Dental implants in Medically Compromised Patient Flashcards
Implant surgery is an ____ procedure
elective
_____ should be performed for appropriate control of the disease process
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)
- encochondral bone formation
- intramembranous bone formation
- micro architectural quality
Hyperglycemia may lead to severe complication 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 patients with:
good/fair metabolic control
_____ glycemic control is highly recommended BEFORE & 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 8% = acceptable
Other co-morbities 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 mouthwashes
What antibiotics may be used pre-operatively to reduce risk of infections with implant placement?
- PCN
- amoxicillin
- clindamycin
- metronidazole
What antiseptic mouth wash my be pre-operatively to reduce risk of infection with implant placement?
Peridex (chlorhexidine)
T/F: You can still place implants if the patient DM status is uncontrolled
False- No implants until controlled
- Generalized reduction in bone density and alterations in the microstructure of bone
- increased risk of fractures
- 54 million U.S. 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 patients their may be an increased risk of complications in:
bone augmentation
The use of dental implants with modified ____ may be preferred for use in osteoporosis patients
hydrophilic surfaces
Osteoporosis patients require a longer healing period for:
osseointegratoni
What is NOT recommended for patients with osteoporosis in regards to implant placement?
NO immediate loading
Accounts for 6% of all malignancies in the U.S
Head and neck cancer
60-80% of patients affected by head and neck cancer undergo:
radiation therapy
Early effects of irradiation for head and neck cancer include damage to:
- salivary glands
- skin
- oral mucosa
Late effects of irradiation for head and neck cancer include:
- bone changes
- demineralization
- fibrosis
- avascular necrosis
What is the ultimate risk of the late effects of irradiation for head and cancer?
Osteoradionecrosis
ORN:
Osteoradionecrosis
A serious complication of head & neck radiation that induces vascular insufficiency rather than infection:
Osteoradionecrosis (ORN)
The 3 H’s involved in ORN:
- Hypocellular
- Hypovascular
- Hypoxia
ORN poses the risk for:
non-healing wound & dead bone
With a radiation dose of greater than or equal 55 Gy there is a significantly:
decreased implant survival rate
With radiation, their 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 affects implant outcomes
In patients who are planned to undergo radiotherapy, place the implants at least ____ prior to or at least ____ after irradiation treatment is recommended
3 weeks prior; 9 months after
Contraindication 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:
- Intravenous bisphosphonates
- Prolonged duration
- Posterior areas after implant placement
T/F: Cancer patients treated with IV bisphosphonates are contraindicated for implant placement
True
T/F: Oral bisphosphates are considered a contraindication for implant placement
False- Oral BPs are fine
List three 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 minimum level of the deficiency coagulation factor before implant surgery?
minimum level of 50%
What procedures should be avoided in bleeding risk individuals
Advanced implant surgical procedures (direct sinus lift and bone graft harvest procedures)
The patients who are taking ____ drugs are at a higher risk of hemorrhage during implant surgery
anticoagulants or antiplatelet drugs
Short half life (12hrs) anti platelet medications such as ___ & ___ should be stopped ____ before the implant procedure
Pradaxa & Xarelto; 1 day
Longer half life (20-60hrs) antiplatelet 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 Chron’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
- Pt is on antiretroviral treatment
What lab values should be checked prior to implant placement in HIV-positive patient?
- CD4 cells
- ANC
- Platelets
What is the strongest predictor of HIV progression?
of CD4 T-lymphocytes
T/F: Immuno-incompetence is NOT a contraindication
True
