{"id":190,"date":"2013-11-26T04:57:23","date_gmt":"2013-11-26T04:57:23","guid":{"rendered":"http:\/\/footpatches.com\/detox\/?p=190"},"modified":"2013-11-26T04:57:23","modified_gmt":"2013-11-26T04:57:23","slug":"complications-in-implant-dentistry","status":"publish","type":"post","link":"http:\/\/footpatches.com\/detox\/2013\/11\/26\/complications-in-implant-dentistry\/","title":{"rendered":"COMPLICATIONS IN IMPLANT DENTISTRY"},"content":{"rendered":"

see the video: http:\/\/vimeo.com\/58581515<\/a><\/p>\n

Dr. Lavine:<\/p>\n

Well, we are going to go ahead and get started.\u00a0 Welcome, everyone.\u00a0 This is Dr. Lorne Lavine.\u00a0 Many of you know me as the Digital Dentist. I wanted to welcome everyone to tonight\u2019s webinar.\u00a0 As of this morning, we had over 650 people that were registered for the webinar.\u00a0 I\u2019m really just so thrilled with the attendance that we\u2019re getting for our webinars.\u00a0 We\u2019ve obviously found some great topics that excite everyone.\u00a0 There\u2019s a good number of you already here.\u00a0 I\u2019m only going to speak for a couple of minutes. I want to make sure that Dr. Domingue has enough time to speak as long as he\u2019d like and to make sure we leave enough time for questions as well.<\/p>\n

On your screen, you should have a little webinar go-to panel where you can ask any questions.\u00a0 Feel free to ask your question throughout the lecture as you think about them.\u00a0 What Danny has requested is that unlike most of the webinars that I do where we tend to save the questions until the end, he\u2019d like to answer as many questions as possible during the webinar.\u00a0 So, I\u2019m going to keep an eye on that question panel, and I\u2019ll interrupt him if it\u2019s relevant to what\u2019s he\u2019s showing on the screen.\u00a0 I think that\u2019s really going to make it interesting for everyone.<\/p>\n

By tomorrow, you\u2019re going to get a number of things.\u00a0 Tomorrow, you should all get a little survey when you log out.\u00a0 Just take a minute to answer it if you\u2019re interested in having one of us follow-up with you at Rocky Mountain Dental Institutefollow-up with you.\u00a0 So, if you have to take a phone call or can\u2019t stay until the end, don\u2019t worry.\u00a0 You\u2019re not going to miss anything.<\/p>\n

I also wanted to thank our sponsor tonight Rocky Mountain Dental Institute.\u00a0 They are graciously agreeing to provide everyone with an ADA certified CE credit.\u00a0 They will be following up with that as well.<\/p>\n

Just a brief introduction about myself for those of you who don\u2019t know me.\u00a0 My name is Dr. Lorne Levine.\u00a0 I am known as the Digital Dentist.\u00a0 What I\u2019ve been doing the last number of years is to present webinars that I think are topics of interest in the general dental practice even though it\u2019s not necessarily my area of expertise, which is now technology.<\/p>\n

I practiced as a periodontist for 10 years.\u00a0 I placed a lot of implants, but my focus right now is technology.\u00a0 My goal is to provide information content that I think is stimulating and interesting, maybe controversial.\u00a0 That\u2019s okay.\u00a0 Hopefully, beneficial.\u00a0 I think we\u2019re going to hit on those things tonight.<\/p>\n

So, the topic for tonight\u2019s presentation is to talk about complications in implant dentistry.\u00a0 We\u2019ve had a number of presentations already on implants.\u00a0 We talked about all the great things that implants can do and all the indications for them, but, as we all know, it doesn\u2019t always work out that way.\u00a0 There are all kinds of complications, whether it\u2018s pre-operative, during the procedure, post-operative.<\/p>\n

There can be anatomical complications, those surprises that you get sometimes when you open things up.\u00a0 Obviously, there\u2019s more to implants than just the fixture, but we have prosthetic concerns and complications there.\u00a0 Of course, unfortunately, we\u2019re not working on mannequins.\u00a0 These are real people, and they have real health concerns and complications as well.<\/p>\n

So, as I said, even though I have placed implants for a long time, it\u2019s been a while, and certainly, as much as I\u2019d like to talk, there\u2019s a lot more people out there who know a lot more about it than I do.\u00a0 So, it gives me great pleasure to introduce Dr. Danny Domingue tonight.\u00a0 He is a graduate of LSU.\u00a0 He graduated a number of years ago.\u00a0 He did a GPR at Brookdale Hospital Medical Center.\u00a0 He was the chief resident there.<\/p>\n

He got all kinds of awards and recognitions.\u00a0 He\u2019s a fellow of the ICOI.\u00a0 He\u2019s an associate fellow at the American Academy of Implant Dentistry.\u00a0 He\u2019s a diplomat from the American Board of Oral Implantology, and as far as I know, he\u2019s the youngest person in the entire country to have that award given to him.\u00a0 He\u2019s in full time practice in Lafayette, Louisiana, focusing mostly on implant dentistry.\u00a0 Hopefully, he\u2019ll also talk about his work with Rocky Mountain Dental Institute by the number of courses.<\/p>\n

We have a number of our clients that have signed up for our courses through the webinars that we\u2019ve given, and I\u2019m certainly sure he\u2019ll mention that during his presentation.\u00a0 So, it gives me great pleasure to turn the mic and the screen over to Danny, and we\u2019re looking forward to tonight\u2019s presentation.<\/p>\n

 <\/p>\n

Dr. Domingue:<\/p>\n

Thank you, man.\u00a0 I appreciate it.\u00a0 So, as you said, there are a lot of complications associated with implant dentistry, and this normally is a three-day seminar on Rocky Mountain Dental Institute.\u00a0 This is just going to be 30 minutes to an hour webinar.<\/p>\n

Like you said Lorne, there\u2019s going to be pre-operative complications associated.\u00a0 There\u2019s operative complications associated with implant dentistry during the procedure such as blood, nerve damage, damage to adjacent teeth.\u00a0 We\u2019ll go through these at RMDI, but this is just going to be a quick overview of what we\u2019re going to talk about, also post-operative complications that can and do arise with implant dentistry such as edema, swelling, pain, post-operative numbness.\u00a0 We\u2019ll talk about management issues, medications recommended for these patients, how to treat these patients, recommend a recall for all these patients.\u00a0 We\u2019ll give you an outline of what to do, how to do it, and researches backed up on the best therapy, the treatment.<\/p>\n

Last but not the least restorative complications always arise, whether you do the best restorative dentistry you could possibly do.\u00a0 When you go to see the implant, the implant doesn\u2019t fit properly.\u00a0 The implant crown doesn\u2019t fit properly, or the implant trajectory is off at a bad angle and it\u2019s hard to restore.\u00a0 It\u2019s too close to a neighboring tooth, or you have papilla issues, not enough tissue, so you have a restore a pink porcelain.\u00a0 All of these are going to be in depth, like you said, at Rocky Mountain Dental Institute.<\/p>\n

Today, we\u2019re mostly going to focus on pre-operative complications that arise in implant dentistry.\u00a0 We\u2019ll start off talking about medical history and just a quick overview of bisphosphonates.\u00a0 This has been a hot topic for many years, and the research that we have now has changed from what we were first told. Initially, we were told if somebody\u2019s taking a bisphosphonate, oral or IV, it\u2019s contraindicated to place an implant.<\/p>\n

Well, that\u2019s no longer the recommendation from the ADA, AMUS, and the Journal of Oral Maxillofacial Surgery.\u00a0 Recently, they published an article saying there\u2019s no evidence of bisphosphonate-associated osteonecrosis of the jaws of patients evaluated when taking oral bisphosphonates.\u00a0 Now, they do suggest if a patient is taking oral bisphosphonates to get a medical clearance, but it is not a direct contraindication to simple implant placement with an extraction.\u00a0 It should not be a contraindication.<\/p>\n

Now, it\u2019s different whenever somebody\u2019s taking long-term IV bisphosphonates.\u00a0 Most of those patients have previous forms of breast cancer, and we would suggest not using dental implant therapy in those patients.\u00a0 They\u2019re a little bit thicker, and implant therapy should not be recommended.\u00a0 Again, patients that are taking oral bisphosphonates such as Actonell\u00ae, Fosamax\u00ae, Boniva\u00ae, the ADA study that the risk of developing bone osteonecrosis on patients with oral bisphosphonate therapy appears to be low.\u00a0 So, it exonerates oral bisphosphonate therapy in conjunction with implant dentistry.<\/p>\n

People that are taking blood thinners, this is just something that you should be aware of.\u00a0 People that are taking aspirin daily or people that are taking Plavixx\u00ae, again, it is not a contraindication, but you just need to be aware of it.\u00a0 Review their medical history.\u00a0 Make sure that they\u2019re taking their Plavixx\u00ae the way they should be.\u00a0 They don\u2019t have any heart concerns, issues.\u00a0 Always get a cardiologist\u2019s clearance if you\u2019re going to do implant therapy just to be aware of other health issues that could arise. Most commonly in people taking Plavixx\u00ae, people taking Plavixx\u00ae are not just going to have a heart condition.\u00a0 They\u2019re probably going to be predisposed to other medical conditions, and it\u2019s good to get a full range and consult with their physicians, find out what else is going on.<\/p>\n

Another thing is warfarin, which is Coumadin\u00ae.\u00a0 Patients that are taking Coumadin\u00ae or warfarin, you really need to know their PT and pTT level, and that\u2019s going to tell you their INR, which is the international normalized ratio.\u00a0 What the American Academy of Oral Medicines suggests is not to alter their medications without the advice or us as the dentists.\u00a0 So, what we should do is find out their INR levels first of all from their physician, and the American Academy of Oral Medicine suggests INR levels of anywhere from 2.0 to 3.0 is not contraindicated to placing an implant.\u00a0 With anything above a 3.0, you\u2019re taking a risk.<\/p>\n

What that number coincides with is if a patient\u2019s INR number is roughly 2.0 that equates to a coagulation time twice the number value of a normal healthy individual.\u00a0 So, if a normal individual coagulates in 5 minutes, if an unhealthy individual has an INR of 2.0, it\u2019s going to take them 10 minutes to coagulate.\u00a0 It\u2019s a simple way to think about that, but always, again, medical clearance.\u00a0 Patients that aren\u2019t taking coagulation therapy and they want multiple implant placements.<\/p>\n

This is a lower interior mandible we did this week, it\u2019s got one of four implants.\u00a0 Great health.\u00a0 He was taking a daily aspirin so that was a concern, but not a lot of bleeding, and the ability to place four implants on the lower interior mandible was very controlled bleeding.\u00a0 This was a very in depth surgery.\u00a0 It was full thickness and flap reflection from distal premolar to contralateral distal of the second molar.\u00a0 Full thickness operation, full osteotomies, four implants placed.\u00a0 It wasn\u2019t a very lengthy procedure, but, again, a lot of soft tissue elevation, which can lead to a lot of bleeding. It\u2019s just good in the medical industry.<\/p>\n

 <\/p>\n

Dr. Lavine:<\/p>\n

Dan?\u00a0 Getting back to the bisphosphonates, what CTX values are you comfortable with?<\/p>\n

 <\/p>\n

Dr. Domingue:<\/p>\n

That\u2019s a great question, and that\u2019s a common question that we get asked a lot.\u00a0 There\u2019s a lot of research that supports different levels, and we\u2019ll talk more about that at Rocky Mountain.\u00a0 Some literature suggest to always get medical clearance, and based off the physician, even if that level is high, it\u2019s still okay to do the surgery.\u00a0 If it\u2019s multiple site implant placement as opposed to single site implant placement, it plays a big role, and we\u2019ll talk more about that and all the literature that backs it up.\u00a0 Great question.\u00a0 Thanks to whoever asked that.<\/p>\n

Uncontrolled diabetes, type II diabetes is a significant relative contraindication only due to the poor peripheral blood circulation in the patient.\u00a0 If the patient has uncontrolled diabetes just don\u2019t place the implant.\u00a0 Get the diabetes under control.\u00a0 Have the patient see their physician.\u00a0 Typically, if they\u2019re not well-controlled, they\u2019re not going to be responsive to their medications.\u00a0 They\u2019re probably not going to be responsive to your medications.\u00a0 They might not be very good patients to do implant surgery on.<\/p>\n

Patients that are \u201cmeth\u201d mouth, these patients are going to be difficult to do surgery on.\u00a0 You can sedate them if you want to, but they definitely need some implants.\u00a0 They need their teeth removed.\u00a0 They\u2019re going to need some work done, but they\u2019re hard to sedate.\u00a0 They\u2019re hard to work on.\u00a0 They\u2019re not very compliant, and just getting trying to get a feel of their history is always good pre-operatively for your patients.<\/p>\n

Then, moving on to dental history, patients that have xerostomia, again, if they lack saliva, they lack the ability to clean off bacteria around teeth.\u00a0 They\u2019re going to have more bacteria on the teeth surfaces.\u00a0 They\u2019re going to have more issues, and this is a prime example.\u00a0 This is a great friend of mine who\u2019s been a patient, and he just stopped coming to the practice.\u00a0 He\u2019s got tons of multiple class V lesions as you can see, root surface caries, and eventually, what he just did is he just gave up.\u00a0 He just stopped coming in to the office.<\/p>\n","protected":false},"excerpt":{"rendered":"

see the video: http:\/\/vimeo.com\/58581515 Dr. Lavine: Well, we are going to go ahead and get started.\u00a0 Welcome, everyone.\u00a0 This is Dr. Lorne Lavine.\u00a0 Many of you know me as the Digital Dentist. I wanted to welcome everyone to tonight\u2019s webinar.\u00a0 As of this morning, we had over 650 people that were registered for the webinar.\u00a0 […]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1],"tags":[],"class_list":["post-190","post","type-post","status-publish","format-standard","hentry","category-detox-foot-patches"],"_links":{"self":[{"href":"http:\/\/footpatches.com\/detox\/wp-json\/wp\/v2\/posts\/190","targetHints":{"allow":["GET"]}}],"collection":[{"href":"http:\/\/footpatches.com\/detox\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"http:\/\/footpatches.com\/detox\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"http:\/\/footpatches.com\/detox\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"http:\/\/footpatches.com\/detox\/wp-json\/wp\/v2\/comments?post=190"}],"version-history":[{"count":1,"href":"http:\/\/footpatches.com\/detox\/wp-json\/wp\/v2\/posts\/190\/revisions"}],"predecessor-version":[{"id":191,"href":"http:\/\/footpatches.com\/detox\/wp-json\/wp\/v2\/posts\/190\/revisions\/191"}],"wp:attachment":[{"href":"http:\/\/footpatches.com\/detox\/wp-json\/wp\/v2\/media?parent=190"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"http:\/\/footpatches.com\/detox\/wp-json\/wp\/v2\/categories?post=190"},{"taxonomy":"post_tag","embeddable":true,"href":"http:\/\/footpatches.com\/detox\/wp-json\/wp\/v2\/tags?post=190"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}