Dental implant treatment has been
|
|
- Gwendolyn Lynch
- 7 years ago
- Views:
Transcription
1 CLINICAL CALCIUM HYDROXIDE PASTE AS A SURFACE DETOXIFYING AGENT FOR INFECTED DENTAL IMPLANTS: TWO CASE REPORTS Dennis Flanagan, DDS Dental implant treatment is successful; however, an implant can become infected during or after osseointegration. The two case reports presented here demonstrate, anecdotally, the effectiveness of endodontic calcium hydroxide paste for the surface treatment of infected, healing, or osseointegrated dental implants. Calcium hydroxide may be an appropriate surface detoxifying agent for local dental implant infections. A sequence of calcium hydroxide and 0.2% chlorhexidine gluconate surface treatment may provide a broad range of antimicrobial action for detoxifying recalcitrant infections. Calcium hydroxide should not be left in the surgical site. Key Words: dental implant, infection, surface treatment INTRODUCTION Dental implant treatment has been shown to be very successful. However, there are reports where an implant has become infected during or after osseointegration Some types of bacteria or fungi may colonize the implant surface and produce localized bone loss or complete loss of bone around the fixture. To salvage an ailing or failing implant, tetracycline or citric acid has been typically used as an implant surface detoxifying agent. 1,3,7,8 The apparent concept is to kill the colonizing bacteria and remove implant surface contaminants without defacing the surface. The surrounding bone should not be damaged to allow for continued or reinstated osseous healing. Many authors have published articles using tetracycline and citric acid as detoxifying agents with successful results. 1,2,3 However, these agents have a ph range of 1 3 for citric acid, depending on concentration, and 1.8 for tetracycline HCl. The low ph may decalcify the osseous tissue around the implant and may inhibit healing. Another available detoxifying agent is calcium hydroxide (CH). CH is well known in dentistry. It has Dennis Flanagan, DDS, is in private practice in Willimantic, Conn. Address correspondence to Dr Dennis Flanagan at 1671 West Main Street, Willimantic, CT ( dffdds@charter.net) been used for decades as an endodontic intracanal medicament. It has a ph of slightly more than 12 that may not decalcify or confound bone healing, but it may be caustic to soft tissue. CH, in the dental pulp capping paste form, is US Food and Drug Administration (FDA) 510(k) approved for endodontic use and now is reported here as an implant surface detoxifying agent for infected implants. CH paste as a surface detoxifier for apical (retrograde) implantitis has been previously reported. 13 CASE REPORT #1 A 44-year-old woman with failing endodontically treated maxillary central incisors presented for treatment (Figure 1). She had an unremarkable medical history. The teeth had been endodontically treated many years prior and had apical radiolucencies (Figure 2). After a discussion of options for treatment, extraction of the 2 teeth and implant placement for implant supported crowns were agreed upon. Both teeth were extracted and the facial cortices were found to be destroyed by the chronic infection. A facial barrier membrane (Biomend, Zimmer Dental, Carlsbad, Calif) was placed, and bone graft material was placed (Puros, Zimmer Dental) with rotated palatal pedicle grafts to attain primary closure (Figure 3). Additionally, the palatal pedicle grafts were used to increase the soft tissue thickness for appropriate 204 Vol. XXXV/No. Four/2009
2 Dennis Flanagan FIGURES 1 4. FIGURE 1. Presenting condition. FIGURE 2. Radiograph of presenting condition. FIGURE 3. Grafted extraction sites. FIGURE 4. Radiograph of placed implants. gingival architecture around the definitive crowns. After 4 months of healing, 1 implant was placed in site #8 ( , Implant Direct, Ventura, Calif). Site #9 had poor bone quality for initial stabilization, therefore, the osteotomy was compressed with an osteotome and a larger implant was installed ( , Implant Direct) (Figure 4).The depth of the implant placement ensured an appropriate emergence profile for both proposed crowns despite the different diameters. At the eighth postoperative week, the patient presented with a small facial swelling at site #9. A drainage tract was seen and a radiograph was made with a #40 gutta percha point placed into the tract to act as an indicator to the source (Figure 5). The source of the infection was the mid body Journal of Oral Implantology 205
3 CALCIUM HYDROXIDE PASTE FIGURES 5 and 6. FIGURE 5. Draining infection tracked with gutta percha point. FIGURE 6. Bone loss at implant mid body. of the #9 implant. The site was locally anesthetized and surgically opened with a #15C scalpel to expose the infected implant body (Figure 6). The area was debrided with a periodontal curet, treated with calcium hydroxide paste (Pulpdent Corp, Watertown, Mass) for less than 30 seconds, and rinsed with sterile saline; an allograft material was then placed in the defect (Puros), and a barrier membrane was placed (Biomend) and was primarily closed with 4-0 polyglycolic acid suture (Vicryl) (Figures 6 through 9). The site healed uneventfully and 2 porcelain fused to metal crowns were subsequently made to complete the treatment (Figure 10). At all surgical visits the patient exhibited normal physiologic vital signs. CASE REPORT #2 A 62-year-old woman presented for treatment of a failing, previously endodontically treated mandibular right lateral incisor. She had an insignificant medical history. Treatment options were discussed and extraction with implant treatment was decided upon. Tooth #26 was atraumatically removed and a implant (Implant Direct) was installed. The implant was immediately nonfunctionally loaded with a provisional bis-acryl crown. After 4 months, the definitive porcelain fused to metal crown was fabricated and delivered. After 4 weeks, the patient presented with pain and slight swelling at the facial of #26. A radiograph taken with a gutta percha indicator revealed a radiolucency that indicated an infected mid body implant surface. The area was locally anesthetized and the fixture was surgically exposed. The bone defect was debrided, the implant surface was treated with calcium hydroxide paste for less than 30 seconds, and then rinsed with sterile saline. A bone allograft material was placed in the defect and primarily closed with polyglycolic acid suture (Vicryl). At all surgical visits the patient exhibited normal physiologic vital signs. The patient returned for follow-up appointments and healed uneventfully. DISCUSSION The root canal treatment paste product used in these cases was CH in aqueous methylcellulose with barium sulfate for radiopacity (TempCanal, Pulpdent Corp). The manufacturer claims the product is bacteriocidal and bacteriostatic. The CH is an alkali and packaged at a concentration of 5 mg/mm 3. This is a very high concentration. It is not considered a carcinogen (Material Safety Data Sheet, TempCanal). Bacterial implant infections can cause failures in healing and osseointegration. Many of these implant infections occur in failed endodontic sites. Both of the patients reported here had bouts of mid body implantitis after placement in sites where there were failed endodontically treated teeth. Both infected implant surfaces and the surrounding bone were successfully treated with CH. In both cases, the CH paste was left on the implant surface and bone defect for less than 30 seconds. 206 Vol. XXXV/No. Four/2009
4 Dennis Flanagan FIGURES FIGURE 7. Debrided site was detoxified with calcium hydroxide paste and thoroughly rinsed. FIGURE 8. Defect was filled with allograft. FIGURE 9. A membrane covered the grafted site. FIGURE 10. Final result. Empirically, the high ph of CH endodontic paste may be better tolerated by osseous tissue than a low decalcifying ph agent such as tetracycline or citric acid. However, both of these low ph agents have had successful treatment results reported. Although CH paste is approved by the FDA for endodontic use, this treatment is an off-label use. This is where an agent is used for a treatment process not claimed by the manufacturer, but the clinician is allowed to use the product in a novel therapeutic way. Enterococcus faecalis and Candida albicans are common species found in failed endodontic teeth.14 It may be that these and/or other species residually remain in the apical bone and vegetate until they are reactivated with implant surgery to colonize the implant surface E faecalis in a vegetative or stationary phase resisted more than 10 minutes of exposure to CH or 0.05% chlorhexidine gluconate or % sodium hypochlorite. However, the bacterial cells in a growth phase were completely killed at an exposure of 3 seconds to these materials.21 Additionally, at the higher concentration of 3.0%, sodium hypochlorite effectively killed E faecalis in both vegetative and growth phases.22 Sodium hypochlorite is corrosive and may not be safe for exposure to Journal of Oral Implantology 207
5 CALCIUM HYDROXIDE PASTE osseous and soft tissue and so may be inappropriate for in situ implant surface treatment. CH is bacteriocidal on contact. It must be in direct contact with the bacteria to be lethal. CH has been shown to be active and not active against E faecalis and Pseudomonas aeruginosa. 14,23 However, as with other antimicrobials, even though there is little effect at lower concentrations, there may be a bacteriocidal effect against E faecalis and other pathogens in high doses, 5 mg/mm 3 of CH, that are applied topically as described here. The literature has described a variation of inhibition of pathogens by CH. Asgary and Kamrani tested CH against Pseudomonas aeruginosa, E faecalis, Staphylococcus aureus, and Escherichia coli and found it to inhibit growth of these bacteria. 24 Another study that tested serial dilution of CH against 6 endodontic pathogens found calcium hydroxide to be effective only at concentrations of about 50%. 25 Generally, planktonic microorganisms can be more susceptible to CH than when they are in a biofilm or adhering to dentin. 26 These two factors increase bacterial resistance to the activity of CH. 26 Conversely, Chai et al found that CH was able to completely eliminate E faecalis in a biofilm in a membrane filter with a 1-hour exposure. 27 Balto in a review article found that CH was limited in its effectiveness in killing E faecalis when the testing was done by culturing techniques. 28 Apparently, CH is effective at higher concentrations against many pathogens and dependent upon the surface onto which the pathogen is adhering. Although not studied, a titanium surface may make the bacteria more susceptible than a dentin surface. One interesting research article by Baik and coworkers found that CH was able to detoxify lipoteichoic acid. This toxin is an important virulence factor for gram-positive bacteria, such as E faecalis. The toxin, when inactivated by CH, did not stimulate the release of tumor necrosis factor in a sheep macrophage cell line. 29 There was no attempt to culture and identify the pathogen in the infected lesions in the cases presented here due to the unreliability of clinical culturing in these areas. CH also is a source of calcium ions. Thus, any small residual material inadvertently left in the site may be of benefit for osteogenesis. However, this author does not recommend leaving any visually apparent material in the surgical site. Material with a ph value this high may not be well tolerated by soft tissue and produce a tissue reaction. The site should be lavaged of all visible calcium hydroxide. Severe sequelae have been reported with calcium hydroxide paste extruded beyond the tooth root foramen. 30 Many anaerobic infections are caused by a mixture of organisms. Bacteroides spp can be inhabitants of tooth periapical lesions. 16 These bacteria are generally susceptible to metronidazole, 31 cefoxitin, 32 chloramphenicol, 33 and clindamycin. 34 Bacteroides spp also encapsulates itself in a polysaccharide that probably promotes its virulence, survival, and importance in mixed infections. 18,35 Bacteroides forsythus has been shown to persist in asymptomatic periradicular endodontic lesions and may survive in bone in an encapsulated form after an extraction and subsequently infect an implant. 36,37 At 10% concentration, calcium hydroxide was effective against Bacteroides fragilis. 38 Interestingly, as much as 50% of an endodontic infection is caused by bacteria that have not yet been cultivated. 39 These bacteria may be left intraosseously after an extraction and subsequently colonize an implant surface. Chlorhexidine gluconate is active against E faecalis and other endodontic pathogens. 14 It may not be as effective against C albicans as calcium hydroxide. 14 While the 2 cases reported here were successful with 1 calcium hydroxide direct topical treatment, a subsequent lavage with 0.2% chlorhexidine may be of value in recalcitrant infections or infections where virulent pathogens are suspected. A sequential treatment of calcium hydroxide paste and 0.2% chlorhexidine gluconate may provide a broad range of antimicrobial action for detoxifying an infected dental implant. 40,41 Because these implant infections uncommonly occur, appropriate long-term studies may be difficult. CONCLUSIONS Calcium hydroxide endodontic paste may be an appropriate direct surface detoxifying agent for infected dental implants when administered in very high concentrations. A subsequent topical treatment of 0.2% chlorhexidine gluconate may provide a broad range of antimicrobial action for detoxifying an infected dental implant. Calcium hydroxide should not be left in the surgical site to prevent a severe tissue reaction. REFERENCES 1. Reiser GM, Nevins M. The implant periapical lesion: etiology, prevention and treatment. Compend Contin Educ Dent. 1995;16: Vol. XXXV/No. Four/2009
6 Dennis Flanagan 2. Sussman HI. Periapical implant pathology. J Oral Implantol. 1998;24: McAllister BS, Masters D, Meffert RM. Treatment of implants demonstrating periapical radiolucencies. Pract Periodontics Aesthet Dent. 1992;4(9): Brisman DL, Brisman AS, Moses MS. Implant failures associated with asymptomatic endodontically treated teeth. J Am Dent Assoc. 2001;132: Scarano A, Di Domizio P, Petrone G, Iezzi G, Piatelli A. Implant periapical lesion: a clinical and histologic case report. J Oral Implantol. 2000;26: Jalbout ZN, Tarnow DP. The implant periapical lesion: four case reports and review of the literature. Pract Proced Aesthet Dent. 2001;13: Meffert RM. How to treat ailing and failing implants. Implant Dent. 1992;1: Bretz WA, Matuck AN, de Oliveira G, Moretti AJ, Bretz WA. Treatment of retrograde peri-implantitis: clinical report. Implant Dent. 1997;6: Mellonig JT, Griffiths G, Mathys E, Spitznagel J Jr. Treatment of the failing implant: case reports. Int J Periodontics Restorative Dent. 1995;15: Balshi TJ, Pappas CE, Wolfinger GJ, Hernandez RE. Management of an abscess around the apex of a mandibular rootform implant: clinical report. Implant Dent. 1994;3: Chaffee NR, Lowden K, Tiffee JC, Cooper LF. Periapical abscess formation and resolution adjacent to dental implants: a clinical report. J Prosthet Dent. 2001;85: Ayangco L, Sheridan PJ. Development and treatment of retrograde peri-implantitis involving a site with a history of failed endodontic and apicoectomy procedures: a series of reports. Int J Oral Maxillofac Implants. 2001;16: Flanagan DF. Apical (retrograde) peri-implantitis; a case report of an active lesion. J Oral Implantol. 2002;28: Ballal V, Kundabala M, Acharya S, Ballal M. Antimicrobial action of calcium hydroxide, chlorhexidine and their combination on endodontic pathogens. Aust Dent J. 2007;52: Abuo-Rass M, Bogen G. Microorganisms in closed periapical lesions. Int Endod J. 1998;31: Sunde PT, Tronstad L, Eribe ER, Lind PO, Olsen I. Assessment of periradicular microbiota by DNA-DNA hybridization. Endod Dent Traumatol. 2000;16: Lindberg AA, Weintraub A. Encapsulation and protection against phagocytosis by Bacteroides fragilis. Scand J Infect Dis Suppl. 1985;46: Brook I, Myhal LA, Dorsey CH. Encapsulation and pilus formation of Bacteroides spp. in normal flora abscesses and blood. J Infect. 1992;25: Brook I. The role of encapsulated anaerobic bacteria in synergistic infections. FEMS Microbiol Rev. 1994;13: Brook I, Walker RI. The role of encapsulation in the pathogenesis of anaerobic gram-positive cocci. Can J Microbiol. 1985;31: Portenier I, Waltimo T, Orstavik D, Haapasalo M. The susceptibility of starved, stationary phase and growing cells of Enterococcus faecalis to endodontic medicaments. J Endod. 2005;31: Abdullah M, Ng YL, Gulabivala K, Moles DR, Spratt DA. Susceptibilities of two Enterococcus faecalis phenotypes to root canal medications. J Endod. 2005;31: Pallotta RC, Ribeiro MS, de Lima Machado ME. Determination of the minimum inhibitory concentration of four medicaments used as intracanal medication. Aust Endod J. 2007;33: Asgary S, Kamrani FA. Antibacterial effects of five different root canal sealing materials. J Oral Sci. 2008;50: Blanscet ML, Tordik PA, Goodell GG. An agar diffusion comparison of the antimicrobial effect of calcium hydroxide at five different concentrations with three different vehicles. J Endod. 2008;34: Brandle N, Zehnder M, Weiger R, Waltimo T. Impact of growth conditions on susceptibility of five microbial species to alkali stress. J Endod. 2008;34: Chai WL, Hamimah H, Cheng SC, Sallam AA, Abdullah M. Susceptibility of Enterococcus faecalis biofilm to antibiotics and calcium hydroxide. J Oral Sci. 2007;49: Balto KA. Calcium hydroxide has limited effectiveness in eliminating bacteria from human root canal. Evid Based Dent. 2007;8: Baik JE, Kum KY, Yun CH, Lee JK, Kim KK, Han SH. Calcium hydroxide inactivates lipoteichoic acid from Enterococcus faecalis. J Endod. 2008;34: Sharma S, Hackett R, Webb R, et al. Severe tissue necrosis following intra-arterial injection of endodontic calcium hydroxide: a case series. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2008;105: Tracy JW, Webster LT. In: Hardman JG, Limbird LE, eds. Goodman and Gilman s the Pharmacological Basis of Therapeutics. 9th ed. New York, NY: McGraw-Hill; 1996: Mandell GL, Petri WA. Drugs used in the chemtherapy of protozoal infections. In: Hardman JG, Limbird LE, eds. Goodman and Gilman s the Pharmacological Basis of Therapeutics. 9th ed. New York, NY: McGraw-Hill; 1996: Kapusnik-Uner JE, Sande MA, Chambers HF. Antimicrobial agents. In: Hardman JG, Limbird LE, eds. Goodman and Gilman s the Pharmacological Basis of Therapeutics. 9th ed. New York, NY: McGraw-Hill; 1996: Kapusnik-Uner JE, Sande MA, Chambers HF. Antimicrobial agents. In: Hardman JG, Limbird LE, eds. Goodman and Gilman s the Pharmacological Basis of Therapeutics. 9th ed. New York, NY: McGraw-Hill; 1996: Brook I. Isolation of capsulated anaerobic bacteria from orofacial abscesses. J Med Microbiol. 1986;22: Gatti JJ, Dobeck JM, Smith C, White RR, Socransky SS, Skobe Z. Bacteria of asymptomatic periradicular endodontic lesions identified by DNA-DNA hybridization. Endod Dent Traumatol. 2000;16: Siqueira JF Jr, Rjas IN, Oliveira JC, Santos KR. Molecular detection of black-pigmented bacteria in infections of endodontic origin. J Endod. 2001;27: Ferreira CM, da Silva Rosa OP, Torres SA, Ferreira FB, Bernardinelli N. Activity of endodontic antibacterial agents selected anaerobic bacteria. Braz Dent J. 2002;13: Sakamoto M, Siqueiro JF, Rocas IN, Benno Y. Bacterial reduction and persistence after endodontic treatment. Oral Microbiol Immunol. 2007;22: Gomes BP, Vianna ME, Sena NT, Zala AA, Ferraz CC, de Souza Filho FJ. In vitro evaluation of the antimicrobial activity of calcium hydroxide combined with chlorhexidine gel used as intracanal medicament. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2006;102: Zerella JA, Fouad AF, Spangberg LS. Effectiveness of a calcium hydroxide and chlorhexidine digluconate mixture as disinfectant during retreatment of failed endodontic cases. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2005;100: Journal of Oral Implantology 209
The Immediate Placement of Dental Implants Into Extraction Sites With Periapical Lesions: A Retrospective Chart Review
IMPLANTS The Immediate Placement of Dental Implants Into Extraction Sites With Periapical Lesions: A Retrospective Chart Review Christopher Lincoln Bell,* David Diehl, Brian Michael Bell, and Robert E.
More informationThe present study reports on the application of silver anode in root canals for disinfection of
Murat AYDIN *, The antibacterial effect of silver anode in root canals Oral Microbiol Immunol Abstract The present study reports on the application of silver anode in root canals for disinfection of infected
More information4-1-2005. Dental Clinical Criteria and Documentation Requirements
4-1-2005 Dental Clinical Criteria and Documentation Requirements Table of Contents Dental Clinical Criteria Cast Restorations and Veneer Procedures... Pages 1-3 Crown Repair... Page 3 Endodontic Procedures...
More informationInstruction manual. Safe and efficient NiTi rotary system. Fulfilling the biological requirement for successful endodontics
Instruction manual Safe and efficient NiTi rotary system Fulfilling the biological requirement for successful endodontics FKG REF. - 99.7AA.50.04B.AN - 06/2010 BioRaCe kit 1 Educational CD 1 Endo Stand
More informationThe definitive implant restoration
CASE REPORT Implant Bone Rings. One-Stage Three-Dimensional Bone Transplant Technique: A Case Report Mark R. Stevens, DDS 1 * Hany A. Emam, MS 2 Mahmoud E. L. Alaily, MS 3 Mohamed Sharawy, PhD 4 A variety
More informationThis article describes the use of the
CLINICAL Immediate Implant Placement Into Infected Sites: Bacterial Studies of the Hydroacoustic Effects of the YSGG Laser Edward R. Kusek, DDS* This article describes the use of an erbium laser to use
More informationHistologic comparison of biologic width around teeth versus implants: The effect on bone preservation
Clinical Histologic comparison of biologic width around teeth versus implants: The effect on bone preservation Kazuto Makigusa 1 Abstract Histological analysis of the biological width surrounding primate
More informationCUSTOMIZED PROVISIONAL ABUTMENT AND PROVISIONAL RESTORATION FOR AN IMMEDIATELY-PLACED IMPLANT
CONTINUING EDUCATION 1 4 CUSTOMIZED PROVISIONAL ABUTMENT AND PROVISIONAL RESTORATION FOR AN IMMEDIATELY-PLACED IMPLANT Gerard J. Lemongello, Jr, DMD* LEMONGELLO 19 7 AUGUST The use of immediate implant
More informationPowertome Assisted Atraumatic Tooth Extraction
Powertome Assisted Atraumatic Tooth Extraction White et al Jason White, DDS 1 2 3 Abstract Background: While traditional dental extraction techniques encourage minimal trauma, luxated elevation and forceps
More informationImmediate Molar Implant Placement: A Private Practice Clinical Investigation. Abstract
Immediate Molar Implant Placement: A Private Practice Clinical Investigation Gargiulo et al Alphonse Gargiulo, DDS, MS 1 Thomas Manos, DDS, MS 2 Mark Kolozenski, DDS, MS 3 Alex Tzanos, DDS, MSD 3 Michael
More informationAnatomic limitations in the maxilla provide challenges
Osteotome Single-Stage Dental Implant Placement With and Without Sinus Elevation: A Clinical Report Orest G. Komarnyckyj, DDS*/Robert M. London, DDS** Forty-three sites in 16 patients were selected for
More information2016 Buy Up Dental Care Plan Procedure List
* This is in addition to the embedded Preventive Plan (see procedure list at deltadentalco.com/kp_preventive. BASIC SERVICES Minor Restorative Services D2140 Amalgam 1 surface, primary or permanent D2150
More informationBioRace NiTi system: biologically desirable apical sizes safely and efficiently
BioRace NiTi system: biologically desirable apical sizes safely and efficiently Dr Martin Trope and Dr Gilberto Debelian explore the BioRace NiTi system, designed to achieve an apical preparation that
More informationThe Treatment of Traumatic Dental Injuries
The Recommended Guidelines of the American Association of Endodontists for The Treatment of Traumatic Dental Injuries 2013 American Association of Endodontists Revised 9/13 The Recommended Guidelines of
More informationRevascularization of Immature Permanent Teeth With Apical Periodontitis: New Treatment Protocol?
JOURNAL OF ENDODONTICS Printed in U.S.A. Copyright 2004 by The American Association of Endodontists VOL. 30, NO. 4, APRIL 2004 CLINICAL RESEARCH Revascularization of Immature Permanent Teeth With Apical
More informationComplications Associated with Tooth Extraction
1 Complications Associated with Tooth Extraction Mark M. Smith, VMD, DACVS, DAVDC Center for Veterinary Dentistry and Oral Surgery 9041 Gaither Road Gaithersburg, MD 20877 Introduction Tooth extraction
More informationStraumann Bone Level Tapered Implant Peer-to-peer communication
Straumann Bone Level Tapered Implant Peer-to-peer communication Clinical cases April, 2015 Clinical Cases Case No. Site 1 Single unit; Anterior Maxilla 2 Multi-unit; Anterior Maxilla Implant placement
More informationSingle anterior tooth replacement: clinical approaches
Single anterior tooth replacement: clinical approaches Paul Swanson examines the role of implant design in approaching a range of treatment protocols for replacing a single tooth Case 1 Figure 1: Patient
More informationoriginal article Keywords: Sodium hypochlorite. Chlorhexidine. Calcium hydroxide. Endodontic infection. Root canal medication.
original article Efficacy of chemo-mechanical preparation with different substances and the use of a root canal medication in dog s teeth with induced periapical lesion Frederico C. Martinho, DDS, MSc
More informationBioPure MTAD Antibacterial Root Canal Cleanser Research
BioPure MTAD Antibacterial Root Canal Cleanser Research ANTIBACTERIAL 1. Torabinejad M, Shabahang S, Aprecio RM, Kettering JD. The antimicrobial effect of MTAD: An in vitro investigation. J Endodon 2003;
More informationHumana Health Plans of Florida. Important:
Humana Health Plans of Florida Important: Dental discount membership in Florida is determined by viewing the member s ID card and verifying that the Humana Logo and Medicare name is listed with an effective
More informationResidency Competency and Proficiency Statements
Residency Competency and Proficiency Statements 1. REQUEST AND RESPOND TO REQUESTS FOR CONSULTATIONS Identify needs and make referrals to appropriate health care providers for the treatment of physiologic,
More informationCDT 2015 Code Change Summary New codes effective 1/1/2015
CDT 2015 Code Change Summary New codes effective 1/1/2015 Code Nomenclature Delta Dental Policy D0171 Re-Evaluation Post Operative Office Visit Not a Covered Benefit D0351 3D Photographic Image Not a Covered
More informationdeltadentalins.com/usc
Plan Benefit Highlights for: UNIVERSITY OF SOUTHERN CALIFORNIA STUDENT PLAN Group No: 05008 The Delta Dental PPO table plan provides you great dental benefits at a reasonable cost. With a table of allowance
More informationLATERAL BONE EXPANSION FOR IMMEDIATE PLACEMENT OF ENDOSSEOUS DENTAL IMPLANTS
LATERAL BONE EXPANSION FOR IMMEDIATE PLACEMENT OF ENDOSSEOUS DENTAL IMPLANTS Department of Oral Maxillofacial Surgery, Chisinau Abstract: The study included 10 using the split control expansion technique
More informationLIST OF DENTAL PROCEDURES (LOW PLAN) PREVENTIVE PROCEDURES
LIST OF DENTAL PROCEDURES (LOW PLAN) The following is a complete list of the dental procedures for which benefits are payable under this section. No benefits are payable for a procedure that is not listed.
More informationModern Tooth Replacement Strategies & Digital Workflow
Modern Tooth Replacement Strategies & Digital Workflow Case Studies by Dr Maurice Salama, DMD AS PUBLISHED BY Dentistry Today, June 2014 Complete Implant Restoration System FACTS: Implant Dentistry Has
More information500 TRANSCORTICAL ANESTHESIAS PERFORMED AS A FIRST-LINE TREATMENT: RESULTS
ORAL SURGERY PERIODONTICS RESTORATIVE ENDODONTICS PROSTHESIS BIOLOGICAL SCIENCES PATHOLOGY IMPLANTOLOGY PHARMACOLOGY MISCELLANEOUS PAEDIATRIC ODONTOLOGY DENTOFACIAL ORTHOPAEDICS ALAIN VILLETTE (*) 500
More informationRehabilitation of Endondontically Failed Anterior teeth by Immediate Replacement and Loading of an Implant supported Crown: A Case Report.
RESEARCH AND REVIEWS: JOURNAL OF DENTAL SCIENCES Rehabilitation of Endondontically Failed Anterior teeth by Immediate Replacement and Loading of an Implant supported Crown: A Case Report. Lalit Kumar 1
More informationLong-term success of osseointegrated implants
Against All Odds A No Bone Solution Long-term success of osseointegrated implants depends on the length of the implants used and the quality and quantity of bone surrounding these implants. As surgical
More informationNon-surgical management of a large periapical lesion using a simple aspiration technique: a case report
doi:10.1111/j.1365-2591.2010.01719.x CASE REPORT Non-surgical management of a large periapical lesion using a simple aspiration technique: a case report M. Fernandes & I. De Ataide Goa Dental College &
More informationEndodontic treatment with MTA apical plugs: a case report
325 Journal of Oral Science, Vol. 49, No. 4, 325-329, 2007 Case Report Endodontic treatment with MTA apical plugs: a case report Pari Ghaziani 1), Navid Aghasizadeh 2) and Mahshid Sheikh-Nezami 1) 1) Department
More informationThe immediate post-extractional insertion of screw implants in dental practice
VARIA The immediate post-extractional insertion of screw implants in dental practice Ioan Sîrbu, Emanuel Bratu, Mihai Sandulescu, Gabriela Tanase, Ion Popovici Bucuresti, Romania Summary This article presents
More informationCase Report(s): Uncomplicated Crown Fractures
Case Report(s): Uncomplicated Crown Fractures Tooth fractures can be classified as follows: Uncomplicated crown fracture = fracture limited to the crown of the tooth with dentin exposure but no pulp exposure.
More informationAttachment S: Benefits Covered - ADULTS - AGE 21 AND OVER
Diagnostic services include the oral examinations and selected radiographs needed to assess the oral health, diagnose oral pathology and develop an adequate treatment plan for the Participant s oral health.
More informationIs The Periapical lesion a Risk For Periimplantitis? (A review)
Review Article Is The Periapical lesion a Risk For Periimplantitis? (A review) Z. Rezaei Esfahrood 1, M. Kadkhodazadeh 2, R. Amid 3, AR. Rokn 4 1 Postgraduate student, Department of Periodontics, Dental
More informationDevelop a specialist who is capable of correlation of basic sciences and clinical sciences, and challenge the requirements for certification.
Course Specification Faculty : Dentistry Department : Endodontics Program Specification: Diploma Degree A-Basic Information 1-Programme Title: Diploma in Endodontics 2-Departments (s): Endodontics 4-Coordinator:
More informationImplant Replacement of the Maxillary Central Incisor Utilizing a Modified Ceramic Abutment (Thommen SPI ART) and Ceramic Restoration
Implant Replacement of the Maxillary Central Incisor Utilizing a Modified Ceramic Abutment (Thommen SPI ART) and Ceramic Restoration ROBERT SCHNEIDER, DDS, MS* ABSTRACT The prosthetic restoration of a
More informationIMPLANT CONSENT FORM WHAT ARE DENTAL IMPLANTS?
IMPLANT CONSENT FORM WHAT ARE DENTAL IMPLANTS? Dental implants are a very successful and accepted treatment option to replace lost or missing teeth. A dental implant is essentially an artificial tooth
More informationBone augmentation procedure without wound closure
THE CREATION OF ATTACHED GINGIVA IMMEDIATELY AFTER EXTRACTION Bone augmentation procedure without wound closure One of the characteristics of wound healing after an extraction is that the alveolar process
More informationBoston College, BS in Biology 1980-1984. University of Southern California, Doctor of Dental Surgery, DDS, 1990.
CLINICAL CASE REPORT Sinus Augmentation with Immediate Implant insertion Multidisciplinary Approach to Anterior Implant Therapy Immediate Implant after Extraction of Lower Molar Tooth DR. SHERMAN LIN Boston
More informationDENTAL IMPLANT THERAPY
DENTAL IMPLANT THERAPY PATIENT WELCOME PACK Dr. Syed Abdullah BDS, MSc (Dental Implants) What are dental implants? In the early 1950s, a Swedish Scientist, Per-Ingvar Branemark observed that titanium metal
More informationWhat Dental Implants Can Do For You!
What Dental Implants Can Do For You! Putting Smiles into Motion About Implants 01. What if a Tooth is Lost and the Area is Left Untreated? 02. Do You Want to Restore Confidence in Your Appearance? 03.
More informationImproving Esthetics with Sequential Treatment Planning and Implant-Retained Dentures
Improving Esthetics with Sequential Treatment Planning and Implant-Retained Dentures by Timothy F. Kosinski, DDS, MAGD While oral function is the primary concern for most patients, the importance of esthetics
More informationTREATMENT REFUSAL FORMS
TREATMENT REFUSAL FORMS These forms are intended to be used when a patient refuses the treatment. These forms help confirm that the patient is informed and aware of the risks involved with not proceeding
More informationDisc Diffusion Susceptibility Methods
Disc Diffusion Susceptibility Methods Introduction When a filter paper disc impregnated with a chemical is placed on agar the chemical will diffuse from the disc into the agar. This diffusion will place
More informationEndodontic treatment outcome is related to treatment expectations of the operator
Endodontic Treatment Outcome: Survey of Oral Health Care Professionals Ilan Rotstein, DDS,* Robert Salehrabi, DDS,* and Jane L. Forrest, BSDH, MS, EdD Abstract This study assessed the opinion of oral health
More informationRidge Reconstruction for Implant Placement
Volume 1, No. 5 July/August 2009 The Journal of Implant & Advanced Clinical Dentistry Ridge Reconstruction for Implant Placement 2 Hours of CE Credit Oral Implications of Cancer Chemotherapy Immediate
More informationPREPARATION OF MOUTH FOR REMOVABLE PARTIAL DENTURES Dr. Mazen kanout
PREPARATION OF MOUTH FOR REMOVABLE PARTIAL DENTURES Dr. Mazen kanout Mouth preparation includes procedures in four categories: 1. Oral Surgical Preparation. 2. Conditioning of Abused and Irritated Tissue.
More informationSpedding Dental Clinic. 73 Warwick Road Carlisle CA1 1EB T: 01228 521889 www.speddingdental.co.uk
DENTAL IMPLANTS Spedding Dental Clinic 73 Warwick Road Carlisle CA1 1EB T: 01228 521889 www.speddingdental.co.uk SPEDDING DENTAL CLINIC Jack Spedding is a partner in Spedding dental clinic. He is a highly
More informationOftentimes, as implant surgeons, we are
CLINICAL AVOIDING INJURY TO THE INFERIOR ALVEOLAR NERVE BY ROUTINE USE OF INTRAOPERATIVE RADIOGRAPHS DURING IMPLANT PLACEMENT Jeffrey Burstein, DDS, MD; Chris Mastin, DMD; Bach Le, DDS, MD Injury to the
More informationEastman Dental Hospital. Dental implants - general information for patients. Department of Restorative Dentistry
Eastman Dental Hospital Dental implants - general information for patients Department of Restorative Dentistry First published: January 2004 Last review date: March 2014 Next review date: March 2016 Leafl
More informationDENTAL TRAUMA GUIDELINES
International Association of Dental Traumatology DENTAL TRAUMA GUIDELINES Revised 2012 CONTENT: Section 1. Fractures and luxations of permanent teeth Section 2. Avulsion of permanent teeth Section 3. Traumatic
More informationSECURITY LIFE INSURANCE COMPANY OF AMERICA Minnetonka, Minnesota
SECURITY LIFE INSURANCE COMPANY OF AMERICA Minnetonka, Minnesota COVERAGE SCHEDULE PREFERRED (In-Network) PROVIDER: WE WILL PAY BASED ON THE CONTRACTED FEE FOR SERVICE WITH THE PREFERRED PROVIDER ORGANIZATION
More informationPATIENT INFORM CONSENT for IMPLANT RESTORATION Rev 04.2012
PATIENT INFORM CONSENT for IMPLANT RESTORATION Rev 04.2012 Implant placement and restoration involves two major stages: surgical placement of the implant(s) followed by the restoration of the implant after
More informationReplacing Hopeless Retained Deciduous Teeth in Adults Utilizing Dental Implants: Concepts and Case Presentation
Replacing Hopeless Retained Deciduous Teeth in Adults Utilizing Dental Implants: Concepts and Case Presentation by Michael Tischler, DDS Published: Dentistry Today November 2005 Photos at end of article
More informationSchedule B Indemnity plan People First Plan Code #4084
: Calendar year deductible Waived for Type I preventive dental services Calendar year maximum Type I, II, III Waiting period Type I, II, III $50 individual $150 family (3 per family) $1,000 per covered
More informationPersistent infection in root-filled tooth: an SEM morphological analysis after apical microsurgery
ISSN: Printed version: 1806-7727 Electronic version: 1984-5685 RSBO. 2012 Oct-Dec;9(4):463-7 Case Report Article Persistent infection in root-filled tooth: an SEM morphological analysis after apical microsurgery
More informationZimmer Trabecular Metal Dental Implant
Zimmer Trabecular Metal Dental Implant TRABECULAR METAL MATERIAL: Designed to Enhance Secondary Stability Through Bone Ingrowth. Artistic Rendering osseoincorporation TRABECULAR METAL MATERIAL Designed
More informationIn many instances where a tooth is no longer
Management of the extraction socket: Site preservation prior to implant placement By Michael Danesh-Meyer, BDS, MDS (Perio) Site preservation through socket grafting will help to optimise bony fill within
More informationTABLE OF DENTAL PROCEDURES PLEASE READ THE FOLLOWING INFORMATION CAREFULLY FOR YOUR PROCEDURE FREQUENCIES AND PROVISIONS.
TABLE OF DENTAL PROCEDURES PLEASE READ THE FOLLOWING INFORMATION CAREFULLY FOR YOUR PROCEDURE FREQUENCIES AND PROVISIONS. The attached is a list of dental procedures for which benefits are payable under
More informationMEDICAID DENTAL PROGRAMS CODING, POLICY AND RELATED FEE REVISION INFORMATION
MEDICAID DENTAL PROGRAMS CODING, POLICY AND RELATED FEE REVISION INFORMATION Effective for dates of service on and after November 1, 2005, the following dental coding, policy and related fee revisions
More informationC HAPTER 4 O RAL AND M AXILLOFACIAL S URGERY
C HAPTER 4 O RAL AND M AXILLOFACIAL S URGERY I. TREATMENT PLANNING GUIDELINES As part of informed consent, the clinician should carefully explain the risks and benefits of oral and maxillofacial surgery
More informationSvea Baumgarten, Dr. med. dent., M Sc, accredited implantologist as per the criteria of the DGZI (German Association of Dental Implantology) 1
The use of ozone in dentistry a case study Svea Baumgarten, Dr. med. dent., M Sc, accredited implantologist as per the criteria of the DGZI (German Association of Dental Implantology) 1 Ozone gas is a
More informationIMMEDIATE CUSTOM IMPLANT PROVISIONALIZATION: A PROSTHETIC TECHNIQUE
IMMEDIATE CUSTOM IMPLANT PROVISIONALIZATION: A PROSTHETIC TECHNIQUE Gerard J. Lemongello, Jr, DMD* LEMONGELLO 19 5 JUNE Surgical and restorative techniques that can reduce the loss of hard and soft tissues
More informationACADEMY OF LASER DENTISTRY COMMITTEE ON REGULATORY AFFAIRS TABLE OF CONTENTS
ACADEMY OF LASER DENTISTRY COMMITTEE ON REGULATORY AFFAIRS INFORMATION PACKET FOR STATE BOARDS OF DENTISTRY May 2014 TABLE OF CONTENTS 1. Mission Statement of the Academy... 1 2. Position Statement on
More informationWhat is a dental implant?
What is a dental implant? Today, the preferred method of tooth replacement is a dental implant. They replace missing tooth roots and form a stable foundation for replacement teeth that look, feel and function
More informationMedical Microbiology Microscopic slides and media
Medical Microbiology Microscopic slides and media Head of Microbiology Department and Laboratory Medical Immunology : Janina Grzegorczyk MD, PhD, professor Implementators: Małgorzata Brauncajs MD Zbigniew
More informationTaking the Mystique out of Implant Dentistry. Dr. Michael Weinberg B.Sc., DDS, FICOI
Taking the Mystique out of Implant Dentistry Dr. Michael Weinberg B.Sc., DDS, FICOI What is Restorative Implant Dentistry? Restorative implant dentistry involves taking a few simple mechanical principles
More informationFORD DENTAL COVERAGE
FORD DENTAL COVERAGE HOW DENTAL COVERAGE WORKS The Trust provides dental coverage to you and your eligible Dependents. A Dental Benefits Manager, Delta Dental of Michigan, whose contact information is
More informationINTERNATIONAL MEDICAL COLLEGE
INTERNATIONAL MEDICAL COLLEGE Joint Degree Master Program: Implantology and Dental Surgery (M.Sc.) Basic modules: List of individual modules Basic Module 1 Basic principles of general and dental medicine
More informationAnthem Blue Dental PPO Plan
Anthem Blue Dental PPO Plan For Individuals and Families Anthem Blue Cross and Blue Shield 700 Broadway Denver, Colorado 80273 anthem.com An independent licensee of the Blue Cross and Blue Shield Association.
More informationendodontic therapy combined to photo-disinfection on patients with periapical lesion. A 6-month follows up.
Antimicrobial comparison on effectiveness of endodontic therapy and endodontic therapy combined to photo-disinfection on patients with periapical lesion. A 6-month follows up. Aguinaldo S Garcez a, Silvia
More informationTooth anatomy risk factors influencing root canal working length accessibility
Int J Oral Sci (2011) 3: 135-140. www.ijos.org.cn ORIGINAL ARTICLE Tooth anatomy risk factors influencing root canal working length accessibility Lu Tang 1,2, Tuo-qi Sun 1,2, Xiao-jie Gao 1, Xue-dong Zhou
More informationDental Benefits (866) 212-2743 A. Choice of Physician and Provider B. Scheduling Appointments C. Referrals to Specialists D. Changing Your Dentist
Dental Benefits Dental Benefits are provided through Delta Dental of California. Upon enrollment you will receive a dental provider directory that lists Delta Dental dentists participating in the Healthy
More informationIdeal treatment of the impaired
RESEARCH IMPLANTS AS ANCHORAGE IN ORTHODONTICS: ACLINICAL CASE REPORT Dale B. Herrero, DDS KEY WORDS External anchorage Pneumatized Often, in dental reconstruction, orthodontics is required for either
More informationProsthetic rehabilitation with dental implants after treatment of a keratocystic odontogenic tumor. case report
Journal section: Oral Surgery Publication Types: Case Report doi:10.4317/jced.3.e360 Prosthetic rehabilitation with dental implants after treatment of a keratocystic odontogenic tumor. case report Amila
More informationCertofix protect More certainty, more safety, more success
Certofix protect More certainty, more safety, more success Highly effective, long-term protection against catheter infection Central Venous Catheters Antimicrobial modified hydrophilic surface We help
More informationThe traumatic injuries of permanent teeth and complex therapy
The traumatic injuries of permanent teeth and complex therapy Dr. Katalin Déri Semmelweis Egyetem Department of Pedodontics and Orthodontics Risk Angle II/1 Predisposing factor: overjet insufficient lip
More informationNature of Injury. Consequences of Trauma. Repair versus Regeneration. Repair versus Regeneration. Repair versus Regeneration
Consequences of Trauma Nature of trauma Separation injury Crushing injury Early wound healing Late wound healing Nature of Injury Wound healing Control of hemmorage Establish line of defense against infection
More informationCAD/CAM technology supporting successful implant therapy
CAD/CAM technology supporting successful implant therapy Suheil M. Boutros, DDS, MS, Manuel Fricke, DT Modern implantology opens up new treatment options for individuals with only minimal or no remaining
More informationDental implants or Endodontic Therapy: A review of factors affecting treatment planning
TECHNOLOGY Dental implants or Endodontic Therapy: A review of factors Ankit Sharma, S Anil Kumar, M Venugopalan Nair* Department of Prosthodontics, Government Dental College, Kottayam, Kerala * Noor- Ul
More informationNetwork Plus Prepaid plan People First Plan Code #4004
Selecting a dentist For participating dentist information you may visit our website at www.humanadental.com/custom/fl/ or call our dedicated Customer Care number at 1-800-943-6880. Once you become enrolled
More informationEndodontics. Colleagues for Excellence. Use and Abuse of Antibiotics
Endodontics Colleagues for Excellence Winter 2012 Use and Abuse of Antibiotics Published for the Dental Professional Community by the American Association of Endodontists www.aae.org/colleagues Cover artwork:
More informationAnalysis of pulp prognosis in 603 permanent teeth with uncomplicated crown fracture with or without luxation
Dental Traumatology 2014; doi: 10.1111/edt.12099 Analysis of pulp prognosis in 603 permanent teeth with uncomplicated crown fracture with or without luxation Chao Wang, Man Qin, Yue Guan Department of
More informationRichmond Crown- A Conventional Approach for Restoration of Badly Broken Posterior Teeth
Richmond Crown- A Conventional Approach for Restoration of Badly Broken Posterior Teeth Abhinav Agarwal 1, Manish Chadha 2, D.R.V.Kumar 3, Prakash Somani 4, Preet Jain 5 Abstract: Restoration of badly
More informationRecovering Cases Using Single-Tooth Immediate Implants
Recovering Cases Using Single-Tooth Immediate Implants by Robert W. Erlach, D.D.S. Robert E. Jarvis II, D.D.S. Dr. Erlach graduated from the University of California at San Francisco School of Dentistry
More informationRESIDENT TRAINING GOALS AND OBJECTIVES STATEMENTS
RESIDENT TRAINING GOALS AND OBJECTIVES STATEMENTS Evaluation and treatment of dental emergencies Recognize, anticipate and manage emergency problems related to the oral cavity. Differentiate between those
More informationTOXIC ELEMENTS RESEARCH FOUNDATION DISCOVERS HIDDEN DANGERS WITHIN DENTAL IMPLANTS
For Immediate Release TOXIC ELEMENTS RESEARCH FOUNDATION DISCOVERS HIDDEN DANGERS WITHIN DENTAL IMPLANTS EXECUTIVE SUMMARY No one wants to lose a tooth, but if it comes to that, can patient s teeth be
More informationWhile the prosthetic rehabilitation of
Restoring Mandibular Single Teeth with the Inclusive Tooth Replacement Solution Go online for in-depth content by Bradley C. Bockhorst, DMD While the prosthetic rehabilitation of full-arch cases provides
More informationDental. Covered services and limitations module
Dental Covered services and limitations module Dental Covered Services and Limitations Module Covered Dental Services for Patients Under the Age of 21...2 Examinations...2 Radiographs and Diagnostic Imaging...2
More informationManagement of Avulsed Permanent Teeth
Management of Avulsed Permanent Teeth Dr. Zuhair Al-Khatib Traumatic injuries to the teeth are so common among any community; trauma to the face especially to the oral region occurs frequently and comprises
More informationCurrent Concepts in American Dentistry: Advances in Implantology and Oral Rehabilitation
2009 New York University College Of Dentistry Linhart Continuing Dental Education Program Presents Current Concepts in American Dentistry: Advances in Implantology and Oral Rehabilitation International
More informationB.S. in Microbiology, University of Maryland, College Park, Maryland, June, 1970.
William L Kos Associate Professor Department of Biomedical Sciences Education: B.S. in Microbiology, University of Maryland, College Park, Maryland, June, 1970. Ph.D. in Microbiology, University of Maryland,
More informationDISCOUNT DENTAL PLAN COMPLETE LISTING OF MEMBER COPAYMENTS
DISCOUNT DENTAL PLAN COMPLETE LISTING OF MEMBER COPAYMENTS 0120 PERIODIC ORAL EXAMINATION - ESTABLISHED PATIENT 20 0140 LIMITED ORAL EVALUATION - PROBLEM FOCUSED 33 0150 COMPREHENSIVE ORAL EVALUATION -
More informationPeriodontal Surgery. What Can I Expect? The word "periodontal" literally means around the tooth. Many factors, such as oral hygiene habits, genetics,
The word "periodontal" literally means around the tooth. Periodontal disease, also known as "gum disease," is a chronic bacterial infection that damages the gums and bone supporting the teeth. Left untreated,
More informationImmediate temporary restoration of single-tooth implants: Prospective clinical study
Journal section: Oral Surgery Publication Types: Research Immediate temporary restoration of single-tooth implants: Prospective clinical study Luis-Antonio Aguirre-Zorzano 1, Carlos Rodríguez-Andrés 2,
More informationEvaluation of the diffusion capacity of calcium hydroxide pastes through the dentinal tubules
Endodontics Endodontics Evaluation of the diffusion capacity of calcium hydroxide pastes through the dentinal tubules Graziela Garrido Mori (a) Fábio Cézar Ferreira (b) Fábio Roberto de Souza Batista (c)
More informationDon t Let Life Pass You By Because Of Missing Teeth
Don t Let Life Pass You By Because Of Missing Teeth Ask For Dental Implant Solutions From BIOMET 3i Scan With Your Smartphone! In order to scan QR codes, your mobile device must have a QR code reader installed.
More informationInterim Endodontic Therapy for Alveolar Socket Bone Regeneration of Infected Hopeless Teeth Prior to Implant Therapy Marwan Abou Rass, DDS, MDS, PhD*
CASE REPORT Interim Endodontic Therapy for Alveolar Socket Bone Regeneration of Infected Hopeless Teeth Prior to Implant Therapy Marwan Abou Rass, DDS, MDS, PhD* The immediate placement of implants in
More information