Menu
Dental implant technology has advanced greatly in the last several years. 3D rendering allows periodontists to accomplish a number of things when planning to place an implant for a patient, helping to create a better aesthetic, improved healing, and a better overall outcome. A 3D rendering is also known as CBCT, or cone beam computer tomography. This technology provides an extremely detailed view of the structures inside the mouth. This can help a periodontist visualize nerves surrounding the area where the implant is to be placed and choose the optimal placement for the dental implant hardware. Additionally, the technology allows jawbone density to be measured, indicating whether or not a patient may need bone grafting before the implant can be placed. The 3-D rendering also helps with determining the best implant size and shape to provide the patient with a natural looking permanent tooth with a precise fit.
Many periodontists use a 3D volume rendering technique that allows for the visualization and measurement of a patient’s bone density prior to the implant procedure. Measuring bone density during the initial implant exam is critical, as it determines the next steps of the procedure. If a patient has low bone density, they may need a bone grafting procedure before the actual implant can be placed. Today’s technology allows periodontists to conduct a painless scan, also called CBCT or cone beam computer tomography, to completely map out all the structures in a patient’s mouth. The 3D volume rendering technique is done to enable the doctor to accurately assess bone density without invasive procedures, and a 3D volumetric reconstruction gives the doctor the information needed to begin planning for bone grafting. The doctor can use the reconstruction to determine where the bone graft should be placed and how much bone will be needed.
3D volumetric reconstruction is a newer technology that can be used in a variety of applications, particularly in the medical field. The area of a patient’s body is scanned via CBCT, or cone beam computer tomography, and is a painless imaging procedure. The structures of the body are recreated with 3D imaging, allowing a doctor to completely visualize the area of the patient’s body and even take certain measurements that help better plan for surgical procedures or treatments. One application of 3-D volumetric reconstruction is periodontics. Placing dental implants without good imaging is difficult and reduces the patient’s chances of a good outcome. X-ray technology helps periodontists visualize a patient’s mouth structures to some degree, however, 3D volumetric reconstruction allows for full visibility. This enables a periodontist to measure bone density, assess the location of nerves, and choose the optimal placement for dental implants.
The term “absorbable” refers to the ability of something to be absorbed, particularly by the body. For instance, absorbance units, absorbent pads, absorbable stitches, and absorbable sutures are all designed to absorb or be absorbed. Absorbable products are key in implant dentistry because it’s not often practical or possible to use other types of products. Absorbable sutures, for example, are necessary during the bone grafting process. These sutures do not have to be removed like traditional sutures or stitches once healing has taken place. Over the course of a couple of weeks or so, absorbable stitches will dissolve in the mouth as the gums heal. With bone grafting specifically, the gums are closed over the graft. Absorbable products are necessary to allow the graft to heal without having to open back up the gums to remove sutures. This promotes a healthier healing experience overall.
In the field of implant dentistry, abutment clamp or preload, refers to the force that an implant screw has on the implant and the abutment. This force is linear and holds the components of the abutment connection together. As the abutment screw is tightened, the force used by the periodontist is transferred to both the internal threads of the implant and the threads of the abutment screw. The force “clamps” the abutment to the body of the implant, which is why it is sometimes referred to as “abutment clamp”. Although preload is measured in Newtons, there’s no ideal amount of clamping force used for abutment screws. A periodontist must follow the manufacturer’s recommendation for specific types of screws to determine how much torque to apply and how much preload is needed to clamp the abutment connection together. The force must be measured using special tools to ensure the correct amount is used.
An abutment connection is the connection between the prosthetic screw and the internal implant. An abutment driver, or hand driver, is used to apply force to the prosthetic screw as it is inserted into the internal implant. The force applied to the screw as it is being inserted is called preload, and how much force is used has a significant impact on the success of the finished implant. Too much or too little force can cause an implant to fail, and it is best for a periodontist to follow the manufacturer’s recommendations on each different type of screw because no standard amount of force exists. It differs from implant to implant. Sometimes an abutment holder is used to reduce the risk of dropping abutments into the patient’s mouth during the insertion of the implant. For an implant to be successful, the abutment connection must be strong.
An abutment driver is a screwdriver, much like you might find in a tool chest, although it is much smaller and designed specifically for implant dentistry. They are also called hand drivers, and are textured on the handle to provide a good grip. The tip of the abutment driver is the part of the mechanism that comes into contact with the abutment screw, and often the tip pattern will differ from manufacturer to manufacturer. Some hand drivers can only be used with certain types of abutment screws. During the dental implant procedure, the periodontist will use the abutment driver to screw the prosthetic into the internal implant. How much force applied during this part of the procedure is called preload, and how much preload is used differs between types of hardware. Too much or too little force applied can result in the failure of a dental implant, so using the right abutment driver and using it properly is critical for success.
An abutment holder for dental implants is a device that helps periodontists avoid dropping abutments into a patient’s mouth. Because abutments, abutment screws, and even abutment drivers are all very small, dropping them is a very real issue. It’s important to keep the area as clean as possible and typically the hardware is sterile. Dropping abutments can be costly, however, an abutment holder can help prevent this issue. Additionally, abutment impression coping can help accurately transfer the position of an abutment or implant in relation to the patient’s teeth. An abutment-level impression can accurately record the position of an implant at the abutment-implant interface. When used together, these tools can help periodontists optimize dental implant placement, decrease the chances of dropping abutments during a dental implant procedure, and help improve the patient’s overall outcome.
An abutment impression coping typically comes in two different types — open tray impression coping and closed tray impression coping. Although what abutment impression coping technique is used depends entirely on the periodontists preferences, many periodontists prefer closed tray impression coping versus open tray. This is because with open tray impression coping, the periodontist must be certain they can find and access the impression coping screw to be able to remove the impression. Failure to do so with an open tray may lead to the impression becoming locked in the patient’s mouth. Although a closed tray impression coping does not have this problem and is generally easier to use, open trays are considered to be more accurate, especially in cases of multiple implants that will need to be splinted in patients who are partially or fully without teeth. This accuracy makes open trays preferred by many periodontists.
Abutment mounts for teeth are prefabricated devices that serve as the connectors between the abutments and the replacement bridges, crowns or dentures. An abutment can be a portion of, attached to or built into the top of a dental implant. This section extends through the tissue of the mouth; therefore, the abutment is designed to firmly support and/or retain the patient’s prosthesis. Since there are numerous kinds of abutments available, the dental abutment mounts are typically included in the package of its coordinating abutment.
A dental abutment screw is used to secure the abutment to the dental implant. Although some patients can receive their dental implants during a single session, others will require a second surgical session: These specifics should be taken into consideration when determining which abutment and abutment mount will serve the patient better.
Types of abutments include:
The dental abutment screw is the device that is used to secure the abutment to the implant. This fastener is threaded and is typically tightened until it reaches its final seating position. There are mechanical or electronic torque measuring devices that will indicate the magnitude of the torque that is being applied to the abutment screw. If proper tightening of the dental abutment screw is overlooked, serious challenges may arise.
One of the most common complications associated with dental implants is the unwanted rotation of the abutment screw. In addition, improperly using the abutment screw can result in deleterious effects on the bone, components of the implant itself and the final restoration result.
Dental abutment screws are available in various sizes, shapes and materials. It is imperative that the dentist performing the implant procedure be knowledgeable in the materials as well as the physical and mechanical aspects necessary to ensure a proper connection between the implant and the abutment.
This refers to the step of the dental implant process in which the type of abutment that will serve the patient best is decided upon. Several factors are taken into consideration when choosing an abutment, some of which include the height of the soft tissue, the angulation of the dental implant, the planned prosthesis, interarch space, occlusal factors (e.g., antagonist teeth and parafunctional activities), phonetic considerations and esthetics. In addition, some patients will require two surgical sessions to complete their dental implant restoration. During the first surgery, these patients receive healing abutments. The healing abutments remain intact until the gum has healed around the dental implant. Once healing is complete, the final abutments and permanent prosthesis can be placed.
Types of abutments include:
Syn: Platform switching
This term refers to using an abutment that has a narrower diameter than the platform of the dental implant itself. Using this method, the dentist can move the implant-abutment junction away from the platform’s edge. The goal of abutment swapping is to prevent crestal bone loss and to increase the soft tissue volume around the platform of the implant. By using an abutment that is smaller than the dental implant platform, any inflammation that occurs will be farther from the crestal bone; thus, preventing peri-implant bone loss due to inflammatory responses.
A thick crestal bone ensures that the implant remains stable and stability is essential for the long-term success of a dental implant, which is why preventing bone loss is so important. When platform switching is utilized, the bone and tissue surrounding the dental implant is preserved, helping to provide patients with exceptional aesthetic results.
After any dental procedure, infection is something a dentist will work to prevent. By using sterile procedures, instruments and educating the patient on what they can and can’t do after the procedure, can go a long way to prevent infection. However, when infection does occur, a quick response is necessary. Bacterial leakage around dental restorations can have a significant impact on the surrounding dental pulp. The dental pulp is the innermost part of the tooth and is a living tissue — it’s filled with blood vessels, nerves, and connective tissue. This is in part what makes dental work so painful. It’s critical for periodontists and dentists to choose dental materials for restoration that are compatible with the pulp. When the materials aren’t compatible, the surrounding area of the mouth can become irritated and inflamed, resulting in bacterial leakage. Bacterial leakage can cause infection and implant failure if not handled quickly.
Also known as a ball attachment, a ball abutment is a type of extracoronal attachment mechanism used with dental implants to retain an overdenture. It consists of a spherical shaped abutment, which fits into an attachment metal housing. Prior to the implant procedure, a patient must first experience full gingival healing. Following this, proper measurement of the tissue thickness must be taken to ensure the correct abutment fit. Once the right attachment diameter is selected, the abutment is properly threaded into place and adjusted using a driver. The attachment part of the mechanism is then seated into the base of the overdenture and the denture itself is affixed to the implant. These metal attachment housings can be exchanged for alternate sizes if needed to create a proper fit. Utilizing a ball abutment can also allow for easier replacement of components and is associated with less stress on the implant. Ball abutments come in a variety of materials and the one selected may depend on the nature of the procedure and the type of implant.
A Basic Structural Unit (BSU) is essentially a building block. In anatomy, the basic structural unit of the body is the cell. All living organisms have cells, which start as the zygote — the single cell at the beginning of life, after a spermatazoon fertilizes an oocyte. In humans, the body has more than 200 different cell types. The human mouth contains bone cells, epithelial cells, endothelial cells, muscle cells, nerve cells, and cartilage cells. These make up four broader categories of tissue in the body: nerve tissue, muscle tissue, connective tissue, and nervous tissue. This means that the oral cavity involves nearly all the different types of tissue and basic structural units of the body. The innermost part of the BSU, or the nucleus, contains the genetic (DNA) information for the organism. Mitochondria provide energy to the cell to perform bodily functions, and the cell membrane functions as an outer wall.
X-ray technology works by utilizing a phenomenon known as “beam hardening.” When an x-ray passes through an object, two things occur: photons that have lower energy are absorbed, while photons with higher energy are left behind. This allows an image to be created of structures within the object that are of higher energy. Skin, for example, has a lower energy level than bone. Bone, however, has a lower energy level than metal. This results in varying shades of gray that can be seen on an x-ray — metal is typically opaque white, while bones are semi-translucent. Folds of skin may be seen, however, most often, soft structures of the body like skin and muscle are completely transparent. Beam hardening technology allows dental professionals to isolate and assess internal oral structures like dental implant screws, tooth roots, and underlying bone to determine the overall best approach for completing dental restorations.
Benign paroxysmal positional vertigo (BPPV) is a common cause of dizziness, or vertigo. It causes the sensation that your body is moving even when it’s not, or that your head is spinning. BPPV results in short but sometimes very intense episodes of vertigo. Usually, these episodes of dizziness are triggered by certain changes in head positioning, such as moving the head vigorously from side to side, leaning down for extended periods, or other sudden movement. The movement is said to cause calcium deposits in the inner ear to dislodge, which move across internal structures of the ear. This causes the ear to send signals to the brain that the body is in motion. Usually, benign paroxysmal positional vertigo (BPPV) is very bothersome for the patient but of little cause for concern other than protecting patients from falls due to loss of balance. One cause of BPPV is TMJ/TMD, or temporomandibular joint dysfunction.
Betamethasone is a type of glucocorticoid, or corticosteroid, with a long half-life. It can be taken orally, applied topically, or inhaled to achieve the required effect. Betamethasone is often used to treat skin conditions to reduce swelling, itching, redness, and irritation. This drug has also been found to have applications in the dental field by promoting healing and reducing swelling. Following more extensive dental procedures, patients often experience inflammation which leads to pain and a delay in the healing process. The use of betamethasone has been shown to lessen these complications. It is generally administered as a mouthwash with one soluble betamethasone tablet being dissolved in water. Patients usually experience a reduction in inflammation, swelling, and pain due to the effects of the drug. For oral lesions, betamethasone can also be administered via inhaler with the inhaler positioned in the mouth so that it is close to the site of the lesion.
A beveled flap is a small section of gingiva that has been surgically separated from its underlying tissues by incising at an acute angle. This allows for visibility to the root surface and bone structure of the patient.
A beveled flap can be classified based on how the bone is exposed after reflection of the flap — e.g. a mucoperiosteal (full thickness flap) or a mucosal (partial thickness) flap. The flap can also be classified based on how it is placed after surgery — e.g. a non-displaced or displaced flap, as well as classified on the management of papilla — e.g. a papilla preservation flap or a conventional flap.
A full thickness flap allows all soft tissue to be completely reflected to gain full visibility to bone structures, while a partial thickness flap only includes incision of the epithelium and some but not all of the underlying tissues. The periosteum remains in place over the bone, allowing for more limited visibility.
A bevel incision, or internal bevel incision, is a type of periodontal flap surgery that allows a periodontist to access to the bone and root surfaces of the teeth. A small incision is made in the gingiva to expose the root surfaces and in some cases, the gingiva can be relocated in patients who have mucogingival involvement. This is done to clean the roots of the teeth, remove the periodontal pocket lining, and treat alveolar bone irregularities. Then, the periodontal flap is laid back down and the bevel incision is closed. The procedure helps reduce the risk of infection and inflammation, and can significantly reduce the size of pockets. A bevel incision is typically made using a #15 or #15C surgical blade, and is made to the alveolar crest beginning about 1 mm or less away from the gingival margin. Sutures are placed after the flap is repositioned to allow for minimal, if any, scarring.
Bicortical stabilization can sometimes be difficult to achieve, however, is an advantageous surgical goal. Biocortical stimulation occurs when a surgeon engages more than a single cortical plate when placing a dental implant. Typically, this is done with the cortical bone of the base of the mandible or the floor of the maxillary sinus or nasal cavity and the crestal cortical bone of the edentulous ridge. However, it can also be done by engaging the lingual and facial cortices.
Biocortical stabilization can reduce maximum stress in the superior cortical plate, assuming no peri-implant defects have occurred. However, each surgeon must decide if the potential gains from this technique outweigh the increased risks that are needed to achieve implant placement with the engagement of more than one cortical plate. Ultimately, the advantages and disadvantages must be evaluated in each patient to determine the best surgical approach.
Bioabsorbable technology continues to grow with the refinement of bioabsorbable polymers for medical devices. At its base, bioabsorbable material was created to address potential problems with synthetic implants of all kinds, including but not limited to growth disturbance, migration of the implant, rigidity, and infection, since the body generally resorbs the material over time.
Bioabsorbable material is commonly used in the medical field where implants are necessary, including bioabsorbable stents for cardiac procedures and bioabsorbable screws for dental implants. Bioabsorbable screws material for dental implants is often referred to as resorbable alloplast, and like a bioabsorbable stent, it is designed to facilitate regeneration of natural tissues.
While some surgeons prefer to continue to use titanium implant material, the use of bioabsorbable material is growing in the field of periodontics. Surgeons and patients may see a reduction in post-operative complications when bioabsorbable screws are used during the dental implant process.
CAD/CAM is a field of dentistry that uses computer-aided design (CAD) and computer-aided manufacturing (CAM) to create dental restorations like dentures, dental implants, veneers, dental crowns, and more. CAD/CAM technology allows dentists and periodontists to fit patients with durable, high-quality, and aesthetically pleasing dental prostheses. Not only does this technology improve the design and creation of dental restorations, it also makes some types of restorations possible that would otherwise not be without computer-aided design and manufacturing. A CAD/CAM system has a digital scanner that scans models and inputs the image into a computer, software that allows professionals to design a prosthesis, and technology that allows for the prosthesis to be created using the computerized image and data. CAD/CAM systems are most often used in a dental lab or production facility, but they can also be used by dentists and periodontists chair-side.
Computer-Assisted Design and Computer-Assisted Manufacturing (CAD/CAM) is a technology that uses computer software to design and manufacture implant abutments. The software uses the information from digital position recognition of the patient’s implant platform to create the custom abutment. This can assist in making a better-fitting abutment-to-implant connection. CAD/CAM abutments are often made of titanium bases due to the material’s biocompatibility and known hygienic characteristics. The use of titanium also creates a strong and corrosion-resistant implant base. CAD/CAM abutments can be made of Telio CAD abutment blocks. These blocks are made of polymethylmethacrylate (PMMA), a durable material that can be shaped and polished to create a natural look. CAD/CAM technology can also be used to create custom healing abutments that better prepare the patient’s tissue for the CAD/CAM implant. Healing abutments created using this technology can require less re-contouring, thereby saving the patient from additional dental work and expense.
Calcium phosphate is a biomaterial that has a chemical structure that is very similar to naturally occurring bones and teeth. It has both osteoconductive and bioactive properties, making it an ideal choice for implant dentistry and orthopedic applications. The calcium phosphate molar mass plays a role in its ability to promote rapid bone formation and osseointegration, and a special calcium phosphate formula is often used to coat the outside of dental implant hardware to help increase the chances of the implant success. Factors that can affect the coating’s performance include but are not limited to the thickness of the coating, the coating’s purity, the crystallinity, and its chemical composition. Additionally, calcium phosphate is often used for other applications in implant dentistry, including bifurcation perforation repair, periapical defect repair, apical barrier formation, and pulp capping. Tricalcium phosphate is a form of calcium phosphate that may also be used.
Calcium sulfate, also referenced as calcium sulphate or CaSO4, is an inorganic compound often used as a dessicant in its anhydrous form. A common example of calcium sulfate is Plaster of Paris, and the readily available compound is used in many other applications, particularly in the field of implant dentistry. It has a history of being used during bone regeneration procedures as a grafting material or a graft extender. It has also been utilized as a barrier for guided tissue regeneration. The compound is extremely biocompatible and the body is able to completely absorb the material over time. The body does not react significantly to calcium sulfate and the area of implantation becomes calcium-rich and primed for dental implant hardware. Studies show that tissue migrates over the material if primary closure is not obtained. While inexpensive and abundant, calcium sulfate is not used as often in dentistry as other biomaterials.
A Caldwell-Luc antrostomy is a procedure often used to remove a damaged mucosal lining from the maxillary sinus, developed by George Caldwell in 1893 and Henry Luc in 1897. The Caldwell-Luc operation indications are usually when sinusitis in the area has not responded to antibiotic treatment, sinus rinses, and other non-invasive treatments. However, the procedure may also be used in cases of malignancy, dental cysts, sinus polyps, fractures in the bone surrounding the maxillary sinus, or the removal of foreign bodies. Most commonly, a Caldwell-luc procedure is performed under general anesthesia due to its invasiveness, but may be performed under local anesthetic in some situations, such as if an allergy to general anesthesia exists. Complications of a Caldwell-Luc antrostomy include potential damage to secondary dentition in children, damage to adult teeth, excessive or uncontrollable bleeding, and pain and discomfort.
Nearly all medical specialties use the scientific process of taking a tissue culture. There are three different types of tissue cultures: callus culture, a seed culture (used for plants), and embryo culture. A callus culture involves the removal of a small specimen from the body and facilitating its growth into a callus in a controlled environment outside the body in order to study it. A callus is a group or mass of unorganized cells. Usually, this is done in agar, a special nutrient-rich gel that feeds the specimen for optimal replication. Different types of micronutrients and macronutrients may be included, and basal salt mixtures may also vary to enhance growth. In dentistry, callus cultures can help professionals identify difficult to treat gingival bacteria or tumor tissue that grows from wounds in the oral cavity. When studied, the callus can help dental professionals develop an appropriately responsive treatment plan through trial and error.
The calvaria definition is a simple one — the calvaria is the topmost part of the neural cranium, which protects the cranial cavity that houses the brain. The calvaria is comprised of several different bones, including the parietal bones, the occipital bones, and the frontal bone, or forehead and is the primary part of the skull roof. The bones of the calvaria are comprised of layers of compact bone, which is separated by diploic veins, or cancellous bone that houses rich, red bone marrow until death. In a fetus and young child, the junctions at which the calvaria joins with other bones in the skull roof are soft and not yet melded together — this process, known as intramembranous ossification, completes after the first few years of life. The skull roof then becomes hard at the junctions and much more difficult to penetrate.
There are two types of bone found in the human body — cortical bone and cancellous bone. Cancellous bone is a spongy type of bone and is responsible for producing stem cells and blood cells. Because of these incredible properties, cancellous bone is typically used for bone grafts due to its concentration of osteoprogenitor cells and therefore a greater ability to form new bone as compared to cortical bone. Although all bone is always in a state of renewal, a cortical vs cancellous bone graft is unlikely to be osteogenic or osteoinductive due to its fundamental lack of cellularity. Cancellous allograft bone chips are often used to fill voids within bone and have a wide range of medical applications, including osteopathy and implant dentistry. The gold standard of bone grafts, including cancellous bone grafts, is when bone can be removed from one area and grafted to another area within the same patient.
A Cantilever, or Cantilever bridge, is a special type of dental bridge that features abutment teeth on only a single side of the edentulous gap. In traditional dental bridges, the pontic (the unanchored artificial tooth) is in the center of two anchors. These anchors are often dental implants, especially for patients who are looking for a permanent solution. In a Cantilever dental bridge, however, the pontic is located on the outside of an anchor tooth, also called the abutment tooth. A dental professional may choose a Cantilever bridge when preparing a traditional bridge with abutment teeth on both sides would not be aesthetically appropriate for the patient, usually due to the location of the bridge. Or, a Cantilever dental bridge might be selected if one of the would-be anchor teeth of a traditional bridge is supporting another dental prosthesis that is unable to be replaced.
A castable abutment, also known as the University of California at Los Angeles (UCLA) abutment, is a prefabricated component, with or without a prefabricated cylinder, used to make a custom abutment for a cement-retained or screw-retained prosthesis. It is created by waxing its plastic burnout pattern and subsequently casting the abutment through a lost-wax technique. The custom-made abutment is then used in the construction of an implant or prosthesis. Such abutments can be made of a variety of materials including metal alloys such as titanium, gold, or chrome cobalt, or from polymers such as polyoxymethylene. When used in the placement of an implant, the abutment allows for height and angle correction while also fitting with the surrounding soft tissue. Following the final implant placement, a sturdy but temporary filling material is used to cover the screw access channel for easy access and adjustment should it be required in the future.
A data merge is diagnostic information that is obtained from a dental CBCT (cone beam computed tomography) scan. It’s merged with visual surface data from an intra-oral or desktop optical scanner. A CBCT is similar to the technology used for a traditional CT scan. The equipment rotates around the patient’s head, capturing data using a cone-shaped x-ray. The data is merged visual surface data to create a 3D (three-dimensional) image of the patient’s entire jaw, mount, surrounding bone structure, teeth, and the ear, nose, and throat. CBCT technology is used to diagnose cavities, assess cleft palates, visualize endodontic issues, and diagnose dental trauma, in addition to being used extensively in the dental implant industry to plan and execute accurate and successful implants. Using CBCT technology with intra-oral or desktop optical scanners is fast, easy, and non-invasive for the patient. However, the FDA recommends that dentists and periodontists only use CBCT scans when absolutely medically necessary for a diagnosis or treatment. Medically appropriate CBCT scans are of low risk to patients compared to the benefits.
De-osseointegration is the loss of a previously achieved osseointegration of a dental implant due to peri-implantitis, occlusal overload, or other factors. Osseointegration takes place when there is direct contact between living bone and a functionally loaded dental implant surface without any interposed soft tissue. Osseointegration creates a secure foundation for the implant and prevents any movement or instability. When de-osseointegration takes place, this foundation is compromised, and implant instability or failure can occur. Peri-implantitis can arise in situations where excess cement is not completely removed following the placement of a cement-retained implant or prosthesis. It has the potential to lead to complications such as de-osseointegration and is one of the greatest disadvantages of a cement-retained implant. Occlusal overload can also cause de-osseointegration and occurs when the chewing force exceeds the capacity of the dental implant, dental interface, or dental componentry. This causes a failure in the overall implant and can reverse the osseointegration process.
Dental decortication refers to the intraoperative perforation or removal of cortical bone to induce bleeding and the release of bone forming cells from the underlying marrow. It is routinely used in combination with onlay block grafts or guided bone regeneration (GBR) procedures. In addition to the dental definition, decortication also refers to a medical procedure including the lung, diaphragm, and chest wall. There are a variety of medical disorders that can lead to the need for decortication. These disorders cause a fibrous tissue layer to form over the lung which causes lung complications. Decortication of the lung removes this tissue layer and frees the lungs to move normally. Indications for this process include difficulties that arise from pathogenic disorders such as tuberculosis and pneumonia. When asking how serious is decortication, it should be understood that while the procedure has high success rates, issues with bleeding, infection, or pain at the incision site are still possible.
A defect is simply an imperfection in something. In dentistry, there are many different types of defects. For example, dental enamel defects (DEDs) are a flaw in the enamel, or the hard outer surface of the tooth. When enamel formations of primary or adult teeth are deficient, dental health can become compromised as it’s easier for bacteria and plaque to enter the structure of the tooth. Since dental enamel cannot regenerate on its own, enamel defects like hypoplasia or hyperpigmentation must be managed by a dental health professional. Congenital dental defects are imperfections that occur during the earliest stages of fetal development in the womb, like a cleft palate, missing adult teeth, or misshapen or fused teeth. Other defects can include periodontal bone defects, furcation defects, alveolar ridge defects, gingival fenestration defects, and more. Treatment for defects depends largely on the type of defect and where it’s located in the mouth.
A dehiscence is an opening or splitting in tissue, usually of an organ. In botany, this typically refers to when a seed pod on a plant splits open to release the seeds inside. In medical terms, it is most often used to describe the reopening of an incision after surgery or a wound that has been otherwise closed. This can be either internal or external. In dentistry, the term is used to describe an entirely different process: the loss of alveolar bone on the front side of the tooth. This results in the appearance of an oval-shaped root-exposed defect underneath the gingiva. This condition is characterized by the degradation of alveolar bone, gum recession, and exposure of the tooth root. Dehiscence can cause patients severe pain, especially when the root of the tooth has become exposed to hot and cold temperatures. It can also result in aesthetic changes and self-esteem issues.
When patients don’t have enough bone to support a dental implant, a bone graft may be necessary. The success of bone grafting depends on the ability of the donor bone to bring in host cells to the site graft and convert them into cells that will form bone. If the bone cannot recruit host cells or facilitate their conversion to bone cells, the graft is usually a failure. The osteogenic, osteoinductive, and osteoconductive capabilities of the donor bone dictate a large part of how successful the graft will be. Demineralized bone matrix (DBM) is a type of allograft bone that has been processed to remove inorganic minerals, leaving only the organic bone matrix behind. The demineralization process increases the bioavailability of allograft donor bone, making it a superior material to demineralized bone grafts. Demineralized bone matrix (DBM) was discovered in 1965 by Marshall Urist, a U.S. orthopedic surgeon practicing in Los Angeles, California.
A demineralized freeze-dried bone allograft (DFDBA) is an allograft composed of demineralized bone matrix (DBM) following the demineralization of a freeze-dried bone allograft (FDBA). Though a variety of bone graft options have been used in the regeneration of periodontal tissue, DFDBA is used the most often. It has been shown to be effective in the reconstruction of both furcation and periodontal defects and has also demonstrated osteoinductive effects. When implanted in bone that is already well-vascularized, it has the ability to stimulate cell attachment, cell migration, and osteogenesis. DFDBA contains bone morphogenic protein (BMP) that causes new bone formation to take place during healing. It is therefore an effective option for bone regeneration. Some dental and oral surgery patients may require bone enhancing procedures prior to receiving an implant or other dental prosthesis. Due to the many benefits of DFDBA, it is a commonly used material for such bone enhancement and bone development processes.
A dentin grinder is a special tool used to grind extracted teeth into usable dentin for autogenous grafts. Autogenous grafts are considered the “gold standard” of grafting material since they come from the patient’s own body, however, the need for a second surgical site typically meant that a different kind of graft was selected to prevent having two incisions and the additional risk for infection. With a dentin grinder, a dentist or periodontist can create autogenous grafting material from the patient’s own extracted teeth. The tooth is inserted into the grinder, which typically produces particulate dentin about three times the volume of the original tooth. Most dentin grinders come with a sterilization kit that allows dental professionals to sterilize the ground dentin before using it in a grafting procedure. Autogenous grafts are at a low risk for infection, improving patient outcomes and overall satisfaction after the procedure has been completed.
Dentures are one of the most commonly used dental devices, along with braces and mouthguards. Dentures are either one or two sets of artificial teeth and gums that are designed to be temporarily worn and removed for cleaning and rest. There are three different types of dentures: traditional full dentures, immediate full dentures, and partial dentures. Traditional full dentures are generally the most common and are a complete set of top and bottom dentures. Partial dentures are as the name indicates: a partial set of upper or lower dentures. Partials can be used when a patient is able to retain some of their natural teeth and only needs dentures for one or two sections of missing teeth, which are connected by a wire similar to a retainer. Finally, immediate full dentures are dentures that are placed right after the extraction of natural teeth so patients do not have to be without their teeth for any length of time.
Depassivation is the loss or the removal of the surface oxide layer of a metal. Since metals will corrode in certain environments, including when in the presence of water, the chemical process of passivation is used to add a protective metal oxide layer to combat this characteristic. Metals are frequently used in dental work in creating crowns, fillings, bridges, and other dental implants or prostheses. These metal-based dental structures are exposed to saliva—a water-based substance—as well as digestive enzymes and acids from foods and the digestive tract. All of these substances can lead to corrosion and therefore metal dental components undergo passivation prior to use. When depassivation takes place, this protective oxide coating is lost, and the metal is once again susceptible to deterioration. This corrosion can lead to several complications including failure of the component, an infection in the tissues of the mouth, or the need for more expansive dental work.
Individuals who were born without one or both of their external ears, or individuals who have suffered trauma to their external ears, can get a realistic looking ear prosthesis attachment. In many cases, the prosthesis looks so natural that the average person won’t be able to tell that it’s a prosthetic. Getting an ear prosthesis is an involved process, because surgery is usually necessary. Ear prosthesis surgery involves placing titanium posts in the bone around the ear to anchor the prosthetic to. Without a solid anchor, the prosthetic could fall off or be torn very easily. This is similar to how dental implants are done — with dental implants, a titanium rod (or a rod of another implant-grade material) is placed into the jawbone and once that heals, the prosthetic tooth can be anchored to the implant. One difference is that a prosthetic ear is removable, while a dental implant generally is not.
Early Crestal bone loss takes place around implants prior to occlusal loading. This means that bone loss occurs around the implant in the first year following the implant procedure. The loss may be caused by a variety of issues including the biological factors of the patients. These factors may include:
How well the patient follows post-surgery directions and the patient’s overall long-term care of their teeth, as well as the care of their implant following surgery also play a role in early crestal bone loss.
Early implant failure occurs when a dental implant is rejected or fails in some other way in the early stages of healing. Although failure rates are low with dental implants as a whole, there are some things that increase the risk of early implant failure. How successful a dental implant is depends largely on the patient’s overall oral health, the experience of the periodontist, where the implant is placed in the mouth, and the type of dental implant used. Early implant failure is usually due to poor osseointegration, which can indicate impaired bone healing. Risk factors for failure include but aren’t limited to smoking, infection, insufficient bone quantity, poor bone quality, and characteristics of the implant. Other risk factors may include patient age and sex, implant height and surface properties, the type of surgical procedure, and not using prophylactic antibiotics. Recognizing preventable risk factors and mitigating them can help dentists improve patient outcome.
The loading of a dental implant refers to the placement of the prosthetic onto the dental implant hardware after the implant has healed. However, early loading is becoming more popular as patients are demanding shorter treatment times. This means that the implant may be loaded before tissues have fully healed and before the implant has completely osseointegrated. There are three types of loading: conventional, early, and immediate. Conventional loading of a dental implant takes place between three and six months after the placement of the implant hardware. However, extended treatment times may be undesirable for some patients, especially when the implant is being done in the front of the mouth. Immediate loading occurs about 48 hours after the placement of the implant hardware, however, studies show that immediately loaded implants are less successful than their conventional counterparts. Early loading refers to loading that occurs at any time between 48 hours and 3-6 months.
Edentulism is the clinical word for being wholly or partially toothless, or having one or more missing teeth. The loss of all teeth is called full edentulism, while the loss of only some teeth is called partial edentulism. While edentulism can be a genetic defect and takes place naturally in some species such as sloths and anteaters, this is rare and most cases of edentulism in humans is the consequences of tooth loss. A person who has one or more missing teeth is said to be edentulous or edentate. The causes of edentulism in humans are most often cavities, poor oral hygiene, gum disease, bone loss, and other periodontal issues. Teeth play an important role in appearance and health: they give the face a fuller appearance while also enabling the proper enunciation of words and syllables. Untreated edentulism can cause the chin to protrude and the cheeks to appear sunken into the face.
Edentulous simply refers to a lack of teeth; an edentulous space is an area of the mouth that no longer has (or was always missing) teeth. An edentulous patient may have only one or two missing teeth, either in one spot or throughout the mouth. An edentulous site with just a few missing teeth may be prime for a dental implant, while a fully edentulous patient may want to consider dentures. Causes of tooth loss include tooth decay, oral trauma, and advanced periodontal disease (gum disease), and an increased risk of tooth loss is noted in patients with hypertension, diabetes, poor nutrition, smoking, and arthritis. The large majority of edentulous adults are missing teeth as a result of periodontal disease; this begins with bacteria that multiplies deep underneath the gums, causing inflammation and the destruction of the bone underneath. This removes the anchor that teeth have, causing them to become loose.
The electrical discharge method, also called electrical discharge machining or spark erosion, is a process used in dentistry to obtain the best passive fit of dental implants, removable dental prosthetics, and titanium/ceramic crowns. During electrical discharge machining (EDM), the desired shape of metal is achieved by using erosion created by an electric current. The current is precisely controlled via two conductive objects placed inside a liquid medium. Essentially, two types of electrical discharge machining exist — a wire type and a probe type, the latter of which is primarily used in the field of restorative dentistry. EDM increases how long a dental restoration lasts and removes the need for traditional soldering techniques. Fitting restorations using the electrical discharge method can be expensive for the patient, but the results are longer lasting than many other restorative procedures. EDM is also used in die making, prototype parts, stamping tools, and even aerospace components.
An emergence profile in dentistry is simply defined as the contour of the tooth or dental restoration where it meets, or “emerges” from the gingiva. Optimizing the emergence profile is a key component of cosmetic dentistry, and recreating a natural emergence when completing dental restorations is critical to the overall aesthetics of the patient’s smile. This is what enables the implant or other restoration to begin to resemble a lifelike tooth. Emergence profiles are important in common types of cosmetic dental procedures, including veneers, crowns, dentures, partial dentures, and dental implants. A good emergence profile should create a smooth, natural-looking transition from the circular implant platform to the tooth at the gingival level, resulting in a completely flawless restoration that is difficult or impossible to spot with the naked or untrained eye. Naturally, the emergence profile is most important when restorations are being done on the upper or lower front teeth.
An enamel matrix derivative, or EMD, is a sterile protein aggregate which comes from the enamel matrix, specifically from amelogenins, and is the precursor of the enamel of developing teeth. The proteins necessary for EMD are harvested from around the developing teeth of pig embryos using a special processing procedure. Enamel matrix protein derivatives are used in the restoration and regeneration of periodontal tissues and assist in the growth or further development of the periodontal ligament, root cementum, and alveolar bone. Though enamel matrix derivatives are harvested from pig embryos, they have not been shown to create a significant immune response when used in humans. The use of EMDs have also demonstrated anti-inflammatory properties. Both of these results suggest that the use of EMD is safe for humans. In addition, the results of EMD therapy are longer-lasting and have been shown to provide significant benefits to patients undergoing periodontal regeneration.
An endodontic implant (also known as an endodontic pin or endodontic stabilizer) is a pin placed into a root canal of a tooth. It extends beyond the apex of the tooth and into the bone. An endodontic implant is also known as a stabilizer because of its function in providing more stability to a weakened tooth. By increasing the root to crown ratio, the implant can provide the patient with tooth stability and allow them to avoid replacement procedures for years. An endodontic implant may be used in situations where a patient has experienced periodontal bone loss, has a chronic abscess where the root apex has been reabsorbed, has a tooth with a very short root, or has a poor crown to root ratio due to tooth fracture. An endodontic stabilizer may also be appropriate in patients where the loss of a tooth would be difficult to manage using other dental processes.
A facebow is a special instrument used by dentists when fitting a patient for dental prosthodontics. The facebow lines up with the patient exactly and allows the dentist or periodontist to accurately measure important parts of the patient’s facial structure, like the maxillary arch and its relationship to the temporomandibular joint, and transfer that data to where it can be used to create dental prosthetics. With the rise of computer-generated dental prosthetics, the facebow has been phased out by many dentists and periodontists and is no longer used to take important measurements. However, the facebow still plays an important role in transferring functional and aesthetic components from the mouth of the patient to the dental articulator. Without a facebow, the measurements taken by a dentist or periodontist may not be as accurate as they assume. This results in having to make multiple adjustments for the esthetics and occlusions later.
A facial prosthesis is a maxillofacial or craniofacial artificial replacement for a part of the face that is missing due to:
Facial prostheses may include the use of a prosthetic mask. They can require prosthetic nose surgery to replace the affected facial features. A prosthetic facial mask can be used to replace more than one feature as well as larger portions of missing or damaged tissue on various parts of the face. A nose prosthesis has a more limited function as it only replaces the lost or damaged nose and surrounding tissue. Such prostheses can provide confidence for those who have been affected. Prosthesis training is required for those in the medical and dental professions to ensure patients are properly fitted. Prostheses can be attached to the affected areas in a variety of ways, with some requiring stabilizing or fixing with the support of specially-designed dental implants.
A facing is more commonly known in cosmetic dentistry as a veneer. They are most commonly used to achieve a perfectly straight, white smile and can restore the look of chipped, broken, cracked, stained, and gapped teeth. Veneers are thin pieces of porcelain that are used to recreate the surface of the teeth, or the “face.” Porcelain is preferable to other materials because it has a similar density and durability as natural tooth enamel, however, some veneers are crafted from resin. Resin is a similar material to composite, or “white” fillings. Each veneer is custom made to the shape of the tooth it will be placed on and is permanently bonded to the tooth with a special procedure. Veneers are not removable and require the surface of the natural tooth to be altered to place the veneer. Patients interested in veneers should discuss the benefits and risks of permanent tooth alteration.
Unfortunately, all dental implants carry a risk of failure and a periodontist’s primary job is to use a wide variety of available tools and techniques to reduce that risk. A dental implant can include one or more teeth, either separate or joined together. They are generally made out of alloplastic materials like titanium or titanium alloy, but ceramics, bioglass, hydroxyapatite, and aluminum oxides may also be used. Osseointegration, or fusing to the bone, is the measure of success for a dental implant and what material the implant is made from and its surface texture plays a significant role in that success. Other factors for dental implant failure include but are not limited to: the location of the implant in the mouth and its placement in bone; what kind of implant screw is placed over the implant body, and the type of abutment used and how it is placed.
Like any medical procedure, dental implants can fail. The failure rate of implants is low, with only about 5-10% of patients experiencing failure. Dental implant failure can be mitigated by taking into account factors of success. The chances of implant failure are higher in patients who have gum disease, who smoke, who have insufficient or weak jawbone, or who have conditions like diabetes or rheumatoid arthritis that can impede healing. Dental implant failure can occur early after the procedure or much later. Early failure factors include an infection at the surgical site, insufficient bone to support the implant hardware, allergic reaction, poor adherence to post-op instructions, and micromovements of the hardware. Late failure factors include tissue and nerve damage at the implant site, foreign body rejection, and injury to the face or jaw that physically dislodges the implant. Signs of failure include problems chewing, pain, swelling, and gum recession.
Dental implants can fail for several reasons, including lack of osseointegration (fusion to the surrounding bone) or peri-implantitis (a post-op infection causing inflammation of the surrounding bone and gum tissues). However, dental implant failure in the long term can be caused by what is known as the fatigue phenomenon. This phenomenon was first discussed in a 1964 article called General Principles for Fatigue Testing of Metals, published in the International Organization for Standardization. The article describes the changes that can occur to metal materials when under intense “cycles” of stress or pressure for a significant period of time. This is most applicable to implant dentistry when dental professionals are considering a dental implant for a patient with bruxism. Bruxism is the repeated grinding or clenching of the teeth, usually at night, that can cause teeth to crack or cause temporomandibular joint disorder (TMJ). Patients with bruxism are more likely to experience implant failure due to fatigue.
Feldspatheic porcelain is a highly translucent, esthetic material for restorations fabricated with the traditional veneering porcelain powder and liquid brush buildup technique. When necessary, opaquer can be added by the laboratory to cover dark stain cases. Feldspathic porcelain closely resembles the color and texture of natural teeth and is a popular choice for veneers, filling gaps between teeth, and other restorative processes. This material has many benefits including minimal preparation. Patients are able to retain much of their original tooth structure which reduces the invasiveness of the procedure as well as the time required for the procedure. Feldspathic porcelain is also biocompatible, durable, and long-lasting meaning patients could potentially enjoy the effects of their replacement or restoration for years before requiring additional work. Despite the many advantages of feldspathic porcelain, it does have some issues including being the weakest of the restoration materials. When it is used, it is best on anterior teeth that still have enamel in place.
In dentistry, a fenestration is a buccal or lingual window defect of either denuded bone or soft tissue occurring over a tooth root, implant, or alveolar ridge. The term may also apply to a man-made fenestration which is created when opening a lateral window to the maxillary sinus for a sinus augmentation procedure. A naturally occurring fenestration leaves the exposed root surface in direct contact with either the alveolar mucosa or the gingiva. The condition may be caused by a variety of factors including tooth movement due to orthodontics, pathology (both endodontic and periodontal), root apex contours, and occlusal issues. Treatment of a fenestration can include guided tissue regeneration, flap surgeries, or free gingival grafting. For some patients, a bone graft may also be required. Prior to orthodontic procedures, it is important that both the root positions and the periodontium condition be evaluated to reduce the risk of fenestration.
A fibrin matrix, or fibrin-rich matrix, is a provisional matrix provided by the fibrin clot and fibronectin during the first phase of wound healing. The fibrin matrix secretes chemicals that summon monocytes, fibroblasts, and epidermal cells to the area of the body that requires healing, thus promoting the healing process. The term may also refer to a membrane-like matrix derived from autologous blood which is strong and pliable. It functions as either a standalone product or can be mixed with other biomaterials to improve wound healing and promote tissue regeneration. In dental applications, a platelet-rich fibrin matrix can be applied following a surgical procedure to speed the healing process. The fibrin matrix also has the capacity to reduce inflammation and swelling and can be used even in advanced surgical techniques. Following implant or grafting procedures, a fibrin matrix can be utilized to speed wound healing and aid in patient recovery.
A fibroblast is a type of cell found within the connective tissues that are responsible for the synthesis of collagen and ground substance. In dentistry, fibroblasts play an important role in the integration of and implant, prosthesis, or restoration. The most common types of fibroblasts involved with dental processes are gingival fibroblasts and periodontal ligament fibroblasts. They are responsible for the synthesis and organization of the collagen fibers that connect the gingiva and alveolar bone to the cementum tooth covering. In addition, fibroblasts also secrete a growth factor that stimulates tissue regeneration in dental pulp cells and the dentin-pulp complex following a tooth injury or oral surgery. Due to the tissue trauma caused by an oral surgery or implant, multiple types of cells are required to repair and regenerate the damaged tissues. Due to the responsibilities of fibroblast cells, they are among some of the most important factors in proper healing and implant success.
Gaps in teeth are common, however, many people feel self-conscious and want to see a dentist. Gap teeth are typically corrected with tooth-colored composite filling, however, dental veneers can also be used for bridging the dental gap. The composite-filling procedure is quick and nearly painless, and the teeth gap filling cost is much less than veneers. However, veneers may be warranted in some cases where other issues like hard-to-treat discoloration, broken teeth, chipped teeth, or more than one space. You can have a veneer put on just one or two teeth to fix a gap, or you can have them put on the teeth that show for a brighter, more uniform smile. If you’ve been wondering can dentist fix gaps in teeth, contact your dentist and set up a consultation for an evaluation to determine the best course of action to fill your tooth gap.
The gap distance is the space between the bone of an osteotomy or an extraction socket and a dental implant at stage-one surgery. A gap may occur at various locations including the lingual or proximal aspect or at the buccal plate. The level of the first bone-to-implant contact is influenced by the dimension of the gap as well as the type of implant used.
Gap distance can also refer to the distance between teeth. To reduce the gap between teeth, different forms of dental or orthodontic work may be required including tooth extraction or braces. To correct the gap between teeth, treatment may require repeated visits which can spread out over a number of months or even years. Gap between teeth treatment costs will vary depending on the type of dental or orthodontic work required as well as the duration of the corrections and number of office visits.
Gingiva is another word for the gums, or the soft, pink tissue that surrounds and protects the bottom of the teeth where they enter the jawbone. The gingiva is attached to the tooth, which forms a seal between the mouth and the underlying bone. Poor oral hygiene causes a buildup of plaque in the crevices of the teeth and gums, which if left untreated, can cause an infection called gingivitis, or gum disease. Gum disease causes inflammation of the gums and weakens the seal, allowing bacteria to enter the tooth root and bone structure. When this happens, the infection progresses to periodontitis, which often results in permanent tooth and bone loss. The gums play an integral role in the overall oral health of a patient and are crucial to keep healthy. Poor gum health contributes to poor oral health and a wide variety of other dental problems.
Gingival crevicular fluid, also called GCF, was recognized as an important factor in diagnosing periodontal disease over six decades ago. It is an inflammatory exudate that is derived from periodontal tissue and contains primarily the byproducts of tissue breakdown, antibodies, inflammatory mediators, and serum. It also contains structural periodontal cells, leukocytes, and normal oral bacteria that is usually present in the mouth. The serum component of this fluid is mostly derived from postcapillary venules, or microvascular, leakage. This fluid has an important role in maintaining the antimicrobial defense of the periodontium and maintaining the structure of the junctional epithelium. The bacteria most often responsible for periodontal disease are Treponema denticola and Porphyromonas gingivalis. The bacteria create broad-spectrum neutral proteinases to attack healthy tissue, which are then found in both samples of gingival crevicular fluid and plaque in patients who have periodontal disease. Patients with periodontal disease have an excess of GCF, whereas patients with healthy gums have very little.
A gingival flap is created during gingival flap surgery, a procedure where gum tissue is separated from surrounding teeth and deflected back to allow a dental surgeon access to the jawbone and the root of the tooth. A gingival flap is created prior to bone grafting and before a dental implant is placed, but it can also be used before treating periodontitis, or gum disease. During the procedure, the gums are numbed with a local anesthetic and a surgeon uses a small scalpel to make a u-shaped incision and fold the flap of gum tissue back. Then, the surgeon will graft bone or place the implant, replace the flap, and suture it closed. This is usually done with dissolvable sutures for patient comfort. With most dental implant procedures, a gingival flap must be made twice and possibly even three times. First to graft bone, then to place an implant, then to remove the cover screw and place the abutment.
Gum recession is a common problem among adults and affects between 4-12% of both men and women. Gum tissue recedes gradually and is often unnoticeable until it becomes severe. Untreated gum disease can cause damage to the bone underneath, resulting in tooth loss. If too much damage has been done to underlying bone, a dental implant may not be able to be placed. A gum tissue graft, also called a gingival graft, involves taking healthy oral tissue from one area of the mouth, usually the hard palate or roof of the mouth, and transplanting it to the desired area. However, some oral surgeons prefer to use donor tissue instead of grafting from the roof of the mouth. Gingival grafts may be done in conjunction with a bone graft or dental implant procedure, since gum disease often creates a need for multiple surgical procedures to repair the bone and gum tissue.
Receding gums, or more accurately known as gingival recession, is the exposure of the root of one or more teeth due to the retraction of the gingival margin or the loss of gum tissue over time. Most commonly, gingival recession is a problem faced by adults over the age of 40, however, younger individuals may also begin to notice signs of receding gums around the age of puberty or during their teen years. Gum recession may occur with the loss of alveolar bone underneath, which decreases the ratio of crown-to-root, affecting an individual’s cosmetic appearance and overall facial aesthetics. Gingival recession is classified using Miller’s classification system, and the causes of this condition are numerous. Most often, gum recession is the result of gum disease, or periodontal disease. It can also be caused by genetics, poor flossing habits, tooth crowding, overaggressive brushing habits, and the use of dipping tobacco.
The gingival sulcus is the point at which the tooth and gums meet, which is the primary component of the emergence profile. This is a highly visible area of the mouth and can impact the overall aesthetics of a patient’s smile. Ideally, the gingival sulcus is close to the tooth, with 3mm or less of space where food particles and bacteria can enter. Beyond this depth, traditional brushing and flossing habits aren’t able to reach and particulates build up over time. This results in bacterial overgrowth and periodontitis, an infection of the gums and potentially the bone tissue underneath. The deeper the gingival sulcus, the more difficult it is to properly clean it without professional care. As time progresses, the infection causes the sulcus to further deepen, compounding the issue and potentially resulting in tooth loss as the alveolar ridge degrades. The depth of the sulcus is easily checked with a dental probe.
Glucocorticoids, or corticosteroids, are a class of steroid hormones that are characterized by an ability to bind with the glucocorticoid receptor. In dentistry, their main therapeutic use is as an anti-inflammatory agent and immunosuppressant. Some of the more commonly used glucocorticoids include betamethasone, dexamethasone, methylprednisolone, prednisolone, prednisone, and triamcinolone. Glucocorticoids can be used for or following a variety of dental procedures such as endodontics for root resorption, oral surgeries to reduce edema and to aid in the prevention of ulcerations and excoriation, and the treatment of oral submucosa fibrosis and oral lichen planus. The use of glucocorticoids can reduce patient discomfort, lessen the time required for healing, aid in the healing process, and aid in the prevention of post-operative issues. The type of steroid used will depend upon the patient’s medical history, prior use of glucocorticoids, type of dental procedure, and the symptom or symptoms that need relieving.
The glycosylated hemoglobin A1c test, also known as the HbA1c or glycated hemoglobin A1c test, is a type of lab test which reveals the average plasma glucose concentration over a period of three months. Specifically, it measures the number of glucose molecules attached to hemoglobin. Results are expressed as a percentage, with 4% to 6% considered to be normal. This test provides information regarding a patient’s possible risk of developing diabetes. By measuring the percentage of sugar-coated hemoglobin, a practitioner can determine a patient’s level of blood sugar control. Higher percentages of sugar-coated hemoglobin typically indicate a higher risk of developing diabetes. Tests such as these may be required prior to dental surgery as they provide insight into health conditions that could possibly hinder the healing process post-surgery. Patients shown to have higher A1c levels may first be required to address their blood sugar levels prior to having a procedure.
A dental implant navigation system includes handpiece and jaw attachments, a motion tracker sensor, motion tracker software, and cameras. This technology is used to create real-time imagery and calculations of where dental tools are in relation to the patient’s jaw so dental implants can be placed precisely where they should be, with accuracy of about a millimeter or so. An image of the patient’s jaw and tooth structures is created within seconds by a CT and with some systems, can include digital impression data. This technology is likened to GPS and allows periodontists and oral surgeons to fully visualize the patient’s mouth and the instrument in their hand in real-time. Dental implant navigation systems allow periodontists to perform flapless surgeries and reduce the necessity of bone augmentation and custom abutments. Overall, these navigation systems enable dental professionals to provide less invasive, safer, and faster care.
A hard tissue graft is used to restore bone height and stimulate the growth of new bone in patients who have lost teeth. A bone graft should be done following tooth loss or extraction to prevent atrophy in the remaining bone and in the gum tissue surrounding it. Following a hard tissue graft, the patient may also require a gum graft. This process removes tissue from another part of the mouth then grafts it onto the existing tissue in the area requiring attention. There are several different options for this procedure and the one selected will depend on the tissue available within the patient’s mouth. The amount of gum pain that a patient may feel, as well as the nature of their gum tissue graft recovery, will vary from one individual to another. While there are not separate gum insurance options, many dental insurance plans will cover gum graft costs.
The structure of bone is an important consideration for the size, type, and surface of dental implants. Haversian canals are microscopic tubes or tunnels in cortical bone that house nerve fibers and a few capillaries. This allows bone to get oxygen and nutrition without being highly vascular. These canals also communicate with bone cells using special connections, or canaliculi. This connection facilitates the deposit and storage of mineral salts, which essentially gives bones their strength. Haversian canals are formed by lamellae, or concentric layers of bone, and are contained inside osteons. Osteons are cyndrylical structures that transport oxygenated blood to bone, and they are arranged parallel to the surface of the bone, along the long axis. Osteons that have intact Haversian canals comprise about 45% of cortical bone, or a little less than half. Haversian canals and osteons are part of the Haversian system, which allows nutrients to pass between the blood and bone.
The human body possesses the incredible ability to heal itself over time. Cells, which are living units that are the foundation of the body; they renew themselves constantly and work to bring the body back to “normal,” or a state of homeostasis. They operate according to instructions found within the DNA, or the body’s unique “blueprint” for life. This includes a healing mechanism: cells that are damaged may be able to repair themselves, and cells that are destroyed are replaced. Healthy cells surrounding an injury, which is essentially a group of destroyed cells, will begin to replicate quickly. At the same time, platelets are sent to the area to stop any bleeding, and white blood cells start digesting dead cells to make room for new ones. When healing is complete, the process simply stops on its own. The body is constantly in a state of healing itself, generating new cells and replacing dead or destroyed cells.
A healing abutment is a special type of abutment designed to facilitate the healing of bone and soft tissue around a dental implant. It takes approximately 4-6 weeks for the gums to heal after a healing abutment is placed, after which a final abutment can be placed. After much research, it was discovered that the material of an implant and its properties — most notably the topography of its surface — plays a significant role in the healing of the tissue around it. Two zones of oral tissue come into contact with healing abutments: fiber-rich connective tissue, and junctional epithelium. These tissues react to the surface texture and chemical composition of the material, and the ability of tissue cells to adhere to the surface of the implant depends largely on the lack of surface contamination and the hydrophilicity of it. While some dental professionals advocate the reuse of healing abutments after sterilization, new abutments should be used for each patient.
Healing by first (primary) intention, or primary closure, refers to the healing of a wound in which the edges are closely re-approximated. In this type of wound healing, union or restoration of continuity occurs directly with minimal granulation tissue and scar formation. It works best with wounds or incisions where there has been little loss of tissue. Healing by primary intention is often used in a surgical setting where a clean incision is present. The wound is closed by using skin adhesive, staples, Steri-Strips, or sutures. This is the opposite approach to the one taken by secondary closure, or healing by second (secondary) intention, in which a gap is left between the edges of the wound for natural healing to occur. In dental applications, primary closure may be used following an oral surgery, implant, or restoration procedure where there has been little tissue loss to help prevent infection and aid in the healing process.
Healing by second intention, also known as secondary closure, is the healing of a wound in which a gap is left between its edges. Union occurs by granulation tissue formation from the base and the sides. This requires epithelial migration, collagen deposition, contraction, and remodeling during healing. Healing by second or secondary intention differs from healing by first or primary intention in that it does not bring the edges of the wound or incision into contact with each other. Healing by first intention is best used in situations where there is a clean incision with little tissue loss while healing by second intention may take place when there is not enough tissue to bring the edges of the wound together for suturing or stapling. Secondary closure is considered the most important type of bone healing in procedures that include maxillo-facial surgeries. It occurs through cell proliferation which eventually becomes lamellar bone.
The healing period, also known as the healing phase, is the time allocated for healing following one surgery and before the next surgery that will be performed at the same site. Dental implant preparations often require more than one procedure to achieve the final product. For example, some patients require bone augmentation procedures before an implant can be placed. The time between the bone augmentation and the implant placement is the healing period or healing phase. This phase may be necessary before subsequent procedures for several reasons including to allow for decrease in swelling and inflammation in affected tissues, to provide time for incisions to heal and for bone osseointegration, and to provide an opportunity for any complications to be addressed and resolved. The healing period allows the procedure site to be in the best possible condition for the success of implant and prosthesis placements or for other subsequent surgeries.
Heat necrosis is cell death caused by effectively prolonged exposure of bone to elevated temperature such as during an osteotomy preparation. An osteotomy is a procedure that cuts, shortens, lengthens, or otherwise reshapes a bone. In dentistry, osteotomies are required in some patients because of a condition where the bones of the face do not meet with the bite position of their teeth. In order to correct this, an osteotomy is done on the lower jaw to bring it into a correct position for proper bite alignment. Heat necrosis can occur during this type of procedure due to the friction involved in bone cutting. To avoid this type of cell death, an osteotomy may be performed using a piezoelectric device. Such devices allow for precise cutting of bone without substantial damage to the surrounding soft tissues. Piezoelectric surgical devices utilize ultrasound technology rather than traditional cutting methods to reduce cell death due to heat necrosis.
A hematoma is a localized mass of extravasated blood, usually clotted, that is relatively or completely confined within an organ or tissue. Hematomas differ from smaller bruises in that the latter occur as a result of damage or injury to small blood vessels while the former comes from damage to larger blood vessels. A hematoma can occur in dentistry following a surgery, treatment, or other oral procedure where the tissues of the mouth are manipulated in such a way that blood vessel damage can occur. Though hematomas are generally not dangerous and can be a common side effect of some dental procedures, the practitioner will often examine it to ensure it will heal without additional aid. Some patients experience a hematoma following an injection used to numb or block the sensation in the tissues around a dental procedure site. Most hematomas will resolve on their own.
What is ibuprofen? Ibuprofen is a non-steroidal anti-inflammatory drug, or NSAID. This means that it reduces inflammation and relieves pain without the use of steroids. Acetaminophen is a similar over-the-counter pain reliever, but lacks the ability to reduce inflammation. There are a number of different ibuprofen brands, however, the actual components of the medicine remain the same between brands even though the inert ingredients may be different and the medicine may look different. Whereas acetaminophen is processed by the liver, ibuprofen is processed by the stomach. It can be hard on the stomach and in some cases may cause stomach upset, gastritis, and ulcers. Mixing ibuprofen with alcohol may exacerbate this side effect. Ibuprofen can be very useful after certain types of procedures where inflammation is present, such as after dental surgery, but it’s important to get the dosage right. Adult, child, and infant ibuprofen dosage varies, and you should consult a physician before administering.
The Iliac crest is the superior part of the Ilium, which is the largest of the three bones that make up the pelvis. It can serve as a site of autogenous bone grafts for dental work. Patients may require a bone graft following some dental procedures and prior to receiving implants or prostheses. The Iliac crest is often a good location from which to harvest bone for dental bone grafts. The Iliac crest also has medical implications, as both the latissimus dorsi and gluteus maximus originate in this area. These major muscles can cause pain or discomfort in the iliac crest due to strain, injury, or tension. Issues with these muscles or with the Iliac crest itself may become obvious when an individual experiences pain after sitting.
An iliac graft, or an iliac crest autogenous bone graft, is a type of bone graft used for a wide variety of surgeries, including periodontal surgery to restore lost jawbone. Other surgeries using iliac grafts include but are not limited to the repair of joint arthrodesis, the treatment of bone defects, infections, and osteonecrosis, and the repair of particularly challenging bone fractures. Both the anterior and posterior surfaces of the iliac crest are used for bone grafting, and the crest itself is the most frequently used source of bone for autogenous bone grafting. This is because it is a superb source of both cancellous and cortical bone and is easy to access compared to other sources of autogenous bone. There are some risks associated with an iliac graft, including pain, redness and swelling of the incision site, infection, bleeding, and in very rare cases, splanchnic or neurologic damage.
Surgical procedures and other medical treatments are complex and require immense skill on the part of the treating physician. Adequate visualization of the area of the body being treated is critical; without it, the rate of complications is significantly higher. However, many areas of the body are difficult to see, particularly in the oral cavity. Image guidance is a newer technology in the field of dentistry that allows dental health professionals to visualize different areas of the mouth before and during the procedure. In the past, implants were typically done only using x-ray technology, which left more room for error. Image guidance is now the preferred method for placing dental implants. CBCT images are obtained and CAD technology is used to “place” the implants virtually in a highly accurate, computerized surgical guide. Image guidance has eliminated the need for a flap in a large number of implant surgeries, reducing the risk of potential complications.
Image stitching, also called photo stitching, is the process of merging multiple photographs together to create a single high resolution or panoramic image. Image stitching is most often done via computer using specific software designed to sense areas of overlap and combine them. The overlaps need to be as exact as possible and the exposures identical to elicit a final image with no visible seams. Because the illumination in two separate images could differ, even if the images are taken in quick succession, image stitching could result in seams between the images. Depending on the application, these seams may or may not be significant. In the field of dentistry, photo stitching is often used for x-rays and CAD/CAM images. This is because it’s not possible to organically capture an image of the entire mouth in one sitting; instead, multiple images from different angles must be obtained and fused together.
With traditional implant dentistry, the dental implant hardware is given time to heal before the prosthetic is loaded onto the abutment. However, many patients dislike this option because it requires approximately three to twelve months for the final dental restoration to be completed. In cases where the implant will be done in the front of the mouth, the long wait is particularly concerning. Immediate implant placement, is a newer type of procedure that allows dental restorations to be completed much more quickly, greatly reducing a patient’s time-to-teeth. Immediate implant placement may be done when appropriate at the same time the natural tooth is removed. Immediate loading, also called immediate function, is the loading of a temporary dental restoration or crown into the implanted abutment directly after it is placed. In some cases, patients may be able to have a tooth removed and a temporary tooth placed in the same day.
In implant dentistry, there are two types of immediate loading: immediate occlusal loading and immediate non-occlusal loading. Immediate occlusal loading occurs when a dental implant is placed with adequate initial stability and the corresponding dental restoration features full centric occlusion in max intercuspation. This type of loading must be done within 48 hours of the placement of the dental implant hardware. The process of immediate occlusal loading is determined by the design of the dental prosthetic to eliminate the potential for micromotion at the implant site. Immediate non-occlusal loading occurs when a dental implant is placed with adequate initial stability but isn’t in functional occlusion. This type of loading is generally exclusively used for aesthetic-only dental implants or for short-term applications. Often, immediate non-occlusal loading is done to provide patients with a temporary tooth replacement while the dental implant hardware heals, especially when patients prefer not to use a removable prosthesis.
Immediate occlusal loading refers to a clinical protocol for the placement and subsequent application of force on dental implants where there is either a fixed or removable restoration in occlusal contact with the opposing dentition. Immediate occlusal loading takes place during the same clinical visit in which the restoration was performed. Immediate occlusal loading allows the new implant, prosthesis, or restoration to come in contact with the opposing teeth directly following the procedure. Though studies have not shown a significant difference in the success or longevity between immediate occlusal loading and non-occlusal loading, a variety of factors can affect the overall life of the restoration. These factors are largely patient-based and include chewing habits, medical history, oral care and hygiene, clenching of the jaw, and injury. In some cases, component failure can also cause the restoration to fail as can an error on the part of the dental professional.
Immediate placement, or immediate implant placement, is the placement of a dental implant into the extraction socket immediately following the extraction procedure. This employs an opposite method than that of non-immediate or delayed placement where subsequent visits are scheduled for the insertion of the implant. Immediate placement is often preferred by patients since less time is required to achieve the end result, there are fewer surgeries needed, and costs may be lower due to fewer office visits. When performed correctly, immediate implant placement has the same success and longevity rates as delayed placement and has been found to preserve soft tissue and bone at the site of the implant. However, prior to selecting this placement method, a patient’s dental history and bone and tissue condition should be closely evaluated to ensure the proper conditions for immediate implant placement are met. Failure to do so prior to placement may result in the failure of the implant.
Immediate provisionalization refers to a clinical protocol for the placement of an interim prosthesis, with or without occlusal contact with the opposing dentition, at the same clinical visit. Prior to the placement of an implant, extraction of the infected or damaged tooth is required. In the past, the patient has then been fitted with a removable prosthesis for the extraction site until the permanent implant is placed. However, the use of immediate provisionalization has been shown to have several benefits. This method not only aides in bone stabilization and the prevention of bone loss, but also has high rates of patient satisfaction. Following the extraction, an implant is immediately placed in the fresh extraction site and non-functionally loaded with an infra-occlusion provisional restoration. In addition to its bone stabilizing effects, immediate provisionalization has also been shown to reduce the treatment time required and provide patients with immediate social and psychological well-being.
An IVJ, or implant verification jig, is an important player in full arch implant reconstructions. This method, when used during the last impression stage, ensures that the final prosthesis fits well onto multi-unit abutments or onto the implants themselves. The implant verification jig offers a solid structure that links the impression copings to make sure the inter-implant relationship is preserved in the final impression. This is especially critical for full-arch cases. With multiple adjacent implants connected securely at the time of the final impression, the implant verification jig allows for a very accurate master cast, a passive fit, and fewer potentially destructive forces that could result in prosthetic failure or bone loss. When impression material flexes, the relative position of two adjacent and unconnected implant transfer copings can move inside the impression material. By using the jig, the periodontist can significantly heighten the accuracy of the master cast that the last restoration will be designed on.
A joint-separating force is any force that has the ability to disengage parts that are joined together by a screw (a screw joint). The opposite of the joint-separating force is called the clamping force. The clamping force must be overcome by the joint-separating force in order for a screw joint to be damaged. This may occur due to incorrect crown height, improper placement of the prosthesis, or even the patient’s chewing habits. A joint-separating force can result in a patient realizing they have a loose implant crown, their implant cap is loose, or even that their implant screw fell out. In the case of a loosened screw, it may be possible to fix the issue without damaging the prosthesis itself. Such problems might be prevented by ensuring the correct torque force is used during the original procedure and by addressing the settling effect before the patient leaves.
The junctional epithelium, sometimes referenced by the initials JE, is the portion of the gingiva or gums that attaches the gums to the enamel, or the surface of the tooth. It’s a thin membrane, about 2-3 mm wide around each tooth, and is only about 15-30 cells thick coronally. Apically, the junctional epithelium tapers to just a single cell. This attachment between the gingiva and the tooth surface is replenished continually throughout a person’s life, about every 4-6 days. Compared to other epithelium in the mouth, which has a regeneration rate of about 6-12 days, the junctional epithelium has a high renewal rate. Junctional epithelium cells have wide intercellular spaces and are non-keratinized, and are responsible for maintaining the seal between the soft tissue of the gums and the tooth. These cells protect jawbone and tooth roots from plaque and bacteria, but in patients with gingivitis or periodontal disease, the seal is weakened.
Estimating implant survival isn’t necessarily complex, but it wouldn’t be considered simple either. When determining how long a dental implant is likely to last, a Kaplan-Meier analysis is typically used. This strategy allows periodontists to accurately estimate the lifespan of the implant under a variety of different conditions. The Kaplan-Meier analysis is one of the most commonly used methods of survival analysis. The estimate is often useful in many situations, particularly in the medical field. For example, it can be used to examine recovery rates, the likelihood of death in certain circumstances, and whether or not a treatment was effective. The Kaplan-Meier analysis is a statistic, and many estimators are used to gauge its variance. A common estimator is Greenwood’s formula. Naturally, patients want their implants to last as long as possible, making calculating implant survival with a number of variables clinically applicable.
The keratinized gingival is the part of the oral mucosa which covers the gingiva and hard palate. It extends from the free gingival margin to the mucogingival junction and consists of the free gingiva as well as the attached gingiva. The width of keratinized gingiva is an important factor when it comes to dental implants. This is because keratinized gingival tissue can play a role in the long-term support of the implant. It may also aid in maintaining oral health, in preventing gum recession, and in overall esthetics. Due to this, the keratinized tissue of the gums around a tooth or implant may require a tissue or skin graft prior to any dental procedures. Such a graft will assist with gum health as well as implant stability. Maintaining the health of the keratinized gingival is important for both the function and look of a patient’s implants.
After a tooth is extracted, the residual alveolar ridge undergoes a remodeling process to repair the initial wound and prepare for long-term healing, or residual ridge resorption (RRR). Residual ridge resorption occurs at markedly different rates for each patient, which can make treatment planning more challenging. Faster bone resorption at the lingual or buccal areas can result in a knife-edge ridge. Faster bone resorption at the crest of the residual bone, on the other hand, results in a more flattened ridge. A knife-edge ridge can be difficult to detect under round gum tissue, but identifying the shape of the residual alveolar bone is essential to the patient’s individual treatment plan. Treatment for a knife-edge ridge may involve removal of the thin bone structure to help the dental implant hardware better adapt at the shoulder level. It’s often difficult to predict which patients will have a knife-edge ridge, but menopause is considered a contributing factor.
The labial plate is the surface of the gums and teeth that face the inside of the upper and lower lips and inside the cheek. Since this is the part of the gums that are most easily seen by people when someone smiles, people have a strong desire that the labial plate be aesthetically pleasing. This is something that must be considered when discussing a dental implant in the front area of the mouth. Calculating the density of the labial plate bone is important when determining if an implant can be placed in the labial plate or if a bone graft will be necessary. If the labial plate is not dense enough, it cannot anchor an implant. For aesthetic purposes, many periodontists use a flapless procedure on dental implants in the labial plate, so it’s extremely difficult if not impossible to tell that a dental implant was done.
A laboratory analog is a replica of an implant, abutment, or attachment mechanism, usually incorporated within a cast for a prosthetic reconstruction. The analog provides a replica which shows the exact position of a patient’s implant. It is made by taking an impression of the patient’s teeth and implants and using that impression to create a copy which exactly shows the anatomy of the implant as it exists in the patient’s mouth. This allows a dental professional to build the prosthesis and properly place the abutments. The use of a laboratory analog can cut down on error involving the placement of implants and implant abutments. There is software available, such as an analog lab app, which can aid in the process of creating a replica. In addition, the use of the lab 3 manual will provide technicians with the instructions needed to properly utilize the software.
A screw is the part of a dental implant that screws into the jawbone to anchor the abutment and the bridge or crown. There are two different types of screws: lab screws, or laboratory screws, and gold screws. A lab screw is generally considered stronger than a gold screw and can withstand excessive force. Gold screws, however, mold to the patient’s jawbone over time since gold is somewhat malleable for a metal. When force is applied, gold screws will slightly change their shape to accommodate the pressure. Laboratory screws are not the industry-recommended method for anchoring dental implants, so it’s important to double-check the warranties on other implant components and make sure they are not rendered invalid by using a lab screw. Because gold screws are created to fail when excess force is applied instead of breaking the implant, gold screws can protect the implant better than lab screws.
The surface of the various components of a dental implant play an important part in the overall success of the implant over time. Defects in the implant body, screw, or abutment can impact osseointegration and in some cases, cause the complete failure of the implant. The abutment is of special significance: it connects the internal implant hardware to the external artificial tooth, or crown. When casting an abutment, however, defects in the surface may occur, causing it to be too uneven to work with. A lapping tool is a common instrument used in dental laboratory settings to smooth any surface defects that were created during the abutment casting process. Often, lapping tools are included in dental abutment kits, along with alignment guides, screwdrivers, reamers, o-rings, and sleeves. The tool is held by the handle and inserted into the apical end of an abutment to even out any ridges in the surface.
While lasers have been used in the dental health industry since 1994, the American Dental Association (ADA) has yet to give the treatment its Seal of Acceptance. Regardless, laser dentistry is becoming an increasingly popular alternative to conventional dental treatment for a number of different issues. Tooth decay, or caries, can be removed using a laser, which also prepares the surrounding enamel for the filling material. Lasers can also be used to perform a biopsy, or the removal of a small piece of tissue to check for the presence of cancerous cells. Lasers cauterize tissue as they exercise, improving overall healing time and reducing the risk of infection. Gum disease can be treated with lasers to remove harmful bacteria and to reshape gum tissue, and can remove canker sores or lesions in the mouth. Cosmetic dentistry also uses lasers for teeth whitening to speed up the process of lightening teeth with a peroxide solution.
The texture of the surface of a dental implant is crucial to its ability to osseointegrate with the patient’s natural bone tissue. A surface that is too smooth has been shown to have a lower success rate than rougher dental implant surfaces. Additionally, a textured surface does more than just boost bone integration: it stabilizes the implant and may provide antibacterial properties as well. There are many different ways to treat the surface of a dental implant including sandblasting, chemical etching, and laser etching. Laser etching is believed to be more precise than both sandblasting and chemical etching, which produce more variable results than a programmable laser. Laser etching can also be used on top of sandblasting or chemical etching to provide a more textured surface that integrates better with bone. Dental abutments can also be laser etched to improve the texture of the surface that will adhere to the implant body, screw, and crown.
Laser therapy has been used in the field of dentistry since nearly its inception due to its high level of accuracy, precision, and low rate of clinical complications. LASER stands for Light Amplification by Stimulated Emission of Radiation and is a device that generates electromagnetic radiation that is uniform in polarization, phase, and wavelength. There are several different types of lasers, including surgical lasers, therapeutic lasers, and high or low powered lasers. Evidence suggests that therapeutic lasers and low powered lasers have anti-inflammatory, bio-stimulatory, and analgesic effects on living tissue. Dentists today are increasingly choosing to offer laser dentistry at their practices to meet consumer demand. Laser-assisted dental procedures can include laser suturing, cauterization, decontamination of bacteria-filled periodontal pockets and root systems, PDL regeneration, bone repair and remodeling, and healing stimulation. Often, the use of a laser during a dental procedure will eliminate the need for anesthesia or strong pain medication.
Laser welding, also called laser beam welding or manual laser welding, is a critical tool for dental labs today. It provides a high-tech, low-error alternative to traditional soldering. Manual laser welding equipment helps dental lab technicians to create or repair dental prosthetics and reconstruction materials, such as posts and loops for tooth additions, cast clasp assemblies, wrought wire single-arm clasps, and cast extensions used for existing partial dentures. Contrary to conventional soldering, laser welding offers complete freedom of controls and precision accuracy. This, along with localized heat, eliminates thermal expansion and results in superior seam welds on dental implant frames and bars, passive fit bridgework, and other frequently used dental prosthetic appliances. Other alternatives to laser beam welding and soldering include torch or plasma welding, spot or resistance welding, and single pulse tungsten inert gas welding. Of all these, laser welding provides the most desirable results for dental prosthetics.
Although dental implantology has come a long way in recent years and the procedure is now known as one of the most widely successful dental procedures that can be done, failure still unfortunately occurs. Implant failure is typically separated into two broad categories: early implant failure and late implant failure. Early implant failure is often caused by issues like a contaminated implant, infection, excessive trauma during the surgical procedure, or lack of primary stability of the implant hardware. Late implant failure is less common, and have fewer causes. Generally, once a patient is out of the woods of early implant failure, the chances of late failure are low. However, traumatic occlusion, occlusal overload, and dental cement that is retained subgingivally. Late implant failure typically occurs within one to three years after the placement of the implant. Bruxism, or nighttime teeth grinding and clenching, is a common cause of late implant failure.
The lateral window technique, or external sinus graft, is the creation of an access point to the maxillary sinus through its lateral wall. The access is used to elevate the Schneiderian membrane for the placement of graft material in the inferior part of the sinus space. The lateral window technique is often used when resorption of alveolar bone leads to severely decreased bone height which impairs the placement of dental implants. An external sinus graft is achieved by placing a bone graft in the new space, or window, that has been created. The bone used in the grafting procedure may be autogenous, come from a human donor, or come from donor bovine bone. Though autogenous bone grafts have been shown to heal faster than grafts from the other two sources, their success rates are similar. If implants are needed, they may be placed during the same procedure or after the graft has healed.
The surface of a dental implant plays a significant role in osseointegration, or the body’s ability to integrate the dental implant into the bony structures of the mouth. The idea is that the rougher the implant surface, the easier it will be for the bone to adhere to it. To improve osseointegration, there are a wide variety of implants available with different types of implant surfaces. Acid etched and sandblasted dental implants are popular choices, however, machined implant surfaces are also used. A machined implant surface simply refers to a manufacturing process that was turned, polished, or milled. While many periodontists believe that etched surfaces have a better osseointegration rate than machined implant surfaces, there are a number of periodontists who use machined implants and have success with them. Patients should discuss with their periodontist about the different types of implant surfaces and which one is recommended.
A macrointerlock is a fixation method which mechanically interlocks the bone and the dental implant. This can include the interlocking connections between abutments and implants. Macrointerlocks can also be used to build up fragile teeth before an implant is placed. Following some dental procedures, the canal of the affected tooth can be left hollow which weakens the strength of the tooth and reduces its ability to support an implant. Prior to implant fixation, a macro-lock post may be used to aid in the reconstruction and build-up of such a canal. Without the use of such posts, the tooth may be too fragile or unstable to allow for an implant. Macro lockers can help strengthen the tooth while also increasing the surface area needed for the implant. Macrointerlocks may also provide stability and longevity to the implant as well as to the bone-to-implant interlock.
Although rare, failure is unfortunately something that still occurs with dental implants, even when periodontists take every possible precaution before and after the dental implant procedure. Once an implant is placed, motion of any kind should be avoided until the implant has had enough time to begin the osseointegration process and become more stable. Macromotion is the term used for excessive motion, most often related to trauma. For example, if a patient gets into a severe car accident soon after their dental implant procedure, macromotion that results from the accident may cause the dental implant to fracture or break. Micromotion is the opposite, a term used for the very minimal motion that is typically expected after implant surgery. Too much micromotion can also cause implant failure, so it’s important for dental professionals to educate patients on both and develop strategies to avoid them as long as possible after surgery.
Not all dental implants are designed to hold a crown or artificial tooth. Dental implants can also be used for magnetic attachments designed to match small metal disks or magnets inside a set of dentures. Magnetic attachments allow a patient with dentures to easily keep their dentures in place without the need for denture adhesive cream. Many patients dislike the taste or feel of denture adhesive, and it may not always work as intended. It’s not uncommon for adhesive to fail at the most inopportune times or to be difficult to remove at the end of the day. A magnetic attachment keeps dentures secure while still making it easy for the patient to put in and take out. Magnetic attachments are simply made of a conventional dental implant with a body and a screw, but the abutment is specially designed for use with one or more sets of magnetic dentures.
Dental implants have a low failure rate, however, failure can be caused by a malpositioned implant. Ideally, implants are placed parallel to other teeth, and each other if there are multiple implants. They should also be vertically aligned with axial forced. When a dental implant is incorrectly positioned or improperly angled and defects in the surrounding soft tissue exist, traditional abutments are impossible to use. A custom-angled abutment is necessary. Healing variables can affect the positioning of a dental implant post-surgery. This includes systemic diseases that impact healing like rheumatoid arthritis and diabetes, contours in hard and soft tissues, the abutment manufacturer, the overall positioning of the implant, and the final design of the dental prosthesis to be fitted. Poor adaptation of a dental prosthesis can tax the implant hardware, causing tiny “micro gaps” to be created between the abutment and the implant below. This results in bacterial accumulation.
The mandibular canal is an important inner structure of the mandible, or lower jaw. It is a small canal that contains the inferior alveolar artery and vein, as well as the alveolar nerve. In the ramus, it runs obliquely forward and downward, and in the body, it runs horizontally forward. The mandibular canal rests underneath the alveoli, which it is able to communicate with via tiny openings. Since this canal contains a nerve and both a vein and an artery, it’s important for dental professionals to determine its location in proximity to the desired procedure site. In root canal therapy of the second molar, a dentist must take care not to extend past the tooth root with either the reamer tool or root canal filling material. If an implant is being placed in this area, the attending surgeon must be sure that the placement of implant hardware does not interfere with the mandibular canal.
Mandibular flexure is a complicated deformation process that can occur in the lower mandible. This can result in a change in the shape and width of the mandible arch, as well as protruding mandibular movements. These are caused by the contraction of various masticatory muscles, particularly the lateral pterygoid muscles. There are generally four types of deformation patterns recognized in mandibular flexure: corporal rotation, anteroposterior shear, dorsoventral shear, and symphyseal bending related to medial convergence. These patterns of deformation can result in excess stress on the bone tissue of the mandible. How the stress is distributed throughout the mandible depends on the shape of the mandible, the quality and quantity of bone, and the amount of force the masticatory muscles exert. Mandibular flexure is important for dental implant surgeons to consider, since excess occlusal loads, such as in cases of bruxism, can potentially result in long-term implant failure.
The mandibular foramen is the opening into the mandibular canal. It is located on the medial surface of the ramus of the mandible providing a passage to the inferior alveolar nerve, artery, and vein. The mandibular foramen thus allows these structures to supply the lower jaw, teeth, and part of the chin with blood, nutrients, gas exchange, and sensation. For oral procedures, the dentist or oral surgeon must be aware of the location and size of the mandibular foramen in order to administer a nerve block to numb the teeth and tissues that will be involved. Since a cranial nerve is involved with the mandibular foramen, it’s location must also be known before placing a dental implant to prevent damage to this nerve. The size and placement of the mandibular foramen can differ between patients since factors such as age, skull shape, and facial dimensions can affect its location.
Mandibular movement refers to the muscle- and ligament-activated border and/or intraborder movements of the lower jaw. There are five types of mandibular movements including rotational, horizontal axis, frontal axis, sagittal axis, and translational. Mandibular movement is affected by several factors such as the muscles used in suspending the jaw, mandibular articulation, and the synovial joint system. Study of this movement is important for the fields of dentistry and orthodontics as it describes the concepts related to dental occlusion and the masticatory processes of the jaw. A detailed understanding of each patient’s unique mandibular movement is also required for the proper design and creation of a customized prosthesis. It provides information regarding their occlusal habits and angle of dentition so a truly functional prosthesis can be formed. Information on mandibular movement is also an important part of dental and medical research pertaining to oral health, mandibular issues, and prosthesis design.
A mandibular ramus is a quadrilateral process projecting upward and backward from the posterior part of the body of the mandible and ending on the other side at the temporomandibular joint in a saddle-like indentation (called the sigmoid notch) between the coronoid and condylar processes. It may serve as a source for bone grafting. The lateral surface of the mandibular ramus is the attachment site of the masseter muscle. In bone grafting, the mandibular ramus provides a good source of autogenous cortical graft best suited for the correction of ridge deficiencies prior to the placement of an implant. Grafts from this location generally require shorter periods of healing, show low levels of resorption, and maintain their density. Obtaining graft bone from the mandibular ramus over other possible facial sources also creates less noticeable facial scars or alterations and is less likely to cause nerve or sensory issues or discomfort.
One of the primary concerns in implant dentistry is ensuring that there is enough bone at the implant site to support the implant. Without adequate bone support, it’s unlikely that proper osseointegration will occur. Periodontists can augment the size of the bone crest with bone grafting, guided bone regeneration, a ridge split technique for placement, and distraction osteogenesis. However, newer technology has been developed to help facilitate dental implant success for patients who have a narrow ridge, which is a ridge smaller than six millimeters. A narrow ridge implant, such as Hoissen SS implants, are specifically designed for patients with narrow ridges. The implant itself is shorter and has a smaller diameter, allowing it to fit better in a narrow ridge. Narrow ridge implants are often more affordable and don’t require as much of a time commitment for the patient versus complex procedures like bone grafting or guided bone regeneration.
The nasopalatine nerve is a part of the parasympathetic nervous system. It is a branch of the pterygopalatine ganglion which passes through the sphenopalatine foramen, across the roof of the nasal cavity to the nasal septum, and obliquely downward to and through the incisive canal. The nasopalatine nerve innervates the anterior part of the hard palate and the mucosa of the nasal septum. A nasopalatine nerve block may be used as local anesthesia for some dental procedures, though it is often painful for the patient. This is due to the resistance of the dense tissue of the palate which requires greater pressure to overcome. It causes significant pain and may lead to tissue trauma. Nasopalatine nerve damage may occur following some types of dental work or after surgery on the nasal septum. This damage often causes a reduction in the sensitivity of the front teeth or the hard palate. Nasopalatine nerve numbness may also be a side effect of the above procedures or of a nasopalatine canal cyst.
In some patients needing a dental implant, the periodontist will need to connect the natural teeth to the bone-supported dental implant using a periodontal ligament that allows for partial movement. This is often the case in partially edentulous patients who have a mixed bite, where natural teeth alternate between spaces that need to be restored with an implant. Some dentists are more reserved about the long-term efficacy of connecting implants and natural teeth, primarily because of the mobility difference between the two. Sometimes, complications can result from the use of a rigid or non-rigid connection between a dental implant and a natural tooth, one of which being the intrusion of the natural tooth, where the natural tooth “intrudes” on the dental implant, potentially causing failure. It’s important that periodontists evaluate the risk of natural tooth intrusion when using the existing dentition of patients to anchor the dental implant hardware.
Navigation surgery, or surgical navigation systems, play an important role in accurate and effective surgical procedures. Imaging is often integrated into these systems using CAS (computer-assisted surgery) technology, making surgery significantly safer in most cases. CAS was first developed in the 1980s by neurosurgeons and ENTs, but the technology has a substantially wide variety of applications in the medical field today. One of the most notable applications is within the field of dental health, or more specifically, during periodontal surgery. Dental implants, for example, are reported to have a lower failure rate when done with CAS technology versus traditional placement techniques. Surgical navigation systems help make surgical procedures less invasive and therefore reduces the risk of potential complications. In implant dentistry, surgeries that once required a flap to be made to expose the alveolar ridge for implantation of the screw can now be done with a small or even no incision.
An Nd:YAG laser, often simply referred to as a YAG laser, is a commonly used true pulse laser technology in many medical applications, including in optometry and dentistry. YAG lasers are close to an infrared wavelength of 1064 nm, which can be absorbed by pigment in living tissue, such as melanin and hemoglobin, and have superior biostimulatory properties. Photothermal interaction allows the laser energy to penetrate into the tissues, and the technology can be used as both non-contact and contact depending on the application or procedure being performed. In dentistry, YAG lasers are used primarily for gum disease or periodontal disease to disinfect and debride bacteria-filled periodontal pockets. This technology can also be used to seal treated pockets and support reattachment by acting as a scaffold, as well as for frenectomies, gingivectomies, and biopsies. They can help improve osteogenesis, help with clotting, and can help prevent alveolitis.
The word “necrosis” originates from the Greek word νέκρωσης, which refers to the act of death or decay. In the English language, necrosis is the result of cell injury that causes the premature death of living tissue cells via autolysis, or in simpler terms, the death of body tissue. When too little oxygenated and nutrient-rich blood reaches tissue, it begins to go through autolysis, or the process of self-digestion by its own enzymes. Necrosis can be caused by exposure to chemicals, radiation, and injury, and cannot be reversed. Once begun, tissue death can only be stopped — the destroyed tissue won’t regenerate without the help of a grafting procedure. In implant dentistry, necrosis of the jaw is a common obstacle to implant procedures. Tooth loss, periodontal disease, and other conditions can cause or contribute to the loss of bone in the jaw. A bone graft may be needed to support an implant.
In medical terminology, neoplasia is described as abnormal tissue growth as a result of the rapid division of mutated cells. Normally, the body’s cells multiply, divide, and extinguish in an orderly manner. Although cells normally divide quickly when the human body is growing, when it reaches adulthood, cells typically only do this as needed when cells die or become injured and require replacement. This is regulated by the body’s unique genetic code contained within the DNA. Neoplasms, or the abnormal tissue that is the result of neoplasia, are often seen in various forms of cancer as a malignant growth. The cells within a neoplasm have mutated and no longer respond to the instructions given by host DNA. They multiply rapidly and don’t die when they ought to, resulting in the unregulated growth of abnormal tissue — in other words, a tumor. While neoplasms are frequently seen with malignancy, they can also be benign or precancerous.
Nerve lateralization, also known as nerve repositioning or nerve transpositioning, is a surgical procedure whereby the course of the inferior alveolar nerve is redirected to allow the placement of longer implants in a mandible with extensive resorption of the posterior ridge. Nerve repositioning requires a portion of the lower jaw be opened to provide access to the nerve. To close this access, a bone graft is required following the placement of the implants. Nerve lateralization is considered a more aggressive procedure in implant surgery as the nerve can sustain long-term or even permanent damage. The inferior alveolar nerve provides feeling and sensation to the lower jaw, lip, and chin and most patients experience varying degrees of numbness following the surgery. Since there are other options for implant placements, such as blade implants, nerve repositioning surgery is generally not the first choice when dealing with patients with extensive posterior ridge resorption.
Nerve repositioning, also known as nerve lateralization or nerve transpositioning, is a surgical procedure whereby the course of the inferior alveolar nerve is redirected to allow the placement of longer implants in a mandible with extensive resorption of the posterior ridge. Alveolar nerve repositioning may also be done as part of a procedure to remove cysts or benign tumors of the mandible. For implant patients experiencing edentulous atrophy in posterior mandibles, repositioning of the alveolar nerve is often the only way a fixed prosthesis or implant can be properly placed. Due to the risks involved in repositioning the alveolar nerve, extreme care and precision must be demonstrated during surgical procedures to avoid damage to the nerve. Damage can cause short-term, long-term, or permanent issues and impair a patient’s ability to experience sensory information. It can also cause pain, numbness, and in some cases, paralysis. Nerve repositioning is done if there are not other suitable implant placement options.
Neurapraxia is the name given to a mild nerve injury that has been caused by either compression or retraction. In neurapraxia, there is no violation of the nerve trunk and no axonal degeneration and spontaneous recovery of the motor and/or sensory functions most often occurs within one to four weeks from the time of injury. Neurapraxia in dentistry is commonly caused by an injury to the inferior alveolar nerve or to the lingual nerve and may occur due to several possibilities including third molar extractions, anesthetic injections, oral disease, and surgical, orthodontic, and endodontic treatments or procedures. Neurapraxia symptoms include numbness, loss of sensation, motor paralysis, and tingling. Though neurapraxia typically does not require any specific treatment, patients should report their symptoms to their practitioner for monitoring and follow-up. In some cases, additional imaging may be needed to ensure there is not another underlying cause for the neurapraxia that must be addressed to promote healing.
When evaluating CBCT (cone beam computed tomography) imagery used to help periodontists choose sites for implant placement, there are two different types of “slices” to look at — oblique slices and orthoradial slices. The orthoradial slice is straight up and down, while the oblique slice is slanted, similar to a forward slash on a computer. These slices help periodontists visualize the anatomical structures in the mouth and evaluate where the optimal placement of a dental implant would be. Although which slice is used depends largely on the treating periodontist’s preferences, studies are showing that the oblique slice tends to be more accurate than the orthoradial slice, helping periodontists to achieve better patient outcomes. Oblique slices tend to be a better choice than orthoradial slices for implant placement in the posterior region or when planning implants that are tilted and if orthoradial slices are used, caution should be exercised.
Occlusal adjustment is the modification of the biting surfaces of a tooth, or teeth, to improve function or morphology. Occlusal adjustment is often used in conjunction with prosthetic placement and involves the grinding and shaping of selected tooth surfaces to improve contact patterns. Bite adjustments may also be made due to night-grinding issues and the discomfort or disfunction this causes for patients. The results of the occlusal adjustment procedure cannot be reversed, which means significant study of the patient’s mouth, tooth surfaces, and bite must occur before any action is taken. This study is usually accomplished through studying the bite contact within the patient’s mouth as well as through the use of dental impressions. Side effects of dental bite adjustment may include some pain or discomfort, though these are usually mild. Occlusal adjustment cost may vary depending on the dental insurance and the extent of the bite adjustment procedure.
An occlusal guard is often called a night guard or a bruxism guard. It protects against bruxism, which is the clenching or grinding of the teeth that happens primarily at night. Because the jaw puts an extreme amount of pressure per square inch on the teeth, grinding and clenching the jaw at night can result in damage to the teeth and painful symptoms of TMJ, or temporomandibular joint disorder. Occlusal guards can be custom-made by a dentist to fit a patient’s mouth exactly, or they can be purchased over the counter. While over-the-counter occlusal guards are less expensive than custom-crafted, they can have a negative impact on oral health if not used properly. Custom-fitted occlusal guards provide patients with better bruxism relief without the discomfort of ill-fitting plastic or metal parts that are one-size-fits-all. Occlusal guards can prevent jaw strain, fatigue, pain, and the chipping or breaking of teeth.
The occlusal load refers to the amount of force applied by the jaw when closing to a dental implant. Occlusal loading is essentially the process by which the force is applied, e.g. biting or chewing. Because the teeth and jaws can create a great amount of force between them, it’s critical that dental implant hardware be designed to withstand a high occlusal load. Many periodontists will use specialized tools to measure a patient’s occlusal load prior to selecting implant hardware, such as pressure sheets, strain gauges, and piezo-electric sensors. Bite force, or occlusal loading, can also be measured using masticatory computational models. By using three-dimensional occlusal load measurements, dental health professionals can enrich the assessment of a patient’s masticatory performance. In patients with bruxism, or the unconscious habit of grinding the teeth at night, the occlusal load may be much higher than in patients without bruxism. Periodontists should account for any conditions which may cause excess grinding of the teeth, including anxiety and drug use.
Occlusal overload refers to when the amount of “bite force,” or occlusal force, is greater than the teeth can withstand. Often, the term occlusal overload is used in conjunction with other dental implant terminology, however, it can also be used in discussions of bruxism. Bruxism is a condition where the patient unconsciously bites down, clenches, or grinds their teeth, usually at night, which increases their occlusal force exponentially. When discussing implant dentistry, occlusal overload can significantly increase the risk of implant rejection. Occlusal force should be measured by the treating periodontist carefully before selecting the size, shape, material, and surface texture of dental implant hardware. The amount of occlusal force that the implant can withstand must be less than the actual occlusal force of the patient’s jaw. If not, occlusal overload occurs, which can permanently damage the prosthetic crown or potentially even the implant hardware underneath. The patient’s gum and bone tissue can also become injured.
The occlusal table is the surface of a tooth that comes into contact with the opposite tooth. These are the grinding surfaces of the teeth that help break down food and the largest occlusal tables tend to be on the back teeth, or molars. The bicuspid teeth also have an occlusal table, and an occlusal load is the amount of force applied to the occlusal table by the jaw or external force. The jaw can exert a great deal of pressure per square inch, which is why teeth — specifically the enamel — is the strongest substance in the body. Injury can occur to the occlusal table, which is called occlusal trauma. The most common type of occlusal trauma is from bruxism, where the surfaces of the occlusal table become damaged and worn from excessive clenching and biting, usually during sleep. Occlusal trauma can also be caused by external forces, such as a blow to the head.
A one-part implant, also called a one-piece dental implant, is one of two types of implants used by dental professionals today. The other is a two-part implant. The two-part dental implant features a design of two separate pieces — the surgical implant or implant screw, and the prosthetic abutment. The implant must be placed first and finished with a cover screw to allow for healing. When the implant has healed over a period of several weeks, the cover screw is removed and the prosthetic is placed. A one-piece dental implant features the surgical implant and the prosthetic abutment in a single part. The one-part implant was intended to eliminate structural weakness, also known as a microgap, that comes with a two-piece implant design. During this procedure, the implant screw is placed and finished with a healing abutment. Often, one-piece dental implants are loaded with a temporary restoration until healing is complete.
A one-piece abutment is an abutment that connects into a dental implant without the use of an additional retaining screw. The abutment can be retained by cement, friction, or screw threads. While one-piece abutments are often used as an immediate method of restoring missing teeth, they can be complicated as the correct angulation must be achieved for the implant to fit properly. In order to attain the correct angulation, the dental professional is often required to position the abutment intraorally. In addition, further complications can arise as the positioning procedure may interfere with primary stability and impair osseointegration. However, the one-piece abutment also has a variety of advantages. The one-piece composition provides additional strength as it removes the structural weakness found in the two-piece implant. The one-piece abutment also requires fewer components reducing the overall inventory and gives the dental professional more precise control over the final fitting of the implant.
A one-piece implant is a type of dental implant in which the endosseous and abutment portions consist of one unit. The one-piece implant was originally designed to address the structural weakness issues that were part of the two-piece implant. The one-piece implant increases the strength and stability of the prosthesis by eliminating the weakest point of the two-piece implant, the abutment interface. In addition, the one-piece implant is an effective choice for patients or surgical sites where there is not enough bone to properly support a prosthesis. Despite these advantages, one-piece dental implants do have a disadvantage in that they are less flexible than the two-piece implant due to their single-unit construction. This lack of flexibility prevents more detailed adjustments once placed. After imaging and a careful evaluation of the patient’s dentition and underlying bone, the dental practitioner will determine which type of implant will best fit the patient’s needs.
The one-screw test is a test used to check the fit of a multiple unit screw-retained dental restoration. It is one of several different types of clinical assessments that may be done to check for implant framework misfit. To perform the one-screw test, a single screw is placed in the terminal dental implant abutment and evaluation is made on the opposite side. If the framework rises or has a ledge, detected clinically or radiologically, the fit is considered inaccurate. This test provides essential information regarding any implant framework misfit present in a fixed prosthesis. Such misfits can cause a variety of issues including the alteration of biomechanical function, increased stress on the implant screws and framework, and the prevention of bone resorption following an implant placement. One possible way to reduce the likelihood of implant framework misfit is to section the framework diagonally prior to placement.
A PAC, or Political Action Committee, is an organization within the United States that raises funds privately to spend on political endeavors in an attempt to influence legislation or elections, especially at the federal level. Often, PAC funds are donated to the campaign of a politician running for a particular office. The American Dental Association has a political action committee, called the ADPAC. Many dentists, periodontists, orthodontists, and other dental professionals support PACs that help lobby for legislation to be passed that benefits their practice, their patients, and the overall profession. Dental professionals can contribute financially to PACs that lobby for initiatives that support them. ADPAC is one of the largest health PACs in the United States and has raised more than $1.2 million. Other smaller dental PACs may exist, however, they are unlikely to be as influential as the American Dental Association PAC.
A palatal graft, or gingival graft, is a surgical procedure performed to establish an adequate amount of keratinized tissue around a tooth or dental implant. It can also be performed to increase the quantity of tissue of an edentulous ridge. This type of connective tissue graft often takes place prior to a dental implant. It helps provide stability and longevity to the implant by building up the amount of keratinized tissue surrounding it. Most patients experience pain or discomfort during gum tissue graft recovery though the severity varies from one individual to another. During the recovery period, patients are encouraged to eat only soft foods of moderate temperature that won’t irritate or burn the graft site. Though gum graft complications are rare, it is possible for an infection to form or for the grafted tissue to not properly adhere to the graft site. Most dental insurance plans will cover at least a portion of the gum graft cost.
A palatal implant is a special type of oral implant that is designed to relieve snoring and other disturbing symptoms of obstructive sleep apnea. Although a continuous positive airway pressure (CPAP) machine is considered the “gold standard” of treatment for obstructive sleep apnea, palatal implants are showing more promise, especially for patients who are unable to sleep well wearing a CPAP and either pull it off in the middle of the night or don’t wear it at all because it’s uncomfortable. In some cases, a palatal implant is used as a first-line treatment. A palatal implant changes the characteristics of the soft tissue of the palate, stiffening it and altering how air flows around it. The device is a group of three cylinder-shaped braided polyester filaments that are implanted permanently into the soft palate, which will relieve snoring by changing the flow of air through the nose and mouth and into the lungs.
The palatal vault is the curvature of the maxillary palate, also called the hard palate. The growth of the maxilla (upper jaw) and the hard palate is influenced by both environmental and genetic factors, and begins transversely. Then, it grows in length and finally in height. The overall shape of the palatal vault can impact chewing and swallowing, sucking, breathing, and language articulation. Narrow or high palates are associated with a variety of health conditions, and oral habits like thumb sucking can cause structural abnormalities in the palate over time. The hard palate is of particular significance to orthodontists, who often need to modify palatal dimensions of dental orthotic devices, such as retainers or dentures, to provide the best fit to patients. The height of the palatal vault increases with age, and male palatal vaults tend to be higher than those of their female counterparts of the same age.
Pamidronate is a type of medication that is used to treat bone lesions, bone metastases, and high blood calcium levels that occur with certain types of cancer, such as prostate cancer, breast cancer, and multiple myeloma. It can also be used to treat Paget’s disease and osteoporosis, both conditions that cause abnormally formed and/or weak bones. Pamidronate is a bisphosphonate, which works by reducing the release of calcium from bones into the blood. This reduces the amount of blood calcium, fractures and broken bones, and associated bone pain. Bisphosphonate therapy can cause a complication known as osteonecrosis of the jaw (ONJ). ONJ can develop after any dental surgery, however, the risk is much higher in patients who receive IV bisphosphonate drugs. The most common presentation of osteonecrosis of the jaw caused by bisphosphonate therapy includes the formation of a socket without extraction, swelling of the gums, discharge, and exposed bone.
A panoramic radiograph is a special type of x-ray that utilizes a minuscule amount of ionizing radiation to produce a single image of the entire mouth. This includes the mandible, maxilla, teeth, and surrounding tissues and structures. While bitewing radiographs and other intraoral x-rays are often still done, the panoramic x-ray has become integral to the diagnosis and treatment of a wide variety of oral and dental health conditions. Unlike other types of radiographs, it provides dental professionals with information about possible bone abnormalities, the position of the teeth and their roots in relation to each other across the entire mouth, and the maxillary sinuses. Panoramic radiographs are often used by dentists to diagnose gingivitis (periodontal disease), oral cancer, tumors in the jaw, sinusitis, jaw bone cysts, impacted wisdom teeth, and TMJ (temporomandibular joint disorder) and other jaw disorders. There is no special preparation needed for patients to undergo a panoramic x-ray.
A panoramic reconstruction is a thin, reformatted section of computed tomography (CT) scan data which is parallel to and following the curvature of the alveolar process as seen in the axial view. Data from a panoramic reconstruction scan can be used in dental applications for the diagnosis of disease. It is also commonly used in implant dentistry to provide a detailed image of the maxilla, maxillary sinuses, and the mandible. There are several advantages of the panoramic reconstruction scan which include the ease of identifying opposing landmarks, the convenience and speed of performance, the information provided on vertical bone height, and the ability to evaluate pathologic findings. Despite these advantages, there are a few concerns regarding the use of panoramic reconstruction as well. These include errors caused by improper patient positioning, the fact it does not show bone quality, and spatial relationships between structures can be difficult to identify.
The papilla is the soft tissue that occupies the interproximal space confined by adjacent crowns in contact. In relation to oral anatomy, the term may apply to interdental papilla which is a portion of the free gingiva that occupies the interproximal space and which is confined by the adjacent teeth that are in contact. It may also refer to interimplant papilla. This is the soft tissue that occupies the interproximal space while being confined by adjacent implant-supported fixed partial dentures which are in contact. In either case, the papilla can become damaged or inflamed due to poor dental hygiene or gingivitis and may recede. If this occurs, oral surgery may be required to restore the papilla between the teeth and restore good oral health. If inflammation and recession of the papilla are taking place due to gingivitis, the condition can be more serious as immediate intervention is required to prevent the development of periodontitis.
Papilla preservation is a surgical and prosthetic measure taken to maintain and/or reduce trauma to the interproximal tissue. One of the negative side effects of periodontal surgery is the reduced papillary height and papillary shrinkage that can lead to the exposure of underlying tissues. To prevent this, a papilla preservation technique can be used by the surgeon to help the papilla maintain a more aesthetic look for the patient’s comfort and confidence. One such technique utilizes the papilla preservation flap method in which no incision is made along the facial surface of the interdental papilla. The modified papilla preservation flap method is another technique that may be utilized following periodontal surgery and involves incisions made around the teeth next to the surgery location. These types of papilla preservation techniques allow patients to enjoy both the benefits of the surgery or implant as well as the appearance of the affected area following surgery.
Papilla reformation is the spontaneous reformation of the interproximal papilla following the establishment of a contact point and the management of the interproximal prosthetic papillary space. The term also refers to the re-establishment of the lost interproximal papilla by surgical means. Following the placement of an implant, the papilla between the neighboring tooth and the implant may be lost or significantly reduced if the neighboring tooth’s periodontal attachment is compromised. Papilla may be regenerated through papilla reformation by using a combination of hard and soft tissue grafting procedures. Bone grafting to replace missing or weakened bone between the teeth is an especially essential step that is often required for papilla reformation to take place. Another possible pathway to papilla reformation involves the use of growth factors used with bone grafting procedures. Papilla reformation is often a challenging process and therefore, proper patient preparation should take in an effort to avoid the loss of interproximal papilla.
Dental implants can help improve the quality of life of patients in a number of different ways. Patients will not only have an improved appearance, but they will also have improved function, meaning that eating, biting, and chewing will be easier. Although the dental implant process can be a long one, especially when bone grafting is involved, the improvement of quality of life is well worth it, especially for a permanent solution. There are different factors that are considered when gauging quality of life, such as the education factor, the spiritual factor, the family factor, the stress factor, the psychological factor, the work factor, and the health and safety factor. Dental implants naturally fall under the health and safety factor, but they can also fall under psychological and work. Self-esteem, relationships, and job opportunities can be affected by missing teeth in need of a dental implant.
The definition of the Physical Quality of Life Index (PQLI) is the measure of the quality of life or well-being of a country. The value is the average of three statistics: basic literacy rate, infant mortality, and life expectancy at age one. These statistics are all equally weighted on a 0 to 100 scale, as used in the dental literature. Quality of life indexes can be presented by country, by state, or by city. The index provides an overall look at the health and literacy of a country, state, or city and can be used to identify areas of the index that should be improved. It can also help measure the success of improvements that are already in place. The 2019 quality of life index will show the rankings of each country, state, or city and may further break down certain aspects of the quality of life of each for an expanded view.
In recent years, the predictability and success rate of dental implants has improved exponentially. This is largely due to improved techniques as a result of improved technology. As implants have become more sophisticated, most dentists are using CBCT technology to plan dental implant materials and procedures. Often, a surgeon will work with a restorative dentist, who examines the patient and determines the optimal placement of the tooth for the best aesthetic and restorative effect. The surgeon then determines if that placement is possible given the patient’s unique bone and tooth structure and what steps would need to be taken before the implant is placed (such as a bone graft). A radiographic guide for dental implants is typically used by both surgeons and restorative dentists to transfer the desired tooth placement to the mouth in a form that can be used with CBCT. A radiographic guide is not a surgical guide, but rather, it is a guide that helps determine if the optimal implant placement is achievable.
A radiographic marker is a radiopaque structure of known dimension. The term also applies to a material incorporated in, or applied to, a radiographic template in order to yield positional or dimensional information. The importance of radiographic markers is due in part to their function: they mark the position of specific x-ray images or areas of interest in an x-ray image. Pro X-ray markers provide dental and medical offices with a variety of marker options that can be personalized according to color, style, font, and initials. These types of personalized markers can help identify the technician who performed the x-ray and aid in x-ray tracking. X-ray marker holders can also be ordered to provide a safe and organized way to store x-ray markers. Some medical or dental offices may choose to select a personalized marker holder that reflects the style, design, or marketing scheme of their practice.
A radiographic template, or radiographic guide, is a type of dental appliance that is designed to convey the desired position of the teeth needing to be implanted in a way that can be included in a cone-beam computed tomography (CBCT) scan. Radiographic templates are typically made by dental professionals for implanting one or more teeth using a type of acrylic to replicate the approximate shape and size of the final crown. When worn during a CBCT, the prosthetic teeth should align with where the dental implants need to be placed. A channel through the teeth replicates where the dentist plans to put the screw head of the abutment egress the incisal or occlusal of the implant. The rest of the template is made from a radiolucent material, which will not show on the scan and helps to hold the radiopaque teeth in place without moving during the CBCT scan.
Radionecrosis, or radiation necrosis, is a term used in the medical industry to describe the aftereffects of radiation therapy. It refers to the breakdown of body tissue at the original tumor site and occurs some time after radiation has been completed. It takes the form of a focal structural lesion that may potentially be a long-term complication of radiosurgery or radiotherapy that affects the central nervous system (CNS). If radiation necrosis occurs, the body may not be able to replace the damaged tissue. While radionecrosis can occur in any type of body tissue treated with radiation, the most common form of this condition found in dentistry is osteoradionecrosis, or the necrosis (death) of bone tissue. Osteoradionecrosis is quite rare, but when it does develop, it typically does so in the lower mandible or jawbone because this area has a lower blood supply than other bony structures of the mouth and jaw.
The word “radiopaque” simply means that a substance is opaque, or cannot be seen through, under radiation. The most common example of something radiopaque is the human skeleton. Bones cannot be seen through under radiation, which is why x-rays are such an effective way of visualizing bones. Human skin, eyes, and other soft tissues are radiotransparent or radiotranslucent, which means they either will not be visible under radiation or they will be faint and easily seen through. Radiopaque substances are often used in the medical field for diagnostic purposes, such as drinking barium before an x-ray to visualize the normally radiotranslucent intestines. In dentistry, radiopaque materials include dental implants, braces, amalgam fillings, and some cosmetic restorative materials. The different levels of radiopacity of fillings, enamel, pulp, tooth decay, gums, and other oral structures help dental professionals diagnose a number of conditions including caries, cysts, gum disease, impacted wisdom teeth, and more.
The term “ramus” refers to the branch or arm of a bone, such as in the pubic bone or the jaw bone. The jawbone has two; one ramus on each side that connects with the skull. In the field of implant dentistry, the ramus is of particular significance to bone grafting procedures. Autogenous bone is often more successful than allograft bone during grafting procedures, and the mandibular ramus provides cortical bone that is suitable for building the alveolar ridge after bone loss prior to dental implant placement. Using grafts from the ramus are highly successful and have a number of advantages, including a low morbidity rate and easy intraoral access. Ramus bone grafts need only a short time to heal, maintain their density after implantation, and exhibits minimal resorption by surrounding bone. Complications of a ramus graft include the possibility of damaging the mandibular neurovascular bundle.
Single dental implants are costly and may not be the best option for patients who need multiple teeth replaced. In the case of patients missing an entire set of top or bottom teeth, dentures are often recommended. For patients who do not want to put in or take out their dentures every day and keep them clean, a special stainless steel implant called a ramus frame implant. This device is shaped like a horseshoe and is implanted into the mandible from the retromolar pad on one side all the way to the retromolar pad on the other. The front of the frame is also implanted into the alveolar ridge above the chin, providing three-point stability. A portion of the device will remain outside the gums, which is what the dentures “clip” or “snap” onto. This may be uncomfortable for some patients, who often choose to wear their dentures over the ramus frame with the exception of removing them for cleaning.
One of the biggest contributing factors to the need for periodontal surgery is the loss of bone. In cases where periodontal disease is very advanced, so much bone may be lost that there is not enough to support a dental implant. In this case, bone grafting may be an option. A bone graft involves the implantation of bone tissue from another source into the area needing bone. The graft heals, integrating with whatever existing bone is present and increasing the amount of bone in the area of the mouth where the implant will be. The Ramus Bone Graft uses a patient’s own bone from the mandibular ramus instead of synthetic (lab-created) or donated bone, meaning that this procedure is considered an autogenous bone graft. This reduces the risk of rejection and other potential complications associated with bone grafts from foreign sources, and encourages the body to generate new bone.
A ramus implant, or a ramus frame implant, is a stainless steel denture anchor that is implanted directly into the bone of the mandible. A ramus implant is one of the earlier types of implants and were originally seen in the mid-1970s. Although large and cumbersome, this type of implant had a 91% success rate over a decade post-surgery. The ramus implant is horseshoe-shaped and is implanted into the retromolar pads on both sides of the mandible and in a third area in the alveolar ridge just above the chin in the center of the mandible. The dentures then “snap” or “clip” onto the part of the implant that sits above the gums. When the dentures are removed, the frame can be felt in the mouth, which some patients may not like. Often, patients will only remove dentures from their ramus frame implant when they need to be cleaned or serviced.
A randomized controlled trial, or RCT, is a study where people are selected completely by random or chance to either receive a treatment or clinical intervention, or to receive the control or standard of comparison. The standard of comparison is often a placebo or sugar pill in the case of medication trials, or it may be a standard practice or no actual intervention at all. A randomized controlled trial is used to measure the outcome of individuals, or participants, who receive treatments or clinical interventions. To assess the nature of the outcomes of participants, they must be compared to the participants who did not receive the intervention or treatment being studied. RCTs are, in short, controlled, comparative trials that are an extremely powerful tool within medical research. Randomized controlled trials are simple to organize and often easy to conduct; the most important factor is that the participants’ selection is absolutely by chance.
Sandblasted, large grit, acid-etched implant surface, (SLA) is a type of surface treatment that creates surface roughness with the goal of enhancing osseointegration through greater bone-to-implant contact (BIC). The SLA process increases the rate at which osseointegration occurs by using a combination of grit and acid etching to give the surface increased roughness on multiple levels. This allows osteoblasts to proliferate and adhere to the implant surface. Through osseointegration, SLA can help provide increased stability of the implant which will ultimately lengthen its longevity. The use of specialized implants by Straumann SLA implants, such as the SLActive implant and the Roxolid SLA implant, reduces the amount of treatment time required while also increasing the treatment predictability. The Roxolid SLA implant can also reduce the need for bone augmentation to assist those patients who have insufficient bone. The SLA process offers a variety of benefits to patients requiring increased ossification prior to an implant.
Treating the surface of a dental implant has been shown to promote osseointegration and reduce the likelihood of dental implant failure. The sandblasting procedure is just one way that the surface of a dental implant can be altered using different equipment to help encourage the success of the implant. The sandblasting process is straightforward and involves using a stationary or portable sandblaster to “blast” sand at the surface of a dental implant at a high velocity to change the texture of the surface. On a microscopic level, the sandblasting procedure “roughs up” the outer layer of the implant, creating a surface that is easier for the bone to grip as the implant heals. Like sandpaper, different sizes of sand or grit can be used to create different outcomes — larger pieces of sand are going to create a rougher surface while smaller grains of sand create a smoother but still textured surface.
The sandwich technique is a specific strategy in restorative dentistry used for fillings. In both open and closed sandwich techniques, the different materials of the composite resin is layered or “stacked” onto the tooth, similar to building the layers of a sandwich. This is done instead of mixing the materials of the resin together before filling the cavity. An open sandwich refers to when the filling is located on one of the sides of the tooth and comes into contact with the oral cavity. A closed sandwich refers to a filling in the center of the tooth that does not come into contact with the oral cavity. Many dental professionals who work in restorative dentistry feel that the sandwich technique provides a stronger filling, because the glass ionomer cement that is layered on first bonds to the tooth structure below and the composite to follow, offering a better seal and increasing filling retention.
The sausage technique is a term used in implant dentistry to describe a specific technique used for bone regeneration. Created by Hungarian periodontist Dr. Istvan Urban, the sausage technique is much less invasive than its predecessors. Before this technique was developed, more autogenous bone had to be harvested, which typically resorbs over time. Now, periodontists attempting to regenerate bone prior to a dental implant can use 50% autogenous bone and 50% xenogenic bone. Instead of using only one material or the other, both materials are used and much less autogenous bone is necessary, which results in a less invasive harvesting procedure. The sausage technique receives its name from the way the native collagen membrane looks when it is stretched out like a skin with small tacks to keep the bone graft from moving. The membrane allows for improved blood flow during healing and bone regeneration, and the host bone is typically reabsorbed by 6 weeks.
Endodontic treatment, or root canals, are a common, although often dreaded, dental procedure. They are often successful at preserving a natural tooth instead of having it extracted, which can cause bone loss and other complications. Endodontic treatment was introduced by Hermann in the 1920s, when he outlined the administration of calcium hydroxide for pulp therapy. This essentially created the foundation for modern endodontic therapy as it is known in dentistry today. Ideally, the outcome of a root canal is the removal of diseased pulp and the replacement of healthy pulp that begins to regenerate itself. To control the differentiation, metabolism, and proliferation of stem cells and to provide spatially correct positioning, appropriate scaffolding is necessary. Different types of scaffolding facilitates the regeneration of various tissues, making it critical that the treating dentist has a robust knowledge of which scaffolding is suitable for the type of tissue attempting to be regenerated.
A scalloped dental implant is an older style of implant that was created to biologically facilitate and guide interproximal bone remodeling during procedure healing and to retain papillae and bone height during functional loading. The scalloped implant design includes areas for both soft and hard tissue apposition, which are set parallel to each other, mirroring the cementoenamel junction. The area for the apposition of hard tissue is meant to facilitate osseointegration, while the area for soft tissue is designed to create a space for the subgingival margin of the restoration and to support various connective tissues. While the design was well-intentioned, it did not work as well as expected during application. A study of 17 scalloped implants that were evaluated for 18 months revealed that the scalloped design increased bone loss more than conventional dental implants that were properly placed. There were no differences in papillae formation in the study.
A scanning abutment is a type of abutment that is used to transmit data related to the angulation and position of seated implants. The data is collected with a digital desktop scanner or an intraoral scanner and is extremely accurate. A scanning abutment includes a biocompatible abutment body. Inside the body is an internally threated titanium screw, which is designed to be compatible with other materials and components used within the specified dental implant system. There are two types of scanning abutments: clinical scanning abutments and laboratory scanning abutments. The former contains barium, a radiopaque material, and is designed to be used with intraoral scanners. The latter contains radiolucent material and is used with both blue-light and red-light desktop scanners. Scanning abutments should be inspected for damage before use, and the use of multiple scanning abutments is not recommended due to the possibility of cross contamination.
A scanographic template, also called a scanography template and sometimes spelled scannography, is a template created for the process of capturing digital images of an object. Typically, the purpose of the template is to create a printable image using a flatbed scanner with a charge-coupled (CCD) array capturing device. Scanograpy differs significantly from conventional document scanning by utilizing three-dimensional or atypical objects. In dentistry, scanography is a type of radiography that is used to produce images of the oral structures of a patient for the purpose of creating restorations. It can also be used as a diagnostic tool to detect abnormalities in the mouth and jaw, as well as tumors, cysts, impacted teeth, dental implant malalignment, caries (tooth decay), and other clinically significant issues. There are two types of scanography used in dentistry: rotational scanography and linear scanography. Linear scanography is used most often as it produces panoramic views.
The Schneiderian membrane, also called the Schneiderian epithelium, is the lining of the paranasal sinuses and nasal cavity. It’s unique in that the ciliated columnar lining is ectodermally derived and features goblet cells. The neighboring respiratory epithelium, which appears similar to the Schneiderian membrane, is derived from the endoderm. One of the most common complications that can occur during a sinus grafting surgery is a tear or perforation in the Schneiderian membrane of the maxillary sinus. If this occurs, typically, the surgeon will repair the perforation at the same time the graft is placed, and few additional risks of complications exist. However, in some cases, patients will develop an infection in the maxillary sinus or surrounding areas of the maxillofacial complex after a substantial or complete tear in the membrane. This infection is serious and may result in the failure of a recently completed bone graft or dental implant.
For many decades, dental implants have been one of the most desirable ways to replace one or more missing teeth. Their outcomes are generally predictable, and the failure rate of dental implants is low overall. However, failure can still occur both in the short and long term. Screw fracture, or the fracture of the screw implanted into the bone to hold the dental prosthetic, is a common reason dental implants fail within the first 10 years. Although nearly half of dental implant patients suffer a screw fracture, removing it is a complex procedure, especially if the screw is fractured or broken in more than one place. Considered a mechanical complication, the fracture of a dental implant screw is often caused by high occlusal loads. In cases of bruxism, where there is constant pressure on the teeth from clenching or grinding them (usually at night), screw fractures are more common.
A tack, or a bone tack, is a small piece of metal that is used to stabilize bone graft material during guided bone regeneration. Stabilizing the membrane can help promote healing. There are many different types of bone tacks and membrane fixation systems. Some are manual while others are automatic and which one is used for bone grafts depends largely on the preferences of the periodontist working with the patient. While bone tacks can be purchased alone, they are most often found in a “tack kit,” which can also include a tack block, a tack mallet, a tack placement instrument, and a drill for dense cortical bone. All of these items in a tack kit are autoclavable, meaning they can be sterilized in between use on patients like most other dental instruments. Most bone tacks are made from titanium alloy, but they can be made from other materials.
There are two types of taps in the dental field. The first is the bone tap. This is a device used to create a threaded channel in bone for a fixation screw or, prior to the insertion of a dental implant, into an osteotomy. A bone tap may be used to prepare the bone for the implant required for a prosthesis. The second type is the metal tap. This is an instrument made of a hard metal used for rethreading damaged internal threads of a dental implant. The type of tap device required will depend on the specific procedure. Since there are a variety of tap dental devices that can be used to help place or fix dental implants, research may be needed prior to purchase. Tap dental appliance reviews may help in the selection of the correct device by using the tap appliance dental code. Appliance parts may also be researched to see which are best suited for the necessary procedures.
A tapered dental implant simply refers to dental implant hardware that is tapered, or narrowed, at the implant end. Tapered implants are most similar to the shape of the natural tooth roots, which helps to create more stability and improved overall aesthetics in the finished dental implant. Tapered dental implants offer maximum bone maintenance, exceptional primary stability, and excellent soft tissue attachment. Many tapered implants boast a wide variety of features that make it a good choice for most implant procedures, including treated surfaces, optimized thread form, color-coded platforms, multiple configurations, and a vast range of sizes. Treated surfaces also mimic the natural tooth, allowing oblique connective tissue to attach and for the periodontist to better control cellular migration. Color coding allows periodontists to quickly and easily identify sizes and components, making the implant procedure faster and more accurate. Tapered implants are more likely to be used in types of bone that are harder to achieve stability with.
Tapping, or EFT (emotional freedom techniques) tapping, is a stress-relief technique that is often used to relieve dental anxiety. As many as 30% of patients report feeling anxious when going to the dentist, but for many people, sedation dentistry is simply not an option. Tapping takes just minutes and can be done at home or in the office with zero side effects. The concept behind EFT tapping is that certain acupressure points on the body, usually the head and upper torso, are “tapped” with the fingers at the same time the individual repeats a self-acceptance phrase. The phrase typically acknowledges the anxiety, such as the sound of a dental drill causing stress, and affirms acceptance regardless of the issue creating the anxious feelings. Beyond relieving dental anxiety, tapping can be used to relieve chronic or general anxiety, post-traumatic stress disorder (PTSD), situational anxiety surrounding public speaking or test-taking, and more.
The removal of calculus and plaque after having dental implants with an ultrasonic scaler, especially during a deep cleaning (also called a scale and root plane) can cause significant damage to dental implant hardware. However, managing plaque and calculus build up becomes even more important after having dental implant surgery. Periodontal disease (gum disease) can cause implant failure similar to how a natural tooth will become loose after untreated periodontal disease begins to destroy the underlying bone. A 1994 study revealed that when ultrasonic scalers are coated in Teflon, the same damage does not occur to plastic implant curettes or smooth titanium surfaces. On rough implant surfaces, however, instrument material residue was discovered. The study determined that coating ultrasonic and sonic scaler tips with Teflon material (also called a Teflon scaler) enables dental professionals to use high-frequency tools to professionally clean dental implants without significant damage.
Teflon tape, also called plumber’s tape, is a common DIY tool used to prevent leakage between two pipes fit together. The term “teflon tape” is actually an incorrect one; the material is known as PTFE tape or thread seal tape. The tape wraps around a set of threads and once screwed in, the tape seals any micro gaps between the threads. Plumber’s tape is also used frequently in cosmetic and implant dentistry, among other fields. It’s most often utilized to seal an abutment screw before sealing the access openings. There are a number of advantages to using PTFE tape to do this: unlike cotton, it won’t absorb fluids like a sponge, it can easily be removed to provide access to the abutment screw, packing can be done quickly, and it seals and protects the area above the top of the abutment screw. It can also be used to obliterate the screw access hole in dental implants.
A telescopic coping is a feature of telescopic dentures, which are classified as an overdenture. An overdenture is any dental prosthesis that is anchored by natural teeth or a dental implant. Telescopic dentures offer more stability than traditional dentures due to their unique design. Abutments are placed strategically in the patient’s mouth, and the primary telescopic coping is cemented to them. The secondary telescopic coping is attached to the denture, which fits onto the primary coping. In the 1970s and 80s, telescopic dentures that were anchored by natural teeth or the roots of natural teeth were considered more popular than traditional dentures. It is believed that telescopic dentures anchored to natural teeth better diffuse the occlusal load and prevent overload by transferring the stress of occlusal forces through the periodontal ligament of retained tooth roots. The extra stability of the copings offers a stronger bite and more efficient chewing.
In dentistry, a temporary abutment (also known as a temporary cylinder) is an abutment used for the fabrication of an interim restoration. The interim restoration may be cemented onto the temporary abutment or the temporary abutment may be incorporated into the interim restoration for a screw-retained prosthesis. Temporary abutments are an essential component in restorative dentistry procedures. They allow the tissue around the implant to heal while also providing an attachment point for the crown, bridge, or other dental restoration. Following implant osseointegration with the surrounding bone, the temporary abutment may be removed for a permanent abutment to take its place. Temporary abutments come in a variety of designs, such as snap abutments and slim abutments, for convenient placement and easy removal. The type of temporary abutment selected for use in a dental procedure will depend upon the kind of procedure, the patient’s oral anatomy, and the type of prosthesis required.
A temporary anchorage device, or TAD, is an implant which is used as an aid for orthodontic tooth movement. A TAD can also refer to a miniscrew, osseointegrated palatal, or retromolar dental implant that is placed to control tooth movement during orthodontic treatment. Temporary anchorage devices are often placed in the alveolar bone or the extra-alveolar bone to provide the strongest orthodontic anchorage. Anchorage as a term refers to an orthodontic reactive unit that resists the opposite movement of the tooth or teeth requiring adjustment. This process utilizes both the biology and anatomy of the mouth as well as the physics of motion. Temporary anchorage devices require an opposing force to work against the teeth needing adjustment and may either be intra-oral, such as another tooth or group of teeth, or outside the mouth as seen with headgear. TADs are often made of titanium as the material is bioinert and durable.
Tensile stress is the stress caused by a load (two forces applied away from one another in the same straight line) that tends to stretch or elongate an object. Tensile stress is not often encountered in dentistry, however there are two situations in which it may be seen. The first occurs when a patient with a crown chews a sticky candy. As the candy becomes stuck to the tooth opposite the crown and the patient opens his/her mouth, the crown is subject to tensile stress which may result in the crown being pulled off. The second situation can be observed when a fixed dental structure, such as a bridge, is flexed. The flexing of the bridge can cause it to deform and no longer fit or function correctly. There are few true cases of tensile stress in dentistry since other types of stress tend to be observed simultaneously.
Ultrasonic bone surgery, also known as piezoelectric ultrasonic bone surgery, is a surgical technique using an ultrasonic device operating at a modulated frequency. It is designed to cut or grind bone but not damage any of the adjacent soft tissues. An ultrasonic bone surgery system provides an efficient way to deal with cutting during oral procedures. This surgical technique allows for the safe completion of more complex procedures. An ultrasonic bone surgery unit works by creating ultrasonic waves within a specific frequency range. These waves cause a deformation of piezoceramic rings which in turn, causes sets of vibrations to take place in an amplifier. These waves are then transmitted to a handpiece which cuts through bone tissue by shattering it on a microscopic level. This process has made many types of dental procedures less traumatic for patients, with less surrounding soft tissue damage, while also improving the healing process.
Dental uncovery is often described as tooth uncovery and is a specific type of dental procedure performed when an adult tooth is developed in the improper position and doesn’t properly erupt in the mouth. This condition is called tooth impaction and can cause a wide variety of problems for the patient if not treated. Healthy teeth can become crowded and new teeth are prevented from growing into their own correct positions, which can result in the need for more invasive dental procedures later on. Dental uncovery involves making a small incision into the gums where the tooth has failed to erupt to expose it. Then, orthodontic devices may be used to facilitate normal growth. Impacted teeth are most often caused by genetics or heredity, excess bone and gum tissue, the abnormal sequence of tooth eruption ankylosis (where the tooth root and bone become fused together), and crossbite.
An Underwood cleft or septum is a fin-shaped projection of bone that sometimes exists in the maxillary sinus on or near the floor of the sinus cavity and is often called a maxillary sinus septum or Underwood’s septa. Its name is derived from Arthur S. Underwood, the anatomist at King’s College in London who first discovered these bones in 1910. An Underwood septum is of special interest to dental professionals when performing surgical procedures designed to elevate the sinus floor, because it increases the likelihood of potentially serious complications like tearing of the Schneiderian membrane, or the thin lining of the maxillary sinus cavity. As many as 32% of patients have been reported to have an Underwood’s septa, and they can often be seen on dental x-rays without the need for additional imaging. Two types of septa exist; primary septa were originally described by Underwood and secondary septa can form after tooth loss.
For a dental implant to be successful, the alveolar ridge must have sufficient volume. When it doesn’t, periodontists can choose to use a unilateral subperiosteal implant, a type of dental implant that was specifically developed for patients who do not have enough residual bone in the alveolar ridge. This type of implant has survival/success rates similar to other modalities. Unilateral subperiosteal implants are contraindicated in patients with an overabundance of bone. The procedure involves two stages; first, a bone impression is taken and second, the custom dental implant is placed. A subperiosteal dental implant is made to rest on top of the bone under the periosteum instead of traditional implant hardware that is placed much deeper into bone. Instead, the implant disperses pressure over a larger surface area, much like a snowshoe. The implant is made from a custom metal casting that adheres to the bone with direct support and surrounding fibrous tissue.
The UCLA abutment has been around since the late 1980’s, however, many periodontists overlook this implant abutment in favor of others. This type of abutment is considered stronger than zirconia abutments because there is an internal connection via a secondary metal component. No matter the implant size, the UCLA abutment can be used with any dental implant system. In fact, UCLA abutments are often used in cases where a smaller implant is needed, because the smaller a zirconia abutment, the weaker it will be. Another benefit to the UCLA abutment is that it was created with ceramic applied and baked to the entire surface instead of just the sub-gingival area. This allows for a completely ceramic crown to be used. A UCLA abutment works particularly well with a bridge, however, crowns and other restorations can benefit from this abutment. Tooth color can be achieved for aesthetic purposes and healing time is similar to other abutment materials.
The Valsalva maneuver is a simple technique that involves breathing out of the nose and mouth while they are closed. This raises the pressure inside the chest and middle ear, and can equalize pressure in the ears and help reduce some heart arrhythmias. Although rare, ear damage can sometimes occur when blowing too hard with the Valsalva maneuver. Ear “popping” sensations are usually felt at the start of the Valsalva maneuver, but to also get the cardiac benefits, the maneuver must continue for 10-15 seconds. The modified Valsalva maneuver involves laying flat with the legs elevated for 15 seconds after exhaling against closed airways for 15 seconds. This modification improves the heart rate in patients with certain types of arrhythmias, and it can be done anytime, anywhere — nothing is needed to perform the Valsalva maneuver. SVT, or supraventricular tachycardia, is a type of fast heart beat that can sometimes be serious and requires medical treatment.
Variance is a measure of statistical dispersion about the mean. The larger the variance, the further individual values of the random variable (observations) tend to be from the mean, or average. Variance exists between individuals of a species for a multitude of traits, including dentition. A number of different genetic, environmental, and mechanical factors may be at the root of this variance. Even in cases of monozygotic twins, dental variation is seen in their individual dentition. This may be due to epigenetic factors, environmental variances, and different phylogenetic influences. Variance in dentistry can also be found in the measurements taken by different tools. Each tool used is calibrated per industry standards but subtle differences in each individual tool will result in minor, or sometimes major, variances. Careful calibration prior to use, proper tool cleaning and maintenance, and proper tool storage and care will help diminish the likelihood of extreme variance between tools.
Vascular endothelial growth factor (VEGF), also called vascular permeability factor (VPF), is a specific type of protein known as a signal protein that encourages the body’s creation of blood vessels. When cells release this protein, it “signals” the body to take action — in the case of VEGF, either by angiogenesis or vasculogenesis. Angiogenesis is the creation of new blood vessels from existing vasculature, while vasculogenesis is the creation of the circulatory system in the embryo. The vascular endothelial growth factor protein is critical to human survival as it’s the protein that restores the supply of oxygen to tissues that have become hypoxic, or suffered a loss of oxygen. Most often, this occurs after cells become injured or to repair muscle after exercise. However, VEGF expression can also result in the formation of new blood vessels to circumvent ones that are blocked, a process called collateral circulation. Overexpression of VEGF can lead to disease.
All parts of the body require oxygen to function, which is carried to the cells via blood vessels or the vascular supply. The heart and lungs require a great deal of oxygen, while other parts of the body, like bone, require less. However, bone can also cease to function without an adequate supply of oxygen. In an average long bone, oxygenated blood is supplied by either periosteal vessels, epiphyseal vessels, or a nutrient artery. By having three systems in place, one can take over the function of the other if it becomes blocked or damaged in some way. If bone tissue does not receive enough oxygen, a process known as avascular necrosis or osteonecrosis occurs. This is the death or decay of the bone due to a lack of oxygenated blood. Osteonecrosis can cause the bone to become brittle, breaking into small pieces and eventually crumbling or collapsing if left untreated.
Veneers are one of the most common cosmetic dental procedures performed in the U.S. A veneer is a thin piece of porcelain (and less commonly, resin) that is placed over the front of a tooth to restore its size, shape, and color. Dental veneers can be used to correct a wide variety of cosmetic issues, including broken or chipped teeth, teeth gaps, and stained or severely discolored teeth. Veneers are permanent because the natural tooth must be altered or filed down to adhere the veneer using dental cement. While a patient can have a single veneer placed, most often, patients interested in significant restoration will have multiple veneers put on. Veneers give teeth the smooth, shiny, uniform look that celebrities often have; this is usually because they also have veneers. Patients can choose bright, white veneers or veneers with a more natural color to achieve their aesthetic goals.
Before manufacturing the prosthetic framework for multiple dental implants, it’s important that periodontists ensure that the framework has the optimal passive seat. To do this, a verification jig is often used. This ensures that the master model is precise before the framework is created. A verification jig mimics the fit of the final restoration framework so the model accuracy can be verified to confirm that the end restoration fits perfectly. The jig is made of temporary cylinders that are joined together with a stiff resinous material and often, rods or sturdy wires. Then, the jig is placed over all of the dental implants in the patient’s mouth; an unstable frame means that the screws need to be adjusted on either side to prevent movement of the jig. The jig can be used for the final framework once all rocking or movement in the mouth has ceased.
The vertical dimension of occlusion (VDO), is the measurement of the relationship between the upper and lower jaw when the teeth are fully occluded in max intercuspation. VDO is sometimes referred to as vertical dimension or occlusal vertical dimension (OVD). Both patients with and without teeth possess a VDO, however, the latter is more subjective in measurement and is generally based on esthetics and phonetics, or the sound of words being pronounced as the jaw is held in the desired position. The vertical dimension of occlusion can roughly be measured by asking the patient to say “Emma.” The position of the lower jaw on the “a” sound is called the vertical dimension at rest (VDR), which is roughly 3mm greater than a patient’s VDO. Reduction of the vertical dimension of occlusion can occur after tooth loss, tooth decay, gum disease, and loss of bone in the alveolar ridge.
Vertical dimension of occlusion (VDO), also known as occlusal vertical dimension (OVD), is a term used in dentistry to indicate the superior-inferior relationship of the maxilla and the mandible when the teeth or wax rims are situated in maximum intercuspation or contact. In dental applications, the vertical dimension of occlusion is an important measurement in determining the correct dimensions for a prosthesis. In oral trauma, the proper vertical dimension of occlusion for the patient must be known so the correct basal bone height reconstruction can be achieved. An increase in basal bone height will reduce the VDO and can lead to problems including speech difficulties, unnatural lip contact, esthetic issues, and temporomandibular joint pain complications. A decrease in basal bone height will also cause issues including drooling of saliva, improper contact of the upper and lower teeth, and injuries to the soft tissue of the cheek due to accidental biting.
A wax-up is a wax and/or resin pattern contoured to the desired form for a trial denture, cast coping, metal framework, or for diagnostic purposes. It is also a process of placing denture teeth on a wax-rim. A wax-up provides a model of what the patient’s dental work will look like and assists the dentist with the implant procedure. A dental wax-up kit is an important part of any office’s dental materials. This contoured pattern can be used for wax-up teeth or for a veneer wax-up. A dental wax-up not only assists the dentist with the implant process but the patient as well. A mockup can be made and placed into the patient’s mouth to give them a better understanding of what their prosthesis will look like once the procedure is complete. It also provides a chance for the patient to request changes or to discuss any esthetic concerns they may have.
A waxing sleeve is placed over the titanium implant post and can be shaped or modified in any way to procure an appropriate metal support for a dental implant. Often, waxing sleeves are used in tissue level impression and with a UCLA-type crown or UCLA abutment. UCLA abutment history says that the abutment was created in 1987. It has a gold cylinder that works with the implant hardware and a plastic sleeve that can have a waxing sleeve placed over it. Usually, the abutments are cast with a high noble alloy and baked with ceramic before use. The UCLA abutment is stronger than a zirconia abutments, and it has better versatility and aesthetics compared to other types of abutments. Whether used with a UCLA-type crown or abutment or not, a waxing sleeve allows for straightforward and accurate fabrication. Essentially, this works to create a better overall finished aesthetic appearance.
Wolff’s Law is a simple ideology that states that the natural bone of a healthy animal or person will adapt to the stress under which it is placed. This law was developed in the 19th century by German surgeon and anatomist Julius Wolff. He posited that if the load under which a bone is placed is increased, the bone naturally reconstructs itself to become stronger and withstand the additional strain. These changes are remarkable and include both primary changes to trabeculae architecture and secondary adaptive changes to external cortical bone, which may become thicker. The opposite is also true; if the strain on a bone decreases, the bone weakens over time due to the lack of stimulation needed to keep bones strong and healthy. Bone strength and density often decreases after a prosthesis is placed as a result of stress shielding, or the transfer of load from bone to prosthetic.
There are two main types of dental X-rays. The first is intraoral (meaning the X-ray film is inside the mouth) such as a periapical radiograph. The second is extraoral (meaning the X-ray film is outside the mouth) such as a panoramic radiograph, or CBCT. An X-ray for dental purposes can assist the dentist in finding any tooth surfaces that have decay or damage issues which a visual examination alone might not reveal. A dental X-ray procedure generally only lasts a few minutes and can be taken from a variety of angles to show multiple views of the problem area. To ensure dental X-ray safety, the patient may wear an apron over their neck and chest to prevent x-ray exposure to other areas of the body. Dental X-rays are often a part of routine check-up and most dental insurance plans will cover at least part of the dental X-ray cost.
A xenograft is a type of bone or skin graft that is taken from a donor of another species. In comparison, an allograft is a type of bone or skin graft that is taken from a donor of the same species. An autologous bone graft (sometimes called an autograft) is a type of graft taken from the patient themselves, and an alloplastic graft is a manufactured or synthetic bone graft made from hydroxyapatite, a natural mineral and the main component of bone. In the dental field, xenografts are usually porcine or bovine, meaning they come from pigs or cows. The grafts are cleaned, sterilized, and prepared for implantation into the human body. The most common grafts to be used in the dental industry are bone grafts. If a patient has bone loss due to disease, trauma, or missing teeth, a bone graft may be necessary before placing a dental implant.
Young’s modulus measures the ability of a material to stand up to changes in length when under lengthwise compression or tension. It’s also called the modulus of elasticity. Learning how to calculate the stiffness of a solid material is relatively straightforward in this case — Young’s modulus is equal to the longitudinal stress divided by the strain. Diamond has the highest Young’s modulus, and rubber has the lowest. Mild steel would be somewhere in between. Using a calculator to determine the Young’s modulus of different materials is important to implant dentistry for a variety of reasons. A periodontist must understand the Young’s modulus of the patient’s bone in the area the implant will be placed as well as the modulus and dimension of the implant itself. If there is a mismatch between the Young’s modulus of the bone and the implant, it could result in implant failure.
Zirconium dioxide, or ZrO2, is often called zirconia but is important to distinguish from zircon. The substance is a crystalline oxide of zirconium, which is usually bright white in color, and is often called “ceramic steel.” It’s an extremely strong substance One of the most common forms of zirconium dioxide is dopant stabilized cubic structured zirconia, or better known as cubic zirconia, or simulated diamonds. In dentistry, zirconium dioxide is used widely by dental professionals as a ceramic oxide. The substance can be used in a variety of applications, including dental crowns, bridges, implants, and inserts, and has been shown to have an excellent safety profile and biocompatibility. Zirconium dioxide nanoparticles are also not harmful to other living organisms, including bacteria, making it a great choice for bone implants as well. Other popular ceramic systems among dental professionals include silica, alumina, leucite, and lithium disilicate.
Zirconia is a newer material used for dental crowns. In the past, dental crowns were made of metals like silver or gold, resin, and porcelain. Zirconia is stronger than porcelain but just as natural looking. Zirconia teeth are nearly indistinguishable from your own teeth and are similar in size, shape, and color. Because it doesn’t require as much preparation to the natural tooth, the price of zirconia is affordable compared to other dental crown materials. When comparing a zirconia crown vs. porcelain crown, there are numerous benefits that zirconia crowns have over porcelain. Zirconia crowns can be milled in the dental office and put in during the same visit, whereas porcelain crowns are typically made in a lab outside the dental office. Zirconia crowns can be cemented or bonded and are biocompatible. Because of these benefits, zirconia crowns are growing in popularity for both crowning natural teeth and dental implants.
A zirconia abutment offers an esthetic alternative to metal implant abutments. Due to the white color of zirconia, abutments made of this material are often not as noticeable. Zirconia abutments can be custom milled or ordered as stock abutments from a specific manufacturer. They are available in a variety of configurations with or without pre-machined margins. The aesthetics of zirconia is often a selling point with patients that have thin gum tissue as there is no gray metal to show through along the gum line. While a zirconia implant is very strong, titanium is known to be even stronger with a higher elasticity which helps resist micro-fractures. The zirconia abutment price is also higher than that of a titanium abutment due to the nature of zirconia. When considering the zirconia abutment vs. the titanium abutment, these are just a few of the factors to research.
Zirconium is a steel-gray, hard ductile metallic element with a high melting point that occurs widely in combined forms. It is highly resistant to corrosion and is used especially in alloys and in refractories and ceramics. Zirconium can be altered to create a material known as zirconia. This is a white ceramic substance which can be used as dental crown material, dental fillings, or to make zirconia implants. Zirconia crowns are often less expensive than porcelain crowns, however, zirconia crowns disadvantages also need to be considered. These include:
Dental implant technology has advanced greatly in the last several years. 3D rendering allows periodontists to accomplish a number of things when planning to place an implant for a patient, helping to create a better aesthetic, improved healing, and a better overall outcome. A 3D rendering is also known as CBCT, or cone beam computer tomography. This technology provides an extremely detailed view of the structures inside the mouth. This can help a periodontist visualize nerves surrounding the area where the implant is to be placed and choose the optimal placement for the dental implant hardware. Additionally, the technology allows jawbone density to be measured, indicating whether or not a patient may need bone grafting before the implant can be placed. The 3-D rendering also helps with determining the best implant size and shape to provide the patient with a natural looking permanent tooth with a precise fit.
Many periodontists use a 3D volume rendering technique that allows for the visualization and measurement of a patient’s bone density prior to the implant procedure. Measuring bone density during the initial implant exam is critical, as it determines the next steps of the procedure. If a patient has low bone density, they may need a bone grafting procedure before the actual implant can be placed. Today’s technology allows periodontists to conduct a painless scan, also called CBCT or cone beam computer tomography, to completely map out all the structures in a patient’s mouth. The 3D volume rendering technique is done to enable the doctor to accurately assess bone density without invasive procedures, and a 3D volumetric reconstruction gives the doctor the information needed to begin planning for bone grafting. The doctor can use the reconstruction to determine where the bone graft should be placed and how much bone will be needed.
3D volumetric reconstruction is a newer technology that can be used in a variety of applications, particularly in the medical field. The area of a patient’s body is scanned via CBCT, or cone beam computer tomography, and is a painless imaging procedure. The structures of the body are recreated with 3D imaging, allowing a doctor to completely visualize the area of the patient’s body and even take certain measurements that help better plan for surgical procedures or treatments. One application of 3-D volumetric reconstruction is periodontics. Placing dental implants without good imaging is difficult and reduces the patient’s chances of a good outcome. X-ray technology helps periodontists visualize a patient’s mouth structures to some degree, however, 3D volumetric reconstruction allows for full visibility. This enables a periodontist to measure bone density, assess the location of nerves, and choose the optimal placement for dental implants.
The term “absorbable” refers to the ability of something to be absorbed, particularly by the body. For instance, absorbance units, absorbent pads, absorbable stitches, and absorbable sutures are all designed to absorb or be absorbed. Absorbable products are key in implant dentistry because it’s not often practical or possible to use other types of products. Absorbable sutures, for example, are necessary during the bone grafting process. These sutures do not have to be removed like traditional sutures or stitches once healing has taken place. Over the course of a couple of weeks or so, absorbable stitches will dissolve in the mouth as the gums heal. With bone grafting specifically, the gums are closed over the graft. Absorbable products are necessary to allow the graft to heal without having to open back up the gums to remove sutures. This promotes a healthier healing experience overall.
In the field of implant dentistry, abutment clamp or preload, refers to the force that an implant screw has on the implant and the abutment. This force is linear and holds the components of the abutment connection together. As the abutment screw is tightened, the force used by the periodontist is transferred to both the internal threads of the implant and the threads of the abutment screw. The force “clamps” the abutment to the body of the implant, which is why it is sometimes referred to as “abutment clamp”. Although preload is measured in Newtons, there’s no ideal amount of clamping force used for abutment screws. A periodontist must follow the manufacturer’s recommendation for specific types of screws to determine how much torque to apply and how much preload is needed to clamp the abutment connection together. The force must be measured using special tools to ensure the correct amount is used.
An abutment connection is the connection between the prosthetic screw and the internal implant. An abutment driver, or hand driver, is used to apply force to the prosthetic screw as it is inserted into the internal implant. The force applied to the screw as it is being inserted is called preload, and how much force is used has a significant impact on the success of the finished implant. Too much or too little force can cause an implant to fail, and it is best for a periodontist to follow the manufacturer’s recommendations on each different type of screw because no standard amount of force exists. It differs from implant to implant. Sometimes an abutment holder is used to reduce the risk of dropping abutments into the patient’s mouth during the insertion of the implant. For an implant to be successful, the abutment connection must be strong.
An abutment driver is a screwdriver, much like you might find in a tool chest, although it is much smaller and designed specifically for implant dentistry. They are also called hand drivers, and are textured on the handle to provide a good grip. The tip of the abutment driver is the part of the mechanism that comes into contact with the abutment screw, and often the tip pattern will differ from manufacturer to manufacturer. Some hand drivers can only be used with certain types of abutment screws. During the dental implant procedure, the periodontist will use the abutment driver to screw the prosthetic into the internal implant. How much force applied during this part of the procedure is called preload, and how much preload is used differs between types of hardware. Too much or too little force applied can result in the failure of a dental implant, so using the right abutment driver and using it properly is critical for success.
An abutment holder for dental implants is a device that helps periodontists avoid dropping abutments into a patient’s mouth. Because abutments, abutment screws, and even abutment drivers are all very small, dropping them is a very real issue. It’s important to keep the area as clean as possible and typically the hardware is sterile. Dropping abutments can be costly, however, an abutment holder can help prevent this issue. Additionally, abutment impression coping can help accurately transfer the position of an abutment or implant in relation to the patient’s teeth. An abutment-level impression can accurately record the position of an implant at the abutment-implant interface. When used together, these tools can help periodontists optimize dental implant placement, decrease the chances of dropping abutments during a dental implant procedure, and help improve the patient’s overall outcome.
An abutment impression coping typically comes in two different types — open tray impression coping and closed tray impression coping. Although what abutment impression coping technique is used depends entirely on the periodontists preferences, many periodontists prefer closed tray impression coping versus open tray. This is because with open tray impression coping, the periodontist must be certain they can find and access the impression coping screw to be able to remove the impression. Failure to do so with an open tray may lead to the impression becoming locked in the patient’s mouth. Although a closed tray impression coping does not have this problem and is generally easier to use, open trays are considered to be more accurate, especially in cases of multiple implants that will need to be splinted in patients who are partially or fully without teeth. This accuracy makes open trays preferred by many periodontists.
Abutment mounts for teeth are prefabricated devices that serve as the connectors between the abutments and the replacement bridges, crowns or dentures. An abutment can be a portion of, attached to or built into the top of a dental implant. This section extends through the tissue of the mouth; therefore, the abutment is designed to firmly support and/or retain the patient’s prosthesis. Since there are numerous kinds of abutments available, the dental abutment mounts are typically included in the package of its coordinating abutment.
A dental abutment screw is used to secure the abutment to the dental implant. Although some patients can receive their dental implants during a single session, others will require a second surgical session: These specifics should be taken into consideration when determining which abutment and abutment mount will serve the patient better.
Types of abutments include:
The dental abutment screw is the device that is used to secure the abutment to the implant. This fastener is threaded and is typically tightened until it reaches its final seating position. There are mechanical or electronic torque measuring devices that will indicate the magnitude of the torque that is being applied to the abutment screw. If proper tightening of the dental abutment screw is overlooked, serious challenges may arise.
One of the most common complications associated with dental implants is the unwanted rotation of the abutment screw. In addition, improperly using the abutment screw can result in deleterious effects on the bone, components of the implant itself and the final restoration result.
Dental abutment screws are available in various sizes, shapes and materials. It is imperative that the dentist performing the implant procedure be knowledgeable in the materials as well as the physical and mechanical aspects necessary to ensure a proper connection between the implant and the abutment.
This refers to the step of the dental implant process in which the type of abutment that will serve the patient best is decided upon. Several factors are taken into consideration when choosing an abutment, some of which include the height of the soft tissue, the angulation of the dental implant, the planned prosthesis, interarch space, occlusal factors (e.g., antagonist teeth and parafunctional activities), phonetic considerations and esthetics. In addition, some patients will require two surgical sessions to complete their dental implant restoration. During the first surgery, these patients receive healing abutments. The healing abutments remain intact until the gum has healed around the dental implant. Once healing is complete, the final abutments and permanent prosthesis can be placed.
Types of abutments include:
Syn: Platform switching
This term refers to using an abutment that has a narrower diameter than the platform of the dental implant itself. Using this method, the dentist can move the implant-abutment junction away from the platform’s edge. The goal of abutment swapping is to prevent crestal bone loss and to increase the soft tissue volume around the platform of the implant. By using an abutment that is smaller than the dental implant platform, any inflammation that occurs will be farther from the crestal bone; thus, preventing peri-implant bone loss due to inflammatory responses.
A thick crestal bone ensures that the implant remains stable and stability is essential for the long-term success of a dental implant, which is why preventing bone loss is so important. When platform switching is utilized, the bone and tissue surrounding the dental implant is preserved, helping to provide patients with exceptional aesthetic results.
After any dental procedure, infection is something a dentist will work to prevent. By using sterile procedures, instruments and educating the patient on what they can and can’t do after the procedure, can go a long way to prevent infection. However, when infection does occur, a quick response is necessary. Bacterial leakage around dental restorations can have a significant impact on the surrounding dental pulp. The dental pulp is the innermost part of the tooth and is a living tissue — it’s filled with blood vessels, nerves, and connective tissue. This is in part what makes dental work so painful. It’s critical for periodontists and dentists to choose dental materials for restoration that are compatible with the pulp. When the materials aren’t compatible, the surrounding area of the mouth can become irritated and inflamed, resulting in bacterial leakage. Bacterial leakage can cause infection and implant failure if not handled quickly.
Also known as a ball attachment, a ball abutment is a type of extracoronal attachment mechanism used with dental implants to retain an overdenture. It consists of a spherical shaped abutment, which fits into an attachment metal housing. Prior to the implant procedure, a patient must first experience full gingival healing. Following this, proper measurement of the tissue thickness must be taken to ensure the correct abutment fit. Once the right attachment diameter is selected, the abutment is properly threaded into place and adjusted using a driver. The attachment part of the mechanism is then seated into the base of the overdenture and the denture itself is affixed to the implant. These metal attachment housings can be exchanged for alternate sizes if needed to create a proper fit. Utilizing a ball abutment can also allow for easier replacement of components and is associated with less stress on the implant. Ball abutments come in a variety of materials and the one selected may depend on the nature of the procedure and the type of implant.
A Basic Structural Unit (BSU) is essentially a building block. In anatomy, the basic structural unit of the body is the cell. All living organisms have cells, which start as the zygote — the single cell at the beginning of life, after a spermatazoon fertilizes an oocyte. In humans, the body has more than 200 different cell types. The human mouth contains bone cells, epithelial cells, endothelial cells, muscle cells, nerve cells, and cartilage cells. These make up four broader categories of tissue in the body: nerve tissue, muscle tissue, connective tissue, and nervous tissue. This means that the oral cavity involves nearly all the different types of tissue and basic structural units of the body. The innermost part of the BSU, or the nucleus, contains the genetic (DNA) information for the organism. Mitochondria provide energy to the cell to perform bodily functions, and the cell membrane functions as an outer wall.
X-ray technology works by utilizing a phenomenon known as “beam hardening.” When an x-ray passes through an object, two things occur: photons that have lower energy are absorbed, while photons with higher energy are left behind. This allows an image to be created of structures within the object that are of higher energy. Skin, for example, has a lower energy level than bone. Bone, however, has a lower energy level than metal. This results in varying shades of gray that can be seen on an x-ray — metal is typically opaque white, while bones are semi-translucent. Folds of skin may be seen, however, most often, soft structures of the body like skin and muscle are completely transparent. Beam hardening technology allows dental professionals to isolate and assess internal oral structures like dental implant screws, tooth roots, and underlying bone to determine the overall best approach for completing dental restorations.
Benign paroxysmal positional vertigo (BPPV) is a common cause of dizziness, or vertigo. It causes the sensation that your body is moving even when it’s not, or that your head is spinning. BPPV results in short but sometimes very intense episodes of vertigo. Usually, these episodes of dizziness are triggered by certain changes in head positioning, such as moving the head vigorously from side to side, leaning down for extended periods, or other sudden movement. The movement is said to cause calcium deposits in the inner ear to dislodge, which move across internal structures of the ear. This causes the ear to send signals to the brain that the body is in motion. Usually, benign paroxysmal positional vertigo (BPPV) is very bothersome for the patient but of little cause for concern other than protecting patients from falls due to loss of balance. One cause of BPPV is TMJ/TMD, or temporomandibular joint dysfunction.
Betamethasone is a type of glucocorticoid, or corticosteroid, with a long half-life. It can be taken orally, applied topically, or inhaled to achieve the required effect. Betamethasone is often used to treat skin conditions to reduce swelling, itching, redness, and irritation. This drug has also been found to have applications in the dental field by promoting healing and reducing swelling. Following more extensive dental procedures, patients often experience inflammation which leads to pain and a delay in the healing process. The use of betamethasone has been shown to lessen these complications. It is generally administered as a mouthwash with one soluble betamethasone tablet being dissolved in water. Patients usually experience a reduction in inflammation, swelling, and pain due to the effects of the drug. For oral lesions, betamethasone can also be administered via inhaler with the inhaler positioned in the mouth so that it is close to the site of the lesion.
A beveled flap is a small section of gingiva that has been surgically separated from its underlying tissues by incising at an acute angle. This allows for visibility to the root surface and bone structure of the patient.
A beveled flap can be classified based on how the bone is exposed after reflection of the flap — e.g. a mucoperiosteal (full thickness flap) or a mucosal (partial thickness) flap. The flap can also be classified based on how it is placed after surgery — e.g. a non-displaced or displaced flap, as well as classified on the management of papilla — e.g. a papilla preservation flap or a conventional flap.
A full thickness flap allows all soft tissue to be completely reflected to gain full visibility to bone structures, while a partial thickness flap only includes incision of the epithelium and some but not all of the underlying tissues. The periosteum remains in place over the bone, allowing for more limited visibility.
A bevel incision, or internal bevel incision, is a type of periodontal flap surgery that allows a periodontist to access to the bone and root surfaces of the teeth. A small incision is made in the gingiva to expose the root surfaces and in some cases, the gingiva can be relocated in patients who have mucogingival involvement. This is done to clean the roots of the teeth, remove the periodontal pocket lining, and treat alveolar bone irregularities. Then, the periodontal flap is laid back down and the bevel incision is closed. The procedure helps reduce the risk of infection and inflammation, and can significantly reduce the size of pockets. A bevel incision is typically made using a #15 or #15C surgical blade, and is made to the alveolar crest beginning about 1 mm or less away from the gingival margin. Sutures are placed after the flap is repositioned to allow for minimal, if any, scarring.
Bicortical stabilization can sometimes be difficult to achieve, however, is an advantageous surgical goal. Biocortical stimulation occurs when a surgeon engages more than a single cortical plate when placing a dental implant. Typically, this is done with the cortical bone of the base of the mandible or the floor of the maxillary sinus or nasal cavity and the crestal cortical bone of the edentulous ridge. However, it can also be done by engaging the lingual and facial cortices.
Biocortical stabilization can reduce maximum stress in the superior cortical plate, assuming no peri-implant defects have occurred. However, each surgeon must decide if the potential gains from this technique outweigh the increased risks that are needed to achieve implant placement with the engagement of more than one cortical plate. Ultimately, the advantages and disadvantages must be evaluated in each patient to determine the best surgical approach.
Bioabsorbable technology continues to grow with the refinement of bioabsorbable polymers for medical devices. At its base, bioabsorbable material was created to address potential problems with synthetic implants of all kinds, including but not limited to growth disturbance, migration of the implant, rigidity, and infection, since the body generally resorbs the material over time.
Bioabsorbable material is commonly used in the medical field where implants are necessary, including bioabsorbable stents for cardiac procedures and bioabsorbable screws for dental implants. Bioabsorbable screws material for dental implants is often referred to as resorbable alloplast, and like a bioabsorbable stent, it is designed to facilitate regeneration of natural tissues.
While some surgeons prefer to continue to use titanium implant material, the use of bioabsorbable material is growing in the field of periodontics. Surgeons and patients may see a reduction in post-operative complications when bioabsorbable screws are used during the dental implant process.
CAD/CAM is a field of dentistry that uses computer-aided design (CAD) and computer-aided manufacturing (CAM) to create dental restorations like dentures, dental implants, veneers, dental crowns, and more. CAD/CAM technology allows dentists and periodontists to fit patients with durable, high-quality, and aesthetically pleasing dental prostheses. Not only does this technology improve the design and creation of dental restorations, it also makes some types of restorations possible that would otherwise not be without computer-aided design and manufacturing. A CAD/CAM system has a digital scanner that scans models and inputs the image into a computer, software that allows professionals to design a prosthesis, and technology that allows for the prosthesis to be created using the computerized image and data. CAD/CAM systems are most often used in a dental lab or production facility, but they can also be used by dentists and periodontists chair-side.
Computer-Assisted Design and Computer-Assisted Manufacturing (CAD/CAM) is a technology that uses computer software to design and manufacture implant abutments. The software uses the information from digital position recognition of the patient’s implant platform to create the custom abutment. This can assist in making a better-fitting abutment-to-implant connection. CAD/CAM abutments are often made of titanium bases due to the material’s biocompatibility and known hygienic characteristics. The use of titanium also creates a strong and corrosion-resistant implant base. CAD/CAM abutments can be made of Telio CAD abutment blocks. These blocks are made of polymethylmethacrylate (PMMA), a durable material that can be shaped and polished to create a natural look. CAD/CAM technology can also be used to create custom healing abutments that better prepare the patient’s tissue for the CAD/CAM implant. Healing abutments created using this technology can require less re-contouring, thereby saving the patient from additional dental work and expense.
Calcium phosphate is a biomaterial that has a chemical structure that is very similar to naturally occurring bones and teeth. It has both osteoconductive and bioactive properties, making it an ideal choice for implant dentistry and orthopedic applications. The calcium phosphate molar mass plays a role in its ability to promote rapid bone formation and osseointegration, and a special calcium phosphate formula is often used to coat the outside of dental implant hardware to help increase the chances of the implant success. Factors that can affect the coating’s performance include but are not limited to the thickness of the coating, the coating’s purity, the crystallinity, and its chemical composition. Additionally, calcium phosphate is often used for other applications in implant dentistry, including bifurcation perforation repair, periapical defect repair, apical barrier formation, and pulp capping. Tricalcium phosphate is a form of calcium phosphate that may also be used.
Calcium sulfate, also referenced as calcium sulphate or CaSO4, is an inorganic compound often used as a dessicant in its anhydrous form. A common example of calcium sulfate is Plaster of Paris, and the readily available compound is used in many other applications, particularly in the field of implant dentistry. It has a history of being used during bone regeneration procedures as a grafting material or a graft extender. It has also been utilized as a barrier for guided tissue regeneration. The compound is extremely biocompatible and the body is able to completely absorb the material over time. The body does not react significantly to calcium sulfate and the area of implantation becomes calcium-rich and primed for dental implant hardware. Studies show that tissue migrates over the material if primary closure is not obtained. While inexpensive and abundant, calcium sulfate is not used as often in dentistry as other biomaterials.
A Caldwell-Luc antrostomy is a procedure often used to remove a damaged mucosal lining from the maxillary sinus, developed by George Caldwell in 1893 and Henry Luc in 1897. The Caldwell-Luc operation indications are usually when sinusitis in the area has not responded to antibiotic treatment, sinus rinses, and other non-invasive treatments. However, the procedure may also be used in cases of malignancy, dental cysts, sinus polyps, fractures in the bone surrounding the maxillary sinus, or the removal of foreign bodies. Most commonly, a Caldwell-luc procedure is performed under general anesthesia due to its invasiveness, but may be performed under local anesthetic in some situations, such as if an allergy to general anesthesia exists. Complications of a Caldwell-Luc antrostomy include potential damage to secondary dentition in children, damage to adult teeth, excessive or uncontrollable bleeding, and pain and discomfort.
Nearly all medical specialties use the scientific process of taking a tissue culture. There are three different types of tissue cultures: callus culture, a seed culture (used for plants), and embryo culture. A callus culture involves the removal of a small specimen from the body and facilitating its growth into a callus in a controlled environment outside the body in order to study it. A callus is a group or mass of unorganized cells. Usually, this is done in agar, a special nutrient-rich gel that feeds the specimen for optimal replication. Different types of micronutrients and macronutrients may be included, and basal salt mixtures may also vary to enhance growth. In dentistry, callus cultures can help professionals identify difficult to treat gingival bacteria or tumor tissue that grows from wounds in the oral cavity. When studied, the callus can help dental professionals develop an appropriately responsive treatment plan through trial and error.
The calvaria definition is a simple one — the calvaria is the topmost part of the neural cranium, which protects the cranial cavity that houses the brain. The calvaria is comprised of several different bones, including the parietal bones, the occipital bones, and the frontal bone, or forehead and is the primary part of the skull roof. The bones of the calvaria are comprised of layers of compact bone, which is separated by diploic veins, or cancellous bone that houses rich, red bone marrow until death. In a fetus and young child, the junctions at which the calvaria joins with other bones in the skull roof are soft and not yet melded together — this process, known as intramembranous ossification, completes after the first few years of life. The skull roof then becomes hard at the junctions and much more difficult to penetrate.
There are two types of bone found in the human body — cortical bone and cancellous bone. Cancellous bone is a spongy type of bone and is responsible for producing stem cells and blood cells. Because of these incredible properties, cancellous bone is typically used for bone grafts due to its concentration of osteoprogenitor cells and therefore a greater ability to form new bone as compared to cortical bone. Although all bone is always in a state of renewal, a cortical vs cancellous bone graft is unlikely to be osteogenic or osteoinductive due to its fundamental lack of cellularity. Cancellous allograft bone chips are often used to fill voids within bone and have a wide range of medical applications, including osteopathy and implant dentistry. The gold standard of bone grafts, including cancellous bone grafts, is when bone can be removed from one area and grafted to another area within the same patient.
A Cantilever, or Cantilever bridge, is a special type of dental bridge that features abutment teeth on only a single side of the edentulous gap. In traditional dental bridges, the pontic (the unanchored artificial tooth) is in the center of two anchors. These anchors are often dental implants, especially for patients who are looking for a permanent solution. In a Cantilever dental bridge, however, the pontic is located on the outside of an anchor tooth, also called the abutment tooth. A dental professional may choose a Cantilever bridge when preparing a traditional bridge with abutment teeth on both sides would not be aesthetically appropriate for the patient, usually due to the location of the bridge. Or, a Cantilever dental bridge might be selected if one of the would-be anchor teeth of a traditional bridge is supporting another dental prosthesis that is unable to be replaced.
A castable abutment, also known as the University of California at Los Angeles (UCLA) abutment, is a prefabricated component, with or without a prefabricated cylinder, used to make a custom abutment for a cement-retained or screw-retained prosthesis. It is created by waxing its plastic burnout pattern and subsequently casting the abutment through a lost-wax technique. The custom-made abutment is then used in the construction of an implant or prosthesis. Such abutments can be made of a variety of materials including metal alloys such as titanium, gold, or chrome cobalt, or from polymers such as polyoxymethylene. When used in the placement of an implant, the abutment allows for height and angle correction while also fitting with the surrounding soft tissue. Following the final implant placement, a sturdy but temporary filling material is used to cover the screw access channel for easy access and adjustment should it be required in the future.
A data merge is diagnostic information that is obtained from a dental CBCT (cone beam computed tomography) scan. It’s merged with visual surface data from an intra-oral or desktop optical scanner. A CBCT is similar to the technology used for a traditional CT scan. The equipment rotates around the patient’s head, capturing data using a cone-shaped x-ray. The data is merged visual surface data to create a 3D (three-dimensional) image of the patient’s entire jaw, mount, surrounding bone structure, teeth, and the ear, nose, and throat. CBCT technology is used to diagnose cavities, assess cleft palates, visualize endodontic issues, and diagnose dental trauma, in addition to being used extensively in the dental implant industry to plan and execute accurate and successful implants. Using CBCT technology with intra-oral or desktop optical scanners is fast, easy, and non-invasive for the patient. However, the FDA recommends that dentists and periodontists only use CBCT scans when absolutely medically necessary for a diagnosis or treatment. Medically appropriate CBCT scans are of low risk to patients compared to the benefits.
De-osseointegration is the loss of a previously achieved osseointegration of a dental implant due to peri-implantitis, occlusal overload, or other factors. Osseointegration takes place when there is direct contact between living bone and a functionally loaded dental implant surface without any interposed soft tissue. Osseointegration creates a secure foundation for the implant and prevents any movement or instability. When de-osseointegration takes place, this foundation is compromised, and implant instability or failure can occur. Peri-implantitis can arise in situations where excess cement is not completely removed following the placement of a cement-retained implant or prosthesis. It has the potential to lead to complications such as de-osseointegration and is one of the greatest disadvantages of a cement-retained implant. Occlusal overload can also cause de-osseointegration and occurs when the chewing force exceeds the capacity of the dental implant, dental interface, or dental componentry. This causes a failure in the overall implant and can reverse the osseointegration process.
Dental decortication refers to the intraoperative perforation or removal of cortical bone to induce bleeding and the release of bone forming cells from the underlying marrow. It is routinely used in combination with onlay block grafts or guided bone regeneration (GBR) procedures. In addition to the dental definition, decortication also refers to a medical procedure including the lung, diaphragm, and chest wall. There are a variety of medical disorders that can lead to the need for decortication. These disorders cause a fibrous tissue layer to form over the lung which causes lung complications. Decortication of the lung removes this tissue layer and frees the lungs to move normally. Indications for this process include difficulties that arise from pathogenic disorders such as tuberculosis and pneumonia. When asking how serious is decortication, it should be understood that while the procedure has high success rates, issues with bleeding, infection, or pain at the incision site are still possible.
A defect is simply an imperfection in something. In dentistry, there are many different types of defects. For example, dental enamel defects (DEDs) are a flaw in the enamel, or the hard outer surface of the tooth. When enamel formations of primary or adult teeth are deficient, dental health can become compromised as it’s easier for bacteria and plaque to enter the structure of the tooth. Since dental enamel cannot regenerate on its own, enamel defects like hypoplasia or hyperpigmentation must be managed by a dental health professional. Congenital dental defects are imperfections that occur during the earliest stages of fetal development in the womb, like a cleft palate, missing adult teeth, or misshapen or fused teeth. Other defects can include periodontal bone defects, furcation defects, alveolar ridge defects, gingival fenestration defects, and more. Treatment for defects depends largely on the type of defect and where it’s located in the mouth.
A dehiscence is an opening or splitting in tissue, usually of an organ. In botany, this typically refers to when a seed pod on a plant splits open to release the seeds inside. In medical terms, it is most often used to describe the reopening of an incision after surgery or a wound that has been otherwise closed. This can be either internal or external. In dentistry, the term is used to describe an entirely different process: the loss of alveolar bone on the front side of the tooth. This results in the appearance of an oval-shaped root-exposed defect underneath the gingiva. This condition is characterized by the degradation of alveolar bone, gum recession, and exposure of the tooth root. Dehiscence can cause patients severe pain, especially when the root of the tooth has become exposed to hot and cold temperatures. It can also result in aesthetic changes and self-esteem issues.
When patients don’t have enough bone to support a dental implant, a bone graft may be necessary. The success of bone grafting depends on the ability of the donor bone to bring in host cells to the site graft and convert them into cells that will form bone. If the bone cannot recruit host cells or facilitate their conversion to bone cells, the graft is usually a failure. The osteogenic, osteoinductive, and osteoconductive capabilities of the donor bone dictate a large part of how successful the graft will be. Demineralized bone matrix (DBM) is a type of allograft bone that has been processed to remove inorganic minerals, leaving only the organic bone matrix behind. The demineralization process increases the bioavailability of allograft donor bone, making it a superior material to demineralized bone grafts. Demineralized bone matrix (DBM) was discovered in 1965 by Marshall Urist, a U.S. orthopedic surgeon practicing in Los Angeles, California.
A demineralized freeze-dried bone allograft (DFDBA) is an allograft composed of demineralized bone matrix (DBM) following the demineralization of a freeze-dried bone allograft (FDBA). Though a variety of bone graft options have been used in the regeneration of periodontal tissue, DFDBA is used the most often. It has been shown to be effective in the reconstruction of both furcation and periodontal defects and has also demonstrated osteoinductive effects. When implanted in bone that is already well-vascularized, it has the ability to stimulate cell attachment, cell migration, and osteogenesis. DFDBA contains bone morphogenic protein (BMP) that causes new bone formation to take place during healing. It is therefore an effective option for bone regeneration. Some dental and oral surgery patients may require bone enhancing procedures prior to receiving an implant or other dental prosthesis. Due to the many benefits of DFDBA, it is a commonly used material for such bone enhancement and bone development processes.
A dentin grinder is a special tool used to grind extracted teeth into usable dentin for autogenous grafts. Autogenous grafts are considered the “gold standard” of grafting material since they come from the patient’s own body, however, the need for a second surgical site typically meant that a different kind of graft was selected to prevent having two incisions and the additional risk for infection. With a dentin grinder, a dentist or periodontist can create autogenous grafting material from the patient’s own extracted teeth. The tooth is inserted into the grinder, which typically produces particulate dentin about three times the volume of the original tooth. Most dentin grinders come with a sterilization kit that allows dental professionals to sterilize the ground dentin before using it in a grafting procedure. Autogenous grafts are at a low risk for infection, improving patient outcomes and overall satisfaction after the procedure has been completed.
Dentures are one of the most commonly used dental devices, along with braces and mouthguards. Dentures are either one or two sets of artificial teeth and gums that are designed to be temporarily worn and removed for cleaning and rest. There are three different types of dentures: traditional full dentures, immediate full dentures, and partial dentures. Traditional full dentures are generally the most common and are a complete set of top and bottom dentures. Partial dentures are as the name indicates: a partial set of upper or lower dentures. Partials can be used when a patient is able to retain some of their natural teeth and only needs dentures for one or two sections of missing teeth, which are connected by a wire similar to a retainer. Finally, immediate full dentures are dentures that are placed right after the extraction of natural teeth so patients do not have to be without their teeth for any length of time.
Depassivation is the loss or the removal of the surface oxide layer of a metal. Since metals will corrode in certain environments, including when in the presence of water, the chemical process of passivation is used to add a protective metal oxide layer to combat this characteristic. Metals are frequently used in dental work in creating crowns, fillings, bridges, and other dental implants or prostheses. These metal-based dental structures are exposed to saliva—a water-based substance—as well as digestive enzymes and acids from foods and the digestive tract. All of these substances can lead to corrosion and therefore metal dental components undergo passivation prior to use. When depassivation takes place, this protective oxide coating is lost, and the metal is once again susceptible to deterioration. This corrosion can lead to several complications including failure of the component, an infection in the tissues of the mouth, or the need for more expansive dental work.
Individuals who were born without one or both of their external ears, or individuals who have suffered trauma to their external ears, can get a realistic looking ear prosthesis attachment. In many cases, the prosthesis looks so natural that the average person won’t be able to tell that it’s a prosthetic. Getting an ear prosthesis is an involved process, because surgery is usually necessary. Ear prosthesis surgery involves placing titanium posts in the bone around the ear to anchor the prosthetic to. Without a solid anchor, the prosthetic could fall off or be torn very easily. This is similar to how dental implants are done — with dental implants, a titanium rod (or a rod of another implant-grade material) is placed into the jawbone and once that heals, the prosthetic tooth can be anchored to the implant. One difference is that a prosthetic ear is removable, while a dental implant generally is not.
Early Crestal bone loss takes place around implants prior to occlusal loading. This means that bone loss occurs around the implant in the first year following the implant procedure. The loss may be caused by a variety of issues including the biological factors of the patients. These factors may include:
How well the patient follows post-surgery directions and the patient’s overall long-term care of their teeth, as well as the care of their implant following surgery also play a role in early crestal bone loss.
Early implant failure occurs when a dental implant is rejected or fails in some other way in the early stages of healing. Although failure rates are low with dental implants as a whole, there are some things that increase the risk of early implant failure. How successful a dental implant is depends largely on the patient’s overall oral health, the experience of the periodontist, where the implant is placed in the mouth, and the type of dental implant used. Early implant failure is usually due to poor osseointegration, which can indicate impaired bone healing. Risk factors for failure include but aren’t limited to smoking, infection, insufficient bone quantity, poor bone quality, and characteristics of the implant. Other risk factors may include patient age and sex, implant height and surface properties, the type of surgical procedure, and not using prophylactic antibiotics. Recognizing preventable risk factors and mitigating them can help dentists improve patient outcome.
The loading of a dental implant refers to the placement of the prosthetic onto the dental implant hardware after the implant has healed. However, early loading is becoming more popular as patients are demanding shorter treatment times. This means that the implant may be loaded before tissues have fully healed and before the implant has completely osseointegrated. There are three types of loading: conventional, early, and immediate. Conventional loading of a dental implant takes place between three and six months after the placement of the implant hardware. However, extended treatment times may be undesirable for some patients, especially when the implant is being done in the front of the mouth. Immediate loading occurs about 48 hours after the placement of the implant hardware, however, studies show that immediately loaded implants are less successful than their conventional counterparts. Early loading refers to loading that occurs at any time between 48 hours and 3-6 months.
Edentulism is the clinical word for being wholly or partially toothless, or having one or more missing teeth. The loss of all teeth is called full edentulism, while the loss of only some teeth is called partial edentulism. While edentulism can be a genetic defect and takes place naturally in some species such as sloths and anteaters, this is rare and most cases of edentulism in humans is the consequences of tooth loss. A person who has one or more missing teeth is said to be edentulous or edentate. The causes of edentulism in humans are most often cavities, poor oral hygiene, gum disease, bone loss, and other periodontal issues. Teeth play an important role in appearance and health: they give the face a fuller appearance while also enabling the proper enunciation of words and syllables. Untreated edentulism can cause the chin to protrude and the cheeks to appear sunken into the face.
Edentulous simply refers to a lack of teeth; an edentulous space is an area of the mouth that no longer has (or was always missing) teeth. An edentulous patient may have only one or two missing teeth, either in one spot or throughout the mouth. An edentulous site with just a few missing teeth may be prime for a dental implant, while a fully edentulous patient may want to consider dentures. Causes of tooth loss include tooth decay, oral trauma, and advanced periodontal disease (gum disease), and an increased risk of tooth loss is noted in patients with hypertension, diabetes, poor nutrition, smoking, and arthritis. The large majority of edentulous adults are missing teeth as a result of periodontal disease; this begins with bacteria that multiplies deep underneath the gums, causing inflammation and the destruction of the bone underneath. This removes the anchor that teeth have, causing them to become loose.
The electrical discharge method, also called electrical discharge machining or spark erosion, is a process used in dentistry to obtain the best passive fit of dental implants, removable dental prosthetics, and titanium/ceramic crowns. During electrical discharge machining (EDM), the desired shape of metal is achieved by using erosion created by an electric current. The current is precisely controlled via two conductive objects placed inside a liquid medium. Essentially, two types of electrical discharge machining exist — a wire type and a probe type, the latter of which is primarily used in the field of restorative dentistry. EDM increases how long a dental restoration lasts and removes the need for traditional soldering techniques. Fitting restorations using the electrical discharge method can be expensive for the patient, but the results are longer lasting than many other restorative procedures. EDM is also used in die making, prototype parts, stamping tools, and even aerospace components.
An emergence profile in dentistry is simply defined as the contour of the tooth or dental restoration where it meets, or “emerges” from the gingiva. Optimizing the emergence profile is a key component of cosmetic dentistry, and recreating a natural emergence when completing dental restorations is critical to the overall aesthetics of the patient’s smile. This is what enables the implant or other restoration to begin to resemble a lifelike tooth. Emergence profiles are important in common types of cosmetic dental procedures, including veneers, crowns, dentures, partial dentures, and dental implants. A good emergence profile should create a smooth, natural-looking transition from the circular implant platform to the tooth at the gingival level, resulting in a completely flawless restoration that is difficult or impossible to spot with the naked or untrained eye. Naturally, the emergence profile is most important when restorations are being done on the upper or lower front teeth.
An enamel matrix derivative, or EMD, is a sterile protein aggregate which comes from the enamel matrix, specifically from amelogenins, and is the precursor of the enamel of developing teeth. The proteins necessary for EMD are harvested from around the developing teeth of pig embryos using a special processing procedure. Enamel matrix protein derivatives are used in the restoration and regeneration of periodontal tissues and assist in the growth or further development of the periodontal ligament, root cementum, and alveolar bone. Though enamel matrix derivatives are harvested from pig embryos, they have not been shown to create a significant immune response when used in humans. The use of EMDs have also demonstrated anti-inflammatory properties. Both of these results suggest that the use of EMD is safe for humans. In addition, the results of EMD therapy are longer-lasting and have been shown to provide significant benefits to patients undergoing periodontal regeneration.
An endodontic implant (also known as an endodontic pin or endodontic stabilizer) is a pin placed into a root canal of a tooth. It extends beyond the apex of the tooth and into the bone. An endodontic implant is also known as a stabilizer because of its function in providing more stability to a weakened tooth. By increasing the root to crown ratio, the implant can provide the patient with tooth stability and allow them to avoid replacement procedures for years. An endodontic implant may be used in situations where a patient has experienced periodontal bone loss, has a chronic abscess where the root apex has been reabsorbed, has a tooth with a very short root, or has a poor crown to root ratio due to tooth fracture. An endodontic stabilizer may also be appropriate in patients where the loss of a tooth would be difficult to manage using other dental processes.
A facebow is a special instrument used by dentists when fitting a patient for dental prosthodontics. The facebow lines up with the patient exactly and allows the dentist or periodontist to accurately measure important parts of the patient’s facial structure, like the maxillary arch and its relationship to the temporomandibular joint, and transfer that data to where it can be used to create dental prosthetics. With the rise of computer-generated dental prosthetics, the facebow has been phased out by many dentists and periodontists and is no longer used to take important measurements. However, the facebow still plays an important role in transferring functional and aesthetic components from the mouth of the patient to the dental articulator. Without a facebow, the measurements taken by a dentist or periodontist may not be as accurate as they assume. This results in having to make multiple adjustments for the esthetics and occlusions later.
A facial prosthesis is a maxillofacial or craniofacial artificial replacement for a part of the face that is missing due to:
Facial prostheses may include the use of a prosthetic mask. They can require prosthetic nose surgery to replace the affected facial features. A prosthetic facial mask can be used to replace more than one feature as well as larger portions of missing or damaged tissue on various parts of the face. A nose prosthesis has a more limited function as it only replaces the lost or damaged nose and surrounding tissue. Such prostheses can provide confidence for those who have been affected. Prosthesis training is required for those in the medical and dental professions to ensure patients are properly fitted. Prostheses can be attached to the affected areas in a variety of ways, with some requiring stabilizing or fixing with the support of specially-designed dental implants.
A facing is more commonly known in cosmetic dentistry as a veneer. They are most commonly used to achieve a perfectly straight, white smile and can restore the look of chipped, broken, cracked, stained, and gapped teeth. Veneers are thin pieces of porcelain that are used to recreate the surface of the teeth, or the “face.” Porcelain is preferable to other materials because it has a similar density and durability as natural tooth enamel, however, some veneers are crafted from resin. Resin is a similar material to composite, or “white” fillings. Each veneer is custom made to the shape of the tooth it will be placed on and is permanently bonded to the tooth with a special procedure. Veneers are not removable and require the surface of the natural tooth to be altered to place the veneer. Patients interested in veneers should discuss the benefits and risks of permanent tooth alteration.
Unfortunately, all dental implants carry a risk of failure and a periodontist’s primary job is to use a wide variety of available tools and techniques to reduce that risk. A dental implant can include one or more teeth, either separate or joined together. They are generally made out of alloplastic materials like titanium or titanium alloy, but ceramics, bioglass, hydroxyapatite, and aluminum oxides may also be used. Osseointegration, or fusing to the bone, is the measure of success for a dental implant and what material the implant is made from and its surface texture plays a significant role in that success. Other factors for dental implant failure include but are not limited to: the location of the implant in the mouth and its placement in bone; what kind of implant screw is placed over the implant body, and the type of abutment used and how it is placed.
Like any medical procedure, dental implants can fail. The failure rate of implants is low, with only about 5-10% of patients experiencing failure. Dental implant failure can be mitigated by taking into account factors of success. The chances of implant failure are higher in patients who have gum disease, who smoke, who have insufficient or weak jawbone, or who have conditions like diabetes or rheumatoid arthritis that can impede healing. Dental implant failure can occur early after the procedure or much later. Early failure factors include an infection at the surgical site, insufficient bone to support the implant hardware, allergic reaction, poor adherence to post-op instructions, and micromovements of the hardware. Late failure factors include tissue and nerve damage at the implant site, foreign body rejection, and injury to the face or jaw that physically dislodges the implant. Signs of failure include problems chewing, pain, swelling, and gum recession.
Dental implants can fail for several reasons, including lack of osseointegration (fusion to the surrounding bone) or peri-implantitis (a post-op infection causing inflammation of the surrounding bone and gum tissues). However, dental implant failure in the long term can be caused by what is known as the fatigue phenomenon. This phenomenon was first discussed in a 1964 article called General Principles for Fatigue Testing of Metals, published in the International Organization for Standardization. The article describes the changes that can occur to metal materials when under intense “cycles” of stress or pressure for a significant period of time. This is most applicable to implant dentistry when dental professionals are considering a dental implant for a patient with bruxism. Bruxism is the repeated grinding or clenching of the teeth, usually at night, that can cause teeth to crack or cause temporomandibular joint disorder (TMJ). Patients with bruxism are more likely to experience implant failure due to fatigue.
Feldspatheic porcelain is a highly translucent, esthetic material for restorations fabricated with the traditional veneering porcelain powder and liquid brush buildup technique. When necessary, opaquer can be added by the laboratory to cover dark stain cases. Feldspathic porcelain closely resembles the color and texture of natural teeth and is a popular choice for veneers, filling gaps between teeth, and other restorative processes. This material has many benefits including minimal preparation. Patients are able to retain much of their original tooth structure which reduces the invasiveness of the procedure as well as the time required for the procedure. Feldspathic porcelain is also biocompatible, durable, and long-lasting meaning patients could potentially enjoy the effects of their replacement or restoration for years before requiring additional work. Despite the many advantages of feldspathic porcelain, it does have some issues including being the weakest of the restoration materials. When it is used, it is best on anterior teeth that still have enamel in place.
In dentistry, a fenestration is a buccal or lingual window defect of either denuded bone or soft tissue occurring over a tooth root, implant, or alveolar ridge. The term may also apply to a man-made fenestration which is created when opening a lateral window to the maxillary sinus for a sinus augmentation procedure. A naturally occurring fenestration leaves the exposed root surface in direct contact with either the alveolar mucosa or the gingiva. The condition may be caused by a variety of factors including tooth movement due to orthodontics, pathology (both endodontic and periodontal), root apex contours, and occlusal issues. Treatment of a fenestration can include guided tissue regeneration, flap surgeries, or free gingival grafting. For some patients, a bone graft may also be required. Prior to orthodontic procedures, it is important that both the root positions and the periodontium condition be evaluated to reduce the risk of fenestration.
A fibrin matrix, or fibrin-rich matrix, is a provisional matrix provided by the fibrin clot and fibronectin during the first phase of wound healing. The fibrin matrix secretes chemicals that summon monocytes, fibroblasts, and epidermal cells to the area of the body that requires healing, thus promoting the healing process. The term may also refer to a membrane-like matrix derived from autologous blood which is strong and pliable. It functions as either a standalone product or can be mixed with other biomaterials to improve wound healing and promote tissue regeneration. In dental applications, a platelet-rich fibrin matrix can be applied following a surgical procedure to speed the healing process. The fibrin matrix also has the capacity to reduce inflammation and swelling and can be used even in advanced surgical techniques. Following implant or grafting procedures, a fibrin matrix can be utilized to speed wound healing and aid in patient recovery.
A fibroblast is a type of cell found within the connective tissues that are responsible for the synthesis of collagen and ground substance. In dentistry, fibroblasts play an important role in the integration of and implant, prosthesis, or restoration. The most common types of fibroblasts involved with dental processes are gingival fibroblasts and periodontal ligament fibroblasts. They are responsible for the synthesis and organization of the collagen fibers that connect the gingiva and alveolar bone to the cementum tooth covering. In addition, fibroblasts also secrete a growth factor that stimulates tissue regeneration in dental pulp cells and the dentin-pulp complex following a tooth injury or oral surgery. Due to the tissue trauma caused by an oral surgery or implant, multiple types of cells are required to repair and regenerate the damaged tissues. Due to the responsibilities of fibroblast cells, they are among some of the most important factors in proper healing and implant success.
Gaps in teeth are common, however, many people feel self-conscious and want to see a dentist. Gap teeth are typically corrected with tooth-colored composite filling, however, dental veneers can also be used for bridging the dental gap. The composite-filling procedure is quick and nearly painless, and the teeth gap filling cost is much less than veneers. However, veneers may be warranted in some cases where other issues like hard-to-treat discoloration, broken teeth, chipped teeth, or more than one space. You can have a veneer put on just one or two teeth to fix a gap, or you can have them put on the teeth that show for a brighter, more uniform smile. If you’ve been wondering can dentist fix gaps in teeth, contact your dentist and set up a consultation for an evaluation to determine the best course of action to fill your tooth gap.
The gap distance is the space between the bone of an osteotomy or an extraction socket and a dental implant at stage-one surgery. A gap may occur at various locations including the lingual or proximal aspect or at the buccal plate. The level of the first bone-to-implant contact is influenced by the dimension of the gap as well as the type of implant used.
Gap distance can also refer to the distance between teeth. To reduce the gap between teeth, different forms of dental or orthodontic work may be required including tooth extraction or braces. To correct the gap between teeth, treatment may require repeated visits which can spread out over a number of months or even years. Gap between teeth treatment costs will vary depending on the type of dental or orthodontic work required as well as the duration of the corrections and number of office visits.
Gingiva is another word for the gums, or the soft, pink tissue that surrounds and protects the bottom of the teeth where they enter the jawbone. The gingiva is attached to the tooth, which forms a seal between the mouth and the underlying bone. Poor oral hygiene causes a buildup of plaque in the crevices of the teeth and gums, which if left untreated, can cause an infection called gingivitis, or gum disease. Gum disease causes inflammation of the gums and weakens the seal, allowing bacteria to enter the tooth root and bone structure. When this happens, the infection progresses to periodontitis, which often results in permanent tooth and bone loss. The gums play an integral role in the overall oral health of a patient and are crucial to keep healthy. Poor gum health contributes to poor oral health and a wide variety of other dental problems.
Gingival crevicular fluid, also called GCF, was recognized as an important factor in diagnosing periodontal disease over six decades ago. It is an inflammatory exudate that is derived from periodontal tissue and contains primarily the byproducts of tissue breakdown, antibodies, inflammatory mediators, and serum. It also contains structural periodontal cells, leukocytes, and normal oral bacteria that is usually present in the mouth. The serum component of this fluid is mostly derived from postcapillary venules, or microvascular, leakage. This fluid has an important role in maintaining the antimicrobial defense of the periodontium and maintaining the structure of the junctional epithelium. The bacteria most often responsible for periodontal disease are Treponema denticola and Porphyromonas gingivalis. The bacteria create broad-spectrum neutral proteinases to attack healthy tissue, which are then found in both samples of gingival crevicular fluid and plaque in patients who have periodontal disease. Patients with periodontal disease have an excess of GCF, whereas patients with healthy gums have very little.
A gingival flap is created during gingival flap surgery, a procedure where gum tissue is separated from surrounding teeth and deflected back to allow a dental surgeon access to the jawbone and the root of the tooth. A gingival flap is created prior to bone grafting and before a dental implant is placed, but it can also be used before treating periodontitis, or gum disease. During the procedure, the gums are numbed with a local anesthetic and a surgeon uses a small scalpel to make a u-shaped incision and fold the flap of gum tissue back. Then, the surgeon will graft bone or place the implant, replace the flap, and suture it closed. This is usually done with dissolvable sutures for patient comfort. With most dental implant procedures, a gingival flap must be made twice and possibly even three times. First to graft bone, then to place an implant, then to remove the cover screw and place the abutment.
Gum recession is a common problem among adults and affects between 4-12% of both men and women. Gum tissue recedes gradually and is often unnoticeable until it becomes severe. Untreated gum disease can cause damage to the bone underneath, resulting in tooth loss. If too much damage has been done to underlying bone, a dental implant may not be able to be placed. A gum tissue graft, also called a gingival graft, involves taking healthy oral tissue from one area of the mouth, usually the hard palate or roof of the mouth, and transplanting it to the desired area. However, some oral surgeons prefer to use donor tissue instead of grafting from the roof of the mouth. Gingival grafts may be done in conjunction with a bone graft or dental implant procedure, since gum disease often creates a need for multiple surgical procedures to repair the bone and gum tissue.
Receding gums, or more accurately known as gingival recession, is the exposure of the root of one or more teeth due to the retraction of the gingival margin or the loss of gum tissue over time. Most commonly, gingival recession is a problem faced by adults over the age of 40, however, younger individuals may also begin to notice signs of receding gums around the age of puberty or during their teen years. Gum recession may occur with the loss of alveolar bone underneath, which decreases the ratio of crown-to-root, affecting an individual’s cosmetic appearance and overall facial aesthetics. Gingival recession is classified using Miller’s classification system, and the causes of this condition are numerous. Most often, gum recession is the result of gum disease, or periodontal disease. It can also be caused by genetics, poor flossing habits, tooth crowding, overaggressive brushing habits, and the use of dipping tobacco.
The gingival sulcus is the point at which the tooth and gums meet, which is the primary component of the emergence profile. This is a highly visible area of the mouth and can impact the overall aesthetics of a patient’s smile. Ideally, the gingival sulcus is close to the tooth, with 3mm or less of space where food particles and bacteria can enter. Beyond this depth, traditional brushing and flossing habits aren’t able to reach and particulates build up over time. This results in bacterial overgrowth and periodontitis, an infection of the gums and potentially the bone tissue underneath. The deeper the gingival sulcus, the more difficult it is to properly clean it without professional care. As time progresses, the infection causes the sulcus to further deepen, compounding the issue and potentially resulting in tooth loss as the alveolar ridge degrades. The depth of the sulcus is easily checked with a dental probe.
Glucocorticoids, or corticosteroids, are a class of steroid hormones that are characterized by an ability to bind with the glucocorticoid receptor. In dentistry, their main therapeutic use is as an anti-inflammatory agent and immunosuppressant. Some of the more commonly used glucocorticoids include betamethasone, dexamethasone, methylprednisolone, prednisolone, prednisone, and triamcinolone. Glucocorticoids can be used for or following a variety of dental procedures such as endodontics for root resorption, oral surgeries to reduce edema and to aid in the prevention of ulcerations and excoriation, and the treatment of oral submucosa fibrosis and oral lichen planus. The use of glucocorticoids can reduce patient discomfort, lessen the time required for healing, aid in the healing process, and aid in the prevention of post-operative issues. The type of steroid used will depend upon the patient’s medical history, prior use of glucocorticoids, type of dental procedure, and the symptom or symptoms that need relieving.
The glycosylated hemoglobin A1c test, also known as the HbA1c or glycated hemoglobin A1c test, is a type of lab test which reveals the average plasma glucose concentration over a period of three months. Specifically, it measures the number of glucose molecules attached to hemoglobin. Results are expressed as a percentage, with 4% to 6% considered to be normal. This test provides information regarding a patient’s possible risk of developing diabetes. By measuring the percentage of sugar-coated hemoglobin, a practitioner can determine a patient’s level of blood sugar control. Higher percentages of sugar-coated hemoglobin typically indicate a higher risk of developing diabetes. Tests such as these may be required prior to dental surgery as they provide insight into health conditions that could possibly hinder the healing process post-surgery. Patients shown to have higher A1c levels may first be required to address their blood sugar levels prior to having a procedure.
A dental implant navigation system includes handpiece and jaw attachments, a motion tracker sensor, motion tracker software, and cameras. This technology is used to create real-time imagery and calculations of where dental tools are in relation to the patient’s jaw so dental implants can be placed precisely where they should be, with accuracy of about a millimeter or so. An image of the patient’s jaw and tooth structures is created within seconds by a CT and with some systems, can include digital impression data. This technology is likened to GPS and allows periodontists and oral surgeons to fully visualize the patient’s mouth and the instrument in their hand in real-time. Dental implant navigation systems allow periodontists to perform flapless surgeries and reduce the necessity of bone augmentation and custom abutments. Overall, these navigation systems enable dental professionals to provide less invasive, safer, and faster care.
A hard tissue graft is used to restore bone height and stimulate the growth of new bone in patients who have lost teeth. A bone graft should be done following tooth loss or extraction to prevent atrophy in the remaining bone and in the gum tissue surrounding it. Following a hard tissue graft, the patient may also require a gum graft. This process removes tissue from another part of the mouth then grafts it onto the existing tissue in the area requiring attention. There are several different options for this procedure and the one selected will depend on the tissue available within the patient’s mouth. The amount of gum pain that a patient may feel, as well as the nature of their gum tissue graft recovery, will vary from one individual to another. While there are not separate gum insurance options, many dental insurance plans will cover gum graft costs.
The structure of bone is an important consideration for the size, type, and surface of dental implants. Haversian canals are microscopic tubes or tunnels in cortical bone that house nerve fibers and a few capillaries. This allows bone to get oxygen and nutrition without being highly vascular. These canals also communicate with bone cells using special connections, or canaliculi. This connection facilitates the deposit and storage of mineral salts, which essentially gives bones their strength. Haversian canals are formed by lamellae, or concentric layers of bone, and are contained inside osteons. Osteons are cyndrylical structures that transport oxygenated blood to bone, and they are arranged parallel to the surface of the bone, along the long axis. Osteons that have intact Haversian canals comprise about 45% of cortical bone, or a little less than half. Haversian canals and osteons are part of the Haversian system, which allows nutrients to pass between the blood and bone.
The human body possesses the incredible ability to heal itself over time. Cells, which are living units that are the foundation of the body; they renew themselves constantly and work to bring the body back to “normal,” or a state of homeostasis. They operate according to instructions found within the DNA, or the body’s unique “blueprint” for life. This includes a healing mechanism: cells that are damaged may be able to repair themselves, and cells that are destroyed are replaced. Healthy cells surrounding an injury, which is essentially a group of destroyed cells, will begin to replicate quickly. At the same time, platelets are sent to the area to stop any bleeding, and white blood cells start digesting dead cells to make room for new ones. When healing is complete, the process simply stops on its own. The body is constantly in a state of healing itself, generating new cells and replacing dead or destroyed cells.
A healing abutment is a special type of abutment designed to facilitate the healing of bone and soft tissue around a dental implant. It takes approximately 4-6 weeks for the gums to heal after a healing abutment is placed, after which a final abutment can be placed. After much research, it was discovered that the material of an implant and its properties — most notably the topography of its surface — plays a significant role in the healing of the tissue around it. Two zones of oral tissue come into contact with healing abutments: fiber-rich connective tissue, and junctional epithelium. These tissues react to the surface texture and chemical composition of the material, and the ability of tissue cells to adhere to the surface of the implant depends largely on the lack of surface contamination and the hydrophilicity of it. While some dental professionals advocate the reuse of healing abutments after sterilization, new abutments should be used for each patient.
Healing by first (primary) intention, or primary closure, refers to the healing of a wound in which the edges are closely re-approximated. In this type of wound healing, union or restoration of continuity occurs directly with minimal granulation tissue and scar formation. It works best with wounds or incisions where there has been little loss of tissue. Healing by primary intention is often used in a surgical setting where a clean incision is present. The wound is closed by using skin adhesive, staples, Steri-Strips, or sutures. This is the opposite approach to the one taken by secondary closure, or healing by second (secondary) intention, in which a gap is left between the edges of the wound for natural healing to occur. In dental applications, primary closure may be used following an oral surgery, implant, or restoration procedure where there has been little tissue loss to help prevent infection and aid in the healing process.
Healing by second intention, also known as secondary closure, is the healing of a wound in which a gap is left between its edges. Union occurs by granulation tissue formation from the base and the sides. This requires epithelial migration, collagen deposition, contraction, and remodeling during healing. Healing by second or secondary intention differs from healing by first or primary intention in that it does not bring the edges of the wound or incision into contact with each other. Healing by first intention is best used in situations where there is a clean incision with little tissue loss while healing by second intention may take place when there is not enough tissue to bring the edges of the wound together for suturing or stapling. Secondary closure is considered the most important type of bone healing in procedures that include maxillo-facial surgeries. It occurs through cell proliferation which eventually becomes lamellar bone.
The healing period, also known as the healing phase, is the time allocated for healing following one surgery and before the next surgery that will be performed at the same site. Dental implant preparations often require more than one procedure to achieve the final product. For example, some patients require bone augmentation procedures before an implant can be placed. The time between the bone augmentation and the implant placement is the healing period or healing phase. This phase may be necessary before subsequent procedures for several reasons including to allow for decrease in swelling and inflammation in affected tissues, to provide time for incisions to heal and for bone osseointegration, and to provide an opportunity for any complications to be addressed and resolved. The healing period allows the procedure site to be in the best possible condition for the success of implant and prosthesis placements or for other subsequent surgeries.
Heat necrosis is cell death caused by effectively prolonged exposure of bone to elevated temperature such as during an osteotomy preparation. An osteotomy is a procedure that cuts, shortens, lengthens, or otherwise reshapes a bone. In dentistry, osteotomies are required in some patients because of a condition where the bones of the face do not meet with the bite position of their teeth. In order to correct this, an osteotomy is done on the lower jaw to bring it into a correct position for proper bite alignment. Heat necrosis can occur during this type of procedure due to the friction involved in bone cutting. To avoid this type of cell death, an osteotomy may be performed using a piezoelectric device. Such devices allow for precise cutting of bone without substantial damage to the surrounding soft tissues. Piezoelectric surgical devices utilize ultrasound technology rather than traditional cutting methods to reduce cell death due to heat necrosis.
A hematoma is a localized mass of extravasated blood, usually clotted, that is relatively or completely confined within an organ or tissue. Hematomas differ from smaller bruises in that the latter occur as a result of damage or injury to small blood vessels while the former comes from damage to larger blood vessels. A hematoma can occur in dentistry following a surgery, treatment, or other oral procedure where the tissues of the mouth are manipulated in such a way that blood vessel damage can occur. Though hematomas are generally not dangerous and can be a common side effect of some dental procedures, the practitioner will often examine it to ensure it will heal without additional aid. Some patients experience a hematoma following an injection used to numb or block the sensation in the tissues around a dental procedure site. Most hematomas will resolve on their own.
What is ibuprofen? Ibuprofen is a non-steroidal anti-inflammatory drug, or NSAID. This means that it reduces inflammation and relieves pain without the use of steroids. Acetaminophen is a similar over-the-counter pain reliever, but lacks the ability to reduce inflammation. There are a number of different ibuprofen brands, however, the actual components of the medicine remain the same between brands even though the inert ingredients may be different and the medicine may look different. Whereas acetaminophen is processed by the liver, ibuprofen is processed by the stomach. It can be hard on the stomach and in some cases may cause stomach upset, gastritis, and ulcers. Mixing ibuprofen with alcohol may exacerbate this side effect. Ibuprofen can be very useful after certain types of procedures where inflammation is present, such as after dental surgery, but it’s important to get the dosage right. Adult, child, and infant ibuprofen dosage varies, and you should consult a physician before administering.
The Iliac crest is the superior part of the Ilium, which is the largest of the three bones that make up the pelvis. It can serve as a site of autogenous bone grafts for dental work. Patients may require a bone graft following some dental procedures and prior to receiving implants or prostheses. The Iliac crest is often a good location from which to harvest bone for dental bone grafts. The Iliac crest also has medical implications, as both the latissimus dorsi and gluteus maximus originate in this area. These major muscles can cause pain or discomfort in the iliac crest due to strain, injury, or tension. Issues with these muscles or with the Iliac crest itself may become obvious when an individual experiences pain after sitting.
An iliac graft, or an iliac crest autogenous bone graft, is a type of bone graft used for a wide variety of surgeries, including periodontal surgery to restore lost jawbone. Other surgeries using iliac grafts include but are not limited to the repair of joint arthrodesis, the treatment of bone defects, infections, and osteonecrosis, and the repair of particularly challenging bone fractures. Both the anterior and posterior surfaces of the iliac crest are used for bone grafting, and the crest itself is the most frequently used source of bone for autogenous bone grafting. This is because it is a superb source of both cancellous and cortical bone and is easy to access compared to other sources of autogenous bone. There are some risks associated with an iliac graft, including pain, redness and swelling of the incision site, infection, bleeding, and in very rare cases, splanchnic or neurologic damage.
Surgical procedures and other medical treatments are complex and require immense skill on the part of the treating physician. Adequate visualization of the area of the body being treated is critical; without it, the rate of complications is significantly higher. However, many areas of the body are difficult to see, particularly in the oral cavity. Image guidance is a newer technology in the field of dentistry that allows dental health professionals to visualize different areas of the mouth before and during the procedure. In the past, implants were typically done only using x-ray technology, which left more room for error. Image guidance is now the preferred method for placing dental implants. CBCT images are obtained and CAD technology is used to “place” the implants virtually in a highly accurate, computerized surgical guide. Image guidance has eliminated the need for a flap in a large number of implant surgeries, reducing the risk of potential complications.
Image stitching, also called photo stitching, is the process of merging multiple photographs together to create a single high resolution or panoramic image. Image stitching is most often done via computer using specific software designed to sense areas of overlap and combine them. The overlaps need to be as exact as possible and the exposures identical to elicit a final image with no visible seams. Because the illumination in two separate images could differ, even if the images are taken in quick succession, image stitching could result in seams between the images. Depending on the application, these seams may or may not be significant. In the field of dentistry, photo stitching is often used for x-rays and CAD/CAM images. This is because it’s not possible to organically capture an image of the entire mouth in one sitting; instead, multiple images from different angles must be obtained and fused together.
With traditional implant dentistry, the dental implant hardware is given time to heal before the prosthetic is loaded onto the abutment. However, many patients dislike this option because it requires approximately three to twelve months for the final dental restoration to be completed. In cases where the implant will be done in the front of the mouth, the long wait is particularly concerning. Immediate implant placement, is a newer type of procedure that allows dental restorations to be completed much more quickly, greatly reducing a patient’s time-to-teeth. Immediate implant placement may be done when appropriate at the same time the natural tooth is removed. Immediate loading, also called immediate function, is the loading of a temporary dental restoration or crown into the implanted abutment directly after it is placed. In some cases, patients may be able to have a tooth removed and a temporary tooth placed in the same day.
In implant dentistry, there are two types of immediate loading: immediate occlusal loading and immediate non-occlusal loading. Immediate occlusal loading occurs when a dental implant is placed with adequate initial stability and the corresponding dental restoration features full centric occlusion in max intercuspation. This type of loading must be done within 48 hours of the placement of the dental implant hardware. The process of immediate occlusal loading is determined by the design of the dental prosthetic to eliminate the potential for micromotion at the implant site. Immediate non-occlusal loading occurs when a dental implant is placed with adequate initial stability but isn’t in functional occlusion. This type of loading is generally exclusively used for aesthetic-only dental implants or for short-term applications. Often, immediate non-occlusal loading is done to provide patients with a temporary tooth replacement while the dental implant hardware heals, especially when patients prefer not to use a removable prosthesis.
Immediate occlusal loading refers to a clinical protocol for the placement and subsequent application of force on dental implants where there is either a fixed or removable restoration in occlusal contact with the opposing dentition. Immediate occlusal loading takes place during the same clinical visit in which the restoration was performed. Immediate occlusal loading allows the new implant, prosthesis, or restoration to come in contact with the opposing teeth directly following the procedure. Though studies have not shown a significant difference in the success or longevity between immediate occlusal loading and non-occlusal loading, a variety of factors can affect the overall life of the restoration. These factors are largely patient-based and include chewing habits, medical history, oral care and hygiene, clenching of the jaw, and injury. In some cases, component failure can also cause the restoration to fail as can an error on the part of the dental professional.
Immediate placement, or immediate implant placement, is the placement of a dental implant into the extraction socket immediately following the extraction procedure. This employs an opposite method than that of non-immediate or delayed placement where subsequent visits are scheduled for the insertion of the implant. Immediate placement is often preferred by patients since less time is required to achieve the end result, there are fewer surgeries needed, and costs may be lower due to fewer office visits. When performed correctly, immediate implant placement has the same success and longevity rates as delayed placement and has been found to preserve soft tissue and bone at the site of the implant. However, prior to selecting this placement method, a patient’s dental history and bone and tissue condition should be closely evaluated to ensure the proper conditions for immediate implant placement are met. Failure to do so prior to placement may result in the failure of the implant.
Immediate provisionalization refers to a clinical protocol for the placement of an interim prosthesis, with or without occlusal contact with the opposing dentition, at the same clinical visit. Prior to the placement of an implant, extraction of the infected or damaged tooth is required. In the past, the patient has then been fitted with a removable prosthesis for the extraction site until the permanent implant is placed. However, the use of immediate provisionalization has been shown to have several benefits. This method not only aides in bone stabilization and the prevention of bone loss, but also has high rates of patient satisfaction. Following the extraction, an implant is immediately placed in the fresh extraction site and non-functionally loaded with an infra-occlusion provisional restoration. In addition to its bone stabilizing effects, immediate provisionalization has also been shown to reduce the treatment time required and provide patients with immediate social and psychological well-being.
An IVJ, or implant verification jig, is an important player in full arch implant reconstructions. This method, when used during the last impression stage, ensures that the final prosthesis fits well onto multi-unit abutments or onto the implants themselves. The implant verification jig offers a solid structure that links the impression copings to make sure the inter-implant relationship is preserved in the final impression. This is especially critical for full-arch cases. With multiple adjacent implants connected securely at the time of the final impression, the implant verification jig allows for a very accurate master cast, a passive fit, and fewer potentially destructive forces that could result in prosthetic failure or bone loss. When impression material flexes, the relative position of two adjacent and unconnected implant transfer copings can move inside the impression material. By using the jig, the periodontist can significantly heighten the accuracy of the master cast that the last restoration will be designed on.
A joint-separating force is any force that has the ability to disengage parts that are joined together by a screw (a screw joint). The opposite of the joint-separating force is called the clamping force. The clamping force must be overcome by the joint-separating force in order for a screw joint to be damaged. This may occur due to incorrect crown height, improper placement of the prosthesis, or even the patient’s chewing habits. A joint-separating force can result in a patient realizing they have a loose implant crown, their implant cap is loose, or even that their implant screw fell out. In the case of a loosened screw, it may be possible to fix the issue without damaging the prosthesis itself. Such problems might be prevented by ensuring the correct torque force is used during the original procedure and by addressing the settling effect before the patient leaves.
The junctional epithelium, sometimes referenced by the initials JE, is the portion of the gingiva or gums that attaches the gums to the enamel, or the surface of the tooth. It’s a thin membrane, about 2-3 mm wide around each tooth, and is only about 15-30 cells thick coronally. Apically, the junctional epithelium tapers to just a single cell. This attachment between the gingiva and the tooth surface is replenished continually throughout a person’s life, about every 4-6 days. Compared to other epithelium in the mouth, which has a regeneration rate of about 6-12 days, the junctional epithelium has a high renewal rate. Junctional epithelium cells have wide intercellular spaces and are non-keratinized, and are responsible for maintaining the seal between the soft tissue of the gums and the tooth. These cells protect jawbone and tooth roots from plaque and bacteria, but in patients with gingivitis or periodontal disease, the seal is weakened.
Estimating implant survival isn’t necessarily complex, but it wouldn’t be considered simple either. When determining how long a dental implant is likely to last, a Kaplan-Meier analysis is typically used. This strategy allows periodontists to accurately estimate the lifespan of the implant under a variety of different conditions. The Kaplan-Meier analysis is one of the most commonly used methods of survival analysis. The estimate is often useful in many situations, particularly in the medical field. For example, it can be used to examine recovery rates, the likelihood of death in certain circumstances, and whether or not a treatment was effective. The Kaplan-Meier analysis is a statistic, and many estimators are used to gauge its variance. A common estimator is Greenwood’s formula. Naturally, patients want their implants to last as long as possible, making calculating implant survival with a number of variables clinically applicable.
The keratinized gingival is the part of the oral mucosa which covers the gingiva and hard palate. It extends from the free gingival margin to the mucogingival junction and consists of the free gingiva as well as the attached gingiva. The width of keratinized gingiva is an important factor when it comes to dental implants. This is because keratinized gingival tissue can play a role in the long-term support of the implant. It may also aid in maintaining oral health, in preventing gum recession, and in overall esthetics. Due to this, the keratinized tissue of the gums around a tooth or implant may require a tissue or skin graft prior to any dental procedures. Such a graft will assist with gum health as well as implant stability. Maintaining the health of the keratinized gingival is important for both the function and look of a patient’s implants.
After a tooth is extracted, the residual alveolar ridge undergoes a remodeling process to repair the initial wound and prepare for long-term healing, or residual ridge resorption (RRR). Residual ridge resorption occurs at markedly different rates for each patient, which can make treatment planning more challenging. Faster bone resorption at the lingual or buccal areas can result in a knife-edge ridge. Faster bone resorption at the crest of the residual bone, on the other hand, results in a more flattened ridge. A knife-edge ridge can be difficult to detect under round gum tissue, but identifying the shape of the residual alveolar bone is essential to the patient’s individual treatment plan. Treatment for a knife-edge ridge may involve removal of the thin bone structure to help the dental implant hardware better adapt at the shoulder level. It’s often difficult to predict which patients will have a knife-edge ridge, but menopause is considered a contributing factor.
The labial plate is the surface of the gums and teeth that face the inside of the upper and lower lips and inside the cheek. Since this is the part of the gums that are most easily seen by people when someone smiles, people have a strong desire that the labial plate be aesthetically pleasing. This is something that must be considered when discussing a dental implant in the front area of the mouth. Calculating the density of the labial plate bone is important when determining if an implant can be placed in the labial plate or if a bone graft will be necessary. If the labial plate is not dense enough, it cannot anchor an implant. For aesthetic purposes, many periodontists use a flapless procedure on dental implants in the labial plate, so it’s extremely difficult if not impossible to tell that a dental implant was done.
A laboratory analog is a replica of an implant, abutment, or attachment mechanism, usually incorporated within a cast for a prosthetic reconstruction. The analog provides a replica which shows the exact position of a patient’s implant. It is made by taking an impression of the patient’s teeth and implants and using that impression to create a copy which exactly shows the anatomy of the implant as it exists in the patient’s mouth. This allows a dental professional to build the prosthesis and properly place the abutments. The use of a laboratory analog can cut down on error involving the placement of implants and implant abutments. There is software available, such as an analog lab app, which can aid in the process of creating a replica. In addition, the use of the lab 3 manual will provide technicians with the instructions needed to properly utilize the software.
A screw is the part of a dental implant that screws into the jawbone to anchor the abutment and the bridge or crown. There are two different types of screws: lab screws, or laboratory screws, and gold screws. A lab screw is generally considered stronger than a gold screw and can withstand excessive force. Gold screws, however, mold to the patient’s jawbone over time since gold is somewhat malleable for a metal. When force is applied, gold screws will slightly change their shape to accommodate the pressure. Laboratory screws are not the industry-recommended method for anchoring dental implants, so it’s important to double-check the warranties on other implant components and make sure they are not rendered invalid by using a lab screw. Because gold screws are created to fail when excess force is applied instead of breaking the implant, gold screws can protect the implant better than lab screws.
The surface of the various components of a dental implant play an important part in the overall success of the implant over time. Defects in the implant body, screw, or abutment can impact osseointegration and in some cases, cause the complete failure of the implant. The abutment is of special significance: it connects the internal implant hardware to the external artificial tooth, or crown. When casting an abutment, however, defects in the surface may occur, causing it to be too uneven to work with. A lapping tool is a common instrument used in dental laboratory settings to smooth any surface defects that were created during the abutment casting process. Often, lapping tools are included in dental abutment kits, along with alignment guides, screwdrivers, reamers, o-rings, and sleeves. The tool is held by the handle and inserted into the apical end of an abutment to even out any ridges in the surface.
While lasers have been used in the dental health industry since 1994, the American Dental Association (ADA) has yet to give the treatment its Seal of Acceptance. Regardless, laser dentistry is becoming an increasingly popular alternative to conventional dental treatment for a number of different issues. Tooth decay, or caries, can be removed using a laser, which also prepares the surrounding enamel for the filling material. Lasers can also be used to perform a biopsy, or the removal of a small piece of tissue to check for the presence of cancerous cells. Lasers cauterize tissue as they exercise, improving overall healing time and reducing the risk of infection. Gum disease can be treated with lasers to remove harmful bacteria and to reshape gum tissue, and can remove canker sores or lesions in the mouth. Cosmetic dentistry also uses lasers for teeth whitening to speed up the process of lightening teeth with a peroxide solution.
The texture of the surface of a dental implant is crucial to its ability to osseointegrate with the patient’s natural bone tissue. A surface that is too smooth has been shown to have a lower success rate than rougher dental implant surfaces. Additionally, a textured surface does more than just boost bone integration: it stabilizes the implant and may provide antibacterial properties as well. There are many different ways to treat the surface of a dental implant including sandblasting, chemical etching, and laser etching. Laser etching is believed to be more precise than both sandblasting and chemical etching, which produce more variable results than a programmable laser. Laser etching can also be used on top of sandblasting or chemical etching to provide a more textured surface that integrates better with bone. Dental abutments can also be laser etched to improve the texture of the surface that will adhere to the implant body, screw, and crown.
Laser therapy has been used in the field of dentistry since nearly its inception due to its high level of accuracy, precision, and low rate of clinical complications. LASER stands for Light Amplification by Stimulated Emission of Radiation and is a device that generates electromagnetic radiation that is uniform in polarization, phase, and wavelength. There are several different types of lasers, including surgical lasers, therapeutic lasers, and high or low powered lasers. Evidence suggests that therapeutic lasers and low powered lasers have anti-inflammatory, bio-stimulatory, and analgesic effects on living tissue. Dentists today are increasingly choosing to offer laser dentistry at their practices to meet consumer demand. Laser-assisted dental procedures can include laser suturing, cauterization, decontamination of bacteria-filled periodontal pockets and root systems, PDL regeneration, bone repair and remodeling, and healing stimulation. Often, the use of a laser during a dental procedure will eliminate the need for anesthesia or strong pain medication.
Laser welding, also called laser beam welding or manual laser welding, is a critical tool for dental labs today. It provides a high-tech, low-error alternative to traditional soldering. Manual laser welding equipment helps dental lab technicians to create or repair dental prosthetics and reconstruction materials, such as posts and loops for tooth additions, cast clasp assemblies, wrought wire single-arm clasps, and cast extensions used for existing partial dentures. Contrary to conventional soldering, laser welding offers complete freedom of controls and precision accuracy. This, along with localized heat, eliminates thermal expansion and results in superior seam welds on dental implant frames and bars, passive fit bridgework, and other frequently used dental prosthetic appliances. Other alternatives to laser beam welding and soldering include torch or plasma welding, spot or resistance welding, and single pulse tungsten inert gas welding. Of all these, laser welding provides the most desirable results for dental prosthetics.
Although dental implantology has come a long way in recent years and the procedure is now known as one of the most widely successful dental procedures that can be done, failure still unfortunately occurs. Implant failure is typically separated into two broad categories: early implant failure and late implant failure. Early implant failure is often caused by issues like a contaminated implant, infection, excessive trauma during the surgical procedure, or lack of primary stability of the implant hardware. Late implant failure is less common, and have fewer causes. Generally, once a patient is out of the woods of early implant failure, the chances of late failure are low. However, traumatic occlusion, occlusal overload, and dental cement that is retained subgingivally. Late implant failure typically occurs within one to three years after the placement of the implant. Bruxism, or nighttime teeth grinding and clenching, is a common cause of late implant failure.
The lateral window technique, or external sinus graft, is the creation of an access point to the maxillary sinus through its lateral wall. The access is used to elevate the Schneiderian membrane for the placement of graft material in the inferior part of the sinus space. The lateral window technique is often used when resorption of alveolar bone leads to severely decreased bone height which impairs the placement of dental implants. An external sinus graft is achieved by placing a bone graft in the new space, or window, that has been created. The bone used in the grafting procedure may be autogenous, come from a human donor, or come from donor bovine bone. Though autogenous bone grafts have been shown to heal faster than grafts from the other two sources, their success rates are similar. If implants are needed, they may be placed during the same procedure or after the graft has healed.
The surface of a dental implant plays a significant role in osseointegration, or the body’s ability to integrate the dental implant into the bony structures of the mouth. The idea is that the rougher the implant surface, the easier it will be for the bone to adhere to it. To improve osseointegration, there are a wide variety of implants available with different types of implant surfaces. Acid etched and sandblasted dental implants are popular choices, however, machined implant surfaces are also used. A machined implant surface simply refers to a manufacturing process that was turned, polished, or milled. While many periodontists believe that etched surfaces have a better osseointegration rate than machined implant surfaces, there are a number of periodontists who use machined implants and have success with them. Patients should discuss with their periodontist about the different types of implant surfaces and which one is recommended.
A macrointerlock is a fixation method which mechanically interlocks the bone and the dental implant. This can include the interlocking connections between abutments and implants. Macrointerlocks can also be used to build up fragile teeth before an implant is placed. Following some dental procedures, the canal of the affected tooth can be left hollow which weakens the strength of the tooth and reduces its ability to support an implant. Prior to implant fixation, a macro-lock post may be used to aid in the reconstruction and build-up of such a canal. Without the use of such posts, the tooth may be too fragile or unstable to allow for an implant. Macro lockers can help strengthen the tooth while also increasing the surface area needed for the implant. Macrointerlocks may also provide stability and longevity to the implant as well as to the bone-to-implant interlock.
Although rare, failure is unfortunately something that still occurs with dental implants, even when periodontists take every possible precaution before and after the dental implant procedure. Once an implant is placed, motion of any kind should be avoided until the implant has had enough time to begin the osseointegration process and become more stable. Macromotion is the term used for excessive motion, most often related to trauma. For example, if a patient gets into a severe car accident soon after their dental implant procedure, macromotion that results from the accident may cause the dental implant to fracture or break. Micromotion is the opposite, a term used for the very minimal motion that is typically expected after implant surgery. Too much micromotion can also cause implant failure, so it’s important for dental professionals to educate patients on both and develop strategies to avoid them as long as possible after surgery.
Not all dental implants are designed to hold a crown or artificial tooth. Dental implants can also be used for magnetic attachments designed to match small metal disks or magnets inside a set of dentures. Magnetic attachments allow a patient with dentures to easily keep their dentures in place without the need for denture adhesive cream. Many patients dislike the taste or feel of denture adhesive, and it may not always work as intended. It’s not uncommon for adhesive to fail at the most inopportune times or to be difficult to remove at the end of the day. A magnetic attachment keeps dentures secure while still making it easy for the patient to put in and take out. Magnetic attachments are simply made of a conventional dental implant with a body and a screw, but the abutment is specially designed for use with one or more sets of magnetic dentures.
Dental implants have a low failure rate, however, failure can be caused by a malpositioned implant. Ideally, implants are placed parallel to other teeth, and each other if there are multiple implants. They should also be vertically aligned with axial forced. When a dental implant is incorrectly positioned or improperly angled and defects in the surrounding soft tissue exist, traditional abutments are impossible to use. A custom-angled abutment is necessary. Healing variables can affect the positioning of a dental implant post-surgery. This includes systemic diseases that impact healing like rheumatoid arthritis and diabetes, contours in hard and soft tissues, the abutment manufacturer, the overall positioning of the implant, and the final design of the dental prosthesis to be fitted. Poor adaptation of a dental prosthesis can tax the implant hardware, causing tiny “micro gaps” to be created between the abutment and the implant below. This results in bacterial accumulation.
The mandibular canal is an important inner structure of the mandible, or lower jaw. It is a small canal that contains the inferior alveolar artery and vein, as well as the alveolar nerve. In the ramus, it runs obliquely forward and downward, and in the body, it runs horizontally forward. The mandibular canal rests underneath the alveoli, which it is able to communicate with via tiny openings. Since this canal contains a nerve and both a vein and an artery, it’s important for dental professionals to determine its location in proximity to the desired procedure site. In root canal therapy of the second molar, a dentist must take care not to extend past the tooth root with either the reamer tool or root canal filling material. If an implant is being placed in this area, the attending surgeon must be sure that the placement of implant hardware does not interfere with the mandibular canal.
Mandibular flexure is a complicated deformation process that can occur in the lower mandible. This can result in a change in the shape and width of the mandible arch, as well as protruding mandibular movements. These are caused by the contraction of various masticatory muscles, particularly the lateral pterygoid muscles. There are generally four types of deformation patterns recognized in mandibular flexure: corporal rotation, anteroposterior shear, dorsoventral shear, and symphyseal bending related to medial convergence. These patterns of deformation can result in excess stress on the bone tissue of the mandible. How the stress is distributed throughout the mandible depends on the shape of the mandible, the quality and quantity of bone, and the amount of force the masticatory muscles exert. Mandibular flexure is important for dental implant surgeons to consider, since excess occlusal loads, such as in cases of bruxism, can potentially result in long-term implant failure.
The mandibular foramen is the opening into the mandibular canal. It is located on the medial surface of the ramus of the mandible providing a passage to the inferior alveolar nerve, artery, and vein. The mandibular foramen thus allows these structures to supply the lower jaw, teeth, and part of the chin with blood, nutrients, gas exchange, and sensation. For oral procedures, the dentist or oral surgeon must be aware of the location and size of the mandibular foramen in order to administer a nerve block to numb the teeth and tissues that will be involved. Since a cranial nerve is involved with the mandibular foramen, it’s location must also be known before placing a dental implant to prevent damage to this nerve. The size and placement of the mandibular foramen can differ between patients since factors such as age, skull shape, and facial dimensions can affect its location.
Mandibular movement refers to the muscle- and ligament-activated border and/or intraborder movements of the lower jaw. There are five types of mandibular movements including rotational, horizontal axis, frontal axis, sagittal axis, and translational. Mandibular movement is affected by several factors such as the muscles used in suspending the jaw, mandibular articulation, and the synovial joint system. Study of this movement is important for the fields of dentistry and orthodontics as it describes the concepts related to dental occlusion and the masticatory processes of the jaw. A detailed understanding of each patient’s unique mandibular movement is also required for the proper design and creation of a customized prosthesis. It provides information regarding their occlusal habits and angle of dentition so a truly functional prosthesis can be formed. Information on mandibular movement is also an important part of dental and medical research pertaining to oral health, mandibular issues, and prosthesis design.
A mandibular ramus is a quadrilateral process projecting upward and backward from the posterior part of the body of the mandible and ending on the other side at the temporomandibular joint in a saddle-like indentation (called the sigmoid notch) between the coronoid and condylar processes. It may serve as a source for bone grafting. The lateral surface of the mandibular ramus is the attachment site of the masseter muscle. In bone grafting, the mandibular ramus provides a good source of autogenous cortical graft best suited for the correction of ridge deficiencies prior to the placement of an implant. Grafts from this location generally require shorter periods of healing, show low levels of resorption, and maintain their density. Obtaining graft bone from the mandibular ramus over other possible facial sources also creates less noticeable facial scars or alterations and is less likely to cause nerve or sensory issues or discomfort.
One of the primary concerns in implant dentistry is ensuring that there is enough bone at the implant site to support the implant. Without adequate bone support, it’s unlikely that proper osseointegration will occur. Periodontists can augment the size of the bone crest with bone grafting, guided bone regeneration, a ridge split technique for placement, and distraction osteogenesis. However, newer technology has been developed to help facilitate dental implant success for patients who have a narrow ridge, which is a ridge smaller than six millimeters. A narrow ridge implant, such as Hoissen SS implants, are specifically designed for patients with narrow ridges. The implant itself is shorter and has a smaller diameter, allowing it to fit better in a narrow ridge. Narrow ridge implants are often more affordable and don’t require as much of a time commitment for the patient versus complex procedures like bone grafting or guided bone regeneration.
The nasopalatine nerve is a part of the parasympathetic nervous system. It is a branch of the pterygopalatine ganglion which passes through the sphenopalatine foramen, across the roof of the nasal cavity to the nasal septum, and obliquely downward to and through the incisive canal. The nasopalatine nerve innervates the anterior part of the hard palate and the mucosa of the nasal septum. A nasopalatine nerve block may be used as local anesthesia for some dental procedures, though it is often painful for the patient. This is due to the resistance of the dense tissue of the palate which requires greater pressure to overcome. It causes significant pain and may lead to tissue trauma. Nasopalatine nerve damage may occur following some types of dental work or after surgery on the nasal septum. This damage often causes a reduction in the sensitivity of the front teeth or the hard palate. Nasopalatine nerve numbness may also be a side effect of the above procedures or of a nasopalatine canal cyst.
In some patients needing a dental implant, the periodontist will need to connect the natural teeth to the bone-supported dental implant using a periodontal ligament that allows for partial movement. This is often the case in partially edentulous patients who have a mixed bite, where natural teeth alternate between spaces that need to be restored with an implant. Some dentists are more reserved about the long-term efficacy of connecting implants and natural teeth, primarily because of the mobility difference between the two. Sometimes, complications can result from the use of a rigid or non-rigid connection between a dental implant and a natural tooth, one of which being the intrusion of the natural tooth, where the natural tooth “intrudes” on the dental implant, potentially causing failure. It’s important that periodontists evaluate the risk of natural tooth intrusion when using the existing dentition of patients to anchor the dental implant hardware.
Navigation surgery, or surgical navigation systems, play an important role in accurate and effective surgical procedures. Imaging is often integrated into these systems using CAS (computer-assisted surgery) technology, making surgery significantly safer in most cases. CAS was first developed in the 1980s by neurosurgeons and ENTs, but the technology has a substantially wide variety of applications in the medical field today. One of the most notable applications is within the field of dental health, or more specifically, during periodontal surgery. Dental implants, for example, are reported to have a lower failure rate when done with CAS technology versus traditional placement techniques. Surgical navigation systems help make surgical procedures less invasive and therefore reduces the risk of potential complications. In implant dentistry, surgeries that once required a flap to be made to expose the alveolar ridge for implantation of the screw can now be done with a small or even no incision.
An Nd:YAG laser, often simply referred to as a YAG laser, is a commonly used true pulse laser technology in many medical applications, including in optometry and dentistry. YAG lasers are close to an infrared wavelength of 1064 nm, which can be absorbed by pigment in living tissue, such as melanin and hemoglobin, and have superior biostimulatory properties. Photothermal interaction allows the laser energy to penetrate into the tissues, and the technology can be used as both non-contact and contact depending on the application or procedure being performed. In dentistry, YAG lasers are used primarily for gum disease or periodontal disease to disinfect and debride bacteria-filled periodontal pockets. This technology can also be used to seal treated pockets and support reattachment by acting as a scaffold, as well as for frenectomies, gingivectomies, and biopsies. They can help improve osteogenesis, help with clotting, and can help prevent alveolitis.
The word “necrosis” originates from the Greek word νέκρωσης, which refers to the act of death or decay. In the English language, necrosis is the result of cell injury that causes the premature death of living tissue cells via autolysis, or in simpler terms, the death of body tissue. When too little oxygenated and nutrient-rich blood reaches tissue, it begins to go through autolysis, or the process of self-digestion by its own enzymes. Necrosis can be caused by exposure to chemicals, radiation, and injury, and cannot be reversed. Once begun, tissue death can only be stopped — the destroyed tissue won’t regenerate without the help of a grafting procedure. In implant dentistry, necrosis of the jaw is a common obstacle to implant procedures. Tooth loss, periodontal disease, and other conditions can cause or contribute to the loss of bone in the jaw. A bone graft may be needed to support an implant.
In medical terminology, neoplasia is described as abnormal tissue growth as a result of the rapid division of mutated cells. Normally, the body’s cells multiply, divide, and extinguish in an orderly manner. Although cells normally divide quickly when the human body is growing, when it reaches adulthood, cells typically only do this as needed when cells die or become injured and require replacement. This is regulated by the body’s unique genetic code contained within the DNA. Neoplasms, or the abnormal tissue that is the result of neoplasia, are often seen in various forms of cancer as a malignant growth. The cells within a neoplasm have mutated and no longer respond to the instructions given by host DNA. They multiply rapidly and don’t die when they ought to, resulting in the unregulated growth of abnormal tissue — in other words, a tumor. While neoplasms are frequently seen with malignancy, they can also be benign or precancerous.
Nerve lateralization, also known as nerve repositioning or nerve transpositioning, is a surgical procedure whereby the course of the inferior alveolar nerve is redirected to allow the placement of longer implants in a mandible with extensive resorption of the posterior ridge. Nerve repositioning requires a portion of the lower jaw be opened to provide access to the nerve. To close this access, a bone graft is required following the placement of the implants. Nerve lateralization is considered a more aggressive procedure in implant surgery as the nerve can sustain long-term or even permanent damage. The inferior alveolar nerve provides feeling and sensation to the lower jaw, lip, and chin and most patients experience varying degrees of numbness following the surgery. Since there are other options for implant placements, such as blade implants, nerve repositioning surgery is generally not the first choice when dealing with patients with extensive posterior ridge resorption.
Nerve repositioning, also known as nerve lateralization or nerve transpositioning, is a surgical procedure whereby the course of the inferior alveolar nerve is redirected to allow the placement of longer implants in a mandible with extensive resorption of the posterior ridge. Alveolar nerve repositioning may also be done as part of a procedure to remove cysts or benign tumors of the mandible. For implant patients experiencing edentulous atrophy in posterior mandibles, repositioning of the alveolar nerve is often the only way a fixed prosthesis or implant can be properly placed. Due to the risks involved in repositioning the alveolar nerve, extreme care and precision must be demonstrated during surgical procedures to avoid damage to the nerve. Damage can cause short-term, long-term, or permanent issues and impair a patient’s ability to experience sensory information. It can also cause pain, numbness, and in some cases, paralysis. Nerve repositioning is done if there are not other suitable implant placement options.
Neurapraxia is the name given to a mild nerve injury that has been caused by either compression or retraction. In neurapraxia, there is no violation of the nerve trunk and no axonal degeneration and spontaneous recovery of the motor and/or sensory functions most often occurs within one to four weeks from the time of injury. Neurapraxia in dentistry is commonly caused by an injury to the inferior alveolar nerve or to the lingual nerve and may occur due to several possibilities including third molar extractions, anesthetic injections, oral disease, and surgical, orthodontic, and endodontic treatments or procedures. Neurapraxia symptoms include numbness, loss of sensation, motor paralysis, and tingling. Though neurapraxia typically does not require any specific treatment, patients should report their symptoms to their practitioner for monitoring and follow-up. In some cases, additional imaging may be needed to ensure there is not another underlying cause for the neurapraxia that must be addressed to promote healing.
When evaluating CBCT (cone beam computed tomography) imagery used to help periodontists choose sites for implant placement, there are two different types of “slices” to look at — oblique slices and orthoradial slices. The orthoradial slice is straight up and down, while the oblique slice is slanted, similar to a forward slash on a computer. These slices help periodontists visualize the anatomical structures in the mouth and evaluate where the optimal placement of a dental implant would be. Although which slice is used depends largely on the treating periodontist’s preferences, studies are showing that the oblique slice tends to be more accurate than the orthoradial slice, helping periodontists to achieve better patient outcomes. Oblique slices tend to be a better choice than orthoradial slices for implant placement in the posterior region or when planning implants that are tilted and if orthoradial slices are used, caution should be exercised.
Occlusal adjustment is the modification of the biting surfaces of a tooth, or teeth, to improve function or morphology. Occlusal adjustment is often used in conjunction with prosthetic placement and involves the grinding and shaping of selected tooth surfaces to improve contact patterns. Bite adjustments may also be made due to night-grinding issues and the discomfort or disfunction this causes for patients. The results of the occlusal adjustment procedure cannot be reversed, which means significant study of the patient’s mouth, tooth surfaces, and bite must occur before any action is taken. This study is usually accomplished through studying the bite contact within the patient’s mouth as well as through the use of dental impressions. Side effects of dental bite adjustment may include some pain or discomfort, though these are usually mild. Occlusal adjustment cost may vary depending on the dental insurance and the extent of the bite adjustment procedure.
An occlusal guard is often called a night guard or a bruxism guard. It protects against bruxism, which is the clenching or grinding of the teeth that happens primarily at night. Because the jaw puts an extreme amount of pressure per square inch on the teeth, grinding and clenching the jaw at night can result in damage to the teeth and painful symptoms of TMJ, or temporomandibular joint disorder. Occlusal guards can be custom-made by a dentist to fit a patient’s mouth exactly, or they can be purchased over the counter. While over-the-counter occlusal guards are less expensive than custom-crafted, they can have a negative impact on oral health if not used properly. Custom-fitted occlusal guards provide patients with better bruxism relief without the discomfort of ill-fitting plastic or metal parts that are one-size-fits-all. Occlusal guards can prevent jaw strain, fatigue, pain, and the chipping or breaking of teeth.
The occlusal load refers to the amount of force applied by the jaw when closing to a dental implant. Occlusal loading is essentially the process by which the force is applied, e.g. biting or chewing. Because the teeth and jaws can create a great amount of force between them, it’s critical that dental implant hardware be designed to withstand a high occlusal load. Many periodontists will use specialized tools to measure a patient’s occlusal load prior to selecting implant hardware, such as pressure sheets, strain gauges, and piezo-electric sensors. Bite force, or occlusal loading, can also be measured using masticatory computational models. By using three-dimensional occlusal load measurements, dental health professionals can enrich the assessment of a patient’s masticatory performance. In patients with bruxism, or the unconscious habit of grinding the teeth at night, the occlusal load may be much higher than in patients without bruxism. Periodontists should account for any conditions which may cause excess grinding of the teeth, including anxiety and drug use.
Occlusal overload refers to when the amount of “bite force,” or occlusal force, is greater than the teeth can withstand. Often, the term occlusal overload is used in conjunction with other dental implant terminology, however, it can also be used in discussions of bruxism. Bruxism is a condition where the patient unconsciously bites down, clenches, or grinds their teeth, usually at night, which increases their occlusal force exponentially. When discussing implant dentistry, occlusal overload can significantly increase the risk of implant rejection. Occlusal force should be measured by the treating periodontist carefully before selecting the size, shape, material, and surface texture of dental implant hardware. The amount of occlusal force that the implant can withstand must be less than the actual occlusal force of the patient’s jaw. If not, occlusal overload occurs, which can permanently damage the prosthetic crown or potentially even the implant hardware underneath. The patient’s gum and bone tissue can also become injured.
The occlusal table is the surface of a tooth that comes into contact with the opposite tooth. These are the grinding surfaces of the teeth that help break down food and the largest occlusal tables tend to be on the back teeth, or molars. The bicuspid teeth also have an occlusal table, and an occlusal load is the amount of force applied to the occlusal table by the jaw or external force. The jaw can exert a great deal of pressure per square inch, which is why teeth — specifically the enamel — is the strongest substance in the body. Injury can occur to the occlusal table, which is called occlusal trauma. The most common type of occlusal trauma is from bruxism, where the surfaces of the occlusal table become damaged and worn from excessive clenching and biting, usually during sleep. Occlusal trauma can also be caused by external forces, such as a blow to the head.
A one-part implant, also called a one-piece dental implant, is one of two types of implants used by dental professionals today. The other is a two-part implant. The two-part dental implant features a design of two separate pieces — the surgical implant or implant screw, and the prosthetic abutment. The implant must be placed first and finished with a cover screw to allow for healing. When the implant has healed over a period of several weeks, the cover screw is removed and the prosthetic is placed. A one-piece dental implant features the surgical implant and the prosthetic abutment in a single part. The one-part implant was intended to eliminate structural weakness, also known as a microgap, that comes with a two-piece implant design. During this procedure, the implant screw is placed and finished with a healing abutment. Often, one-piece dental implants are loaded with a temporary restoration until healing is complete.
A one-piece abutment is an abutment that connects into a dental implant without the use of an additional retaining screw. The abutment can be retained by cement, friction, or screw threads. While one-piece abutments are often used as an immediate method of restoring missing teeth, they can be complicated as the correct angulation must be achieved for the implant to fit properly. In order to attain the correct angulation, the dental professional is often required to position the abutment intraorally. In addition, further complications can arise as the positioning procedure may interfere with primary stability and impair osseointegration. However, the one-piece abutment also has a variety of advantages. The one-piece composition provides additional strength as it removes the structural weakness found in the two-piece implant. The one-piece abutment also requires fewer components reducing the overall inventory and gives the dental professional more precise control over the final fitting of the implant.
A one-piece implant is a type of dental implant in which the endosseous and abutment portions consist of one unit. The one-piece implant was originally designed to address the structural weakness issues that were part of the two-piece implant. The one-piece implant increases the strength and stability of the prosthesis by eliminating the weakest point of the two-piece implant, the abutment interface. In addition, the one-piece implant is an effective choice for patients or surgical sites where there is not enough bone to properly support a prosthesis. Despite these advantages, one-piece dental implants do have a disadvantage in that they are less flexible than the two-piece implant due to their single-unit construction. This lack of flexibility prevents more detailed adjustments once placed. After imaging and a careful evaluation of the patient’s dentition and underlying bone, the dental practitioner will determine which type of implant will best fit the patient’s needs.
The one-screw test is a test used to check the fit of a multiple unit screw-retained dental restoration. It is one of several different types of clinical assessments that may be done to check for implant framework misfit. To perform the one-screw test, a single screw is placed in the terminal dental implant abutment and evaluation is made on the opposite side. If the framework rises or has a ledge, detected clinically or radiologically, the fit is considered inaccurate. This test provides essential information regarding any implant framework misfit present in a fixed prosthesis. Such misfits can cause a variety of issues including the alteration of biomechanical function, increased stress on the implant screws and framework, and the prevention of bone resorption following an implant placement. One possible way to reduce the likelihood of implant framework misfit is to section the framework diagonally prior to placement.
A PAC, or Political Action Committee, is an organization within the United States that raises funds privately to spend on political endeavors in an attempt to influence legislation or elections, especially at the federal level. Often, PAC funds are donated to the campaign of a politician running for a particular office. The American Dental Association has a political action committee, called the ADPAC. Many dentists, periodontists, orthodontists, and other dental professionals support PACs that help lobby for legislation to be passed that benefits their practice, their patients, and the overall profession. Dental professionals can contribute financially to PACs that lobby for initiatives that support them. ADPAC is one of the largest health PACs in the United States and has raised more than $1.2 million. Other smaller dental PACs may exist, however, they are unlikely to be as influential as the American Dental Association PAC.
A palatal graft, or gingival graft, is a surgical procedure performed to establish an adequate amount of keratinized tissue around a tooth or dental implant. It can also be performed to increase the quantity of tissue of an edentulous ridge. This type of connective tissue graft often takes place prior to a dental implant. It helps provide stability and longevity to the implant by building up the amount of keratinized tissue surrounding it. Most patients experience pain or discomfort during gum tissue graft recovery though the severity varies from one individual to another. During the recovery period, patients are encouraged to eat only soft foods of moderate temperature that won’t irritate or burn the graft site. Though gum graft complications are rare, it is possible for an infection to form or for the grafted tissue to not properly adhere to the graft site. Most dental insurance plans will cover at least a portion of the gum graft cost.
A palatal implant is a special type of oral implant that is designed to relieve snoring and other disturbing symptoms of obstructive sleep apnea. Although a continuous positive airway pressure (CPAP) machine is considered the “gold standard” of treatment for obstructive sleep apnea, palatal implants are showing more promise, especially for patients who are unable to sleep well wearing a CPAP and either pull it off in the middle of the night or don’t wear it at all because it’s uncomfortable. In some cases, a palatal implant is used as a first-line treatment. A palatal implant changes the characteristics of the soft tissue of the palate, stiffening it and altering how air flows around it. The device is a group of three cylinder-shaped braided polyester filaments that are implanted permanently into the soft palate, which will relieve snoring by changing the flow of air through the nose and mouth and into the lungs.
The palatal vault is the curvature of the maxillary palate, also called the hard palate. The growth of the maxilla (upper jaw) and the hard palate is influenced by both environmental and genetic factors, and begins transversely. Then, it grows in length and finally in height. The overall shape of the palatal vault can impact chewing and swallowing, sucking, breathing, and language articulation. Narrow or high palates are associated with a variety of health conditions, and oral habits like thumb sucking can cause structural abnormalities in the palate over time. The hard palate is of particular significance to orthodontists, who often need to modify palatal dimensions of dental orthotic devices, such as retainers or dentures, to provide the best fit to patients. The height of the palatal vault increases with age, and male palatal vaults tend to be higher than those of their female counterparts of the same age.
Pamidronate is a type of medication that is used to treat bone lesions, bone metastases, and high blood calcium levels that occur with certain types of cancer, such as prostate cancer, breast cancer, and multiple myeloma. It can also be used to treat Paget’s disease and osteoporosis, both conditions that cause abnormally formed and/or weak bones. Pamidronate is a bisphosphonate, which works by reducing the release of calcium from bones into the blood. This reduces the amount of blood calcium, fractures and broken bones, and associated bone pain. Bisphosphonate therapy can cause a complication known as osteonecrosis of the jaw (ONJ). ONJ can develop after any dental surgery, however, the risk is much higher in patients who receive IV bisphosphonate drugs. The most common presentation of osteonecrosis of the jaw caused by bisphosphonate therapy includes the formation of a socket without extraction, swelling of the gums, discharge, and exposed bone.
A panoramic radiograph is a special type of x-ray that utilizes a minuscule amount of ionizing radiation to produce a single image of the entire mouth. This includes the mandible, maxilla, teeth, and surrounding tissues and structures. While bitewing radiographs and other intraoral x-rays are often still done, the panoramic x-ray has become integral to the diagnosis and treatment of a wide variety of oral and dental health conditions. Unlike other types of radiographs, it provides dental professionals with information about possible bone abnormalities, the position of the teeth and their roots in relation to each other across the entire mouth, and the maxillary sinuses. Panoramic radiographs are often used by dentists to diagnose gingivitis (periodontal disease), oral cancer, tumors in the jaw, sinusitis, jaw bone cysts, impacted wisdom teeth, and TMJ (temporomandibular joint disorder) and other jaw disorders. There is no special preparation needed for patients to undergo a panoramic x-ray.
A panoramic reconstruction is a thin, reformatted section of computed tomography (CT) scan data which is parallel to and following the curvature of the alveolar process as seen in the axial view. Data from a panoramic reconstruction scan can be used in dental applications for the diagnosis of disease. It is also commonly used in implant dentistry to provide a detailed image of the maxilla, maxillary sinuses, and the mandible. There are several advantages of the panoramic reconstruction scan which include the ease of identifying opposing landmarks, the convenience and speed of performance, the information provided on vertical bone height, and the ability to evaluate pathologic findings. Despite these advantages, there are a few concerns regarding the use of panoramic reconstruction as well. These include errors caused by improper patient positioning, the fact it does not show bone quality, and spatial relationships between structures can be difficult to identify.
The papilla is the soft tissue that occupies the interproximal space confined by adjacent crowns in contact. In relation to oral anatomy, the term may apply to interdental papilla which is a portion of the free gingiva that occupies the interproximal space and which is confined by the adjacent teeth that are in contact. It may also refer to interimplant papilla. This is the soft tissue that occupies the interproximal space while being confined by adjacent implant-supported fixed partial dentures which are in contact. In either case, the papilla can become damaged or inflamed due to poor dental hygiene or gingivitis and may recede. If this occurs, oral surgery may be required to restore the papilla between the teeth and restore good oral health. If inflammation and recession of the papilla are taking place due to gingivitis, the condition can be more serious as immediate intervention is required to prevent the development of periodontitis.
Papilla preservation is a surgical and prosthetic measure taken to maintain and/or reduce trauma to the interproximal tissue. One of the negative side effects of periodontal surgery is the reduced papillary height and papillary shrinkage that can lead to the exposure of underlying tissues. To prevent this, a papilla preservation technique can be used by the surgeon to help the papilla maintain a more aesthetic look for the patient’s comfort and confidence. One such technique utilizes the papilla preservation flap method in which no incision is made along the facial surface of the interdental papilla. The modified papilla preservation flap method is another technique that may be utilized following periodontal surgery and involves incisions made around the teeth next to the surgery location. These types of papilla preservation techniques allow patients to enjoy both the benefits of the surgery or implant as well as the appearance of the affected area following surgery.
Papilla reformation is the spontaneous reformation of the interproximal papilla following the establishment of a contact point and the management of the interproximal prosthetic papillary space. The term also refers to the re-establishment of the lost interproximal papilla by surgical means. Following the placement of an implant, the papilla between the neighboring tooth and the implant may be lost or significantly reduced if the neighboring tooth’s periodontal attachment is compromised. Papilla may be regenerated through papilla reformation by using a combination of hard and soft tissue grafting procedures. Bone grafting to replace missing or weakened bone between the teeth is an especially essential step that is often required for papilla reformation to take place. Another possible pathway to papilla reformation involves the use of growth factors used with bone grafting procedures. Papilla reformation is often a challenging process and therefore, proper patient preparation should take in an effort to avoid the loss of interproximal papilla.
Dental implants can help improve the quality of life of patients in a number of different ways. Patients will not only have an improved appearance, but they will also have improved function, meaning that eating, biting, and chewing will be easier. Although the dental implant process can be a long one, especially when bone grafting is involved, the improvement of quality of life is well worth it, especially for a permanent solution. There are different factors that are considered when gauging quality of life, such as the education factor, the spiritual factor, the family factor, the stress factor, the psychological factor, the work factor, and the health and safety factor. Dental implants naturally fall under the health and safety factor, but they can also fall under psychological and work. Self-esteem, relationships, and job opportunities can be affected by missing teeth in need of a dental implant.
The definition of the Physical Quality of Life Index (PQLI) is the measure of the quality of life or well-being of a country. The value is the average of three statistics: basic literacy rate, infant mortality, and life expectancy at age one. These statistics are all equally weighted on a 0 to 100 scale, as used in the dental literature. Quality of life indexes can be presented by country, by state, or by city. The index provides an overall look at the health and literacy of a country, state, or city and can be used to identify areas of the index that should be improved. It can also help measure the success of improvements that are already in place. The 2019 quality of life index will show the rankings of each country, state, or city and may further break down certain aspects of the quality of life of each for an expanded view.
In recent years, the predictability and success rate of dental implants has improved exponentially. This is largely due to improved techniques as a result of improved technology. As implants have become more sophisticated, most dentists are using CBCT technology to plan dental implant materials and procedures. Often, a surgeon will work with a restorative dentist, who examines the patient and determines the optimal placement of the tooth for the best aesthetic and restorative effect. The surgeon then determines if that placement is possible given the patient’s unique bone and tooth structure and what steps would need to be taken before the implant is placed (such as a bone graft). A radiographic guide for dental implants is typically used by both surgeons and restorative dentists to transfer the desired tooth placement to the mouth in a form that can be used with CBCT. A radiographic guide is not a surgical guide, but rather, it is a guide that helps determine if the optimal implant placement is achievable.
A radiographic marker is a radiopaque structure of known dimension. The term also applies to a material incorporated in, or applied to, a radiographic template in order to yield positional or dimensional information. The importance of radiographic markers is due in part to their function: they mark the position of specific x-ray images or areas of interest in an x-ray image. Pro X-ray markers provide dental and medical offices with a variety of marker options that can be personalized according to color, style, font, and initials. These types of personalized markers can help identify the technician who performed the x-ray and aid in x-ray tracking. X-ray marker holders can also be ordered to provide a safe and organized way to store x-ray markers. Some medical or dental offices may choose to select a personalized marker holder that reflects the style, design, or marketing scheme of their practice.
A radiographic template, or radiographic guide, is a type of dental appliance that is designed to convey the desired position of the teeth needing to be implanted in a way that can be included in a cone-beam computed tomography (CBCT) scan. Radiographic templates are typically made by dental professionals for implanting one or more teeth using a type of acrylic to replicate the approximate shape and size of the final crown. When worn during a CBCT, the prosthetic teeth should align with where the dental implants need to be placed. A channel through the teeth replicates where the dentist plans to put the screw head of the abutment egress the incisal or occlusal of the implant. The rest of the template is made from a radiolucent material, which will not show on the scan and helps to hold the radiopaque teeth in place without moving during the CBCT scan.
Radionecrosis, or radiation necrosis, is a term used in the medical industry to describe the aftereffects of radiation therapy. It refers to the breakdown of body tissue at the original tumor site and occurs some time after radiation has been completed. It takes the form of a focal structural lesion that may potentially be a long-term complication of radiosurgery or radiotherapy that affects the central nervous system (CNS). If radiation necrosis occurs, the body may not be able to replace the damaged tissue. While radionecrosis can occur in any type of body tissue treated with radiation, the most common form of this condition found in dentistry is osteoradionecrosis, or the necrosis (death) of bone tissue. Osteoradionecrosis is quite rare, but when it does develop, it typically does so in the lower mandible or jawbone because this area has a lower blood supply than other bony structures of the mouth and jaw.
The word “radiopaque” simply means that a substance is opaque, or cannot be seen through, under radiation. The most common example of something radiopaque is the human skeleton. Bones cannot be seen through under radiation, which is why x-rays are such an effective way of visualizing bones. Human skin, eyes, and other soft tissues are radiotransparent or radiotranslucent, which means they either will not be visible under radiation or they will be faint and easily seen through. Radiopaque substances are often used in the medical field for diagnostic purposes, such as drinking barium before an x-ray to visualize the normally radiotranslucent intestines. In dentistry, radiopaque materials include dental implants, braces, amalgam fillings, and some cosmetic restorative materials. The different levels of radiopacity of fillings, enamel, pulp, tooth decay, gums, and other oral structures help dental professionals diagnose a number of conditions including caries, cysts, gum disease, impacted wisdom teeth, and more.
The term “ramus” refers to the branch or arm of a bone, such as in the pubic bone or the jaw bone. The jawbone has two; one ramus on each side that connects with the skull. In the field of implant dentistry, the ramus is of particular significance to bone grafting procedures. Autogenous bone is often more successful than allograft bone during grafting procedures, and the mandibular ramus provides cortical bone that is suitable for building the alveolar ridge after bone loss prior to dental implant placement. Using grafts from the ramus are highly successful and have a number of advantages, including a low morbidity rate and easy intraoral access. Ramus bone grafts need only a short time to heal, maintain their density after implantation, and exhibits minimal resorption by surrounding bone. Complications of a ramus graft include the possibility of damaging the mandibular neurovascular bundle.
Single dental implants are costly and may not be the best option for patients who need multiple teeth replaced. In the case of patients missing an entire set of top or bottom teeth, dentures are often recommended. For patients who do not want to put in or take out their dentures every day and keep them clean, a special stainless steel implant called a ramus frame implant. This device is shaped like a horseshoe and is implanted into the mandible from the retromolar pad on one side all the way to the retromolar pad on the other. The front of the frame is also implanted into the alveolar ridge above the chin, providing three-point stability. A portion of the device will remain outside the gums, which is what the dentures “clip” or “snap” onto. This may be uncomfortable for some patients, who often choose to wear their dentures over the ramus frame with the exception of removing them for cleaning.
One of the biggest contributing factors to the need for periodontal surgery is the loss of bone. In cases where periodontal disease is very advanced, so much bone may be lost that there is not enough to support a dental implant. In this case, bone grafting may be an option. A bone graft involves the implantation of bone tissue from another source into the area needing bone. The graft heals, integrating with whatever existing bone is present and increasing the amount of bone in the area of the mouth where the implant will be. The Ramus Bone Graft uses a patient’s own bone from the mandibular ramus instead of synthetic (lab-created) or donated bone, meaning that this procedure is considered an autogenous bone graft. This reduces the risk of rejection and other potential complications associated with bone grafts from foreign sources, and encourages the body to generate new bone.
A ramus implant, or a ramus frame implant, is a stainless steel denture anchor that is implanted directly into the bone of the mandible. A ramus implant is one of the earlier types of implants and were originally seen in the mid-1970s. Although large and cumbersome, this type of implant had a 91% success rate over a decade post-surgery. The ramus implant is horseshoe-shaped and is implanted into the retromolar pads on both sides of the mandible and in a third area in the alveolar ridge just above the chin in the center of the mandible. The dentures then “snap” or “clip” onto the part of the implant that sits above the gums. When the dentures are removed, the frame can be felt in the mouth, which some patients may not like. Often, patients will only remove dentures from their ramus frame implant when they need to be cleaned or serviced.
A randomized controlled trial, or RCT, is a study where people are selected completely by random or chance to either receive a treatment or clinical intervention, or to receive the control or standard of comparison. The standard of comparison is often a placebo or sugar pill in the case of medication trials, or it may be a standard practice or no actual intervention at all. A randomized controlled trial is used to measure the outcome of individuals, or participants, who receive treatments or clinical interventions. To assess the nature of the outcomes of participants, they must be compared to the participants who did not receive the intervention or treatment being studied. RCTs are, in short, controlled, comparative trials that are an extremely powerful tool within medical research. Randomized controlled trials are simple to organize and often easy to conduct; the most important factor is that the participants’ selection is absolutely by chance.
Sandblasted, large grit, acid-etched implant surface, (SLA) is a type of surface treatment that creates surface roughness with the goal of enhancing osseointegration through greater bone-to-implant contact (BIC). The SLA process increases the rate at which osseointegration occurs by using a combination of grit and acid etching to give the surface increased roughness on multiple levels. This allows osteoblasts to proliferate and adhere to the implant surface. Through osseointegration, SLA can help provide increased stability of the implant which will ultimately lengthen its longevity. The use of specialized implants by Straumann SLA implants, such as the SLActive implant and the Roxolid SLA implant, reduces the amount of treatment time required while also increasing the treatment predictability. The Roxolid SLA implant can also reduce the need for bone augmentation to assist those patients who have insufficient bone. The SLA process offers a variety of benefits to patients requiring increased ossification prior to an implant.
Treating the surface of a dental implant has been shown to promote osseointegration and reduce the likelihood of dental implant failure. The sandblasting procedure is just one way that the surface of a dental implant can be altered using different equipment to help encourage the success of the implant. The sandblasting process is straightforward and involves using a stationary or portable sandblaster to “blast” sand at the surface of a dental implant at a high velocity to change the texture of the surface. On a microscopic level, the sandblasting procedure “roughs up” the outer layer of the implant, creating a surface that is easier for the bone to grip as the implant heals. Like sandpaper, different sizes of sand or grit can be used to create different outcomes — larger pieces of sand are going to create a rougher surface while smaller grains of sand create a smoother but still textured surface.
The sandwich technique is a specific strategy in restorative dentistry used for fillings. In both open and closed sandwich techniques, the different materials of the composite resin is layered or “stacked” onto the tooth, similar to building the layers of a sandwich. This is done instead of mixing the materials of the resin together before filling the cavity. An open sandwich refers to when the filling is located on one of the sides of the tooth and comes into contact with the oral cavity. A closed sandwich refers to a filling in the center of the tooth that does not come into contact with the oral cavity. Many dental professionals who work in restorative dentistry feel that the sandwich technique provides a stronger filling, because the glass ionomer cement that is layered on first bonds to the tooth structure below and the composite to follow, offering a better seal and increasing filling retention.
The sausage technique is a term used in implant dentistry to describe a specific technique used for bone regeneration. Created by Hungarian periodontist Dr. Istvan Urban, the sausage technique is much less invasive than its predecessors. Before this technique was developed, more autogenous bone had to be harvested, which typically resorbs over time. Now, periodontists attempting to regenerate bone prior to a dental implant can use 50% autogenous bone and 50% xenogenic bone. Instead of using only one material or the other, both materials are used and much less autogenous bone is necessary, which results in a less invasive harvesting procedure. The sausage technique receives its name from the way the native collagen membrane looks when it is stretched out like a skin with small tacks to keep the bone graft from moving. The membrane allows for improved blood flow during healing and bone regeneration, and the host bone is typically reabsorbed by 6 weeks.
Endodontic treatment, or root canals, are a common, although often dreaded, dental procedure. They are often successful at preserving a natural tooth instead of having it extracted, which can cause bone loss and other complications. Endodontic treatment was introduced by Hermann in the 1920s, when he outlined the administration of calcium hydroxide for pulp therapy. This essentially created the foundation for modern endodontic therapy as it is known in dentistry today. Ideally, the outcome of a root canal is the removal of diseased pulp and the replacement of healthy pulp that begins to regenerate itself. To control the differentiation, metabolism, and proliferation of stem cells and to provide spatially correct positioning, appropriate scaffolding is necessary. Different types of scaffolding facilitates the regeneration of various tissues, making it critical that the treating dentist has a robust knowledge of which scaffolding is suitable for the type of tissue attempting to be regenerated.
A scalloped dental implant is an older style of implant that was created to biologically facilitate and guide interproximal bone remodeling during procedure healing and to retain papillae and bone height during functional loading. The scalloped implant design includes areas for both soft and hard tissue apposition, which are set parallel to each other, mirroring the cementoenamel junction. The area for the apposition of hard tissue is meant to facilitate osseointegration, while the area for soft tissue is designed to create a space for the subgingival margin of the restoration and to support various connective tissues. While the design was well-intentioned, it did not work as well as expected during application. A study of 17 scalloped implants that were evaluated for 18 months revealed that the scalloped design increased bone loss more than conventional dental implants that were properly placed. There were no differences in papillae formation in the study.
A scanning abutment is a type of abutment that is used to transmit data related to the angulation and position of seated implants. The data is collected with a digital desktop scanner or an intraoral scanner and is extremely accurate. A scanning abutment includes a biocompatible abutment body. Inside the body is an internally threated titanium screw, which is designed to be compatible with other materials and components used within the specified dental implant system. There are two types of scanning abutments: clinical scanning abutments and laboratory scanning abutments. The former contains barium, a radiopaque material, and is designed to be used with intraoral scanners. The latter contains radiolucent material and is used with both blue-light and red-light desktop scanners. Scanning abutments should be inspected for damage before use, and the use of multiple scanning abutments is not recommended due to the possibility of cross contamination.
A scanographic template, also called a scanography template and sometimes spelled scannography, is a template created for the process of capturing digital images of an object. Typically, the purpose of the template is to create a printable image using a flatbed scanner with a charge-coupled (CCD) array capturing device. Scanograpy differs significantly from conventional document scanning by utilizing three-dimensional or atypical objects. In dentistry, scanography is a type of radiography that is used to produce images of the oral structures of a patient for the purpose of creating restorations. It can also be used as a diagnostic tool to detect abnormalities in the mouth and jaw, as well as tumors, cysts, impacted teeth, dental implant malalignment, caries (tooth decay), and other clinically significant issues. There are two types of scanography used in dentistry: rotational scanography and linear scanography. Linear scanography is used most often as it produces panoramic views.
The Schneiderian membrane, also called the Schneiderian epithelium, is the lining of the paranasal sinuses and nasal cavity. It’s unique in that the ciliated columnar lining is ectodermally derived and features goblet cells. The neighboring respiratory epithelium, which appears similar to the Schneiderian membrane, is derived from the endoderm. One of the most common complications that can occur during a sinus grafting surgery is a tear or perforation in the Schneiderian membrane of the maxillary sinus. If this occurs, typically, the surgeon will repair the perforation at the same time the graft is placed, and few additional risks of complications exist. However, in some cases, patients will develop an infection in the maxillary sinus or surrounding areas of the maxillofacial complex after a substantial or complete tear in the membrane. This infection is serious and may result in the failure of a recently completed bone graft or dental implant.
For many decades, dental implants have been one of the most desirable ways to replace one or more missing teeth. Their outcomes are generally predictable, and the failure rate of dental implants is low overall. However, failure can still occur both in the short and long term. Screw fracture, or the fracture of the screw implanted into the bone to hold the dental prosthetic, is a common reason dental implants fail within the first 10 years. Although nearly half of dental implant patients suffer a screw fracture, removing it is a complex procedure, especially if the screw is fractured or broken in more than one place. Considered a mechanical complication, the fracture of a dental implant screw is often caused by high occlusal loads. In cases of bruxism, where there is constant pressure on the teeth from clenching or grinding them (usually at night), screw fractures are more common.
A tack, or a bone tack, is a small piece of metal that is used to stabilize bone graft material during guided bone regeneration. Stabilizing the membrane can help promote healing. There are many different types of bone tacks and membrane fixation systems. Some are manual while others are automatic and which one is used for bone grafts depends largely on the preferences of the periodontist working with the patient. While bone tacks can be purchased alone, they are most often found in a “tack kit,” which can also include a tack block, a tack mallet, a tack placement instrument, and a drill for dense cortical bone. All of these items in a tack kit are autoclavable, meaning they can be sterilized in between use on patients like most other dental instruments. Most bone tacks are made from titanium alloy, but they can be made from other materials.
There are two types of taps in the dental field. The first is the bone tap. This is a device used to create a threaded channel in bone for a fixation screw or, prior to the insertion of a dental implant, into an osteotomy. A bone tap may be used to prepare the bone for the implant required for a prosthesis. The second type is the metal tap. This is an instrument made of a hard metal used for rethreading damaged internal threads of a dental implant. The type of tap device required will depend on the specific procedure. Since there are a variety of tap dental devices that can be used to help place or fix dental implants, research may be needed prior to purchase. Tap dental appliance reviews may help in the selection of the correct device by using the tap appliance dental code. Appliance parts may also be researched to see which are best suited for the necessary procedures.
A tapered dental implant simply refers to dental implant hardware that is tapered, or narrowed, at the implant end. Tapered implants are most similar to the shape of the natural tooth roots, which helps to create more stability and improved overall aesthetics in the finished dental implant. Tapered dental implants offer maximum bone maintenance, exceptional primary stability, and excellent soft tissue attachment. Many tapered implants boast a wide variety of features that make it a good choice for most implant procedures, including treated surfaces, optimized thread form, color-coded platforms, multiple configurations, and a vast range of sizes. Treated surfaces also mimic the natural tooth, allowing oblique connective tissue to attach and for the periodontist to better control cellular migration. Color coding allows periodontists to quickly and easily identify sizes and components, making the implant procedure faster and more accurate. Tapered implants are more likely to be used in types of bone that are harder to achieve stability with.
Tapping, or EFT (emotional freedom techniques) tapping, is a stress-relief technique that is often used to relieve dental anxiety. As many as 30% of patients report feeling anxious when going to the dentist, but for many people, sedation dentistry is simply not an option. Tapping takes just minutes and can be done at home or in the office with zero side effects. The concept behind EFT tapping is that certain acupressure points on the body, usually the head and upper torso, are “tapped” with the fingers at the same time the individual repeats a self-acceptance phrase. The phrase typically acknowledges the anxiety, such as the sound of a dental drill causing stress, and affirms acceptance regardless of the issue creating the anxious feelings. Beyond relieving dental anxiety, tapping can be used to relieve chronic or general anxiety, post-traumatic stress disorder (PTSD), situational anxiety surrounding public speaking or test-taking, and more.
The removal of calculus and plaque after having dental implants with an ultrasonic scaler, especially during a deep cleaning (also called a scale and root plane) can cause significant damage to dental implant hardware. However, managing plaque and calculus build up becomes even more important after having dental implant surgery. Periodontal disease (gum disease) can cause implant failure similar to how a natural tooth will become loose after untreated periodontal disease begins to destroy the underlying bone. A 1994 study revealed that when ultrasonic scalers are coated in Teflon, the same damage does not occur to plastic implant curettes or smooth titanium surfaces. On rough implant surfaces, however, instrument material residue was discovered. The study determined that coating ultrasonic and sonic scaler tips with Teflon material (also called a Teflon scaler) enables dental professionals to use high-frequency tools to professionally clean dental implants without significant damage.
Teflon tape, also called plumber’s tape, is a common DIY tool used to prevent leakage between two pipes fit together. The term “teflon tape” is actually an incorrect one; the material is known as PTFE tape or thread seal tape. The tape wraps around a set of threads and once screwed in, the tape seals any micro gaps between the threads. Plumber’s tape is also used frequently in cosmetic and implant dentistry, among other fields. It’s most often utilized to seal an abutment screw before sealing the access openings. There are a number of advantages to using PTFE tape to do this: unlike cotton, it won’t absorb fluids like a sponge, it can easily be removed to provide access to the abutment screw, packing can be done quickly, and it seals and protects the area above the top of the abutment screw. It can also be used to obliterate the screw access hole in dental implants.
A telescopic coping is a feature of telescopic dentures, which are classified as an overdenture. An overdenture is any dental prosthesis that is anchored by natural teeth or a dental implant. Telescopic dentures offer more stability than traditional dentures due to their unique design. Abutments are placed strategically in the patient’s mouth, and the primary telescopic coping is cemented to them. The secondary telescopic coping is attached to the denture, which fits onto the primary coping. In the 1970s and 80s, telescopic dentures that were anchored by natural teeth or the roots of natural teeth were considered more popular than traditional dentures. It is believed that telescopic dentures anchored to natural teeth better diffuse the occlusal load and prevent overload by transferring the stress of occlusal forces through the periodontal ligament of retained tooth roots. The extra stability of the copings offers a stronger bite and more efficient chewing.
In dentistry, a temporary abutment (also known as a temporary cylinder) is an abutment used for the fabrication of an interim restoration. The interim restoration may be cemented onto the temporary abutment or the temporary abutment may be incorporated into the interim restoration for a screw-retained prosthesis. Temporary abutments are an essential component in restorative dentistry procedures. They allow the tissue around the implant to heal while also providing an attachment point for the crown, bridge, or other dental restoration. Following implant osseointegration with the surrounding bone, the temporary abutment may be removed for a permanent abutment to take its place. Temporary abutments come in a variety of designs, such as snap abutments and slim abutments, for convenient placement and easy removal. The type of temporary abutment selected for use in a dental procedure will depend upon the kind of procedure, the patient’s oral anatomy, and the type of prosthesis required.
A temporary anchorage device, or TAD, is an implant which is used as an aid for orthodontic tooth movement. A TAD can also refer to a miniscrew, osseointegrated palatal, or retromolar dental implant that is placed to control tooth movement during orthodontic treatment. Temporary anchorage devices are often placed in the alveolar bone or the extra-alveolar bone to provide the strongest orthodontic anchorage. Anchorage as a term refers to an orthodontic reactive unit that resists the opposite movement of the tooth or teeth requiring adjustment. This process utilizes both the biology and anatomy of the mouth as well as the physics of motion. Temporary anchorage devices require an opposing force to work against the teeth needing adjustment and may either be intra-oral, such as another tooth or group of teeth, or outside the mouth as seen with headgear. TADs are often made of titanium as the material is bioinert and durable.
Tensile stress is the stress caused by a load (two forces applied away from one another in the same straight line) that tends to stretch or elongate an object. Tensile stress is not often encountered in dentistry, however there are two situations in which it may be seen. The first occurs when a patient with a crown chews a sticky candy. As the candy becomes stuck to the tooth opposite the crown and the patient opens his/her mouth, the crown is subject to tensile stress which may result in the crown being pulled off. The second situation can be observed when a fixed dental structure, such as a bridge, is flexed. The flexing of the bridge can cause it to deform and no longer fit or function correctly. There are few true cases of tensile stress in dentistry since other types of stress tend to be observed simultaneously.
Ultrasonic bone surgery, also known as piezoelectric ultrasonic bone surgery, is a surgical technique using an ultrasonic device operating at a modulated frequency. It is designed to cut or grind bone but not damage any of the adjacent soft tissues. An ultrasonic bone surgery system provides an efficient way to deal with cutting during oral procedures. This surgical technique allows for the safe completion of more complex procedures. An ultrasonic bone surgery unit works by creating ultrasonic waves within a specific frequency range. These waves cause a deformation of piezoceramic rings which in turn, causes sets of vibrations to take place in an amplifier. These waves are then transmitted to a handpiece which cuts through bone tissue by shattering it on a microscopic level. This process has made many types of dental procedures less traumatic for patients, with less surrounding soft tissue damage, while also improving the healing process.
Dental uncovery is often described as tooth uncovery and is a specific type of dental procedure performed when an adult tooth is developed in the improper position and doesn’t properly erupt in the mouth. This condition is called tooth impaction and can cause a wide variety of problems for the patient if not treated. Healthy teeth can become crowded and new teeth are prevented from growing into their own correct positions, which can result in the need for more invasive dental procedures later on. Dental uncovery involves making a small incision into the gums where the tooth has failed to erupt to expose it. Then, orthodontic devices may be used to facilitate normal growth. Impacted teeth are most often caused by genetics or heredity, excess bone and gum tissue, the abnormal sequence of tooth eruption ankylosis (where the tooth root and bone become fused together), and crossbite.
An Underwood cleft or septum is a fin-shaped projection of bone that sometimes exists in the maxillary sinus on or near the floor of the sinus cavity and is often called a maxillary sinus septum or Underwood’s septa. Its name is derived from Arthur S. Underwood, the anatomist at King’s College in London who first discovered these bones in 1910. An Underwood septum is of special interest to dental professionals when performing surgical procedures designed to elevate the sinus floor, because it increases the likelihood of potentially serious complications like tearing of the Schneiderian membrane, or the thin lining of the maxillary sinus cavity. As many as 32% of patients have been reported to have an Underwood’s septa, and they can often be seen on dental x-rays without the need for additional imaging. Two types of septa exist; primary septa were originally described by Underwood and secondary septa can form after tooth loss.
For a dental implant to be successful, the alveolar ridge must have sufficient volume. When it doesn’t, periodontists can choose to use a unilateral subperiosteal implant, a type of dental implant that was specifically developed for patients who do not have enough residual bone in the alveolar ridge. This type of implant has survival/success rates similar to other modalities. Unilateral subperiosteal implants are contraindicated in patients with an overabundance of bone. The procedure involves two stages; first, a bone impression is taken and second, the custom dental implant is placed. A subperiosteal dental implant is made to rest on top of the bone under the periosteum instead of traditional implant hardware that is placed much deeper into bone. Instead, the implant disperses pressure over a larger surface area, much like a snowshoe. The implant is made from a custom metal casting that adheres to the bone with direct support and surrounding fibrous tissue.
The UCLA abutment has been around since the late 1980’s, however, many periodontists overlook this implant abutment in favor of others. This type of abutment is considered stronger than zirconia abutments because there is an internal connection via a secondary metal component. No matter the implant size, the UCLA abutment can be used with any dental implant system. In fact, UCLA abutments are often used in cases where a smaller implant is needed, because the smaller a zirconia abutment, the weaker it will be. Another benefit to the UCLA abutment is that it was created with ceramic applied and baked to the entire surface instead of just the sub-gingival area. This allows for a completely ceramic crown to be used. A UCLA abutment works particularly well with a bridge, however, crowns and other restorations can benefit from this abutment. Tooth color can be achieved for aesthetic purposes and healing time is similar to other abutment materials.
The Valsalva maneuver is a simple technique that involves breathing out of the nose and mouth while they are closed. This raises the pressure inside the chest and middle ear, and can equalize pressure in the ears and help reduce some heart arrhythmias. Although rare, ear damage can sometimes occur when blowing too hard with the Valsalva maneuver. Ear “popping” sensations are usually felt at the start of the Valsalva maneuver, but to also get the cardiac benefits, the maneuver must continue for 10-15 seconds. The modified Valsalva maneuver involves laying flat with the legs elevated for 15 seconds after exhaling against closed airways for 15 seconds. This modification improves the heart rate in patients with certain types of arrhythmias, and it can be done anytime, anywhere — nothing is needed to perform the Valsalva maneuver. SVT, or supraventricular tachycardia, is a type of fast heart beat that can sometimes be serious and requires medical treatment.
Variance is a measure of statistical dispersion about the mean. The larger the variance, the further individual values of the random variable (observations) tend to be from the mean, or average. Variance exists between individuals of a species for a multitude of traits, including dentition. A number of different genetic, environmental, and mechanical factors may be at the root of this variance. Even in cases of monozygotic twins, dental variation is seen in their individual dentition. This may be due to epigenetic factors, environmental variances, and different phylogenetic influences. Variance in dentistry can also be found in the measurements taken by different tools. Each tool used is calibrated per industry standards but subtle differences in each individual tool will result in minor, or sometimes major, variances. Careful calibration prior to use, proper tool cleaning and maintenance, and proper tool storage and care will help diminish the likelihood of extreme variance between tools.
Vascular endothelial growth factor (VEGF), also called vascular permeability factor (VPF), is a specific type of protein known as a signal protein that encourages the body’s creation of blood vessels. When cells release this protein, it “signals” the body to take action — in the case of VEGF, either by angiogenesis or vasculogenesis. Angiogenesis is the creation of new blood vessels from existing vasculature, while vasculogenesis is the creation of the circulatory system in the embryo. The vascular endothelial growth factor protein is critical to human survival as it’s the protein that restores the supply of oxygen to tissues that have become hypoxic, or suffered a loss of oxygen. Most often, this occurs after cells become injured or to repair muscle after exercise. However, VEGF expression can also result in the formation of new blood vessels to circumvent ones that are blocked, a process called collateral circulation. Overexpression of VEGF can lead to disease.
All parts of the body require oxygen to function, which is carried to the cells via blood vessels or the vascular supply. The heart and lungs require a great deal of oxygen, while other parts of the body, like bone, require less. However, bone can also cease to function without an adequate supply of oxygen. In an average long bone, oxygenated blood is supplied by either periosteal vessels, epiphyseal vessels, or a nutrient artery. By having three systems in place, one can take over the function of the other if it becomes blocked or damaged in some way. If bone tissue does not receive enough oxygen, a process known as avascular necrosis or osteonecrosis occurs. This is the death or decay of the bone due to a lack of oxygenated blood. Osteonecrosis can cause the bone to become brittle, breaking into small pieces and eventually crumbling or collapsing if left untreated.
Veneers are one of the most common cosmetic dental procedures performed in the U.S. A veneer is a thin piece of porcelain (and less commonly, resin) that is placed over the front of a tooth to restore its size, shape, and color. Dental veneers can be used to correct a wide variety of cosmetic issues, including broken or chipped teeth, teeth gaps, and stained or severely discolored teeth. Veneers are permanent because the natural tooth must be altered or filed down to adhere the veneer using dental cement. While a patient can have a single veneer placed, most often, patients interested in significant restoration will have multiple veneers put on. Veneers give teeth the smooth, shiny, uniform look that celebrities often have; this is usually because they also have veneers. Patients can choose bright, white veneers or veneers with a more natural color to achieve their aesthetic goals.
Before manufacturing the prosthetic framework for multiple dental implants, it’s important that periodontists ensure that the framework has the optimal passive seat. To do this, a verification jig is often used. This ensures that the master model is precise before the framework is created. A verification jig mimics the fit of the final restoration framework so the model accuracy can be verified to confirm that the end restoration fits perfectly. The jig is made of temporary cylinders that are joined together with a stiff resinous material and often, rods or sturdy wires. Then, the jig is placed over all of the dental implants in the patient’s mouth; an unstable frame means that the screws need to be adjusted on either side to prevent movement of the jig. The jig can be used for the final framework once all rocking or movement in the mouth has ceased.
The vertical dimension of occlusion (VDO), is the measurement of the relationship between the upper and lower jaw when the teeth are fully occluded in max intercuspation. VDO is sometimes referred to as vertical dimension or occlusal vertical dimension (OVD). Both patients with and without teeth possess a VDO, however, the latter is more subjective in measurement and is generally based on esthetics and phonetics, or the sound of words being pronounced as the jaw is held in the desired position. The vertical dimension of occlusion can roughly be measured by asking the patient to say “Emma.” The position of the lower jaw on the “a” sound is called the vertical dimension at rest (VDR), which is roughly 3mm greater than a patient’s VDO. Reduction of the vertical dimension of occlusion can occur after tooth loss, tooth decay, gum disease, and loss of bone in the alveolar ridge.
Vertical dimension of occlusion (VDO), also known as occlusal vertical dimension (OVD), is a term used in dentistry to indicate the superior-inferior relationship of the maxilla and the mandible when the teeth or wax rims are situated in maximum intercuspation or contact. In dental applications, the vertical dimension of occlusion is an important measurement in determining the correct dimensions for a prosthesis. In oral trauma, the proper vertical dimension of occlusion for the patient must be known so the correct basal bone height reconstruction can be achieved. An increase in basal bone height will reduce the VDO and can lead to problems including speech difficulties, unnatural lip contact, esthetic issues, and temporomandibular joint pain complications. A decrease in basal bone height will also cause issues including drooling of saliva, improper contact of the upper and lower teeth, and injuries to the soft tissue of the cheek due to accidental biting.
A wax-up is a wax and/or resin pattern contoured to the desired form for a trial denture, cast coping, metal framework, or for diagnostic purposes. It is also a process of placing denture teeth on a wax-rim. A wax-up provides a model of what the patient’s dental work will look like and assists the dentist with the implant procedure. A dental wax-up kit is an important part of any office’s dental materials. This contoured pattern can be used for wax-up teeth or for a veneer wax-up. A dental wax-up not only assists the dentist with the implant process but the patient as well. A mockup can be made and placed into the patient’s mouth to give them a better understanding of what their prosthesis will look like once the procedure is complete. It also provides a chance for the patient to request changes or to discuss any esthetic concerns they may have.
A waxing sleeve is placed over the titanium implant post and can be shaped or modified in any way to procure an appropriate metal support for a dental implant. Often, waxing sleeves are used in tissue level impression and with a UCLA-type crown or UCLA abutment. UCLA abutment history says that the abutment was created in 1987. It has a gold cylinder that works with the implant hardware and a plastic sleeve that can have a waxing sleeve placed over it. Usually, the abutments are cast with a high noble alloy and baked with ceramic before use. The UCLA abutment is stronger than a zirconia abutments, and it has better versatility and aesthetics compared to other types of abutments. Whether used with a UCLA-type crown or abutment or not, a waxing sleeve allows for straightforward and accurate fabrication. Essentially, this works to create a better overall finished aesthetic appearance.
Wolff’s Law is a simple ideology that states that the natural bone of a healthy animal or person will adapt to the stress under which it is placed. This law was developed in the 19th century by German surgeon and anatomist Julius Wolff. He posited that if the load under which a bone is placed is increased, the bone naturally reconstructs itself to become stronger and withstand the additional strain. These changes are remarkable and include both primary changes to trabeculae architecture and secondary adaptive changes to external cortical bone, which may become thicker. The opposite is also true; if the strain on a bone decreases, the bone weakens over time due to the lack of stimulation needed to keep bones strong and healthy. Bone strength and density often decreases after a prosthesis is placed as a result of stress shielding, or the transfer of load from bone to prosthetic.
There are two main types of dental X-rays. The first is intraoral (meaning the X-ray film is inside the mouth) such as a periapical radiograph. The second is extraoral (meaning the X-ray film is outside the mouth) such as a panoramic radiograph, or CBCT. An X-ray for dental purposes can assist the dentist in finding any tooth surfaces that have decay or damage issues which a visual examination alone might not reveal. A dental X-ray procedure generally only lasts a few minutes and can be taken from a variety of angles to show multiple views of the problem area. To ensure dental X-ray safety, the patient may wear an apron over their neck and chest to prevent x-ray exposure to other areas of the body. Dental X-rays are often a part of routine check-up and most dental insurance plans will cover at least part of the dental X-ray cost.
A xenograft is a type of bone or skin graft that is taken from a donor of another species. In comparison, an allograft is a type of bone or skin graft that is taken from a donor of the same species. An autologous bone graft (sometimes called an autograft) is a type of graft taken from the patient themselves, and an alloplastic graft is a manufactured or synthetic bone graft made from hydroxyapatite, a natural mineral and the main component of bone. In the dental field, xenografts are usually porcine or bovine, meaning they come from pigs or cows. The grafts are cleaned, sterilized, and prepared for implantation into the human body. The most common grafts to be used in the dental industry are bone grafts. If a patient has bone loss due to disease, trauma, or missing teeth, a bone graft may be necessary before placing a dental implant.
Young’s modulus measures the ability of a material to stand up to changes in length when under lengthwise compression or tension. It’s also called the modulus of elasticity. Learning how to calculate the stiffness of a solid material is relatively straightforward in this case — Young’s modulus is equal to the longitudinal stress divided by the strain. Diamond has the highest Young’s modulus, and rubber has the lowest. Mild steel would be somewhere in between. Using a calculator to determine the Young’s modulus of different materials is important to implant dentistry for a variety of reasons. A periodontist must understand the Young’s modulus of the patient’s bone in the area the implant will be placed as well as the modulus and dimension of the implant itself. If there is a mismatch between the Young’s modulus of the bone and the implant, it could result in implant failure.
Zirconium dioxide, or ZrO2, is often called zirconia but is important to distinguish from zircon. The substance is a crystalline oxide of zirconium, which is usually bright white in color, and is often called “ceramic steel.” It’s an extremely strong substance One of the most common forms of zirconium dioxide is dopant stabilized cubic structured zirconia, or better known as cubic zirconia, or simulated diamonds. In dentistry, zirconium dioxide is used widely by dental professionals as a ceramic oxide. The substance can be used in a variety of applications, including dental crowns, bridges, implants, and inserts, and has been shown to have an excellent safety profile and biocompatibility. Zirconium dioxide nanoparticles are also not harmful to other living organisms, including bacteria, making it a great choice for bone implants as well. Other popular ceramic systems among dental professionals include silica, alumina, leucite, and lithium disilicate.
Zirconia is a newer material used for dental crowns. In the past, dental crowns were made of metals like silver or gold, resin, and porcelain. Zirconia is stronger than porcelain but just as natural looking. Zirconia teeth are nearly indistinguishable from your own teeth and are similar in size, shape, and color. Because it doesn’t require as much preparation to the natural tooth, the price of zirconia is affordable compared to other dental crown materials. When comparing a zirconia crown vs. porcelain crown, there are numerous benefits that zirconia crowns have over porcelain. Zirconia crowns can be milled in the dental office and put in during the same visit, whereas porcelain crowns are typically made in a lab outside the dental office. Zirconia crowns can be cemented or bonded and are biocompatible. Because of these benefits, zirconia crowns are growing in popularity for both crowning natural teeth and dental implants.
A zirconia abutment offers an esthetic alternative to metal implant abutments. Due to the white color of zirconia, abutments made of this material are often not as noticeable. Zirconia abutments can be custom milled or ordered as stock abutments from a specific manufacturer. They are available in a variety of configurations with or without pre-machined margins. The aesthetics of zirconia is often a selling point with patients that have thin gum tissue as there is no gray metal to show through along the gum line. While a zirconia implant is very strong, titanium is known to be even stronger with a higher elasticity which helps resist micro-fractures. The zirconia abutment price is also higher than that of a titanium abutment due to the nature of zirconia. When considering the zirconia abutment vs. the titanium abutment, these are just a few of the factors to research.
Zirconium is a steel-gray, hard ductile metallic element with a high melting point that occurs widely in combined forms. It is highly resistant to corrosion and is used especially in alloys and in refractories and ceramics. Zirconium can be altered to create a material known as zirconia. This is a white ceramic substance which can be used as dental crown material, dental fillings, or to make zirconia implants. Zirconia crowns are often less expensive than porcelain crowns, however, zirconia crowns disadvantages also need to be considered. These include:
