Dental Implants in the Medically Compromised PT. Flashcards
When should the following questions be considered? :
Is there any relative or absolute contraindication for dental implant surgery in this patient for medical reasons?
Does the patient have any medical condition or take any medications that jeopardizes the normal osseointegration and healing of the implant surgery ?
Initial Consult
Implant surgery is an______ procedure
elective
______ ______ for appropriate control of the disease process
Medical consultation
What does the acronym MRONJ mean?
Medication Related Osteonecrosis of the Jaws
- Diabetes Mellitus
- Osteoporosis
- Head and Neck Cancer irradiation
- Patients at risk for developing MRONJ (Medication Related Osteonecrosis of the Jaws)
- Congenital Bleeding disorders - - Patients on Oral anticoagulants/Antiplatelet Medication
- Cardiovascular diseases -Corticosteroids - —
- Immunocompromised Patients - -Neuro-Psychiatric Disorders
Medically Compromised Patients Commonly Seen In The Dental Office
- Disorder of glucose metabolism
- Two major type
- Type I: Insulin-dependent - Type II: Non-insulin-dependent (95%)
- New cases: 1.4 million are diagnosed per year
- Increases with age – 90% over 45 y/o
DiabetesMellitus
- Its global prevalence was estimated to be 2.8% in 2000 and is expected to rise to 4.4% in 2030 - 25% end stage renal disease - Leading cause of blindness - 7th leading cause of death
DiabetesMellitus
Hyperglycemia has a negative effect on bone metabolism
What is that called?
Diabetic osteopathy
________ may lead to severe complications
Macro/micro angiopathy, neuropathy, increased risk of infections
Hyperglycemia
t/f: Current literatures support the use of dental implants in diabetic patientswith good metabolic glucose control
true
t/f: Strict glycemic control dental implant treatment is highly recommended before and after
true
A comparable survival rates ____%-____%were reported on dental
implants placed in diabetic patients with good/fair metabolic control.
(85.5 to 100%)
- Prepared by both dentist and endocrinologist - Monitor blood glucose levels
- current level and improvement - Preoperative HbA1c value
- ≤ 7% is ideal; ≤ 8% is acceptable - Others: co-morbidities, restoration of proper oral hygiene, cessation of tobacco, treatment of periodontitis
Preoperative Management of Diabetes Mellitus
Preoperative HbA1c value
- ≤__% is ideal;
7%
Preoperative HbA1c value
≤ _% is acceptable
≤ 8%
_______ _____With a diabetes pt.
- To reduce the potential risk of infections
- Consider antibiotics and antiseptic mouthwashes
- Antibiotics: penicillin, amoxicillin, clindamycin or metronidazole - Antiseptic mouthwashes: Peridex (Chlorhexidine)
- Reinforce supportive therapy/maintenance systems
Preoperative Management
t/f: uncontrolled DM:
NO IMPLANTS until it’s under controlled
Conventional solutions could be good alternative options
Removable dentures OR bridges as fixed prosthesis
true
- Generalized reduction in bone density and alterations in the microstructure of bone
Osteoporosis
t/f: - Not enough evidence to consider osteoporosis as an absolute contraindication for implant placement
true
________ may increase risk of complications in bone augmentation
osteoporosis
t/f: Use of dental implants with modified, hydrophilic surfaces improves success rate in Osteoporosis pt.
true
t/f: - Immediate loading of the dental implants is not recommended
true
_____ & ______ ________
- Account for 6 percent of all malignancies in the US - Surgery and radiation therapy
- 60-80% patients affected by head and neck cancer
have radiation therapy
Head and neck cancer
What areas are impacted by the early effects of Irradiation of Head and Neck Cancer?
Salivary glands, skin, oral mucosa
Late effects of Head & Neck Cancer Irradiation
Bone changes, demineralization, fibrosis, avascular necrosis
- One serious complication of head & neck radiation - Induce vascular insufficiency rather than infection
- Hypocellular, hypovascular and hypoxia
- Non healing wound and dead bone - Mandible or site with radiation ≥ 6500 Rads/65Gy
Osteoradionecrosis
ORN