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Implant Dentistry - E-Book

Implant Dentistry - E-Book

Arun K. Garg

(2009)

Additional Information

Book Details

Abstract

Get the practical information you need to add dental implants to your practice! Dr. Arun Garg, a leading dental implant educator, clinician, and researcher, uses a clear, succinct writing style to inform and guide you through the full scope of dental implantology. A patient-focused approach covers surgical templates and techniques, sterilization, pharmacology, bone biology, complications, and more. A robust appendix offers handy information including insurance codes, consent forms, surgical tray set-ups, and food recipes for patients recovering from surgery.

  • A practical yet comprehensive approach covers all aspects of implant dentistry from patient history to post-operative care, with minimal use of jargon, in an easy-to-read format.
  • Outstanding photos help you visualize and understand patient outcomes.
  • An appendix on post-operative instructions includes a unique section on delicious yet recovery-specific recipes.

Table of Contents

Section Title Page Action Price
Front cover cover
Half title page i
Implant Dentistry iii
Copyright page iv
Preface v
Acknowledgments vii
New to this Edition ix
Outstanding photos and illustrations! ix
Keep up with the innovations, techniques, and procedures of oral implantology with these new chapters! x
Practical information for you and your patients! xi
Table of Contents xii
1 The Historical Development of Dental Implants 1
Dentistry and Dental Implants in the Pre-Modern Era 3
Pain Relief, Better Function, and Pretty Smiles 3
Scientific and Technical Advancements 3
Modern History of Implants: 1700-1900 5
Modern History of Implants: 1900-1980 5
Modern History of Implants: 1980-Present 6
SUMMARY 12
REFERENCES 13
2 Basic Armamentarium for Implant Surgery 15
Bite Block 16
Curette 16
Elevator 17
Forceps 17
Extraction Forceps 18
Hemostat 18
Needle Holder 18
Periosteal Elevator 19
Retractor 19
Rongeurs 20
Scalpel 20
Scissors 21
Tissue Forceps 21
Suction Tips 21
Implant Guiding System 22
Surgical Technique 22
SUMMARY 25
REFERENCES 25
3 Patient Medical History for Dental Implant Surgery 27
Dental and Medical History Form 28
General Information 28
Medical History 28
Diabetes Mellitus 35
Blood Dyscrasias 36
Regular Intake of Corticosteroid or Immunosuppressive Drugs 36
Cardiovascular Ailments and Hypertension 37
Cancer Therapies: Radiation, Chemotherapy 38
Alcohol, Drug, and Tobacco Addiction 39
Pregnancy, Nursing, Menstrual Conditions, Birth Control Pills/Chemicals, and Menopause 39
Osteoporosis 40
Dental History 40
Patient Interview 41
Medical Consultation 42
SUMMARY 42
REFERENCES 42
4 Anatomic Considerations in Oral Implantology 47
Bone Structures of the Oral Cavity 48
Maxilla 48
Mandible 50
Sensory and Motor Innervations of the Oral Cavity 52
The Trigeminal Nerve (V) 52
The Facial Nerve (VII) 54
Vasculature of the Oral Cavity 54
The Facial Artery 54
The Maxillary Artery 55
The Facial Vein 55
The Maxillary Vein 55
SUMMARY 56
REFERENCES 56
5 Sterilization, Disinfection, and Asepsis in Implantology 59
Operating Room 60
Surgical Instrument Care 60
Dental Team 61
Surgical Scrub 61
Surgical Attire 62
Patient Preparation 63
Preoperative Preparation 63
Preparation of the Surgical Field 63
SUMMARY 63
REFERENCES 64
6 Radiographic Modalities for Dental Implants 67
Intraoral Films 68
Panoramic Radiographs 69
Lateral Cephalometric Radiographs 71
Plain (Conventional) Tomography 72
Computed Tomography 72
Cone Beam CT 73
3G: Variable and Multiple Fields of View 77
Digital Subtraction Radiography 77
Magnetic Resonance Imaging 79
SUMMARY 79
REFERENCES 80
7 Implant Surgical Templates in Implant Dentistry 83
Surgical Templates: The Literature 84
The Development of Surgical Templates 84
Stability of the Surgical Template 86
The Edentulous Maxilla/Mandible and Immediate Loading 87
Surgical Templates: An Overview 88
Surgical Templates for Fully Edentulous Patients 88
Surgical Templates for Partially Edentulous Patients 90
Method I 91
Method II 91
Computerized Surgical Template Systems 91
The Compu-Guide Surgical Template System 92
SurgiGuides: The Bone-Supported Concept 92
NobelGuide 93
SUMMARY 94
REFERENCES 94
8 Generalized Surgical Technique for Endosseous Root-Form Implants 97
Incision Design 98
Implant Handpiece Usage and Irrigation 99
Preparation of the Implant Bed 99
Postoperative Course 99
Exposure of the Implants 100
SUMMARY 102
9 Wound Healing and Suturing Techniques in Dental Implant Surgery 103
Surgical Wounds and Wound Healing 104
Types of Wounds and Wound Healing 104
The Wound Healing Process 104
Hemostasis 104
Inflammation 105
Proliferation (Granulation) 105
Remodeling (Maturation) 106
Factors Affecting Wound Healing 106
Suture Materials 106
Types of Sutures 106
Nonresorbable Sutures. 107
Resorbable Sutures. 107
Suturing Techniques 107
Surgical Knotting Techniques 110
Square Knot. 111
Slip Knot. 111
Surgeon’s Knot. 111
SUMMARY 111
REFERENCES 111
10 Pharmacological Agents in Implant Dentistry 113
Inflammatory Pain 114
Aspirin-Like Analgesics 114
Opioid Analgesics 115
Glucocorticosteroids 116
Local Anesthetics 118
Anxiolytic Medications and Oral Conscious Sedation 119
Documentation 121
Equipment and Supplies 121
Training 122
Potential Problems and Complications 122
Antibiotics 122
SUMMARY 123
REFERENCES 123
11 Anterior Single-Tooth Implants in the Esthetic Zone 127
Pretreatment Guidelines 129
Soft Tissue Considerations 129
Bone Dimension 129
Root Morphology 130
Site Preparation Using Osteotomes 130
Implant Placement 131
Flap Design 134
Prosthetic Considerations 135
Final Restoration 136
Two-Stage vs. One-Stage Protocols in the Anterior Maxilla 136
Current Two-Stage Approach to Single-Tooth Implants in the Anterior Maxilla 136
Original Techniques and New Technologies for Implant Placement and Restoration 138
Immediate Placement and Loading of Implants in Extraction Sites in the Esthetic Zone 139
Discussion 140
Case Management 141
Summary 142
REFERENCES 142
12 Implant Exposure Techniques at Second-Stage Surgery 145
General Considerations for Second-Stage Surgery 146
Second-Stage Surgery Techniques 147
Excisional Techniques 148
Incisional Techniques Without Tissue Transference 149
Incisional Techniques With Tissue Transference 149
Summary 150
REFERENCES 150
13 Impression Materials, Concepts, and Techniques for Dental Implants 153
Classification of Impression Materials 154
Requirements for Implant Prosthetics 154
Nonelastomeric Impression Materials 155
Hydrocolloids 156
Elastomeric Impression Materials 157
Impression Technique for Osseointegrated Implants 159
Summary 161
REFERENCES 161
14 Principles of Occlusion in Implant Dentistry 163
Ideal Occlusion 164
Balanced Occlusion 164
Lingualized Occlusion 165
Mutually Protected Occlusion 166
Group Function Occlusion 166
Different Types of Occlusal Loads 167
Occlusal Factors Specific to Osseointegrated Implants 168
Bruxism and Occlusion 169
Signs of Unstable Occlusion 169
Trial Therapy for the Bruxing Patient 169
Occlusal Triggers to Bruxing Habits 169
Bruxism and Contraindications for Implants 170
SUMMARY 170
REFERENCES 171
15 Immediate Loading of Implants in the Edentulous Patient 173
Introduction 174
Immediate Extractions, Implant Placement, Grafting, and Loading 175
Immediate Implants in Extraction Sites 178
Immediate Loading of Implants in Extraction Sites 178
Immediate Loading in Extraction, Implantation, and Augmented Sites 178
The Mandible: Immediate and Early Loading Protocols 179
The Maxilla: Immediate and Early Loading Protocols 182
Wound Healing and Tissue Augmentation 182
Platelet-Rich Plasma 182
Bone Grafting Materials 183
Membrane Barriers for Guided Tissue Regeneration 184
Immediate Loading: Abutment Types and Rationale for Different Implant Designs 185
General Implant Designs 185
Implant Designs: Mandible 186
SUMMARY 186
REFERENCES 186
16 Bone Biology, Osseointegration, and Bone Grafting 193
Bone Biology 194
Bone Cells 194
Bone Metabolism 194
Bone Structure 195
Osseous Repair (Bone Modeling and Remodeling) 197
Osseointegration 200
Osteophyllic Phase 200
Osteoconductive Phase 200
Osteoadaptive Phase 200
Biological Factors Related to Failure of Osseointegrated Oral Implants 201
Systemic Factors 202
Age and Genetics 202
General Health 202
Smoking 202
Local Factors 202
Bone Quality, Quantity, and Anatomical Location 202
Radiation Therapy 202
Operator-Related Factors 203
Operator Experience 203
Operator Technique (surgical trauma, bacterial contamination) 203
Operator Policy 203
Autogenous Bone Graft Techniques 203
Sinus Augmentation Procedures 203
Maxillary Sinus Anatomy 203
Bone Grafting Materials 204
Surgical Techniques 206
Intraoperative Bleeding 206
Grafting Procedure 206
Nasal Floor and Block Grafts for Premaxilla Augmentation 206
SUMMARY 208
REFERENCES 208
17 Considerations for Implants in the Geriatric Patient 213
Age-related Considerations 214
Discussion 215
SUMMARY 216
REFERENCES 217
18 Peri-implantitis: 219
Soft Tissue–implant Interface 220
Normal Flora within the Oral Cavity 221
Development of Subgingival Microflora Around Dental Implants 222
Prevention of Peri-implantitis 224
Patient Home Care 224
Follow-up Treatment 225
Diagnosis of Peri-implantitis 225
Treating the Ailing and Failing Implant 226
SUMMARY 228
REFERENCES 228
19 Guidelines for Handling Complications Associated With Implant Surgical Procedures 231
Postsurgical Complications 232
Chronic Pain 232
Altered/Lost Sensation 232
Persistent Edema 233
Hemorrhage/Hematoma 233
Peri-implant Complications 234
Soft Tissue Compromise (Peri-implant Mucositis) 234
Peri-implant Infections (Peri-implantitis) 234
Peri-implant Bone Loss 235
Damage to Adjacent Teeth 236
Retention of Excess Cement 236
Important Surgical Complications 237
With Split-Ridge Techniques 237
With Inferior Alveolar Nerve Repositioning 237
Sinus Membrane Perforations 238
Fractured Mandible 238
Tool/Component Aspirations 239
Mechanical Complications 239
Screw Loosening/Fracture 239
Implant Fracture 240
Esthetic/Prosthetic Complications 241
Gingival Recession 241
Improper Implant Positioning/Alignment 241
Fractured Prostheses 242
SUMMARY 242
REFERENCES 243
Glossary 245
A 245
B 248
C 251
D 254
E 256
F 258
G 260
H 261
I 262
J 266
K 266
L 266
M 267
O 270
P 272
Q 276
R 276
S 278
T 282
U 284
V 284
W 285
X 285
Y 285
Z 285
appendix A Useful Dental Codes for Dental Implant Surgery and Related Procedures 287
4265 biologic materials to aid in soft and osseous tissue regeneration 287
4266 guided tissue regeneration—resorbable barrier, per site 287
4273 subepithelial connective tissue graft procedures, per tooth 287
6010 surgical placement of implant body: endosteal implant 287
6040 surgical placement: eposteal implant 288
6050 surgical placement: transosteal implant 288
6080 implant maintenance procedures, including removal of prosthesis, cleansing of prosthesis and abutments, and reinsertion of prosthesis 288
6090 repair implant supported prosthesis, by report 288
6095 repair implant abutment, by report 288
6100 implant removal, by report 288
6190 radiographic/surgical implant index, by report 288
6199 unspecified implant procedure, by report 288
7941 osteotomy—mandibular rami 288
7943 osteotomy—mandibular rami with bone graft; includes obtaining the graft 288
7944 osteotomy—segmented or subapical—per sextant or quadrant 288
7945 osteotomy—body of mandible 288
7250 surgical removal of residual tooth roots (cutting procedure) 288
7950 osseous, osteoperiosteal, or cartilage graft of the mandible or facial bones—autogenous or nonautogenous, by report 288
7953 bone replacement graft for ridge preservation—per site 288
7995 synthetic graft—mandible or facial bones, by report 289
7996 implant-mandible for augmentation purposes (excluding alveolar ridge), by report 289
7999 unspecified oral surgery procedure, by report 289
9230 analgesia, anxiolysis, inhalation of nitrous oxide 289
9241 intravenous conscious sedation/analgesia—first 30 minutes 289
9242 intravenous conscious sedation/analgesia—each additional 15 minutes 289
9248 non-intravenous conscious sedation 289
Useful Codes for Dental Implant Prosthetics and Related Procedures 289
6053 implant/abutment-supported removable denture for completely edentulous arch 289
6054 implant/abutment-supported removable denture for partially edentulous arch 289
6055 dental implant supported connecting bar 289
6056 prefabricated abutment—includes placement 289
6057 custom abutment—includes placement 289
6058 abutment-supported porcelain/ceramic crown 289
6059 abutment-supported porcelain fused to metal crown (high noble metal) 289
6060 abutment-supported porcelain fused to metal crown (predominantly base metal) 290
6061 abutment-supported porcelain fused to metal crown (noble metal) 290
6062 abutment-supported cast metal crown (high noble metal) 290
6063 abutment-supported cast metal crown (predominantly base metal) 290
6064 abutment-supported cast metal crown (noble metal) 290
6094 abutment-supported crown—(titanium) 290
6065 implant-supported porcelain/ceramic crown 290
6066 implant-supported porcelain fused to metal crown (titanium, titanium alloy, high noble metal) 290
6067 implant-supported metal crown (titanium, titanium alloy, high noble metal) 290
6068 abutment-supported retainer for porcelain/ceramic FPD 290
6069 abutment-supported retainer for porcelain fused to metal FPD (high noble metal) 290
6070 abutment-supported retainer for porcelain fused to metal FPD (predominantly base metal) 290
6071 abutment-supported retainer for porcelain fused to metal FPD (noble metal) 290
6072 abutment-supported retainer for cast metal FPD (high noble metal) 291
6073 abutment-supported retainer for cast metal FPD (predominantly base metal) 291
6074 abutment-supported retainer for cast metal FPD (noble metal) 291
6194 abutment-supported retainer crown for FPD—(titanium) 291
6075 implant-supported retainer for ceramic FPD 291
6076 implant-supported retainer for porcelain fused to metal FPD (titanium, titanium alloy, or high noble metal) 291
6077 implant-supported retainer for cast metal FPD (titanium, titanium alloy, or high noble metal) 291
6078 implant/abutment-supported fixed denture for completely edentulous arch 291
6079 implant/abutment-supported fixed denture for partially edentulous arch 291
appendix B Consent Form: Dental Implant(s) 293
Part 1—Patient and Doctor Information 293
Part 2—Details of Consent 293
Condition 293
Procedure—Dental Implant 293
Alternatives 294
Consequences of not Having Procedure Performed 294
Other Procedures 294
Risks 294
Drugs, Medications, and Anesthesia 295
Implant Database 295
No guarantee 295
Part 3—My Responsibility 295
Part 4—Miscellaneous 296
Photography 296
Fees 296
Part 5—Signature 296
Understanding 296
appendix C Surgical Trays 297
Extraction Setup Kits and Instruments 297
Additional Instruments 297
Ridge Preservation Setup 298
Implant Surgical Setup 298
Soft Tissue Grafting Setup 298
Sinus Grafting Setup 298
Ridge Splitting Setup 298
Postoperative Setup 299
Possible Infection or Dry Socket Setup 299
appendix D Postoperative Instructions and Menus for Patients of Implant Surgery 301
Section 1. Easy Postoperative Care 301
Bleeding, Pain, and Swelling 301
Immediately After Surgery 301
Bleeding 301
Swelling 301
Pain 302
Cold Then Warm 302
Ongoing Oral Hygiene 302
Diet 302
Maintain Proper Diet 302
Wearing Your Prosthesis 302
Activity 302
Postop Care Recap 302
Section 2. The First 24 Hours 303
BEVERAGES 303
MAIN COURSES 305
DESSERTS 307
Section 3. Days 2-5 308
BEVERAGES 308
BREAKFAST 309
SOUPS 310
LUNCH AND DINNER 312
DESSERTS 313
Section 4. Days 6 to 14 314
MAIN COURSES 314
Day 14 and Beyond 317
Fitness 101 317
Five Pillars of Fitness 317
Strength 317
Push-Ups 317
Crunches 317
Squats 318
Lunges 318
Leg Lift 318
Lifestyle Activities That Encourage Strength: Weightlifting, Swimming, Rowing 318
Agility 318
Shuttle Run 318
Ski Hops 318
Broad Jump 318
One-Foot Balance 319
Figure 8 Pattern 319
Lifestyle Activities That Encourage Agility: Soccer, Football, Tennis, Badminton, Basketball 319
Flexibility 319
Toe Touch 319
Chest Lift 319
Shoulder Roll 319
Knee Hug 319
Side Stretch 320
Lifestyle Activities That Encourage Flexibility: Yoga, Tai Chi, Dance/Ballet, Stretching 320
Cardiovascular 320
Jumping Rope 320
Swimming 320
Fast Walking 320
Squash/Tennis 320
Walking Stairs 321
Lifestyle Activities That Encourage Cardio Development: Cycling, Running/Jogging, Boxing, Soccer, Dancing Vigorously, Trampoline Jumping, Gym Activities—Treadmill and Elliptical, As Well As Tennis and Squash, of Course 321
Endurance 321
Lifestyle Activities That Encourage Endurance: Swimming, Bicycling, Walking Briskly, Tennis, Volleyball, Rowing, Dancing, Climbing Stairs or Hills, Skiing, Hiking, Jogging 321
ABCs of Vitamins and Nutrition 321
Vitamin A 321
Vitamin B1 321
Vitamin B2 321
Vitamin B3 321
Vitamin B4 322
Vitamin B5 322
Vitamin B6 322
Vitamin B9 322
Vitamin B12 322
Vitamin C 322
Vitamin D 322
Vitamin E 322
Vitamin K 322
Top 5 Minerals 322
5. Potassium 322
4. Iron 322
3. Sodium 322
2. Zinc 323
1. Calcium 323
Balanced Diet 323
Protein Power 323
Four Tips for a Protein-Packed Day 323
Index 325
A 325
B 326
C 327
D 328
E 329
F 330
G 330
H 330
I 331
J 331
K 331
L 332
M 332
N 333
O 333
P 334
R 335
S 336
T 337
U 338
V 338
W 338
X 338
Y 338
Z 338