Dental Implantology- What to know before going for it? What ware the Companies Manufacturing Implants? Is my Case Suitable for Implants? What is the Success Rate of Implants? How will Implant Treatment change the way I look, talk and my personality?

Dental Implants- A Patients Guide

Dental Implants, as the name suggests is a Small Metal Implant placed inside your Bone to act as artificial root for your artificial tooth.

Our human tooth is a great piece of engineering. It bears all the chewing forces, which is around 100kgs. That is when we chew we exert a pressure equal to 100kg between our teeth. Tooth is made of four layers, the Outermost is Enamel, second to Enamel is Dentin and the innermost is soft part called as Pulp. There is a sub-structure Cementum that comprises root part of tooth.

Enamel the Outermost White part of tooth that we see is the Hardest structure in our body. It has 90% Calcium whereas the stiffest bone has around 60% Calcium. So by this we can imagine how hard our tooth is from outside. Enamel has no life.

Dentine is 63% Calcium, yellow in colour and second most hard structure in our body. Actually often people complain of yellowness of their teeth, it is not due to staining but due to exposure of Dentine caused by very hard brush and wrong brushing technique. Dentine is partly live and partly dead. 

Pulp is soft part and living part of tooth. We experience pain and hot&cold sensitivity because of this living part. When we do RCT (Root Canal Treatment) we actually remove this living part. 

Root of our tooth has all these three components and a fourth component that is Cementum. Cementum is similar to bone and may be at places even softer than bone. Cementum is also Yellow in colour and when our gums recedes downwards causing exposure of cementum. Cementum when exposed also causes hot and cold sensitivity.

Coming back to our core topic of discussion, i.e. Implants, implant mimics our natural tooth. It has a Root part and a Crown part. Theoretically implant is only the Root Component whereas the Crown Portion is called as Abutment.

Picture 1

Picture 2

 Picture 1 shows Implant whereas Picture 2 ( sorry for blurr image) shows the Implant loaded with Abutment and Tooth. 

FAQ's

1. How to know whether i am a fit candidate for Implant Treatment or not?

Ans. Any person desiring of getting Implant should be:

1. Medically fit.

2. No signs of Diabetes, and if present should have sufficient history of it being under control.

3. No signs of Hypertension and if present then the Blood Pressure readings before surgery should be below: 150/95 mm Hg

4. No recent history of any Cardiac problem and/or surgery.

5. No recent history of any Thyroid problem.

6. No recent history of any Blood disease like Thalassemia, Leukemia, etc.

7. No recent history of any Infectious disease.

2. How to decide how many implants do i need?

Ans. Rule is simple:

1. Each Molar should be replaced with  One Implant each.

2. Rest all other teeth can be restored using simple rule that the total number of implants supporting the teeth should have equal or more surface area than the teeth being supported on them.

3. Full Mouth Fixed Prosthesis requires how many Implants?

Ans. Greater the number better it is. But 6 Implants for Upper Prosthesis and 5 Implants for Lower Prosthesis.

4. What are the various Companies manufacturing Implants and which one is the Best?

Ans. There are several companies. 

Dentsply Ankylos

Noble Biocare

Leader Italia

MIS

BOI

etc.

It will be unfair to call any company as best, because all are awesome systems. 

Noble Biocare are oldest people manufacturing Implants and have a very great Brand Value. 

Whereas Dentsply Friadent Ankylos is leading implant system and relatively the most advanced one as well. The specially tapered design of Ankylos makes it the most preferred and sturdy implant. Ankylos stands out as an implant system.

Leader Italia is relatively newer system but equally good. This is a very economical system and you will find most dental surgeons in colleges doing this as this is relatively easier to learn and practice.

MIS is a second system which is equivalent to Leader Italia, a bit costlier than Leader though.

BOI is revolutionary system, and the best. But it has certain limitations and being a very radical implant, it is not common. Very few doctors are doing BOI.

5. What is the cost of Implant?

Ans. Normally Each Implant costs varies with the company. Ankylos Costs Rs.25,000 ($500) to 35,000 ($700) each. Leader costs Rs.14000 ($280) whereas MIS around Rs.20000($400) each. Noble Biocare is costliest with costs around $750+. 

6. What tests should be done for Implant surgery?

Ans. CT, BT, Hb, TLC, DLC, BP and Sugar. and any other case specific test.

7. What is most common problem with Implants?

Ans. Loosening of Implant is most common problem associated with Implant system. Every person having an implant at least once has encountered this problem. Recently two companies have introduced Implants with Morse Taper Design which drastically reduces the chances of loosening.

Dentsply Implant and Leader Implus Implants have unique Morse effect, which prevents loosening of the Implant at any point during its life.

So, what is Morse Effect?

The screw with self-locking

tapered head

The screw with self-locking

tapered head is different from the

traditional screw because of the

tapered design of one of its part.

Moreover, the abutment has a

seat with the same tapering in the

hole for the connection screw. The

taper of the cones is 5° 

Inserting with pressure an element with a tapered external surface in a corresponding female element that has a hole with an identical tapered design, the friction between the two tapered surfaces, combined with the push created by the insertion force that presses them together, locks the male cone in the female one. This locking remains and keeps itself efficient also when the insertion force applied ceases. This is the "Morse" effect.

The locking force, which is proportional to the insertion force, prevents the male cone from being extracted from the female one, whether trying to rotate it or by applying an axial push.

A suitable tapering of the cones guarantees such "locking" that will become a safe and natural engaging system for the screw that connects the abutment to the implant.

Keep Reading this Section for More.

Dr. Aman Singh

MClinDent Endodontics

B.D.S. 

On Panel: Lead Medical, New York, USA

                  Share Care, Chicago, USA

                  Lambdon School Dental Project, New Zealand

Member of Netherland Dental Association

Member of Kenyan Dental Association

Member of Indian Dental Association

Reach me at: www.odontos.in

                        www.facebook.com/odontosdh

                        Tweet @odontosindia

DRUG INTERACTIONS IN DENTISTRY- ODONTOS DENTAl HOSPITAL

DRUG INTERACTIONS IN

DENTISTRY

INDEX

 Pages-

1-2                             Introduction & definition

3                                Antibiotics, Antifungals, antiinfectives

4-7                            Antibiotics/oral contraceptives;antibiotics-   

                                                                             enzyme induction                      

                                                                                                          

7-8                           Antibiotics/Cationic agents

9 -13                       LA & vasoconstrictor interactions

14                           Drugs causing P450 enzyme induction

15-16                     Opioid analgesic interactions

17-18                     Serotonin Syndrome

19-21                    NSAID interactions

22                          References & Conclusion

DEFINITION-

Drug interaction may be defined as a measurable modification (in magnitude and/or duration) of the action of one drug by prior or concomitant administration of another substance, including prescription, non-prescription drugs, food, alcohol, cigarette smoking or diagnostic tests.

The mechanism of drug-drug interactions can be categorized

    into 5 major areas:

Ø Additive or synergistic pharmacological responses

Ø Antagonistic pharmacological responses

Ø Incompatibility

Ø Common pharmacokinetic pathways

Ø Altered defense mechanism of the host

Ø ADDITIVE OR SYNERGISTIC PHARMACOLOGICAL RESPONSE

EXAMPLE:

    When opioid analgesics such as hydrocodine or oxycodine are prescribed for pain and phenothiazine anti-emetics such as promethazine are prescribed for nausea, each causes sedation and will have an additive effect of potentially excessive sedation.

                                                    1                                              

Ø ANTAGONISTIC PHARMACOLOGICAL RESPONSE

 EXAMPLE:

    Patients treated for attention deficit disorder may be more difficult to sedate with benzodiazepines such as midazolam because of the stimulant effects of psychostimulants

Ø INCOMPATIBILITY

 EXAMPLE:

•         When the antibiotic vancomycin is administered parenterally through the same intravenous line either before or after the antibiotic ceftazidime, a cephalosporin, a precipitate will be formed which may occlude the line. Thus to avoid this ceftazidime should be administered first and the intravenous line should be flushed before administering vancomycin.

•         Tetracycline antibiotics such as doxycycline form insoluble complexes called chelates with divalent cations, such as calcium or magnesium. Therefore, if doxycycline is taken with milk, other dairy products or antacids, a chelate will form and doxycycline will not be absorbed in the GIT but will be excreted. To avoid this tetracyclines should not be administered within 2 hrs of calcium sources.

                                                      2

Ø COMMON PHARMACOKINETIC PATHWAY

  EXAMPLE:

  The drug probenecid was designed to occupy the tubular secretion site for organic acids in the kidney. By administering probenecid to a patient, their kidneys did not tubularly secrete other organic acids such as penicillins, prolonging the length of time that the penicillin stayed in the body.

    ( this drug interaction was utilized to preserve the small supplies   of penicillin antibiotics when treating the wounded during          World War II) 

ANTIBIOTICS, ANTIFUNGALS AND OTHER ANTI-INFECTIVE AGENTS

Antibiotic prophylaxis before treatment for periodontal patients is required in following cases:

Ø Patients at risk of developing endocarditis

Ø Patients with prosthetic cardiac valve

Ø Congenital heart disease

Ø Orthopedic joint replacement

Ø Patients who have received an organ transplant

                                                        3

ANTIBIOTICS 

                    &

           

                 ORAL CONTRACEPTIVES

Mechanism of interaction:

  

  The mechanism in this interaction involves the enterohepatic recycling of the conjugated estrogen excreted in the bile, reactivated by the gastrointestinal flora and reabsorbed as active drug. Because today’s oral contraceptives are low-dose or very low-dose estrogen products, it is theorised that even small decreases in estrogen absorption could render the pill ineffective.

Table: Inhibition of cytochrome P450 enzymes by antibiotics, antifungals

and anti-infectives which increase interacting drug effects

                                              

                                                     4

                                                                                        5

kz

                                                                          6       

Ø The macrolide antibiotic azithromycin does not inhibit hepatic enzymes and is a safe alternative in patients taking these interacting medications.

Ø  Nystatin may be used as an alternative antifungal for mild oral fungal infections in patients who are not immunocompromised, but true therapeutic alternatives do not exist for treatment with azole anti-fungals.

Ø Metronidazole is used to treat the anaerobic component of oral infection with penicillin treating the aerobic component, clindamycin may be used alone as an alternative to treat those mixed infections.

Ø ANTIBIOTICS Vs CATIONIC AGENTS

Ø Several agents can substantially reduce the absorption of fluoroquinolones and tetracyclines thereby causing treatment failure.

Ø Divalent cations (calcium and magnesium) and trivalent cations (aluminum and ferrous sulfate) can form insoluble complexes in the gut if they are taken concurrently with fluoroquinolones thus reducing absorption of fluoroquinolones and tetracyclines by 60-75%.

Ø To avoid this, the fluoroquinolone/tetracycline and cation product should be administered at least two hours apart (preferably four hours apart).

Ø Common products containing divalent or trivalent cations are listed in Table .

                                                               7

TABLE
Common Products Containing Divalent or Trivalent Cations

Aluminum	Alu-Cap, AlternaGel, Amphojel, Basaljel
Aluminum and magnesium combinations	Gelusil, Maalox, Mylanta, Riopan
Calcium	Caltrate, Citracal, Os-Cal, PhosLo, Titralac, Tums
Iron	Feosol, Fergon, Niferex, Nu-Iron, Slow Fe
Magnesium	Almora, Citrate of Magnesia, Mag-Ox 400, Milk of Magnesia, Slow-Mag, Uro-Mag

                                                                      8

LOCAL ANESTHETICS

   The most common time for an emergent or adverse event to occur in a dental office is around the time of the administration of the local anesthetic. Local anesthetics carpules used in dentistry frequently contain a vasoconstrictor in addition to the local anesthetic. The presence of vasoconstrictor provide the greater source for potential drug-drug interactions than does the local anesthetic.

VASOCONSTRICTOR

The vasoconstrictor is present to localise the injection to the site of administration and to decrease bleeding in the area. The two vasoconstrictors commonly used in dentistry are epinephrine and levonordefrin.

Ø Epinephrine stimulates both alpha and beta (both beta-1 and beta-2) adrenergic receptors equally(50/50)

Ø Levonordefrin stimulates alpha receptors 3 times more than beta-1 receptors(75/25).

Good Oral Hygiene Plays Role in Overall Healthly body

Dentist in Harlem agrees with the American Academy of Periodontology and other dental professionals that the public needs to be informed and educated about studies that link oral inflammation and infections to problems elsewhere in the body. Research shows that there is a connection between periodontal disease and other chronic conditions, such as diabetes, cardiovascular disease, and Alzheimer's.

A recent study found clear associations between bacteria infections of the mouth and pancreatic cancer. Dentists believe that treating periodontal inflammation - such as gingivitis or gum disease - can also help with the management of other conditions. Oral hygiene and maintaining oral health is critical to overall well-being.

The new study published in the journal, Gut, is revealing. Subjects with high antibody levels of the more infectious periodontal bacteria strains were at twice the risk for developing pancreatic cancer, which is responsible for 40,000 deaths a year in the United States. On the other hand, those with high levels of antibodies of some type of harmless oral bacteria had 45% less risk of getting pancreatic cancer.

If you suspect, or have been diagnosed, with an inflammatory condition, it is critical that you see both a general physician and a dental health professional, such as your NYC dentist. Signs of gum disease or gingivitis, include bleeding gums, mouth sores, swollen gums, and gums that are tender to the touch or have a shiny appearance. Sometimes the only way to find out if you have an infection is to have a thorough dental evaluation. An evaluation may be critically important if you have the following:

    High risk for periodontal disease
    Have heart disease, diabetes, respiratory disease, osteoporosis, or are thinking about getting pregnant.
    Have a family member with periodontal disease (research suggests that the bacteria that causes periodontal disease can be passed through saliva).
    Have a sore or irritation in the mouth that lasts longer than two weeks.

Dentists have known for a long time that there is a correlation between oral bacteria and systemic diseases. Although studies are still ongoing, the public needs to be educated on the issue in order to take preventive measures. Brushing and flossing regularly, eating a healthy diet, and visiting your NYC dentist on a regular basis is vital. Regular checkups, not only keep your mouth healthy, but can catch early signs of problems.

Not smoking is also a good preventive measure. Tobacco users are six times more likely to develop gum disease. They also have more serious gum disease that doesn't respond to treatment and can lead to tooth loss.

Dentists agree - and the public needs to know - that an unhealthy mouth is linked to other serious diseases. Taking care of your teeth can keep the rest of the body healthy and vibrant. Preventive care is critical to maintaining healthy teeth and a healthy body.
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Dental Problems and Solutions

When you think about dental health, your focus is likely to be on preventingcavities in your teeth. But it's important to pay attention to your gums, too. Your gums play a major role not only in your dental health, but in your overall well-being.

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In many instances, swollen and bleeding gums are a sign of gum disease. But there are a number of other factors that could be causing your gum problems. Whatever the cause of your sore, painful gums, there are steps you can take to minimize gum damage and discomfort.

Causes of Sore, Swollen, and Bleeding Gums: Improper Brushing Technique

In your quest to keep your teeth clean, you might be tempted to brush your teeth as vigorously as you can. Your gums are made of sensitive tissue, though, so brushing the wrong way could damage them.

Whether you opt for a manual or electric toothbrush, choose one with soft nylon bristles that have blunted ends. Even though you can find brushes with medium or hard bristles, they may damage the enamel on your teeth or cause red and swollen gums.

When you brush, make sure you use gentle, circular motions to massage and clean the teeth and gums. While many people use a back-and-forth motion, this motion can actually irritate and damage your gums, making them sore and more likely to bleed or recede.

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Causes of Sore, Swollen, and Bleeding Gums: Improper Flossing Technique

We all know the importance of flossing every day to help remove plaque from places where your toothbrush cannot reach. To make sure that your healthy habit isn't causing swollen or bleeding gums, be gentle when you floss. Rather than forcing the floss between your teeth, carefully slide it up and down, following the curve of each tooth.

Causes of Sore, Swollen, and Bleeding Gums: Gum Disease

More than three-quarters of American adults over the age of 35 suffer from periodontal (gum) disease. While most people with gum disease have the less severe form, called gingivitis, between 5% and 15% of the population has a much more serious type of gum disease known as periodontitis.

When people do not practice proper dental hygiene, bacteria in the mouth form plaque on the teeth. These bacteria may cause your gums to become inflamed, which results in red, swollen, or bleeding gums. For many people with gingivitis, this inflammation is not painful. If you catch gingivitis early, it can be reversed and healed with proper oral hygiene. But left untreated, gingivitis can worsen and ultimately lead to tooth loss. Be sure to seek medical attention if you have the following symptoms, even if you are not experiencing any discomfort:

• changes in the way teeth fit together on biting, or in the fit of partialdentures
• formation of deep pockets between teeth and gums
• gums that bleed during and after toothbrushing
• loose or shifting teeth
• persistent bad breath or bad taste in the mouth
• receding gums
• red, swollen, or tender gums

When gingivitis progresses, it develops into periodontitis, a condition in which the gums and bones that hold the teeth in place can be severely compromised. The bacteria on the teeth release toxic substances that harm your gums and cause them to become infected. The infection and the inflammation that result when your body attacks the bacteria can degrade your gums and the bones in your jaw. You may experience exceptionally swollen, painful gums that are likely to bleed. If not treated, periodontitis can lead to tooth loss.

Causes of Sore, Swollen, and Bleeding Gums: Canker Sores

Common culprits behind painful gums arecanker sores, or mouth ulcers. These painful sores can develop anywhere inside the mouth, including on the gums, and they often have a whitish center with red around the edges. You may experience one canker sore at a time, making only one area on your gums sore, or you may have multiple sores at the same time throughout your mouth.

While researchers don't know exactly what causes canker sores, and they're not contagious, there may be bacterial or viral involvement. People with certain autoimmune diseases may also be more likely to suffer gum problems caused by canker sores. Canker sores often recur over time.
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Causes of Sore, Swollen, and Bleeding Gums: Chemotherapy

Chemotherapy can have a number of unpleasant side effects, including painful, swollen, and bleeding gums. Many people undergoing treatment forcancer suffer from stomatitis, which causes the development of painful sores and ulcers on the gums and throughout the mouth.

Causes of Sore, Swollen, and Bleeding Gums: Tobacco Products

Using cigarettes and other tobacco products can be extremely damaging to your gums, and people who smoke are far more likely to develop gum disease. You may find that your smoking habit gives you a number of gum problems from sensitive gums that bleed to painful sores.

Causes of Sore, Swollen, and Bleeding Gums: Hormonal Changes

Some women find that they experience gum problems during puberty,menstruation, pregnancy, and menopause. The increase in hormones during puberty can heighten blood flow to the gums, making them red, swollen, and sensitive. For women with menstrual gingivitis, the gums become red, swollen, and more likely to bleed shortly before each menstrual period. These problems typically subside after the period begins. Pregnancy gingivitis typically starts in the second or third month of pregnancy and continues through the eighth month, causing sore, swollen, and bleeding gums. The use of oral birth control products may cause similar gum problems. Though uncommon, some women going through menopause may find that their gums become extremely dry and therefore sore and likely to bleed.

- Dr Aman Singh,
M.S. Endodontics
B.D.S. , M.A.D.A., M.I.D.A., M.A.N.T., M.K.D.A.
Ex. National Dental College and Hospital, Chandigarh
For any dental consultation contact: 9988446478, dr.aman@aol.in


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