BOOK
Misch's Avoiding Complications in Oral Implantology - E-Book
Carl E. Misch | Randolph Resnik
(2017)
Additional Information
Book Details
Abstract
See how to effectively manage ALL dental implant complications throughout ALL phases of treatment! Avoiding Complications in Oral Implantology provides evidence-based management protocols for a wide range of implant problems such as placement complications, malpositioning, bleeding, infection, and nerve injuries. Hundreds of high-quality, full-color photos and illustrations clearly demonstrate the complications and their resolution. Edited by Carl Misch and Randolph Resnik — both well-known names in dental implantology and prosthodontics — and with a team of expert contributors, this authoritative guide helps you handle the implant-related complications that can occur as more and more patients choose dental implants.
- Expert authors are joined by a panel of recognized leaders in implant dentistry — many of whom are associated with the Misch International Implant Institute — to share their extensive experience with handling complications through all phases of treatment.
- Comprehensive approach to complications that occur in the different phases of oral implantology provides the knowledge and skills you need to handle treatment planning, implant placement, post-operative complications, prostheses-related complications, and more.
- Over 1,000 images include full-color clinical photographs, radiographs, line drawings, and diagrams, clearly demonstrating complications, procedures, and outcomes.
- Management protocols developed by world-renowned dental implantologists provide a proven system and authoritative guidance in managing complications with dental implants.
- Evidence-based solutions make it easier to manage a wide variety of clinical problems associated with dental implants, with state-of-the-art guidance supported by the best available research.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover | cover | ||
| Avoiding Complications in Oral Implantology | i | ||
| Copyright Page | iv | ||
| Contributors | v | ||
| Foreword | vi | ||
| Preface | vii | ||
| Acknowledgments | ix | ||
| In Memoriam | x | ||
| Dedication | xii | ||
| Table Of Contents | xiii | ||
| 1 Classification of Dental Implant Complications | 1 | ||
| COMPLICATION STUDIES | 1 | ||
| Etiology of Complications | 1 | ||
| Increased Demand for Dental Implants | 1 | ||
| An Accepted Treatment by the Population | 6 | ||
| More Dentists Placing Implants | 7 | ||
| Manufacturers Course Training | 7 | ||
| Implants Being Placed in Compromised Sites | 7 | ||
| Medically Compromised Patients | 7 | ||
| Lack of Medical Clearance Prior to Surgery | 8 | ||
| Immediate Implant Procedures | 8 | ||
| Overuse of “Mini” Implants | 8 | ||
| Poor Treatment Planning | 9 | ||
| Poor Communication With Patients | 9 | ||
| Poor Understanding of Complications and Failure to Refer | 9 | ||
| Complication Classification | 10 | ||
| Minor vs. Major | 10 | ||
| Unavoidable vs. Avoidable | 10 | ||
| Reversible vs. Irreversible | 10 | ||
| Legal Ramifications | 10 | ||
| Complications Prevention | 10 | ||
| Increase Education | 10 | ||
| Seek Accreditation | 11 | ||
| Literature Review Updates | 11 | ||
| Patient Information | 11 | ||
| Do Not Rush Treatment | 11 | ||
| Treat for the Long Term, Not the Short Term | 11 | ||
| Follow-Up Care | 11 | ||
| Summary | 12 | ||
| References | 12 | ||
| 2 Medical/Medication Complications in Oral Implantology | 13 | ||
| Contraindications to Treatment | 13 | ||
| Medical History | 13 | ||
| Cardiovascular System | 13 | ||
| Classification of Hypertension | 14 | ||
| Surgical/Implant Implications | 14 | ||
| Intraoperative elevated blood pressure. | 14 | ||
| Orthostatic hypotension. | 14 | ||
| Antihypertensive medications + NSAIDs. | 14 | ||
| Beta blockers. | 15 | ||
| Calcium channel blockers. | 15 | ||
| Multiple antihypertensive drugs. | 15 | ||
| Susceptibility to other cardiovascular events. | 15 | ||
| Implant healing. | 15 | ||
| Complication Prevention | 15 | ||
| Stress reduction protocol. | 15 | ||
| Monitoring. | 15 | ||
| Maintain antihypertensive therapy. | 15 | ||
| Slow administration of local anesthetics. | 15 | ||
| Reduction in the use of vasoconstrictors. | 16 | ||
| Angina | 16 | ||
| Surgical/Implant Implications | 16 | ||
| Acute angina attack. | 16 | ||
| Stable vs. unstable angina. | 16 | ||
| Complication Implication | 16 | ||
| Postnitroglycerin issues. | 16 | ||
| Complication Prevention | 16 | ||
| Decrease dental procedural stress. | 16 | ||
| Use of nitrous oxide sedation. | 16 | ||
| Hypertension treatment summary | 16 | ||
| Myocardial Infarction (MI) | 16 | ||
| 3 Treatment Planning Complications | 54 | ||
| Type of Prosthesis | 54 | ||
| Treatment Planning | 54 | ||
| Not Understanding and Communicating the Types of Prostheses | 54 | ||
| Complication. | 54 | ||
| Prevention | 54 | ||
| Prosthesis treatment planning first. | 54 | ||
| Treatment plan according to finances. | 54 | ||
| Patient should be educated on all viable treatment plans. | 54 | ||
| Understand the differences between the types of prostheses. | 55 | ||
| Fixed Prostheses | 55 | ||
| FP-1 | 55 | ||
| Definition. | 55 | ||
| Implant Criteria. | 55 | ||
| Complication. | 55 | ||
| Prevention. | 56 | ||
| Hard tissue augmentation. | 56 | ||
| Soft tissue augmentation. | 56 | ||
| Ideal implant positioning. | 56 | ||
| FP-2 | 56 | ||
| Definition. | 56 | ||
| Implant Criteria. | 56 | ||
| Complication. | 57 | ||
| Prevention | 57 | ||
| Patient communication. | 57 | ||
| Preoperative smile zone evaluation. | 57 | ||
| Ideal implant position. | 59 | ||
| FP-3 | 59 | ||
| Definition. | 59 | ||
| Implant Criteria. | 59 | ||
| Complication. | 59 | ||
| Prevention | 59 | ||
| Patient communication. | 59 | ||
| Understanding of smile zone variations. | 59 | ||
| Color of the pink tissue. | 60 | ||
| Understand the two types of FP-3 prostheses. | 60 | ||
| Spacing of multiple implants. | 60 | ||
| Tissue space. | 60 | ||
| Removable Prostheses | 61 | ||
| RP-4 | 61 | ||
| Definition. | 61 | ||
| Implant Criteria. | 61 | ||
| Complication. | 61 | ||
| 4 Radiographic Complications and Evaluation | 148 | ||
| Radiographic Modalities | 148 | ||
| 2-Dimensional | 148 | ||
| Periapical Radiograph | 148 | ||
| Limitations | 148 | ||
| Complication Implications. | 148 | ||
| Panoramic Radiograph | 148 | ||
| Limitations | 149 | ||
| Complication Implications. | 150 | ||
| Cone Beam Tomography | 150 | ||
| 3-Dimensional | 150 | ||
| CBCT Technology Complications | 150 | ||
| Sensor (Detector) Type. | 150 | ||
| Voxel Size. | 150 | ||
| Spatial Resolution. | 150 | ||
| Contrast Resolution. | 151 | ||
| Bit Depth. | 151 | ||
| Bone Density: MDCT. | 151 | ||
| Bone Density: Dental CBCT. | 151 | ||
| Artifact Complications | 151 | ||
| Beam Hardening. | 151 | ||
| Motion-Related Artifacts. | 152 | ||
| Streak Artifacts. | 152 | ||
| Scatter. | 152 | ||
| Noise. | 152 | ||
| Bone Dehiscence on 3-D Reformatted Images. | 152 | ||
| Scanning Technique Complications | 153 | ||
| Imaging Protocol. | 153 | ||
| Position of the Scanning Template. | 154 | ||
| Mucosal Thickness. | 154 | ||
| CBCT Anatomic Radiographic | 154 | ||
| Anatomy | 154 | ||
| Incidental Findings | 154 | ||
| Complication Prevention | 154 | ||
| Understanding Incidence of Incidental Findings. | 154 | ||
| Obtaining a Radiology Report. | 154 | ||
| Use of the Smallest FOV as Possible. | 154 | ||
| Normal Radiographic Anatomy | 154 | ||
| Mandibular Anatomy | 155 | ||
| Location of the Mandibular Canal in the Mandible | 155 | ||
| Buccal-Lingual Mandibular Canal Locations | 155 | ||
| 5 Dental Implant Intraoperative Complications | 194 | ||
| Implant Placement: Surgical Related | 194 | ||
| Placement of Implants Into Sites With Preexisting Pathology | 194 | ||
| 6 Ideal Implant Positioning | 234 | ||
| Mesial-Distal (“X” Axis): Implant–Natural Tooth | 234 | ||
| Insufficient Implant–Root Apex Distance | 234 | ||
| Etiology | 234 | ||
| Complications | 234 | ||
| Damage to Adjacent Periodontal Ligament. | 234 | ||
| Loss of Implant. | 234 | ||
| Loss of Tooth. | 234 | ||
| Prevention | 234 | ||
| Ideal Position. | 234 | ||
| Proper Treatment Planning. | 235 | ||
| Use of Study Casts. | 235 | ||
| Two-Dimensional Radiographs. | 235 | ||
| Caution With Orthodontic Implants. | 235 | ||
| Maxillary Lateral Incisor Region. | 235 | ||
| Maxillary First Premolar Site. | 235 | ||
| FP-2, FP-3, RP-4, and RP-5. | 235 | ||
| Treatment | 236 | ||
| Initial Placement. | 236 | ||
| Past Placement. | 236 | ||
| Lack of Implant–Coronal Distance | 236 | ||
| Etiology | 236 | ||
| Complications | 236 | ||
| Interproximal Bone Loss. | 236 | ||
| Compromised Emergence Profile. | 237 | ||
| Hygiene Difficulties. | 237 | ||
| Reduced Papilla Height. | 237 | ||
| Prevention | 237 | ||
| Treatment Planning. | 237 | ||
| Preoperative Modification. | 237 | ||
| Surgical Adjuvants. | 242 | ||
| Treatment | 242 | ||
| Initial Placement. | 242 | ||
| Past Placement. | 242 | ||
| Too Great a Distance Between Implant and Tooth | 242 | ||
| Etiology | 242 | ||
| Complications | 243 | ||
| Overcontoured Crowns. | 243 | ||
| Atypical Prosthesis. | 243 | ||
| Cantilever Effect (Biomechanics). | 243 | ||
| Food Impaction. | 244 | ||
| Periodontal Complications. | 244 | ||
| Prevention | 244 | ||
| Positioning Devices. | 244 | ||
| Surgical Templates. | 244 | ||
| Treatment | 244 | ||
| Initial Placement. | 244 | ||
| Past Placement. | 244 | ||
| Mesial-Distal (“X” Axis): Implant–Implant | 244 | ||
| Lack of Implant-Implant Distance | 244 | ||
| Etiology | 244 | ||
| Complications | 244 | ||
| Bone Loss. | 244 | ||
| Lack of Interimplant Papilla. | 246 | ||
| Hygiene Difficulty. | 246 | ||
| Prosthetic Issues. | 246 | ||
| Prevention | 246 | ||
| Ideal Distance. | 246 | ||
| Osteotomy Measurement. | 247 | ||
| Treatment | 247 | ||
| Initial Placement. | 247 | ||
| Past Placement. | 248 | ||
| Implant Angulation Positioning (“Y” and “Z” Axis) | 248 | ||
| Buccolingually (“Y-Axis”) | 248 | ||
| Fp-1 and Fp-2 Prosthesis | 248 | ||
| Prevention | 248 | ||
| Cement-retained (anterior). | 248 | ||
| Screw-retained (anterior). | 249 | ||
| Posterior region (cement- or screw-retained). | 249 | ||
| Complications | 249 | ||
| Facial. | 249 | ||
| Lingual. | 249 | ||
| FP-3 Prosthesis | 249 | ||
| Prevention | 249 | ||
| Screw-retained. | 249 | ||
| Cement-retained. | 251 | ||
| Complications | 251 | ||
| Facial. | 251 | ||
| 7 Intraoperative Complications | 267 | ||
| Risk of Bleeding | 267 | ||
| Mechanism of Hemostasis | 267 | ||
| Vascular and Platelet Activity (Primary Hemostasis). | 267 | ||
| Blood Coagulation (Secondary Hemostasis). | 267 | ||
| Fibrinolysis (Tertiary Hemostasis). | 268 | ||
| Factors Contributing to Intraoperative Bleeding | 268 | ||
| Medications | 269 | ||
| Anticoagulants. | 269 | ||
| Novel Oral Anticoagulant (NOACs). | 269 | ||
| Antiplatelet Medications. | 270 | ||
| Nonsteroidal Anti-Inflammatory Drugs (NSAIDs). | 270 | ||
| Herbal Supplements. | 270 | ||
| Systemic Bleeding Disorders | 271 | ||
| Factor Disorders. | 271 | ||
| Liver Disorders. | 271 | ||
| Evaluation of the Coagulation Process | 271 | ||
| Laboratory Tests | 271 | ||
| Prothrombin Time (PT) | 271 | ||
| International Normalized Ratio (INR) | 272 | ||
| Partial Thromboplastin Time (PTT) | 272 | ||
| Bleeding Time | 272 | ||
| Platelet Count | 272 | ||
| Interuption of Anticoagulant Therapy | 272 | ||
| General Approach | 272 | ||
| Techniques to Decrease and Control Bleeding | 272 | ||
| Mechanical Methods | 272 | ||
| Positional Changes | 273 | ||
| Direct Pressure | 273 | ||
| Suturing | 273 | ||
| Clamped Vessel With Hemostat Forceps | 273 | ||
| Thermal Techniques | 274 | ||
| Electrocautery | 274 | ||
| Buzzing the Hemostat: (Electrocautery + Hemostat Ligation) | 275 | ||
| Lasers | 275 | ||
| Pharmacologic Techniques | 275 | ||
| Epinephrine | 275 | ||
| Tranexamic Acid Solution | 276 | ||
| Topical Hemostatic Agents | 276 | ||
| Active Hemostatic Agents | 277 | ||
| Thrombin | 277 | ||
| Types of Thrombin. | 278 | ||
| Advantages. | 278 | ||
| Disadvantages. | 278 | ||
| Passive Hemostatic Agents | 278 | ||
| Collagen | 279 | ||
| Bovine Collagen (OraPlug, OraTape [Salvin Dental Specialties, Inc.]). | 279 | ||
| Microfibrillar Collagen (Avitene Microfibrillar Collagen Hemostat [Davol Inc.]). | 279 | ||
| Cellulose | 279 | ||
| Resorbable Oxidized Cellulose/Fabric Meshwork (Surgicel [Ethicon US]). | 279 | ||
| Cellulose Fabric Meshwork (ActCel [Coreva Health Science, LLC]). | 279 | ||
| Regenerated Cotton Cellulose (BloodSTOP [LifeScience PLUS Inc.]). | 280 | ||
| Gelatin | 280 | ||
| Gelatin-Based Hemostatic Agents (Gelfoam [Pfizer Inc.]). | 280 | ||
| Chitosan | 281 | ||
| Chitosan-Based Hemostatic Agents (HemCon Dressing [Tricol Biomedical, Inc.]). | 281 | ||
| Mechanical | 281 | ||
| Beeswax. | 281 | ||
| Synthetic Bone Hemostat Material (Ostene [Ceremed Inc.). | 282 | ||
| Combination Agents | 282 | ||
| Combination Hemostatic Agents (FloSeal Matrix Hemostatic Sealant [Baxter Healthcare Corporation]). | 282 | ||
| Advantages. | 282 | ||
| Disadvantages. | 282 | ||
| Summary of Techniques to Decrease and Control Bleeding | 283 | ||
| Prevention/Treatment of Bleeding | 283 | ||
| Anatomic Areas | 283 | ||
| Incision/Reflection of Tissue | 283 | ||
| Anatomy/ Anatomic Variants | 283 | ||
| Mandibular Anterior: Intraosseous Vessels | 283 | ||
| Median Vascular Canal | 283 | ||
| Prevention. | 283 | ||
| 8 Intraoperative Complications | 294 | ||
| Risk of Infection | 294 | ||
| Diagnosis of an Infection | 295 | ||
| Etiology of the Infectious Process | 295 | ||
| Host Response to Infection | 296 | ||
| Impaired Host Defenses | 296 | ||
| Physiologic. | 296 | ||
| Disease Related. | 297 | ||
| Impaired Immune System. | 297 | ||
| Drug Related. | 297 | ||
| Cytoxic drug group. | 297 | ||
| Glucocorticosteroids. | 297 | ||
| Antibodies (e.g., mono- and polyclonal). | 297 | ||
| Drugs acting on immunophilins. | 297 | ||
| Signs of Infection | 297 | ||
| Vital Signs | 297 | ||
| Objective Signs | 297 | ||
| Mild vs. Severe Infection | 297 | ||
| Mild Infection. | 297 | ||
| Severe Infection. | 297 | ||
| Trismus. | 297 | ||
| Lymphadenopathy. | 297 | ||
| Dysphagia. | 297 | ||
| Dyspnea. | 298 | ||
| Definitions of Terms Related to Postoperative Infection | 298 | ||
| Stages of Infection | 298 | ||
| Cellulitis Stage | 298 | ||
| Abscess Stage | 298 | ||
| Determination of infection stage. | 299 | ||
| Routes of Infection | 299 | ||
| Lymphatic Spread of Infection | 300 | ||
| Lymph Node Examination. | 302 | ||
| Fascial Spaces of the Face (see Fig. 8.5) | 302 | ||
| Canine Space. | 302 | ||
| Buccal Space. | 302 | ||
| Masticatory Spaces | 303 | ||
| Masseteric space (and submasseteric space). | 303 | ||
| Pterygoidmandibular space. | 303 | ||
| Temporal space. | 303 | ||
| Sublingual Space. | 303 | ||
| Submental Space. | 303 | ||
| Submandibular Space. | 304 | ||
| Lateral Pharyngeal Space. | 304 | ||
| Significant Complications of Infections | 304 | ||
| Head And Neck | 304 | ||
| Osteomyelitis | 304 | ||
| Medication-Related Osteonecrosis of the Jaws (MRONJ) | 306 | ||
| Cavernous Sinus Thrombosis | 309 | ||
| Brain Abscess | 309 | ||
| Neoplasms | 310 | ||
| Treatment of Infections | 311 | ||
| Incision and Drainage | 311 | ||
| Procedure | 312 | ||
| Culture and Sensitivity | 313 | ||
| Procedure | 313 | ||
| Antibiotics Used in Implant Dentistry (Table 8.4) | 313 | ||
| Beta-Lactam Antibiotics | 313 | ||
| Penicillins | 313 | ||
| Penicillin V. | 313 | ||
| Amoxicillin. | 313 | ||
| Amoxicillin/Clavulanic Acid (Augmentin). | 313 | ||
| Cephalosporins | 314 | ||
| Cephalexin/Cefadroxil. | 314 | ||
| Macrolides | 315 | ||
| Clindamycin | 316 | ||
| Tetracyclines | 317 | ||
| Fluoroquinolones | 317 | ||
| Metronidazole | 317 | ||
| Prevention and Treatment of Infection | 317 | ||
| Prophylactic Antibiotics | 317 | ||
| The Appropriate Antibiotic for the Surgical Procedure Must Be Selected | 318 | ||
| Least Toxic Antibiotic Should Be Selected | 318 | ||
| An Appropriate Tissue Concentration of the Antibiotic Must Be Present at the Time of Surgery | 318 | ||
| Use of the Shortest Effective Antibiotic | 318 | ||
| Complications of Antibiotic Prophylaxis. | 318 | ||
| Use of Prophylactic Antibiotics in Oral Implantology. | 319 | ||
| Treatment. | 319 | ||
| Therapeutic Antibiotics in Implant Dentistry | 319 | ||
| Chlorhexidine | 319 | ||
| Use of Chlorhexidine in Oral Implantology | 319 | ||
| Sterile Technique | 319 | ||
| Sterile Field | 320 | ||
| Surgical Scrub | 320 | ||
| Summary | 320 | ||
| References | 326 | ||
| 9 Neurosensory Deficit Complications in Implant Dentistry | 329 | ||
| Anatomy | 329 | ||
| Peripheral Nerve Fiber Anatomy | 329 | ||
| Trigeminal Nerve | 329 | ||
| V1: Ophthalmic | 330 | ||
| V2: Maxillary | 330 | ||
| Nasopalatine Nerve. | 330 | ||
| Clinical significance. | 330 | ||
| Infraorbital Nerve. | 332 | ||
| Clinical significance. | 332 | ||
| Anterior Superior Alveolar Nerve. | 332 | ||
| Clinical relevance. | 332 | ||
| V3: Mandible | 332 | ||
| Inferior Alveolar Nerve. | 333 | ||
| 10 Postoperative Complications | 364 | ||
| Medical Issues | 364 | ||
| Edema (Postoperative) Surgical Swelling | 364 | ||
| Etiology | 364 | ||
| Prevention | 364 | ||
| Nonsteroidal Antiinflammatory Drugs. | 364 | ||
| Glucocorticosteroids. | 364 | ||
| Cryotherapy. | 365 | ||
| Decrease Activities. | 365 | ||
| Treatment | 365 | ||
| Ecchymosis (Bruising) | 367 | ||
| Etiology | 367 | ||
| 11 Wound Dehiscence | 402 | ||
| Classification of Incision Line Opening Complications | 402 | ||
| Morbidity Consequences of ILO With Implants and Bone Grafting | 402 | ||
| Immediate Implants | 402 | ||
| Esthetic Consequences | 402 | ||
| Postoperative Care | 402 | ||
| Classification and Types of Wound Healing | 403 | ||
| Phases of Wound Healing | 403 | ||
| Inflammatory Phase. | 403 | ||
| Proliferation Phase. | 404 | ||
| Maturation Phase. | 405 | ||
| Types of Wound Healing | 405 | ||
| Primary Intention. | 405 | ||
| Secondary Intention. | 405 | ||
| Tertiary Intention. | 406 | ||
| Factors That Affect Wound Healing/Incision Line Opening | 406 | ||
| Saliva | 406 | ||
| 12 Bone Grafting Complications | 440 | ||
| Treatment Planning | 440 | ||
| Failure to Understand Bone Resorption | 440 | ||
| Etiology. | 440 | ||
| Complication. | 440 | ||
| 13 Posterior Maxilla Complications | 499 | ||
| Anatomy | 499 | ||
| Anatomic Disadvantages to the Posterior Maxilla | 499 | ||
| Pneumatization of the Maxillary Sinus | 499 | ||
| Clinical Implication. | 499 | ||
| Ridge Width/Lingual Repositioning | 499 | ||
| Clinical Implications. | 499 | ||
| Bone Density | 499 | ||
| 14 Complications Associated With Immediate Implant Placement | 557 | ||
| General Considerations | 557 | ||
| Available Bone | 557 | ||
| Available Bone Height | 557 | ||
| Available Bone Width | 558 | ||
| Available Bone Length | 558 | ||
| Bone Angulation | 558 | ||
| Type of Prosthesis | 561 | ||
| Bone Density | 561 | ||
| Anatomic Location | 562 | ||
| Presence of Bacteria/ Existing Pathology | 562 | ||
| Biomechanical Overload Issues | 562 | ||
| Learning Curve | 562 | ||
| Implant Size | 562 | ||
| Length Relative to Tooth or Teeth Being Replaced | 562 | ||
| Implant Design | 563 | ||
| Potential Complications Related to Immediate Placement Protocol | 564 | ||
| Intraoperative Complications | 565 | ||
| Prevention Related to an Immediate Placement Protocol | 565 | ||
| Presence of Nonintact Alveolar Socket | 565 | ||
| Prevention | 565 | ||
| Thorough Pretreatment Evaluation. | 565 | ||
| Atraumatic Tooth Extraction. | 565 | ||
| Treatment Options | 566 | ||
| Abort Procedure. | 566 | ||
| Bone Grafting. | 566 | ||
| Thick five bony wall defect. | 566 | ||
| Four- to five-wall bony socket. | 566 | ||
| Barrier membrane with alloplast/freeze-dried bone. | 566 | ||
| Socket seal surgery. | 567 | ||
| Two to Three Bony Wall Defects. | 567 | ||
| One Bony Wall Defects. | 567 | ||
| Barrier membranes and guided bone regeneration. | 567 | ||
| Implant insertion and guided bone regeneration. | 568 | ||
| Inability to Achieve Primary Stability | 568 | ||
| Prevention | 569 | ||
| Complete Osteotomy Preparation in Appropriate Location and Sequence. | 569 | ||
| Underprepare Osteotomy Width and Over Prepare Osteotomy Length. | 570 | ||
| Clinically Confirm Primary Stability. | 570 | ||
| Implant design and initial stability. | 572 | ||
| Treatment Options | 572 | ||
| Bone Density. | 572 | ||
| Use of Larger Implant. | 572 | ||
| Leave Implant in Place. | 572 | ||
| Abort the Procedure. | 573 | ||
| Implant Malposition. | 573 | ||
| Postoperative Complications | 573 | ||
| Transitional Prosthesis Impingement | 573 | ||
| Neurosensory Impairment | 574 | ||
| Excessive Postoperative Pain | 574 | ||
| Patient Management: Medicolegal Considerations | 575 | ||
| Incision Line Opening | 575 | ||
| Complications Following First Stage | 575 | ||
| Bone Healing | 575 | ||
| Compromised Implant Position | 575 | ||
| Long-Term Results | 575 | ||
| Summary | 575 | ||
| References | 577 | ||
| 15 Removable Implant Complications | 580 | ||
| Complications of Overdentures for the Edentulous Patient | 580 | ||
| Not Understanding the Disadvantages of Edentulism | 580 | ||
| Continued Bone Loss | 580 | ||
| Decreased Occlusal Biting Force | 581 | ||
| Decreased Masticatory Efficiency | 581 | ||
| Increased Soft Tissue Discomfort | 582 | ||
| Systemic Consequences | 582 | ||
| Lack of Prosthesis Satisfaction | 582 | ||
| Speech Difficulty | 583 | ||
| Psychologic Impact of Edentulism | 583 | ||
| Advantages of an Implant-Supported Prosthesis (Box 15.4) | 583 | ||
| Maintenance of Existing Bone | 583 | ||
| More Ideal Occlusion | 583 | ||
| Increased Masticatory Function | 584 | ||
| Less Morbidity in Comparison to Teeth | 584 | ||
| Increased Biting Force | 584 | ||
| Improvement of Retention and Stability | 584 | ||
| Enhanced Phonetics | 584 | ||
| Improved Psychologic Health | 584 | ||
| Not Understanding the Disadvantages of a Removable Implant Prosthesis (Overdenture) | 585 | ||
| Not a Fixed Prosthesis | 585 | ||
| Need of Adequate Crown Height Space (CHS) | 585 | ||
| Maintenance | 585 | ||
| Food Impaction | 585 | ||
| Loss of Posterior Bone | 585 | ||
| Not Understanding the Wide Range of Overdenture Retention | 587 | ||
| Etiology | 587 | ||
| Prevention | 587 | ||
| Understand Overdenture Mechanics. | 587 | ||
| Treat According to Patient’s Desires. | 587 | ||
| Understand Prosthesis Movement. | 587 | ||
| Not Understanding the Concept of Prosthesis Movement | 587 | ||
| Prosthesis Movement | 588 | ||
| PM-0. | 588 | ||
| PM-2. | 588 | ||
| PM-3. | 589 | ||
| PM-4. | 589 | ||
| PM-6. | 589 | ||
| Height of the Attachment | 589 | ||
| Too Large of a Cantilever (“Hidden Cantilever”) | 590 | ||
| Etiology | 590 | ||
| Prevention | 590 | ||
| Mandibuar Overdenture Complications | 590 | ||
| Inadequate Crown Height Space | 591 | ||
| Etiology | 591 | ||
| Prevention | 591 | ||
| Poor Osseous Angulation (C-A) | 592 | ||
| Etiology | 592 | ||
| 16 Fixed Prosthodontics Complications | 631 | ||
| Biomechanics: Force-Related Issues | 631 | ||
| Screw Loosening | 631 | ||
| Etiology | 631 | ||
| External Force Factors (Box 16.1). | 631 | ||
| Cantilevers/Increased Crown Height Space. | 631 | ||
| Parafunction. | 632 | ||
| Splinted vs. Nonsplinted Crowns. | 633 | ||
| Crown/Abutment Not Fully Seated. | 633 | ||
| Insufficient/Excessive Torqueing. | 633 | ||
| Screw Diameter. | 633 | ||
| Screw Material. | 633 | ||
| Component Fit. | 635 | ||
| Implant Design. | 636 | ||
| Screw vs. Cement Retained. | 637 | ||
| Anatomic Location. | 638 | ||
| Prevention | 638 | ||
| Decreased Force. | 638 | ||
| Prosthetic Design. | 638 | ||
| Ideal Preload. | 639 | ||
| Screw Tightening Sequence. | 639 | ||
| Settling Effect. | 639 | ||
| Torque Under Moist Conditions. | 640 | ||
| Wider Implant Bodies. | 640 | ||
| Treatment | 640 | ||
| Implant Movement. | 640 | ||
| Abutment Screw Movement | 640 | ||
| Option 1. | 640 | ||
| Option 2. | 640 | ||
| Screw Fracture | 643 | ||
| Etiology | 643 | ||
| Prevention | 643 | ||
| Immediate Treatment of Loose Screw. | 643 | ||
| Treatment | 644 | ||
| Explorer. | 644 | ||
| Ultrasonic/cavitron Device. | 644 | ||
| Round Bur (205LN). | 645 | ||
| Inverted Cone Bur (≈ Bur). | 645 | ||
| Slot the Top of Screw. | 645 | ||
| Manufactured Retrieval Instruments. | 645 | ||
| Excessive Torque Applied to the Abutment Screw/Prosthesis | 645 | ||
| Etiology | 645 | ||
| Prevention | 645 | ||
| Ideal Torque. | 645 | ||
| Consistent Torque. | 646 | ||
| Prostheses Fractures/Occlusal Material Fracture | 646 | ||
| Etiology | 646 | ||
| Material. | 648 | ||
| Cement vs. Screw. | 649 | ||
| Prevention/Treatment | 649 | ||
| Reduce Force. | 649 | ||
| Ideal Porcelain Thickness. | 650 | ||
| Uncemented Prosthesis | 651 | ||
| Etiology | 651 | ||
| Implant Abutment. | 651 | ||
| Prevention | 651 | ||
| Retention/Resistance Form. | 651 | ||
| Abutment Taper. | 651 | ||
| Abutment Surface Area. | 652 | ||
| Abutment Height. | 652 | ||
| Geometry of Abutment. | 652 | ||
| Abutment Surface Texture. | 653 | ||
| Abutment Resistance Form. | 653 | ||
| Prosthesis Complications | 656 | ||
| Improper Crown Margin | 656 | ||
| Etiology | 656 | ||
| Position. | 656 | ||
| 17 Occlusion Complications | 711 | ||
| Differences Between Natural Teeth and Dental Implants | 711 | ||
| Peripheral Feedback System | 711 | ||
| Teeth | 711 | ||
| Implants | 712 | ||
| Force-Related Factors | 713 | ||
| Vertical Occlusal Loads | 713 | ||
| Tooth. | 713 | ||
| Implant. | 713 | ||
| Nonvertical Occlusal Loads (Horizontal) | 714 | ||
| Tooth. | 714 | ||
| Implant. | 715 | ||
| Excessive Contacts/Occlusal Overloading | 715 | ||
| Clinical Significance. | 715 | ||
| Masticatory | 715 | ||
| Masticatory Efficiency | 715 | ||
| 18 Periodontal and Maintenance Complications | 771 | ||
| Peri-Implant Disease | 771 | ||
| Diagnosis | 771 | ||
| Complication | 771 | ||
| Etiology | 771 | ||
| Prevention | 772 | ||
| Evaluation of Periodontal Indices | 773 | ||
| Mobility | 773 | ||
| Natural Tooth vs. Implant Support Systems. | 773 | ||
| Tooth movement. | 773 | ||
| Implant movement. | 774 | ||
| Evaluating Dental Implant Mobility | 775 | ||
| Mirror handles. | 775 | ||
| Periotest. | 775 | ||
| Osstell. | 776 | ||
| Plaque Biofilm | 776 | ||
| 19 Medicolegal Aspects of Implant Dentistry | 827 | ||
| Litigation Process Part 1 | 828 | ||
| Presuit | 828 | ||
| Notification | 828 | ||
| Records Request. | 828 | ||
| Time to respond. | 829 | ||
| Documentation of records request. | 829 | ||
| Official Notice Letter. | 829 | ||
| Requirements After Receiving Notice | 829 | ||
| Responsibility of the Insured Dentist | 829 | ||
| Proactive response. | 829 | ||
| Cooperation. | 832 | ||
| Responsibility of Insurance Carrier | 832 | ||
| Defense and indemnity. | 832 | ||
| Assignment of counsel. | 832 | ||
| Consent to settle. | 832 | ||
| Appointment of Legal Council | 832 | ||
| Defense Counsel Appointment. | 832 | ||
| Personal Counsel. | 832 | ||
| Plaintiff’s Requirements for the Filing of a Lawsuit | 832 | ||
| Affidavit of Merit. | 833 | ||
| Statute of Limitations. | 833 | ||
| Filing of the Lawsuit | 833 | ||
| Complaint. | 833 | ||
| Service of Process. | 835 | ||
| Summons. | 835 | ||
| Response to the Complaint. | 835 | ||
| Miscellaneous Presuit Recommendations | 835 | ||
| Discussing the Claim. | 835 | ||
| Do Not Attempt to Communicate With Patient/Plaintiff Lawyer. | 835 | ||
| Calling Subsequent Providers. | 835 | ||
| Secure All Records. | 838 | ||
| Uninsured Defendant. | 838 | ||
| Litigation Process Part 2 | 838 | ||
| Discovery Phase | 838 | ||
| Forms of Discovery | 838 | ||
| Interrogatories. | 838 | ||
| Requests for Disclosure. | 838 | ||
| Production of Documents and Things. | 838 | ||
| Request for Admissions. | 838 | ||
| Expert Reports. | 838 | ||
| Depositions. | 838 | ||
| Preparation for the Deposition | 844 | ||
| Doctor/Defendant Testimony at Deposition. | 844 | ||
| Patient/Plaintiff Testimony at Deposition. | 844 | ||
| Mediation | 845 | ||
| Pretrial Modes of Disposition | 845 | ||
| Motion for Summary Judgment. | 845 | ||
| Motion to Dismiss. | 845 | ||
| Voluntary Nonsuit. | 845 | ||
| Settlement. | 845 | ||
| Settling a Lawsuit | 846 | ||
| Ramification of Settling a Malpractice Case. | 846 | ||
| Consent to Settle Policy. | 846 | ||
| Potential Nonsettlement Ramifications. | 846 | ||
| Litigation Process Part 3 | 846 | ||
| Malpractice Trial | 846 | ||
| Court Docket | 847 | ||
| Continuance | 847 | ||
| Civil Courtroom Layout | 847 | ||
| Jury Selection | 847 | ||
| Opening Statement | 847 | ||
| Patient/Plaintiff Case Presentation | 847 | ||
| Witness Order | 850 | ||
| Expert Witnesses | 850 | ||
| Impeachment | 850 | ||
| Inadmissible Information | 850 | ||
| Closing Arguments | 850 | ||
| Deliberation | 851 | ||
| Verdict | 851 | ||
| Damages | 851 | ||
| Comparative Fault | 851 | ||
| Postverdict Adjustments | 851 | ||
| Excess Verdict | 851 | ||
| Types of Malpractice Insurance | 851 | ||
| Occurrence. | 851 | ||
| Claims-Made. | 852 | ||
| Limits of Malpractice Insurance | 852 | ||
| Entity Coverage | 852 | ||
| Separate Limits Coverage. | 852 | ||
| Shared Limits Coverage. | 852 | ||
| Reporting to National Data Base | 852 | ||
| State Dental Licensure Complaints | 852 | ||
| Legal Representation. | 853 | ||
| Avoiding Lawsuits | 853 | ||
| Maintaining Accurate, Concise Dental Records | 853 | ||
| Potential Complications | 854 | ||
| Inadequate Documentation Concerning Implant Procedures. | 854 | ||
| Altering, Adding, Deleting Information From the Patient Records. | 854 | ||
| Comprehensive Medical-Dental History Forms | 854 | ||
| Index | 866 | ||
| A | 866 | ||
| B | 867 | ||
| C | 869 | ||
| D | 871 | ||
| E | 873 | ||
| F | 873 | ||
| G | 875 | ||
| H | 875 | ||
| I | 875 | ||
| J | 878 | ||
| K | 878 | ||
| L | 878 | ||
| M | 878 | ||
| N | 881 | ||
| O | 882 | ||
| P | 883 | ||
| Q | 886 | ||
| R | 886 | ||
| S | 887 | ||
| T | 889 | ||
| U | 890 | ||
| V | 890 | ||
| W | 891 | ||
| X | 891 | ||
| Y | 891 | ||
| Z | 891 |