Implant Surgery

Contents

Preface: Implant Surgery xiii

Harry Dym

Medically Complex Dental Implant Patients: Controversies About Systemic Disease

and Dental Implant Success/Survival 1
Leslie R. Halpern and David R. Adams
Advances in dental implant therapy have created choices to enhance the
expectations of dental practitioners and their patients with respect to oral
rehabilitation at any age after childhood and regardless of, in most cases,
medical disabilities. The medical status of the patient however can signif-
icantly influence the success rate of dental implant therapy. This article ap-
plies the hierarchy of scientific evidence ranging from case reports,
retrospective, prospective cohort investigations, systematic reviews, and
meta-analyses criteria in order to determine whether dental implant place-
ment in medically compromised patients yields any detrimental sequelae.

Placement of Short Implants: A Viable Alternative? 21

David Sheen and Levon Nikoyan
The placement of short implants, which measure less than 10 mm in
length, requires the practitioner to have a thorough comprehension of
implant dentistry to achieve acceptable results. Innovation of the rough-
surface implant and the progression of the implant-abutment interface
from an external hex to an internal connection have considerably influ-
enced the longevity of short implants. Dentists are better equipped to
serve their patients because the utilization of short implants may preclude
the need for advanced surgical bone-grafting procedures.

How to Avoid Life-Threatening Complications Associated with Implant Surgery 33

Earl Clarkson, Eunsu Jung, and Spencer Lin
Life-threatening complications of dental implant surgery are rare, but
include hematoma/hemorrhage of the floor of the mouth, aspiration, and
ingestion. Prevention of lethal hemorrhagic complications stem from
knowledge of anatomic structures and precise surgical planning. Preven-
tion of aspiration and ingestion can be improved by simple techniques
while understanding clinical settings and factors that put patients at higher
risk. In the event of these potential lethal situations, early recognition of
signs and symptoms along with immediate action followed by transfer to
an emergency department is often necessary.

An Update on the Treatment of Periimplantitis 43

Raza A. Hussain, Michael Miloro, and Jennifer B. Cohen
As implant placement increases within all dental specialties, it is expected
that the number of suboptimal results will increase, as well. The goal of this
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article is to provide clinicians with an outline of the management of periim-

plantitis cases, ranging from simple to complex. It will review signs and
symptoms, diagnosis, case selection, and armamentarium. In addition,
this chapter will discuss basic techniques which can be utilized at various
stages to salvage the compromised implant.

Soft Tissue Injury in Preparation for Implants 57

Earl Clarkson, Monica Hanna, and Guillermo Puig
Diagnosis and treatment planning are critical in preparation for implant
placement. Adequate evaluation, preoperative imaging, and surgical plan-
ning minimize early and late-stage soft tissue injuries. Correct placement
of dental implants can be challenging with several contributing factors
such as lack of proper preoperative soft tissue evaluation and surgical
experience in dealing with soft tissue incisions and flap reflection, resulting
in injury and complications involving the soft tissues.

Guided Implant Surgery: A Technique Whose Time Has Come 67

Peter Chen and Levon Nikoyan
Guides used in dental implant surgery add accuracy and an overall pre-
dictability. Successful guided implant workflow depends on 3-dimensional
image acquisition and precise medical model fabrication. The contempo-
rary process blends acquired images to existing dentition to create
implant-specific precise guides. We discuss the overall process, types
of guides, and complications to expect during surgery.

Implant Material Sciences 81

Allen Glied and Junaid Mundiya
In the past, the only way to replace missing teeth was to have a removable
appliance. However, these days, dental implants are commonly being
used to replace missing teeth. The dental implants are improving as a
result of new technological and scientific advances. Different materials
have been used in the past for dental implants such as lead, stainless steel,
and gold. Currently, the focus is on using Roxolid, surface-modified tita-
nium implants, and zirconia. These materials have superior esthetic and
functional characteristics for dental implants.

Immediate Implants 89
Raymond Fan, Harvey A. Quinton, Marvin B. Golberg, and Jason E. Portnof
Immediate implants have become a popular option for replacing teeth.
This article describes the surgical and restorative considerations involved
in the planning and placement of an immediate implant. Immediate im-
plants require appropriate hard and soft tissue assessment. Virtual plan-
ning can help assist in planning of immediate implants. Radiographic
and computed tomographic guidance can help in establishing the relation-
ship between the planned implant to the hard tissue and anatomic struc-
tures. This article discusses a technique in fabrication of the immediate
provisional and final restoration.
 Contents ix

Vertical and Horizontal Augmentation of Deficient Maxilla and Mandible for

Implant Placement 103
Amanda Andre and Orrett E. Ogle
Ridge augmentation for implant procedures has been shown to be highly
successful. There are several techniques available to the dentist, but they
require some degree of surgical expertise and experience. No particular
technique has been shown to be superior. This article presents the indica-
tions, techniques, and complications of the various procedures for alveolar
ridge augmentation. This information will educate the general dental prac-
titioner of the techniques available and provide information on the surgical
procedures that could be used to discuss with patients when they are be-
ing referred to a specialist.

Implant Surgery Update for the General Practitioner: Dealing with Common
Postimplant Surgery Complications 125
Rinil Patel and Earl Clarkson
It is essential for practitioners who place dental implants to be able to di-
agnose and treat common complications or know when to refer to a
specialist. Common complications can include nerve injuries, infections,
sinus membrane perforations, and edema. This article discusses these
complications, incidence rates, tips to avoid common complications,
and management options when a patient returns with a complication.

Prosthodontic Principles in Dental Implantology: Adjustments in a Coronavirus

Disease-19 Pandemic-Battered Economy 135
Ricardo A. Boyce
More patients are requesting fixed prosthesis to replace missing teeth.
More than 5 million dental implants are placed annually in the United
States. This number will decrease in 2020 owing to the coronavirus
disease-19 pandemic. The edentulous patient has a decreased quality of
life. Prosthodontic rehabilitation/reconstruction of edentulism improves
overall quality of life. Patient-reported outcome measures are subjective
reports of patients’ perceptions of their oral health status and the impact
that it has on their quality of life. This chapter contains a variety of prostho-
dontic principles for the reader to help satisfy the needs and expectations
of the patient.

Maxillofacial Bone Grafting Materials: 2021 Update 167

Nabil Moussa, Yijiao Fan, and Harry Dym
For successful outcomes in bone grafting, it is important to have a clear
and detailed understanding of the fundamentals and basics in regenerative
science. This article summarize the grafting materials and growth factors
that are now in use to provide an improved understanding of the properties
of each material and indications for subsequent use. The article gives an
overview of the fundamentals of bone healing, including the physiology
of regeneration. It is hoped that clinicians can make improved decisions
that are based in literature when considering treatment options for
restoring patients’ functional dentition.
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Update on Maxillary Sinus Augmentation 197

Natasha Bhalla and Harry Dym
Implant stability is critical to implant success, and the amount of available
bone is vital to achieving that end. Because of low-lying maxillary sinuses,
adequate alveolar height on the posterior maxilla is often lacking in many
patients in need of implant replacement. This chapter reviews both the
traditional lateral sinus lift maxillary approach to achieve vertical augmen-
tation as well as the transcrestal osteotome intraoral approach. A discus-
sion of osseodensification will also be mentioned as an alternative
approach.

All-on-4 Concept Update 211

Michael H. Chan and Yoav A. Nudell
Over the past 17 years, the All-on-4 treatment concept has been a reliable
and predictable modality to rehabilitate edentulous jaws with immediate
function as full-arch prostheses. This article highlights clinically relevant
data compiled by numerous All-on-4 investigators including complications
and their remedies, occlusion and cantilever trends, implant size utiliza-
tion, and controversial topics. We provide insights for navigating the com-
plexities of medically diverse populations, faced by our daily practice, with
a focus on patient avoidance, risk factors for implant and prosthetic fail-
ures, in hopes to minimize complications so clinicians would choose this
treatment with confidence.

Zygomatic Implants: A Solution for the Atrophic Maxilla: 2021 Update 229
Jonathan Rosenstein and Harry Dym
Restoring the dentition of an edentulous patient is often challenging. Endo-
sseous dental implants have allowed for far more versatility in this area but
still require adequate maxillary and mandibular alveolar bone. Often, un-
less significant bone grafting techniques are used, true restoration of the
dentition can be impossible with traditional endosseous implants. The
advent of zygomatic implants, however, may provide a viable, predictable,
and stable alternative for the restoration of the dentition in patients with se-
vere maxillary alveolar bone loss.