Dental Implants and Endodontic Procedures

Question 1

Dental Implants Overview

Answer 1

Dental implants are titanium posts surgically implanted into the bone to hold artificial teeth or abutments. This type of restoration represents the closest simulation to tooth root form and natural teeth.

With an implant, artificial teeth are anchored to surgically embedded tissue or bone. This specialty incorporates principles from both fixed and removable prosthodontics in conjunction with the use of bone-anchored implants.

Question 2

Preliminary evaluations for implants

Answer 2

a seriers of evaluation must be made to determine whether a patient can receive implants.

proper surgical preparation must be undertaken to perform implant surger

-Psychological evaluation: The dentist assesses the patient’s attitude, ability to cooperate during complex procedures, and overall outlook on dental treatment.

-Dental Evaluation: the dentist evaluates the condition of the teeth, soft tissues, areas of attached and unattached tissue, and height and width of edentulous alveolar bone ridge.

• Medical evaluationL the dentist asseses any existing medical conditions that could worsen as a result od stress of implant surgery.

-Radiographs: panoramic and cephalometric radiographs, as well as tomograms, are needed to evaluate the height, width, and quality of bone.

-Preliminary impressions: a surgical stent is made.

Question 3

Consent forms

Answer 3

in addition, written informed patient consent must be obtained prior to the procedure. The consent form should include the items listed here.

1. backdrop information on implants
2. complications of implant surgery
3. prognosis
4. time frame
   5.home care
   6.follow up appointments

Question 4

Dental Implants: Indications and Contraindications

Answer 4

Having a dental implant placed requires commitment on the patient’s part. Care and maintenance of the implant by the patient throughout all phases of treatment is essential for long-term success. It is necessary for the dental team to educate the patient about the risks, rewards, expectations, maintenance, and hygiene required for a successful dental implant outcome.

There are several indications for, and coraindications to, the use of dental implants.

Indications for Dental Implant Use Contraindications for Dental Implant Use 👍🏻

• To increase the support, stability, and patient satisfaction for a full lower denture
• To increase the patient’s comfort in chewing
• To increase the patient’s confidence in smiling and speaking
• To increase the patient’s overall psychological health
• To replace one or more teeth as single nits with crowns
• To improve aesthetics
• To provide support for a partial denture

Contraindications for dental implant use👎🏻

• they require a greater financial investment
• treatment time can take up to nne months
• there is a risk of infection and other complication
• implant might loosen and require replacement
  *Impant procedures might be challenging for some patients

*Bruxism ( involuntary cleanching or grinding of teeh) often is a component of failed implants.

• Patients with certain medical complications should not have implants.

Question 5

Endosteal implants

Answer 5

Endosteal implants also are referred to as ossseointegrated implants becuase the fixture bonds to the bone through the process of ossseointegration.

The endosteal implant process requires two surgeries.

First Surgery
* The implant fixture is placed in receptor sites in the jawbone at predetermined locations.
* The mucosa is sutured over the fixtures.
* Over a period of three to six months, the fixture bonds to the bone.

Second surgery
* the implant fixture is exposed and the abutment screw is connected to the anchor

• the implant protrudes through the mucosa and connects the fixture to the prosthesis
• the patient begin the restorative phase.

Question 6

subperiosteal implants

Answer 6

A second type of implant is a superiosteal implant. In this type of implant, a metal frame is placed under the periosteum but on top of the bone.

A subperiosteal implant requires two surgeries.
First Surgery
* The alveolar ridge is exposed and impressions are taken.
* The tissue is repositioned over the ridge and sutured back into place.
* The impression is sent to the laboratory, where a metal frame with posts is fabricated.

Second Surgery
* Three to six months of healing time is required between the first and second surgeries.
* Sterile surgical conditions are enforced during the procedure.
* The alveolar ridge is surgically exposed.
* The metal frame is placed over the ridge.
* With the frame in place, the tissues are repositioned and sutured into place.

Question 7

Transosteal implants

Answer 7

A third type id implant is a Transosteal implants. These implants are primarily used patients with severely resorbed ridges. The implant is inserted through the inferior border of the mandible and into the edentulous area.

Implants also can be used with dentures; in these cases, several implants are placed. During another appointment, 2-6 months later, tthe denture is secured to the implant.

Question 8

Maintenance of Dental Implants

Answer 8

Patients must be instructed how to properly care for and remove plaque from implants.

Dental implants can be maintained using the following home-care devices:
-Toothbrushes (manual or electric)
-Single-tufted toothbrushes
Partial-denture clasp brushes
-Interproximal brushes
-Dental-implant floss
-Floss

Question 9

Regular Office Visits

Answer 9

Patients receiving implants require routine follow-up office visits. Patient should be scheduled ar regular intervals for a variety of maintenance procedures.
1: Examinations
2: Radiographs
3: Prophylaxis
4: Removal of fixed components
5: Replacement of components
6:Relines and remakes as recommended

Question 10

Endodontics

Answer 10

Endodontics is the specialty of dentistry that manages the prevention, diagnosis, and treatment of the dental pulp and the periradicular tissues surrounding the root of the tooth.

Through Endodontics treatment or the root canal the dentist can retain the natural tooth in the arch and maintain the oral health of the patients. This process is necessary when the pulp of the tooth has become infected and threatens the health of the tooth and the surrounding tissues.

Question 11

Pulpal nerve damage

Answer 11

Pulpal nerve damage is usually the result of one of the following:
- physical irritation
- trauma

The signs and symptoms of plural nerve damage including:
- Pai or occlusion
- pain duig mastication
- sensitivity to hot or cold drinks
-facial swelling.

Question 12

Diagonostic conclusions

Answer 12

Diagonostic tests helps the dentist make conclusions about the condition of the pulp.

• Normal pulp: no subjective symptoms or objective signs are noted. The tooth responds normally to sensory stimuli, and health layer of dentin surrounds the pupl.

-Pulpitis: The pulp tissues have become inflamed

• Reversible pulpitis: the pulp is irritated and the patient is experiencing pain in response to thermal stimuli

*Irrerversible Pulpitis: the tooth displays symptoms of lingering pain

• periradicular abscess: The pulp is irritated and patient is experiencing pain in response to thermal stimuli.
• periodontal abscess: The tooth displays symptoms of lingering pain.
• periradicular cystz: The inflammatory reaction to pulpal infection can be chronic or acute onset with pain, tenderness of tooth in response to pressure, pus formation, and swelling of the tissues.

-pulp fibrosis: This inflammatory reactions is frequently caused by bacteria trapped in the periodontal sulcus. A patient will experience rapid onset of pain and tenderness of the tooth in response to pressure ,puse formation and swelling.

• nercotic tooth: This type of cyst develops at or near the root of the necrotic tooth. The cyst develops as an inflammatory response to pulpral infection and necrosis of the pulp.

Question 13

Radipgraphs

Answer 13

Several radiographs are used throughout endodontic diagnosis and treatment, including:

• Initial radiograph: taken for diagnosis
• Working-length film: used to determine the length of the canal
• Final-instrumentation film: used to determine the length of the canal
• Root-canal completion film: taken after the tooth has been temporized
• Recall films: taken at evaluations

Endodontic films must show 4 to 5 mm beyond the apex of the tooth and the surrounding bone or pathologic condition. They must present an accurate image of the tooth without elongation or foreshortening and must exhibit good contrast so that all pertinent structures are readily identifiable.

Question 14

Diagnostic tests

Answer 14

A number of specific diagnostics tests are performed for endoodontic diagnosis.

• Percussion tests: are used to determine whether the inflammatory process has extended into the periodical tissues. The dentist taps on the incisal or occlusal surface with the end of the mouth mirror handle held parallel to the long axis of the tooth.

Papation tests: are diagnostic tests used to determine if the inflammatory process has extended into the periapical tissues. The dentist applied firm pressure to the mucosa above the apex of the root.

Question 15

Thermal sensitivity

Answer 15

Thermal sensitivity tests are another types if diagnostics test performed for endodontic diagnosis

-Cold: ice, dray ice, or ethyi chloride is used to determine the response of the tooth to cold.

-Heat: a piece of gutta percha or an instrument handle is heated and applied to the facial surface of the tooth to determine the response of the tooth to heat.

Question 16

Thermal sensitivity readings

Answer 16

several factors might influence Thermal sensitivity readings:

-The patient has extensive restorations

• the patient has teeth with more than one canal

-failing pulp produces a variety of response

-Control teeth don’t respond as anticipated

-There is moisture on the tooth during testing
-The batteries in the tester are week

Question 17

Electric pulp testing

Answer 17

Necrotic pulp: dead or damaged pulp resulting from infection.
Necrotic pulp will not respond to cold or heat.

Electric pulp testing: test that involves a small electrical stimulus delivered to the pulp.

Electric pulp testing is also performed for endodontic diagnosis. Electric pulp testing invlves a small electric stimulus delivered to the pulp. This test is used to determine whether the pulp is vital or nonvital. The results of this tests are not always reliable; further diagnostics are necessary to confirm results.

Question 18

Endodontic diagnosis

Answer 18

Both subjective and objective are used in Endodontic diagnosis

*subjective examination: ckecks for following symptoms of pulpal damage:

• chief complaint
• character and duration of pain
• painful stimuli
  -sensitivity to biting and pressures
• objective examination:
  -extent of decay
• periodontal conditions
  -extensive restoration
• tooth mobility
• swelling or discoloration
  -pulp exposure

Question 19

pulp capping

Answer 19

After the diagnosis is complete the dentist will choose an endodontic treatment option. option including capping, pulpotomy and pulpectomy.

With capping the dentist places calcium hydroxide over an exposed or nearly exposed pulp encourages the formation of dentin at the site of injury. The goal is to promote pulpal healing and to stimulate production of reparative dentin.

-capping: can be used as an attempt to dave the pulp. This procedure is most frequently used when bacteria have come very close to infecting the pulp. capping can be categorized as being either indirect o direct.

• Indirect pulp capping (IPC) is a procedure in which medicated cement is placed on partially exposed pulp to allow the tooth to repair itself. The procedure is indicated when a thin partition of dentin is still intact.
• Direct pulp capping DPC) is procedure used when there is deep decay. but no indication of infection and the pulp is only slightly exposed.

Question 20

Pulpotomy and Pulpectomy

Answer 20

In addition to capping, other endodontic treatment options are pulpotomy and pulpectomy.

Let’s look first at the pulpotomy. A pulpotomy is a procedure that involves removal of the coronal portion of an exposed vital pulp. It is used to preserve the vitality of the remaining portion of the pulp within the root of the tooth. The procedure is commonly indicted for vital primary teeth, teeth with deep carious lesions, and emergency situations.

In this procedure, the tooth is prepared and the pulp is removed. Then a medicated cotton pellet is placed in the space followed by zinc oxide-eugenol temporary restoration cement.

A pulpectomy is also referred to as root canal therapy. This procedure involves the complete removal of the dental pulp.

Question 21

Root canal therapy

Answer 21

Root canal is performed to serve a tooth from extraction. Root canal therapy consists of following steps

steps

1. Anesthesis and pain control: nerve block. this allows the dentist to cut through the enamel and dentin with high speed bur to gain access to the decay tooth structure.

2.Isolation of the site: prior to cutting through the enamel and dentin, the tooth must be isolated using a dental dam.

3.Access preparation: Using a high-speed bur, the dentist will cut into the tooth structure to gain access to the affected area. The dentist then uses a slow-speed handpiece round bur to remove the decayed tooth structure. A spoon excavator can also be used. This excavation will give the dentist access to the pulp chamber

4. Bebridement and shaping of the canal: The dentist will place a file or files down into the canals to accurately measure in millimeters the depth for filing and filling. At this time, a radiograph will be taken. Each root is debrided to remove necrotic nerve tissue and other debris widening the canals using graduated files. The dentist also uses bacteriocidal rinses to clean out the insides of the tooth This area is then rinsed with saline.

5.obturation: A good seal is necessary at the apex of the root to avoid the development of periapical disease. The roots must be completely filled without any voids. Gutta-percha is the most common material used to obturate or fill the root canals; it is cemented into place. Once the root canal is completely filled, the tooth will need to be built up because most teeth are not sturdy due to excessive tooth loss. A post will be placed in one or two root canals to retain the core and provide extra support. The core build-up replaces lost tooth structure and helps to ensure the longevity of the restoration. Common core materials are amalgam, gold, and composite.

Question 22

Endodontic instructions

Answer 22

• Endodontic exploer
  -file
  -gates glidden blur
• Endodontic spoon excavator
  -lentulo spiral
• peeso reamer
• broach
  -Endodontic spreader
  -apec finder
  -reamer
  -Endodontic condenser
  -Endodontic handpiece

Question 23

Additional surgical interventions

Answer 23

Apicoectomy: An apicoectomy is a procedure to surgically remove the apical portion of the root with the use of a high-speed handpiece and bur. The root end is then filled with a biocompatible material. In addition, an apical curettage might be necessary to surgically remove diseased tissue surrounding a root apex without excision of the root tip. The purpose of an apicoectomy is to evaluate:
* Inadequate sealing of the canal
* Accessory canals
* Fractures of the root * Pathologic tissue around the root apex

Retrografe restoration: Retrograde restoration is used in conjunction with apicoectomy, apical curettage, or both. It is undertaken when an apical seal is not adequate. A small Class I preparation is made at the apex and sealed with filling materials such as gutta-percha, amalgam, or composite. Amalgam is the most commonly used filling material.

Root Amputation: Root amputation is performed to remove one or more roots of a multirooted tooth without removing the crown. During a hemisection, the root and the crown are sectioned lengthwise and removed.

Question 23

Endodontic Accessory materilas

Answer 23

Accessory materilas are also used in endodontic procedures

Irrigating solution: Irrigation solutions help to remove debris. They also bleach and deodorize the canal, as well as control hemorrhaging. Sodium hypochlorite is the most commonly used irrigation solution. Hydrogen peroxide or parachlorophenol (PCP) can also be used.

endodontic sealer: A sealer used to fill gaps between the root filling and the canal wall. It is used with gutta-percha and acts as a lubricant to seat the gutta-percha cones.

Gutta-percha: Made from a rubber material from the Palaquium gutta tree, it is a pink-colored plastic that is solid at room temperature and requires a heat source during filling. It is easily molded and maintains its shape well. Gutta-percha points are used to obturate or fill the pulpal canal after endodontic therapy.