Quick Reference to Dental Implant Surgery

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.

1

Case Selection and Diagnosis

Part A: Medical Consideration in Implant Dentistry

1 Commonly Ordered Blood Tests in Implant Dentistry¹

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)

A chronic autoimmune disease affecting the exocrine glands, primarily the salivary and lacrimal glands. The etiology of SS is far from being under-stood.

The most common symptoms of SS are extreme tiredness, along with dry eyes (keratoconjunctivitis sicca) and dry mouth (xerostomia).

Xerostomia can eventually lead to difficulty in swallowing, severe and progressive tooth caries, or oral infections.

Currently, there is no cure for SS, and treatment is mainly palliative.

Literature on implant performance in patients with SS is scarce. There are no controlled studies available, and only one case series