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Implant Dentistry > Dental Implants in the Medically Compromised PT. > Flashcards

Dental Implants in the Medically Compromised PT. Flashcards

1
Q

When should the following questions be considered? :

Is there any relative or absolute contraindication for dental implant surgery in this patient for medical reasons?

Does the patient have any medical condition or take any medications that jeopardizes the normal osseointegration and healing of the implant surgery ?

A

Initial Consult

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2
Q

Implant surgery is an______ procedure

A

elective

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3
Q

______ ______ for appropriate control of the disease process

A

Medical consultation

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4
Q

What does the acronym MRONJ mean?

A

Medication Related Osteonecrosis of the Jaws

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5
Q
  • Diabetes Mellitus
  • Osteoporosis
  • Head and Neck Cancer irradiation
  • Patients at risk for developing MRONJ (Medication Related Osteonecrosis of the Jaws)
  • Congenital Bleeding disorders - - Patients on Oral anticoagulants/Antiplatelet Medication
  • Cardiovascular diseases -Corticosteroids - —
  • Immunocompromised Patients - -Neuro-Psychiatric Disorders
A

Medically Compromised Patients Commonly Seen In The Dental Office

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6
Q
  • Disorder of glucose metabolism
  • Two major type
  • Type I: Insulin-dependent - Type II: Non-insulin-dependent (95%)
  • New cases: 1.4 million are diagnosed per year
  • Increases with age – 90% over 45 y/o
A

DiabetesMellitus

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7
Q
  • Its global prevalence was estimated to be 2.8% in 2000 and is expected to rise to 4.4% in 2030 - 25% end stage renal disease - Leading cause of blindness - 7th leading cause of death
A

DiabetesMellitus

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8
Q

Hyperglycemia has a negative effect on bone metabolism

What is that called?

A

Diabetic osteopathy

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9
Q

________ may lead to severe complications

Macro/micro angiopathy, neuropathy, increased risk of infections

A

Hyperglycemia

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10
Q

t/f: Current literatures support the use of dental implants in diabetic patientswith good metabolic glucose control

A

true

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11
Q

t/f: Strict glycemic control dental implant treatment is highly recommended before and after

A

true

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12
Q

A comparable survival rates ____%-____%were reported on dental
implants placed in diabetic patients with good/fair metabolic control.

A

(85.5 to 100%)

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13
Q
  • Prepared by both dentist and endocrinologist - Monitor blood glucose levels
  • current level and improvement - Preoperative HbA1c value
  • ≤ 7% is ideal; ≤ 8% is acceptable - Others: co-morbidities, restoration of proper oral hygiene, cessation of tobacco, treatment of periodontitis
A

Preoperative Management of Diabetes Mellitus

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14
Q

Preoperative HbA1c value

- ≤__% is ideal;

A

7%

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15
Q

Preoperative HbA1c value

≤ _% is acceptable

A

≤ 8%

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16
Q

_______ _____With a diabetes pt.

  • To reduce the potential risk of infections
  • Consider antibiotics and antiseptic mouthwashes
  • Antibiotics: penicillin, amoxicillin, clindamycin or metronidazole - Antiseptic mouthwashes: Peridex (Chlorhexidine)
  • Reinforce supportive therapy/maintenance systems
A

Preoperative Management

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17
Q

t/f: uncontrolled DM:
NO IMPLANTS until it’s under controlled
Conventional solutions could be good alternative options
Removable dentures OR bridges as fixed prosthesis

A

true

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18
Q
  • Generalized reduction in bone density and alterations in the microstructure of bone
A

Osteoporosis

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19
Q

t/f: - Not enough evidence to consider osteoporosis as an absolute contraindication for implant placement

A

true

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20
Q

________ may increase risk of complications in bone augmentation

A

osteoporosis

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21
Q

t/f: Use of dental implants with modified, hydrophilic surfaces improves success rate in Osteoporosis pt.

A

true

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22
Q

t/f: - Immediate loading of the dental implants is not recommended

A

true

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23
Q

_____ & ______ ________
- Account for 6 percent of all malignancies in the US - Surgery and radiation therapy
- 60-80% patients affected by head and neck cancer
have radiation therapy

A

Head and neck cancer

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24
Q

What areas are impacted by the early effects of Irradiation of Head and Neck Cancer?

A

Salivary glands, skin, oral mucosa

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25
Q

Late effects of Head & Neck Cancer Irradiation

A

Bone changes, demineralization, fibrosis, avascular necrosis

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26
Q
  • One serious complication of head & neck radiation - Induce vascular insufficiency rather than infection
  • Hypocellular, hypovascular and hypoxia
  • Non healing wound and dead bone - Mandible or site with radiation ≥ 6500 Rads/65Gy
A

Osteoradionecrosis

ORN

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27
Q

t/f: “Radiation dose ≥ 55 Gy significantly decreased implant survival.”

A

true

28
Q

t/f:

“Better implant survival rate in the mandible (93.3%) than the maxilla (78.9%)”

A

true

29
Q

t/f: “An increased implant failure risk (RR 2.74) in irradiated patients”

A

true

30
Q

t/f: In patients who are planned to undergoing radiotherapy, place the implants at least 3 weeks (21 days) prior to or at least 9 months after irradiation treatment is recommended

A

true

31
Q

t/f: If a pt has irradiation induced mucositis it is a contradiction of dental implants

A

true

32
Q
  • Antibiotic prophylaxis and strict surgical sepsis. - Render Hyperbaric Oxygen Treatment (HBOT) when the total irradiation dose is ≥ 50 Grays. - Avoid immediate loading and use implant supported prosthesis without mucosal contact
A

preoperative Management of Irradiated pts.

33
Q

Interfere with bone turnover at the dental implant interface Increase the risk of developing osteonecrosis of the jaws (ONJ)

A

MRONJ

Medication Related Osteonecrosis of the Jaws

34
Q

Current evidence found the higher risk of ONJ for the following situations: (3)

A
  • Intravenous BP
  • Prolonged duration
  • Posterior areas after implant placement
35
Q

t/f: Cancer patients treated with intravenous BP are contraindicated for implant placement

A

true

36
Q

are oral Bisphosphonates a contraindication for implants?

A
  • Oral BP are not considered a contraindication
  • In patients taking oral BP for ≤ 5 years, neither the
    short term (1-4 years) implant survival nor the risk of
    ONJ seem to be increased.
37
Q

A ___ ___ has limited evidence in preoperative management of MRONJ:

A

drug holiday

38
Q
  • Discontinue BP 2 months before and 3 months after surgery for ≥ 4
    years in patients taking BP alone or associated with corticosteroids/
    anti-angiogenic medication
A

drug holiday

39
Q

The following are examples of _____ ______:

  • Inherited bleeding disorders
  • Von Willebrand Disease
  • Hemophilia A and Hemophila B - Medication associated bleeding disorders
  • Oral anticoagulants
  • Antiplatelet Medication
A

bleeding disorders

40
Q

t/f: - Inherited bleeding disorder may increase the risk of hemorrhage during implant surgery. - Not a contraindication for implant survival/success

A

true

41
Q

a minimum level of __% Assessment and augmentation of the deficient coagulation factor before surgery if necessary

A

50%

42
Q

Operative Management of ____ ______:

  • Use local anesthesia with vasoconstrictor (slow injection technique and fine needles) - Use appropriate suturing technique - Use local hemostatic measures to achieve hemostasis
  • Use anti-fibrinolytic agents (5% tranexamic
    mouthwash) during surgery and up to 7 days post-
    surgery
A

Bleeding Disorder

43
Q

______ _______ of Bleeding disorder pts. :

  • Reduce the risk of the infection
    -Use topical antiseptics (chlorhexidine mouthwashes)
    or antibiotics - Reduce the risk of postoperative bleeding
  • Discuss the use of non-steroidal anti-inflammatory
    medications for pain management with the physician
A

post operative

44
Q

t/f: The patients who are currently taking oral anticoagulants or antiplatelet drugs are at higher risk of hemorrhage during implant surgery

A

true

45
Q
  • Short half life (12hrs)
  • Examples: Pradaxa and Xarelto
  • Stopped 1 day before the Implant procedure - Longer half life (20-60hrs)
  • Examples: Coumadin
  • Risk at developing a thromboembolic episode
A

Anticoagulants and Antiplatelet medication

46
Q

Consult the physciain before stopping ____ ___ _______ medications

A

Anticoagulants and Antiplatelet medication

47
Q

t/f: Medical interactions increase the anticoagulant effect of Coumadin:
- Antibiotics: amoxicillin, erythromycin,
metronidazole, clarithromycin, ciprofloxacin
- Analgesics: NSAID

A

true

48
Q

INR >3-3.5 (contraindication for Implant)??

A

true

49
Q

Platelet count

A

<50,000/mm3

50
Q

For HIV pts:

Dental implant treatment can be rendered only when……

A
  • The CD4 cell count rates are high

- The patient is on antiretroviral treatment

51
Q

For HIV + pts, what labs values must be check before surgery?

A
  • CD4 ell count
  • Absolute neutrophil count (ANC)
  • Platelet count
52
Q

if a pt has Less than 500/mm³ neutrophil granulocytes present in the blood it is considered a ____ risk of infection

A

severe

53
Q

if a pt has More than 1500/mm³ neutrophil granulocytes present in the blood it is considered a ____ risk of infection

A

normal risk of infection

54
Q

t/f: - Successful dental implant therapy has been reported in patients receiving organ transplantation (mainly liver and kidney) with long-term cyclosporin therapy

A

true

55
Q

Characterized by the presence of several antibody‐ antigen complexes, leading to autoimmune inflammatory processes in many parts of the body

A

Crohn’s Disease

56
Q

t/f: “Crohn’s disease showed a significant effect on early
implant failure and resulted in increased, however not
significant, implant loss.”

A

true

57
Q

t/f: -Immuno-incompetence is not an contraindication

  • Appropriate medical consultation
  • Assess the degree of immuno-compromise
  • Reduce risk of infections by rendering antibiotic
    prophylaxis/antiseptic mouthwashes
A

true

58
Q

true or false:
- NOT suitable to place dental implants

  • Significant immunosuppression cases
  • Eg. Total White Blood Cell count <1,500-3,000/mcL
    (Normal: 3,500-10,500/mcL)
A

true

59
Q
  • Exerts a negative feedback control on the HPA axis
  • Suppress corticotropin
    releasing hormone(CRH) then
    corticotropin(ACTH) secretion
  • Adrenal atropy and loss of
    cortisol secretory capability - Reduce bone density, increase epithelial fragility and immunosuppression - Adrenal Crisis
A

Long Term Effects of Corticosteroids

60
Q

t/f: use of systemic glucocorticod might compromise dental implant oseointegration and peri-implant healing.

A

true

61
Q

Does dental Implant failure rate and/or surgical morbidity increase in patients under systemic corticosteroids?

A

NO

No evidence in literature that have been demonstrated it.

62
Q

t/f; - For dental implant surgery, take regular steroid dose
prior to the surgical procedure “No need to double
the dose of steroids”

A

true

63
Q

t/f: No evidence that cardiac disorders are contraindicated - Consider other issues

  • The occurrence of bleeding (Hypertension)
  • Cardiac ischemia (Coronary artery disease)
A

true

64
Q

the following are steps in ____ _____ _____:

  • Supplemental oxygen
  • Sedation
  • Effective local anesthesia with aspiration (limit epinephrine use)
  • Minimize duration of appointment - - - Position semi-supine
A

stress reduction protocol

65
Q

With cardiac disorders, Only Emergency procedures if MI is within ____ months

A

2 months

66
Q

It is important to consider the following for pts with ____ ______.

  • Poor oral hygiene
  • Oral parafunctions
  • Harmful habits
  • Behavioral problems
A

Neuropsychiatric disorders

Implant Dentistry (14 decks)

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