractured right maxillary central incisor.

Figure 3.2

Radiograph of the same tooth.

Figure 3.3

The extraction socket following atraumatic extraction.

Figure 3.4

Immediate implant in place.

Figure 3.5

Radiograph of the implant in place.

Figure 3.6

Resin-cemented provisional crown with sulcus former.

Figure 3.7

Radiograph of the provisional crown.

Figure 3.8

Clinical photo of the provisional crown.

Figure 3.9

Clinical photo of the edentulous space maxillary left area.

Figure 3.10

The window osteotomy.

Figure 3.11

Window elevated.

Figure 3.12

Bone graft putty injected into the created window space.

Figure 3.13

Complete packing of the bone graft.

Figure 3.14

An implant bone drill held to determine adequate bone height for the proposed implant.

Figure 3.15

Mattress suture of the surgical area, including the horizontal and vertical incisions.

Figure 3.16

Preoperative.

Figure 3.17

Shortening the pontic to allow for the implanted tissue.

Figure 3.18

Tunnel vertical incision, full thickness.

Figure 3.19

The dermal acellular matrix folded to increase the volume.

Figure 3.20

The matrix implanted.

Figure 3.21

Postoperative healing.

Figure 3.22

Postoperative healing.

Figure 3.23

Complete healing with adequate soft tissue augmentation below the pontic.

Figure 3.24

Donor site of mental graft.

Figure 3.25

Bone harvesting from donor site.

Figure 3.26

Premaxillary ridge deficiency.

Figure 3.27

Mental onlay grafts in recipient site secured with titanium straps.

Figure 3.28

Voids between only graft and recipient site are filled with allograft particulates.

Figure 3.29

CT scan of the premaxillary defect prior to the augmentation.

Figure 3.30

CT scan of the premaxillary defect following the augmentation.

Figure 3.31

Onlay grafts harvested below the atrophic site and secured in place with titanium screws.

Figure 3.32

The recipient site and the onlay graft covered with particulate allograft.

Figure 3.33

Healed recipient and donor sites.

Chapter 4

Figure 4.1

Case 1: moderate peri-implantitis.

Figure 4.2

Autogenous bone harvested.

Figure 4.3

Grafted implant surface after surface treatment.

Figure 4.4

Resorbable membrane covering the bone graft.

Figure 4.5

Flap sutured to ensure complete coverage of the bone graft and membrane.

Figure 4.6

Case 2: severe peri-implantitis.

Figure 4.7

Trephine drill used to remove implant.

Figure 4.8

Removed implant.

Figure 4.9

New implant placed using surgical stent.

Figure 4.10

Bone graft to fill in the voids between the new implant and the walls of the osteotomy.

Figure 4.11

Membrane covering the bone graft.

Figure 4.12

Sutured flap.

Figure 4.13

Case 3: peri-implantitis due to trauma from orthodontic appliance.

Figure 4.14

Implant surface cleaned.

Figure 4.15

Grafted implant bone defect.

Figure 4.16

Radiograph before treatment.

Figure 4.17

Radiograph after treatment.

Guide

Cover

Table of Contents

Preface and Introduction

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About the Author

Mohamed A. Maksoud graduated from Tufts University School of Dental Medicine in Boston, where he earned a Doctor of Dental Medicine degree in addition to a postgraduate periodontology specialty.

He served as faculty member in multiple dental institutions in the United States and abroad, and he is currently at Harvard University School of Dental Medicine in Boston.

Dr. Maksoud is board certified by the American Board of Implant Dentistry, and he is a Diplomate of the International Congress of Oral Implantology.

He has published numerous articles and book chapters in the field of implant dentistry, besides presentations at national and international dental conventions. He is actively involved in teaching training seminars and continuing education courses on dental implants to dentists worldwide, in addition to research and clinical trials in tissue engineering and implant dentistry.

Preface and Introduction

Implantology at present is arguably the most significant discipline in dentistry. It has become a source of intellectual pursuit and patient referrals. Advances in all areas of implant dentistry are occurring at record paces. In the current medico-legal climate, it is important that all practitioners, especially those starting out in implant dentistry, become knowledgeable in all areas. The values of adding skills to one's present capabilities are inestimable. Implantology is one such skill. It offers treatment modalities and techniques of broad and varied interests to all practitioners who wish to work alone or to join others in team efforts.

This book will serve as a unique tool for dental professionals to become proficient in the field of implant dentistry. It illustrates a smooth and systematic approach to all fields in surgical implantology from case selection and diagnostic aids to surgical principles, treatment modalities, and complications. The objective of the book is to provide the reader with a quick and easy navigation guide in a table-based format, with recommendations at the end of each section. It can serve as a teaching reference in dental teaching institutions for dental students and residents, or as a companion in a clinical practice for beginning and advanced implant dentists.

1Case Selection and Diagnosis

Part A: Medical Consideration in Implant Dentistry

1 Commonly Ordered Blood Tests in Implant Dentistry1

Blood test

Normal

Clinical significance

Hematocrit (Hct)

Female: 36–46% Male: 42–52%

Low values: Anemia; monitor for fatigue, dyspnea, tachycardia, and tachypnea.

Hemoglobin (Hgb)

Female: 12–15 g/dl Male: 14–17 g/dl

Low values: Anemia; monitor for fatigue, dyspnea, tachycardia, and tachypnea.

Red blood cell (RBC) count

Female: 4–5.5 million/mm

3

Male: 4.5–6.2 million/mm

3

Low values: Anemia; monitor for fatigue, dyspnea, tachycardia, and tachypnea. High values: In chronic obstructive pulmonary disease (COPD), this may indicate polycythemia, a compensation for pulmonary dysfunction that makes blood thicker, increases risk of cerebrovascular accident (CVA).

Total white blood cell (WBC) count

5000–10,000/mm

3

>10,000 indicates systemic infection (more than just local colonization).

Platelets and thrombocytes

200,000–500,000/mm

3

30,000–50,000: Risk of internal hemorrhage.

Erythrocyte sedimentation rate (ESR)

Female: 1–25 mm/h Male: 0–17 mm/h

Bad if elevated. Used to diagnose, or follow the course of, inflammatory diseases (e.g., rheumatic conditions).

Creatinine

Female: 0.6–1.2 mg/dl Male: 0.5–1.1 mg/dl

Renal function measure: High values are bad. May indicate nephropathy, or end-stage renal disease.

Potassium (K)

3.5–5.0 mEq/l

Results of low K: Ventricular arrhythmias. Results of high K: Ventricular arrhythmias and asystole.

Calcium (Ca)

8.2–10.2 mg/dl

Results of low Ca: Osteoporosis, muscle spasms or tetany, calcium deposits in tissue, cardiac arrhythmia, and asystole. Results of high Ca: thirst, polyuria, renal stones, decreased muscle tone, tachycardia, cardiac arrhythmia, and asystole.

Sodium (Na)

136–145 mEq/l

Results of low Na: postural hypotension, abdominal cramps, headache, fatigue, and weakness. Results of high Na: edema and tachycardia.

Fasting blood glucose (FBG)

70 to 99 mg/dL

100 to 125 mg/dL: Impaired fasting glucose (pre-diabetes). >126 mg/dL: Diabetes.

Serum c-telopeptide collagen

Adult male 18–29 Years 87–1200 pg/mL 30–39 Years 70–780 pg/mL 40–49 Years 60–700 pg/mL 50–68 Years 87–345 pg/mL Adult female 18–29 Years 60–640 pg/mL 30–39 Years 60–650 pg/mL 40–49 Years 40–465 pg/mL

High in osteoporosis, osteopenia, and primary hyperthyroidism.

Alkaline phosphates

30–120 IU/L

High values: liver disease, osteoclastic activity, Paget's disease, bone cancer, and osteoporosis.

Prothrombin time (PT)

1–18 sec

Measures extrinsic clotting of blood. Prolonged in liver disease, impaired vitamin K production, and surgical trauma with blood loss.

Partial thromboplastin time (PTT)

By laboratory control

Measures intrinsic clotting of blood and congenital clotting disorders. Prolonged in hemophilia A, B, and C.

International Normalized Ratio (INR)

Without anticoagulant therapy: 1 Anticoagulant therapy target range: 2–3

Measures extrinsic clotting function. Increased with anticoagulant therapy.

Bleeding time (BT)

1–6 min

Measures quality of platelets. Prolonged in thrombocytopenia.

A Recommendations

Low platelet count and abnormal clotting tests in addition to abnormal BT, PT, PTT, or INR value is a contraindication in implant surgery, especially in a sinus grafting procedure, due to the possibility of uncontrolled bleeding.

Abnormal c-telopeptide values related to the use of oral or systemic bisphosphonates should be considered prior to implant surgery.

Consult with a physician in writing regarding any abnormal values, and attach a copy of the blood test results.

2 ASA Classifications

ASA Physical Status 1: A normal healthy patient.

ASA Physical Status 2: A patient with mild systemic disease.

ASA Physical Status 3: A patient with severe systemic disease.

ASA Physical Status 4: A patient with severe systemic disease that is a constant threat to life.

ASA Physical Status 5: A moribund patient who is not expected to survive without the operation.

ASA Physical Status 6: A declared brain-dead patient whose organs are being removed for donor purposes.

A Recommendations

ASA Status 1 and 2 can be treated in a dental office.

ASA Status 3 and 4 should be treated in an in-patient facility.

3 Medical Conditions1

A Scleroderma

A multisystem disorder characterized by inflammatory, vascular, and sclerotic changes of the skin and various internal organs, especially the lungs, heart, and gastrointestinal tract.

Typical clinical features in the facial region are a masklike appearance, thinning of the lips, microstomia, sclerosis of the sublingual ligament, and indurations of the tongue.

The symptoms cause the skin of the face and lips as well as the intraoral mucosa to become taut, thereby hindering dental treatment and complicating or even preventing the insertion of dental prostheses.

No controlled studies were found for scleroderma to demonstrate any positive or negative effects on the outcome of implant therapy.

B Oral Lichen Planus (OLP)

A common T-cell-mediated autoimmune disease of unknown cause that affects stratified squamous epithelium exclusively.

OLP has been considered a contraindication for the placement of dental implants possibly because of the altered capacity of the oral epithelium to adhere to the titanium surface.

OLP as a risk factor for implant surgery and long-term success cannot be properly assessed.

C Ectodermal Dysplasia (ED)

A hereditary disease characterized by congenital dysplasia of one or more ectodermal structures.

Common extra- and intraoral manifestations include defective hair follicles and eyebrows, frontal bossing, nasal bridge depression, protuberant lips, hypo- or anodontia, conical teeth, and generalized spacing.

Most search results for ED were case reports demonstrating treatment success with dental implants.

A few larger case series report survival and success rates of implants in such patients. All studies reported significantly lower survival and success rates in the maxilla than in the mandible.

D Sjögren's Syndrome (SS)