This document discusses dental implants and implant maintenance. It provides details on:
- The types of bacteria that typically colonize dental implants compared to natural teeth. Gram-positive cocci and facultative rods are most common on healthy implants.
- The development of plaque biofilm on implants, beginning with gram-positive cocci and potentially leading to peri-implant diseases if not properly maintained.
- Criteria for implant success, including lack of mobility, bone loss less than 0.2mm/year, and a minimum success rate of 85% after 5 years.
- Proper techniques and tools for cleaning implants to avoid damage, including plastic-tipped scalers and air polishers.
Impression tecnique for implant supported rehabilitation/ dental coursesIndian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
socket shield technique is a modified method of implant placement where many short comings of implant placement can be solved...
it is nothing but retaining of buccal cortical plate during extraction and implant is placed immediatly
Indian Dental Academy: will be one of the most relevant and exciting training
center with best faculty and flexible training programs for dental
professionals who wish to advance in their dental practice,Offers certified
courses in Dental implants,Orthodontics,Endodontics,Cosmetic Dentistry,
Prosthetic Dentistry, Periodontics and General Dentistry.
Impression tecnique for implant supported rehabilitation/ dental coursesIndian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
socket shield technique is a modified method of implant placement where many short comings of implant placement can be solved...
it is nothing but retaining of buccal cortical plate during extraction and implant is placed immediatly
Indian Dental Academy: will be one of the most relevant and exciting training
center with best faculty and flexible training programs for dental
professionals who wish to advance in their dental practice,Offers certified
courses in Dental implants,Orthodontics,Endodontics,Cosmetic Dentistry,
Prosthetic Dentistry, Periodontics and General Dentistry.
The maxillary sinuses were first illustrated and described by Leonardo Da Vinci in 1489 and later documented by the English anatomist Nathaniel Highmore in 1651.
The maxillary sinus, or antrum of Highmore, lies within the body of the maxillary bone and is the largest and first to develop of the paranasal sinuses.
Shape- a pyramid-shaped cavity; base- adjacent to the nasal wall; apex- pointing to zygoma.
Size- insignificant until eruption of permanent dentition; average dimensions of adult sinus- 2.5–3.5 cm wide, 3.6–4.5 cm tall, and 3.8–4.5 cm deep; estimated volume of approximately 12–15 cm.
Extent- Anteriorly, extends to canine and premolar area. sinus floor usually has its most inferior point near the first molar region.
Screw vs cement retained implant prosthesisApurva Thampi
This is a journal club presentation featuring a recent article regarding a screw and cement retained implant prosthesis.
the presentation and all its related material is available on request. Mail me at apurvathampi@gmail.com
This seminar deals with implant-related complications that lead to implant failure.this also discus diagnostic criteria and preventive methods for an implant failure.
The socket shield technique at molar sitesNaveed AnJum
The socket-shield technique for avoiding postextraction tissue alteration was first described in 2010. The technique was developed for hopeless teeth in anterior esthetic sites but has not yet been described for molar sites. Managing postextractive ridge changes in the posterior region by prevention or regeneration remains a challenge. The socket shield aims to offset these ridge changes wherever possible, preserving the patient’s residual tissues at immediate implants.
Implant abutment and implant abutment connectionsDR.BHAVESH JHA
this ppt enlightened with different types of implant abutment connection. Detailed classification of abutments. Different types of abutments. Latest trends of abutments. Smart abutments. Platform switching, rationale of platform switching and related articles.
loading protocols in dental implants about indications and contraindications of conventional , immediate,progressive and delayed loading of dental implants
Standard surgical procedure for implant placement Diana Abo el Ola
The lecture gives in details step by step how to replace an implant in the osteotomy site. Also, mention the preoperative and postoperative procedures.
The maxillary sinuses were first illustrated and described by Leonardo Da Vinci in 1489 and later documented by the English anatomist Nathaniel Highmore in 1651.
The maxillary sinus, or antrum of Highmore, lies within the body of the maxillary bone and is the largest and first to develop of the paranasal sinuses.
Shape- a pyramid-shaped cavity; base- adjacent to the nasal wall; apex- pointing to zygoma.
Size- insignificant until eruption of permanent dentition; average dimensions of adult sinus- 2.5–3.5 cm wide, 3.6–4.5 cm tall, and 3.8–4.5 cm deep; estimated volume of approximately 12–15 cm.
Extent- Anteriorly, extends to canine and premolar area. sinus floor usually has its most inferior point near the first molar region.
Screw vs cement retained implant prosthesisApurva Thampi
This is a journal club presentation featuring a recent article regarding a screw and cement retained implant prosthesis.
the presentation and all its related material is available on request. Mail me at apurvathampi@gmail.com
This seminar deals with implant-related complications that lead to implant failure.this also discus diagnostic criteria and preventive methods for an implant failure.
The socket shield technique at molar sitesNaveed AnJum
The socket-shield technique for avoiding postextraction tissue alteration was first described in 2010. The technique was developed for hopeless teeth in anterior esthetic sites but has not yet been described for molar sites. Managing postextractive ridge changes in the posterior region by prevention or regeneration remains a challenge. The socket shield aims to offset these ridge changes wherever possible, preserving the patient’s residual tissues at immediate implants.
Implant abutment and implant abutment connectionsDR.BHAVESH JHA
this ppt enlightened with different types of implant abutment connection. Detailed classification of abutments. Different types of abutments. Latest trends of abutments. Smart abutments. Platform switching, rationale of platform switching and related articles.
loading protocols in dental implants about indications and contraindications of conventional , immediate,progressive and delayed loading of dental implants
Standard surgical procedure for implant placement Diana Abo el Ola
The lecture gives in details step by step how to replace an implant in the osteotomy site. Also, mention the preoperative and postoperative procedures.
Complication & failure of dental implants / cosmetic dentistry trainingIndian dental academy
Indian Dental Academy: will be one of the most relevant and exciting
training center with best faculty and flexible training programs
for dental professionals who wish to advance in their dental
practice,Offers certified courses in Dental
implants,Orthodontics,Endodontics,Cosmetic Dentistry, Prosthetic
Dentistry, Periodontics and General Dentistry.
Failure of the Prosthetic part of an Implant Treatment is viewed as a catastrophic failure altogether by the patients and some clinicians. We break them down to 3 PROBLEMS and how to prevent/avoid these failures.
Indian Dental Academy: will be one of the most relevant and exciting training
center with best faculty and flexible training programs for dental
professionals who wish to advance in their dental practice,Offers certified
courses in Dental implants,Orthodontics,Endodontics,Cosmetic Dentistry,
Prosthetic Dentistry, Periodontics and General Dentistry.
Biofilms on the teeth are the root cause of inflammation on the gums and periodontium. Understanding the formation of biofilms will make improve our treatment modalities towards disruption of biofilms hence provide better periodontal health to our patients at large.
implant supported complete denture/ cosmetic dentistry trainingIndian dental academy
Indian Dental Academy: will be one of the most relevant and exciting
training center with best faculty and flexible training programs
for dental professionals who wish to advance in their dental
practice,Offers certified courses in Dental
implants,Orthodontics,Endodontics,Cosmetic Dentistry, Prosthetic
Dentistry, Periodontics and General Dentistry.
ABSTRACT- Initially when dental implants were first introduced their success was assumed to be dependent mostly on the surgical technique and later their placement. However, without a regular program of clinical reevaluation, plaque control, oral hygiene instruction, and reassessment of biomechanical factors, the benefits of treatment often are lost and inflammatory disease in the form of recurrent periodontitis or peri-implantitis may result. Maintenance of the periodontal health is a critical factor in the long-term success of dental implant therapy. This article reviews the goals, types, and appropriate frequency of periodontal maintenance in dental implant therapy, as well as the incidence and etiology of peri-implant disease and strategies for management when recurrent disease develops during the maintenance phase of treatment. Key-words- Dental Implants, Maintenance, Hygiene, Peri-implantitis, Peri-implant mucocitis, Interdental Aids, Chemotherapeutic Aids
ABSTRACT- Initially when dental implants were first introduced their success was assumed to be dependent mostly on the surgical technique and later their placement. However, without a regular program of clinical reevaluation, plaque control, oral hygiene instruction, and reassessment of biomechanical factors, the benefits of treatment often are lost and inflammatory disease in the form of recurrent periodontitis or peri-implantitis may result. Maintenance of the periodontal health is a critical factor in the long-term success of dental implant therapy. This article reviews the goals, types, and appropriate frequency of periodontal maintenance in dental implant therapy, as well as the incidence and etiology of peri-implant disease and strategies for management when recurrent disease develops during the maintenance phase of treatment. Key-words- Dental Implants, Maintenance, Hygiene, Peri-implantitis, Peri-implant mucocitis, Interdental Aids, Chemotherapeutic Aids
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
A lecture for 5th stage dental students.
any questions or notes please contact me on theses links :
https://www.youtube.com/channel/UCOamwwIygP5uCZa6HBntFxw
https://www.slideshare.net/mohamedrahilalhadithy?
utm_campaign=profiletracking&utm_medium=sssite&utm_source=ssslideview
https://web.facebook.com/mohamedrahil.alhadithy
https://www.instagram.com/mohamed_rhael/
https://twitter.com/DrMohamed_rahil
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
HOT NEW PRODUCT! BIG SALES FAST SHIPPING NOW FROM CHINA!! EU KU DB BK substit...GL Anaacs
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We specializes in exporting high quality Research chemical, medical intermediate, Pharmaceutical chemicals and so on. Products are exported to USA, Canada, France, Korea, Japan,Russia, Southeast Asia and other countries.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
1. Maintenance of Dental Implants: Implant
Quality of Health Scale
CARL MISCH CHAPTER 42
2. PLAQUE BIOFILM AND DENTAL
IMPLANTS
implants more susceptible to inflammation and bone loss
Plaque biofilm development and maturation have similarities for
natural teeth and dental implants.
The gingival sulcus in periodontal health and the peri mucosal
attachment of a successful dental implant are essentially sirnilar.
3. PLAQUE BIOFILM AND DENTAL
IMPLANTS
In a study by Mombelli and Mericske-Stern of the plaque from 18
edentulous patients with successful dental implants, facultative
anaerobic cocci (52.8%) and facultative anaerobic rods (17.4%)
were reported.
However, the pathogens P. gingiva/is and spirochetes were absent,
and minimal (7.3%) gram-negative rods were present.
4. PLAQUE BIOFILM AND DENTAL
IMPLANTS
Generally, pellicle adheres to the intraoral structure, whether it be a
tooth or an implant.
Gram-positive cocci bacteria are the first "early colonizers,"
beginning with single cocci and progressing to streptococci forms.
Without appropriate oral hygiene measures additional bacteria
colonies including gram-negative rod-shaped bacteria grow with
the established gram-positive bacteria.( late colonizers).(e.g.,
Bacteroides, Prevotelia, Porphyromonas, Fusobacterium).
5. PLAQUE BIOFILM AND DENTAL
IMPLANTS
This finding suggests that staphylococci may be more significant in
developing peri-implantitis lesions than previously recognized.
Natural dentitions with dental implants appear to increase the risk
for implant infections, compared with completely edentulous
patients.
This suggests that natural teeth may serve as a reservoir for
periodontal pathogens that may extend their growth to contiguous
implants in the same oral cavity.
6. PLAQUE BIOFILM AND DENTAL
IMPLANTS
Peri-implant mucositis is an inflammatory change of the soft tissue
surrounding an implant.
Like gingivitis: The primary etiology is plaque biofilm, and reversible,
no loss of attachment apparatus.
If allowed to progress, peri-implantitis may result, which includes loss
of osteointegration, similar to loss of attachment and bone with
periodontitis.
7. SOFT TISSUE INTERFACE
If oral irrigation is used, the patient should be instructed to use the
lowest setting and direct the irrigation flow through the contacts to
avoid excessive pressure to the implant tissue cuff.
Incorrect use could alter tissue adaptation and induce bacteremia
around the implant.
8. INSTRUMENT SELECTION
tip designs :not bulky .
Metallic ultrasonic and sonic scalers have been reported to gouge
titaniurn.
A plastic or rubber sleeve over an ultrasonic scaler appears not to
alter titaniurn.
Conventional ultrasonic scalers with a nonmetal tip also are suitable
for implant maintenance.
Air polishers are effective and safe for maintenance procedures
around implants.
9. INSTRUMENT SELECTION
A variety of nonmetallic, plastic, graphite, nylon, or Teflon-coated
instruments are available and have been proven to be safe to use
on titanium implant surfaces.
A titanium curette and a rubber cup with flour of pumice are
suitable for cleaning implant surfaces.
10. IMPLANT MAINTENANCE PROCEDURES
Unlike the attachment to the porosities of teeth, the adherence and
tenacity of calculus around implants are usually less binding.
Because the perimucosal seal is more fragile than a normal tooth
sulcus, it is important to use short, exploratory working strokes with
light pressure.
Depending on the location of the calculus, a horizontal, vertical, or
oblique stroke may need to be.
11. IMPLANT MAINTENANCE PROCEDURES
When an instrument must be used subgingivally to remove calculus
or excess cement, insertion and instrumentation should be gentle
and light strokes should be in a semicircular pattern.
Attention to placing the blade carefully under the deposit and
drying calculus or cement with compressed air may make
detection and removal easier and more comfortable for the
patient.
12. CHEMOTHERAPEUTIC AGENTS
Chlorhexidine gluconate has proved to be a useful irrigant.
It is also wise to use a neutral sodium fluoride in a patient with
dental implants because certain acidic fluorides can alter titanium .
13. Criteria for Implant Success
An individual, unattached implant is immobile when tested
clinically.
A radiograph does not demonstrate any evidence of periimplant
radiolucency.
Vertical bone loss is less that 0.2 mm annually after the first year of
service of the implant.
Individual implant performance is characterized by an absence of
persistent or irreversible signs and symptoms such as pain, infections,
neuropathies, paresthesia, or violation of the mandibular canal.
In the context of the foregoing, a success rate of 85% at the end of
a 5-year observation period and 80% at the end of a 1O-year
period are minimum criteria for success.
14. Ideal Clinical Conditions of Teeth
Absence of pain
Less than 0.1 mm initial horizontal mobility under lateral forces less
than 100 g
Less than 0.15 mm secondary mobility with lateral forces of 500 g
Absence of observed vertical mobility
Periodontal probing depths less than 2.5 mm
Radiographic crestal bone height 1.5 to 2.0 mm below cement-
enamel junction
Intact lamina dura
No bleeding on probing
No exudate
Absence of recession
Absence of furcation involvement on multirooted teeth
15. Implant Quality Scale
I. Success (optimum health)
II. Survival (satisfactory health)
III. Survival (compromised health)
IV. Failure (clinical or absolute failure)
16. I. Success (optimum health)
No pain or tenderness upon function
0 mobility
<2 mm radiographic bone loss from initial surgery
Probing depth <5 mm
No exudate history
MANAGEMENT :Normal maintenance
17. II. Survival (satisfactory health)
No pain
0 mobility
2-4 mm radiographic bone loss
Probing depth 5 to 7 mm
No exudate history
Reduction of stresses
Shorter intervals between hygiene appointments
Gingivoplasty
Yearly radiographs
18. III. Survival (compromised health)
No pain upon functiona
0 mobility
Radiographic bone loss> 4 mm
Probing depth> 7 mm
May have exudate history
Reduction of stresses
Drug therapy (antibiotics, chlorhexidine)
Surgical reentry and revision
Change in prosthesis or implants
19. IV. Failure (clinical or absolute
failure)
Any of the following:
Pain upon function
Mobility
Radiographic bone loss >1/2 length of implant
Uncontrolled exudate
No longer in mouth
Removal of implant
20. REPAIR OF THE AILING, FAILING DENTAL
IMPLANT
I. If an active infection (purulence, bleeding, swelling) is present with radiographically visible
bone loss and the disease process is continuing, the following steps should be implemented:
A. Reflect the tissue and degranulate the defect (metallic curettes are acceptable)
B. If the implant is hydroxyapatite (HA) coated and the HA is undergoing resorption and has
changed color and texture, remove all the HA until the metallic surface is visible. Use of
ultrasonics such as Cavitron is best; use of hand curettes is too slow, and use of air abrasives is
dangerous because of danger of air emboli in marrow spaces.
C. Detoxify the dental implant with citric acid applied with cotton pledget or camel's hair
brush. Thirty seconds per surface is sufficient.
D.graft
F. Leave the repaired implant out of function and "covered" for 10 to 12 weeks
21. REPAIR OF THE AILING, FAILING DENTAL
IMPLANT
2. If no active infection is present and if an HA-coated implant is in place and the HA looks
intact without ongoing resorption (bone loss from traumatic occlusion, overloading, off-axis
loading, and so on):
A. Reflect the tissue and degranulate the defect with metallic curettes.
B. Detoxify the surface with citric acid (40%,pH 1) for 30 seconds per surface. Flush and irrigate
with sterile water or sterile saline to stop demineralization process of the citric acid. Thirty
seconds of citric acid application will detoxify and "freshen" the surface.
C. Continue with grafting.
22. Do not use tetracycline on intact HA because it changes the
calcium/phosphate ratio of HA.
Do not leave citric acid on HA surface for more than 1 minute; it
continues to "remove".
23. IMPLANT CROWN ESTHETIC INDEX
The nine selected items were as follows:
Mesiodistal Dimension of the Crown. The mesiodistal dimension must be in harmony with
the adjacent and contralateral tooth; a judgment can be given on a 5-point rating
scale (grossly undercontoured, slightly undercontoured, no deviation, slightly
overcontoured,grossly overcontoured).
Position of the Incisal Edge of the Crown. The position must be in harmony with the
adjacent and contralateral tooth; a judgment can be given on a 5-point rating scale
(grossly undercontoured, slightly undercontoured, no deviation, slightly overcontoured,
grossly overcontoured).
24. IMPLANT CROWN ESTHETIC INDEX
Labial Convexity of the Crown. Convexity of the labial surface of the crown must be in
harmony withthe adjacent and contralateral tooth; a judgment can be given on a 5-point
rating scale (grossly undercontoured,slightly undercontoured, no deviation, slightly
overcontoured, grossly overcontoured).
Color and Translucency of the Crown. Color and translucency of the crown must be in
harmony with the adjacent and contralateral tooth; a judgment can be given on a 3-
point rating scale (gross mismatch, slight mismatch, no mismatch).
25. IMPLANT CROWN ESTHETIC INDEX
Surface of the Crown. Labial surface characteristics of the crown, such as roughness and
ridges, must be in harmony with the adjacent and contralateral tooth;a judgment can be
given on a 3-point rating scale (gross mismatch, slight mismatch, no mismatch).
Position of the Labial Margin of the Peri-Implant Mucosa. The labial margin of the peri-
implant mucosa must be at the same level as the contralateral tooth and in harmony with
the adjacent teeth; a judgment can be given on a 3-point rating scale (deviation of 1.5
mm or more, deviation less than 1.5 rnrn, no deviationj).
26. IMPLANT CROWN ESTHETIC INDEX
Position of Mucosa in the Approximal Embrasures. The interdental papillae must be in their
natural position; a judgment can be given on a 3-point rating scale (deviation of 1.5 mm or
more, deviation less than 1.5 mm, no deviation).
Contour of the Labial Surface of the Mucosa. The contour of the mucosa at the alveolar bone
must be inharmony with the adjacent and contralateral tooth; a judgment can be given on a
5-point rating scale (grossly undercontoured, slightly undercontoured, no deviation, slightly
overcontoured, grossly overcontoured).
Color and Surface of the Labial Mucosa Color (redness) and surface characteristics (presence
of attached mucosa) must be in harmony with the adjacent and contralateral tooth and must
have a natural appearance; a judgment can be given on a 3-point rating scale (gross
mismatch, slight mismatch, no mismatch). It has been decided to use the adjacent