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intro to implant dentistry > Dental implants in medically compromised patient > Flashcards

Dental implants in medically compromised patient Flashcards

1
Q

Implant surgery is a _____ procedure

A

elective

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2
Q

_____ should be performed for appropriate control of the disease processes

A

medical consultation

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3
Q

What potentially causes failure of dental implant from healing:

A

poorly controlled disease process

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4
Q

What poses a surgical or medical risk at the time of surgery:

A

controlled disease process

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5
Q

Disorder of glucose metabolism:

A

DM

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6
Q

Hyperglycemia has a negative effect on:

A

bone metabolism

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7
Q

Diabetic osteopathy reduces: (2)

A
  1. bone mineral density
  2. bone mechanical properties
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8
Q

Diabetic osteopathy increases:

A
  1. risk of fracture
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9
Q

Diabetic osteopathy impairs: (3)

A
  1. endochondrial bone formation
  2. intramembranouse bone formation
  3. mircoarchitectural quality
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10
Q

Hyperglycemia may lead to severe complications including:

A
  1. macro/micro angiopathy
  2. neuropathy
  3. increased risk of infections
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11
Q

Current literatures support the use of dental implants in diabetic patients with:

A

GOOD metabolic glucose control

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12
Q

A comparable survival rates (85.5 -100%) were reported on dental implants placed in diabetic patient with:

A

good/fair metabolic control

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13
Q

_____ glycemic control is highly recommended BEFORE AND AFTER dental implant treatment

A

STRICT

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14
Q

What is an ideal HbA1c value for dental implants:

What is an acceptable HbA1c value for dental implants:

A

less than or equal to 7% (ideal)

less than or equal to 8% (acceptable)

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15
Q

Other co-morbidities that need to be addressed prior to implant placement include:

A
  1. proper oral hygiene
  2. cessation of tobacco
  3. treatment of periodontitis
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16
Q

A pre-operative strategy to reduce the potential risk of infections includes considering:

A
  1. antibiotics
  2. antiseptic moutwashes
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17
Q

What antibiotics may be used pre-operatively to reduce risk of infections with implant placement?

A
  1. PCN
  2. amoxicillin
  3. clindamycin
  4. metronidazole
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18
Q

What antiseptic mouthwash may be pre-operatively to reduce risk of infections with implant placement?

A

Peridex (Chlorhexidine)

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19
Q

T/F: You can still place implants if the patients DM status is uncontrolled

A

FALSE- NO implants until controlled status

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20
Q

-generalized reduction in bone density and alterations in the microstructure of bone
-increased risk of fractures
-54 million US adults older than 50 affected

A

osteoporosis

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21
Q

T/F: There is not enough evidence to consider osteoporosis as an absolute contraindication for implant placement

A

True

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22
Q

If your patient has osteoporosis and wants implants what should be done prior to decision if they are candidate?

A

Careful evaluation of bone mineral density through DEXA/DXA (bone densitometry) scan

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23
Q

In osteoporosis patient there may be an increased risk of complications in:

A

bone augmentation

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24
Q

The use of dental implants with modified ____ may be preferred for use in patients with osteoporosis

A

hydrophilic surfaces

25
Q

Patients with osteoporosis requires longer healing period for:

A

osseointegration

26
Q

What is NOT recommended for patients with osteoporosis in regards to dental implant placement?

A

NO immediate loading

27
Q

Accounts for 6% of all malignancies in the US:

A

Head & neck cancer

28
Q

60-80% of patients affected by head and neck cancer undergo:

A

radiation therapy

29
Q

Early effects of irradiation for head & neck cancer include damage to:

A
  1. salivary glands
  2. skin
  3. oral mucosa
30
Q

Late effects of irradiation for head & neck cancer include:

A
  1. bone changes
  2. demineralization
  3. fibrosis
  4. avascular necrosis
31
Q

What is the ultimate risk of the late effects of irradiation for head & neck cancer?

A

Osteoradionecrosis

32
Q

ORN:

A

Osteoradionecrosis

33
Q

A serious complication of head & neck radiation that induces vascular insufficiency rather than infection:

A

Osteoradionecrosis (ORN)

34
Q

The three H’s involved in ORN:

A
  1. Hypocellular
  2. Hypovascular
  3. Hypoxia
35
Q

ORN poses the risk for:

A

non-healing wound and dead bone

36
Q

With a radiation dose of greater than or equal to 55 Gy there is a significantly:

A

decreased implant survical rate

37
Q

With radiation there is a better implant survival rate in the ____ than the ____

A

mandible (93.3%); maxilla (78.9%)

38
Q

T/F: Radiotherapy does NOT affect implant outcomes

A

False- radiotherapy does affect implant outcomes

(an increased risk of implant failure in irradiated patients)

39
Q

In patients who are planned to undergo radiotherapy place the implants at least ____ prior to or atleast _____ after irradiation treatment is recommended

A

3 weeks prior
9 months after

40
Q

Contraindications to placing implants involving radiation therapy:

A
  1. DURING radiation treatment
  2. when patient has irradiation induced mucositis
41
Q

Current evidence found the HIGHER RISK of ONJ in the following situations: (3)

A
  1. intravenous bisphosphenates
  2. prolonged duration
  3. posterior areas after implant placements
42
Q

T/F: Cancer patients treated with IV bisphosphonates are contraindicated for implant placement

A

true

43
Q

T/F: Oral bisphosphonates are considered a contraindication for implant placement

A

false- oral BPs are okay

44
Q

List there inherited bleeding disorders:

A
  1. Von Willebrand disease
  2. Hemophilia A
  3. Hemophilia B
45
Q

T/F: inherited bleeding disorders may increase the risk of hemorrhage during implant surgery however are NOT a contraindication for implant survival/success

A

True

46
Q

What is the minimum level of the deficient coagulation factor before implant surgery?

A

Minimum level of 50%

47
Q

What procedures should be avoided in bleeding-risk individuals?

A

advance implant surgical procedures (direct sinus lift & bone graft harvest procedures)

48
Q

The patients who are taking _____ drugs are at a higher disk hemorrhage during implant surgery

A

anticoagulants or antiplatelet drugs

49
Q

Short half-life (12 hour) anti platelet medications such as _____ & ____ should be stopped _____ before the implant procedure

A

Pradaxa & Xarelto ; 1 day

50
Q

Longer half life (20-60 hours) anti platelet medications such as ____ pose a risk of the patient developing a ____

A

Coumadin; thromboembolic episode

51
Q

An INR of _____ is a contraindication to implant surgery

A

greater than 3-3.5

52
Q

A platelet count of ____ is a contraindication to implant surgery

A

less than 50k

53
Q

HIV infection, organ transplantation and Crohn’s disease are all examples of:

A

immunodeficiency disorders

54
Q

In HIV-positive patients, dental implant treatment can be rendered only when: (2)

A
  1. CD4 cell count rates are high
  2. patient is on antiretroviral treatment
55
Q

What lab values should be checked prior to implant placement in HIV-positive patients?

A
  1. CD4 cells
  2. ANC
  3. PLTs
56
Q

What is the strongest predictor of HIV progression?

A

number of CD4 T lymphocytes

57
Q

T/F: Immuno-incompetence is NOT a contraindication

A

true

58
Q
A

intro to implant dentistry (8 decks)

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