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Intro to Implants > Dental implants in Medically Compromised Patient > Flashcards

Dental implants in Medically Compromised Patient Flashcards

1
Q

Implant surgery is an ____ procedure

A

elective

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2
Q

_____ should be performed for appropriate control of the disease process

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

risk of fracture

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9
Q

Diabetic osteopathy impairs: (3)

A
  1. encochondral bone formation
  2. intramembranous bone formation
  3. micro architectural quality
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10
Q

Hyperglycemia may lead to severe complication 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 patients with:

A

good/fair metabolic control

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13
Q

_____ glycemic control is highly recommended BEFORE & 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 8% = acceptable

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15
Q

Other co-morbities 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 mouthwashes
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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 mouth wash my be pre-operatively to reduce risk of infection with implant placement?

A

Peridex (chlorhexidine)

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19
Q

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

A

False- No implants until controlled

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20
Q
  • Generalized reduction in bone density and alterations in the microstructure of bone
  • increased risk of fractures
  • 54 million U.S. 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 patients their 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 osteoporosis patients

A

hydrophilic surfaces

25
Q

Osteoporosis patients require a longer healing period for:

A

osseointegratoni

26
Q

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

A

NO immediate loading

27
Q

Accounts for 6% of all malignancies in the U.S

A

Head and 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 and neck cancer include damage to:

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

Late effects of irradiation for head and 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 and 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 3 H’s involved in ORN:

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

ORN poses the risk for:

A

non-healing wound & dead bone

36
Q

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

A

decreased implant survival rate

37
Q

With radiation, their 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 affects implant outcomes

39
Q

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

A

3 weeks prior; 9 months after

40
Q

Contraindication 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:

A
  1. Intravenous bisphosphonates
  2. Prolonged duration
  3. Posterior areas after implant placement
42
Q

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

A

True

43
Q

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

A

False- Oral BPs are fine

44
Q

List three 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 minimum level of the deficiency coagulation factor before implant surgery?

A

minimum level of 50%

47
Q

What procedures should be avoided in bleeding risk individuals

A

Advanced implant surgical procedures (direct sinus lift and bone graft harvest procedures)

48
Q

The patients who are taking ____ drugs are at a higher risk of hemorrhage during implant surgery

A

anticoagulants or antiplatelet drugs

49
Q

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

A

Pradaxa & Xarelto; 1 day

50
Q

Longer half life (20-60hrs) antiplatelet 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 Chron’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. Pt is on antiretroviral treatment
55
Q

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

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

What is the strongest predictor of HIV progression?

A

of CD4 T-lymphocytes

57
Q

T/F: Immuno-incompetence is NOT a contraindication

A

True

58
Q
A

Intro to Implants (8 decks)

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