Dental implants in medically compromised patient Flashcards
Implant surgery is a _____ procedure
elective
_____ should be performed for appropriate control of the disease processes
medical consultation
What potentially causes failure of dental implant from healing:
poorly controlled disease process
What poses a surgical or medical risk at the time of surgery:
controlled disease process
Disorder of glucose metabolism:
DM
Hyperglycemia has a negative effect on:
bone metabolism
Diabetic osteopathy reduces: (2)
- bone mineral density
- bone mechanical properties
Diabetic osteopathy increases:
- risk of fracture
Diabetic osteopathy impairs: (3)
- endochondrial bone formation
- intramembranouse bone formation
- mircoarchitectural quality
Hyperglycemia may lead to severe complications including:
- macro/micro angiopathy
- neuropathy
- increased risk of infections
Current literatures support the use of dental implants in diabetic patients with:
GOOD metabolic glucose control
A comparable survival rates (85.5 -100%) were reported on dental implants placed in diabetic patient with:
good/fair metabolic control
_____ glycemic control is highly recommended BEFORE AND AFTER dental implant treatment
STRICT
What is an ideal HbA1c value for dental implants:
What is an acceptable HbA1c value for dental implants:
less than or equal to 7% (ideal)
less than or equal to 8% (acceptable)
Other co-morbidities that need to be addressed prior to implant placement include:
- proper oral hygiene
- cessation of tobacco
- treatment of periodontitis
A pre-operative strategy to reduce the potential risk of infections includes considering:
- antibiotics
- antiseptic moutwashes
What antibiotics may be used pre-operatively to reduce risk of infections with implant placement?
- PCN
- amoxicillin
- clindamycin
- metronidazole
What antiseptic mouthwash may be pre-operatively to reduce risk of infections with implant placement?
Peridex (Chlorhexidine)
T/F: You can still place implants if the patients DM status is uncontrolled
FALSE- NO implants until controlled status
-generalized reduction in bone density and alterations in the microstructure of bone
-increased risk of fractures
-54 million US adults older than 50 affected
osteoporosis
T/F: There is not enough evidence to consider osteoporosis as an absolute contraindication for implant placement
True
If your patient has osteoporosis and wants implants what should be done prior to decision if they are candidate?
Careful evaluation of bone mineral density through DEXA/DXA (bone densitometry) scan
In osteoporosis patient there may be an increased risk of complications in:
bone augmentation
The use of dental implants with modified ____ may be preferred for use in patients with osteoporosis
hydrophilic surfaces
Patients with osteoporosis requires longer healing period for:
osseointegration
What is NOT recommended for patients with osteoporosis in regards to dental implant placement?
NO immediate loading
Accounts for 6% of all malignancies in the US:
Head & neck cancer
60-80% of patients affected by head and neck cancer undergo:
radiation therapy
Early effects of irradiation for head & neck cancer include damage to:
- salivary glands
- skin
- oral mucosa
Late effects of irradiation for head & neck cancer include:
- bone changes
- demineralization
- fibrosis
- avascular necrosis
What is the ultimate risk of the late effects of irradiation for head & neck cancer?
Osteoradionecrosis
ORN:
Osteoradionecrosis
A serious complication of head & neck radiation that induces vascular insufficiency rather than infection:
Osteoradionecrosis (ORN)
The three H’s involved in ORN:
- Hypocellular
- Hypovascular
- Hypoxia
ORN poses the risk for:
non-healing wound and dead bone
With a radiation dose of greater than or equal to 55 Gy there is a significantly:
decreased implant survical rate
With radiation there is a better implant survival rate in the ____ than the ____
mandible (93.3%); maxilla (78.9%)
T/F: Radiotherapy does NOT affect implant outcomes
False- radiotherapy does affect implant outcomes
(an increased risk of implant failure in irradiated patients)
In patients who are planned to undergo radiotherapy place the implants at least ____ prior to or atleast _____ after irradiation treatment is recommended
3 weeks prior
9 months after
Contraindications to placing implants involving radiation therapy:
- DURING radiation treatment
- when patient has irradiation induced mucositis
Current evidence found the HIGHER RISK of ONJ in the following situations: (3)
- intravenous bisphosphenates
- prolonged duration
- posterior areas after implant placements
T/F: Cancer patients treated with IV bisphosphonates are contraindicated for implant placement
true
T/F: Oral bisphosphonates are considered a contraindication for implant placement
false- oral BPs are okay
List there inherited bleeding disorders:
- Von Willebrand disease
- Hemophilia A
- Hemophilia B
T/F: inherited bleeding disorders may increase the risk of hemorrhage during implant surgery however are NOT a contraindication for implant survival/success
True
What is the minimum level of the deficient coagulation factor before implant surgery?
Minimum level of 50%
What procedures should be avoided in bleeding-risk individuals?
advance implant surgical procedures (direct sinus lift & bone graft harvest procedures)
The patients who are taking _____ drugs are at a higher disk hemorrhage during implant surgery
anticoagulants or antiplatelet drugs
Short half-life (12 hour) anti platelet medications such as _____ & ____ should be stopped _____ before the implant procedure
Pradaxa & Xarelto ; 1 day
Longer half life (20-60 hours) anti platelet medications such as ____ pose a risk of the patient developing a ____
Coumadin; thromboembolic episode
An INR of _____ is a contraindication to implant surgery
greater than 3-3.5
A platelet count of ____ is a contraindication to implant surgery
less than 50k
HIV infection, organ transplantation and Crohn’s disease are all examples of:
immunodeficiency disorders
In HIV-positive patients, dental implant treatment can be rendered only when: (2)
- CD4 cell count rates are high
- patient is on antiretroviral treatment
What lab values should be checked prior to implant placement in HIV-positive patients?
- CD4 cells
- ANC
- PLTs
What is the strongest predictor of HIV progression?
number of CD4 T lymphocytes
T/F: Immuno-incompetence is NOT a contraindication
true
