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Surgical Articles

Importance of soft tissue in interdisciplinary cases: A case study involving orthodontics, periodontics, dental implants by Delia Tuttle, DDS

Importance of soft tissue in interdisciplinary cases: A case study involving orthodontics, periodontics, dental implants

The importance of keratinized soft tissue around both dental implants and natural teeth has been demonstrated in the literature to support effective home care, prevent sensitivity and tissue breakdown, as well as aid in esthetic value. Unfortunately, clinical exams can often overlook the need for soft-tissue enhancement until the patient becomes symptomatic and/or desires esthetic improvement. Soft-tissue augmentation prior to orthodontic treatment, prosthodontic treatment, and implant therapy can be of tremendous benefit to ensure a long-term, successful result. This case study highlights the use of soft-tissue augmentation prior to orthodontic and implant therapy to enhance the zone of keratinized tissue, increase root coverage, and improve esthetics.

Perio-Implant Advisory ‘JOMI Clinical Pearls’: Discussions on zirconia versus titanium implants, peri-implantitis, and dental implant geometry by Joan Pi-Anfruns, DMD

Perio-Implant Advisory JOMI Clinical Pearls: Discussions on zirconia versus titanium implants, peri-implantitis, and dental implant geometry

Dr. Joan Pi-Anfruns authors this JOMI Clinical Pearls column in Perio-Implant Advisory, where he discusses three articles from The International Journal of Oral and Maxillofacial Implants (JOMI)—the official journal of the Academy of Osseointegration (AO)—as reviewed by a member of the Academy’s Young Clinicians Committee (YCC). Topics cover zirconia versus titanium implants, peri-implantitis, and dental implant geometry.

Establishing hemostasis post-extraction by Gregg A. Jacob, DMD, FAACMFS

Establishing hemostasis post-extraction

Dr. Gregg Jacob, an oral and maxillofacial surgeon in New York, says, “One of the most common clinical scenarios that I am faced with in daily dental practice is the management of patients who have alterations to their coagulation.” Here, he shares his insight and valuable advice on how to handle patients who present with various medical issues and who have risks to consider.

Restorative Articles

Perio-Implant Advisory ‘JOMI Clinical Pearls’: Discussions on zirconia versus titanium implants, peri-implantitis, and dental implant geometry by Joan Pi-Anfruns, DMD

Perio-Implant Advisory JOMI Clinical Pearls: Discussions on zirconia versus titanium implants, peri-implantitis, and dental implant geometry

Dr. Joan Pi-Anfruns authors this JOMI Clinical Pearls column in Perio-Implant Advisory, where he discusses three articles from The International Journal of Oral and Maxillofacial Implants (JOMI)—the official journal of the Academy of Osseointegration (AO)—as reviewed by a member of the Academy’s Young Clinicians Committee (YCC). Topics cover zirconia versus titanium implants, peri-implantitis, and dental implant geometry.

Step-by-step procedure to simplified and efficient root canal techniques by Peter Mann, DDS, FICOI, FAGD

Step-by-step procedure to simplified and efficient root canal techniques

Manhattan dentist Dr. Peter Mann says, “There are many dentists I’ve met who are great and efficient at performing root canals daily in their practices. However, many more dentists shy away from performing root canals, refer out all molar cases, and don’t see the procedure as being profitable for their practices at all. I’m a general dentist, and root canals are one of the procedures I enjoy performing the most. Root canals have become a predictable and efficient part of my practice. Let me explain.”

This month’s clinical tip from the editor: ‘The implant you put in my mouth is now bleeding; what should I do?’ by Scott Froum, DDS

This month's clinical tip from the editor: 'The implant you put in my mouth is now bleeding; what should I do?'

A dreaded phone call that every dental office involved in dental implant therapy may encounter is when a patient calls and says, “Hey Doc, the implant you put in my mouth a few days (or months or years) ago started to bleed.” Most often patients will claim that the problem started “out of the blue” and they tried rinsing their mouths with various medicaments all to no avail. Perio-Implant Advisory Editorial Director Scott Froum, DDS, shares his advice and gives the top five reasons why implant restorations can bleed in his clinical tip of the month.

Legal and Financial

Getting your dental implant patient to say ‘yes’ to periodontal therapy by Dennis Wang, DDS

Getting your dental implant patient to say 'yes' to periodontal therapy

One of the most challenging issues with implant patients is proper dental implant maintenance. Lack of proper implant maintenance can lead to peri-implantitis, which, in turn, can lead to failure of the prosthesis altogether. Dr. David Wang suggests ways you can get patients to recognize the value of periodontal therapy, which will, in turn, encourage them to accept recommended treatment.


Getting paid for signing an agreement not to compete: The ‘garden leave’ alternative by Evan Miles Goldberg

Getting paid for signing an agreement not to compete: The 'garden leave' alternative

The information-based economy has yielded to increased job mobility. Modern dentists—like modern professionals in general—are unlikely to spend their career with a single practice or firm. As a result, there has been an upsurge in noncompete agreements, otherwise known as “covenants-not-to-compete,” found in employment agreements. Evan Miles Goldberg explains how dentists can negotiate a device into their employment contracts called the “garden leave” agreement that stems from a British tradition.

Turbocharging your retirement using a cash balance plan by Stephen M. Lippman

Turbocharging your retirement using a cash balance plan

Recent US tax rate increases have made it harder to save for retirement, just when below-average expected returns and increased longevity have underscored the need to do so. Many dentists deal with this issue by maxing out their defined-contribution plans, such as 401(k) and profit-sharing plans. But such plans have limits on their contributions, and some investors have both the ability and desire to save more. Enter cash balance defined-benefit plans, which offer predetermined annual benefits in combination with individual account balances. The maximum annual contributions to these plans far exceed the maximum for defined-contribution plans, and they tend to be excellent vehicles for dental practices, where the ratio of staff to owners is less than 10 to one.

Hygiene Articles

A guideline for clinical practice: The search for a successful adjunctive periodontal therapy by R. Bruce Cochrane, DDS

A guideline for clinical practice: The search for a successful adjunctive periodontal therapy

In July 2015, the Journal of the American Dental Association published an “Evidence-based clinical practice guideline on the nonsurgical treatment of chronic periodontitis by means of scaling and root planing with or without adjuncts.” Dr. R. Bruce Cochrane says, “The problem for all practitioners is that the guidelines offer only a limited evaluation of adjunctive care.” In this article, he explains the protocol he uses that helps him achieve his goal of solid teeth, little to no bleeding, minimal pocket depth, and happier and healthier patients.

10 steps to perform an oral cancer screening by Scott Froum, DDS

10 steps to perform an oral cancer screening

Squamous cell carcinoma of the oral cavity and throat account for about 45,000 cases each year in the United States, resulting in approximately 8,000 deaths per year. Studies show that successful treatment is highly dependent upon diagnosis and treatment of this disease in its early stages. Although there have been advances in surgical, chemotherapy, and radiation treatment, five-year survival rates of patients with moderate to advanced cases of oral cancer are less than 60%. Patients who do survive typically have trouble chewing, speaking, eating, and smiling after treatment thus it is extremely important to diagnose OC before it becomes advanced, since treatment for early cancer is not as severe. Editorial Director Dr. Scott Froum offers steps to use as you screen patients in your office.

Increasing dental case acceptance through the use of salivary diagnostics by Michael A. Scialabba, DDS

Increasing dental case acceptance through the use of salivary diagnostics

A tremendous amount of literature supports the correlations between gingivitis and/or periodontitis and systemic health. Reports and research continue to find correlations between inflammation of the oral cavity and other inflammatory disease processes, especially cardiovascular disease and diabetes. Educating patients about these links and encouraging oral health awareness has always been a challenge. Dr. Michael Scialabba talks about how salivary testing along with personalized custom periodontal therapy can be a tool to help patients improve not only their oral health but also their overall health.

A chairside resource for the entire dental team

Perio-Implant Advisory focuses on issues relating to periodontal and implant medicine.

Editorial Director Scott Froum, DDS, brings an unbiased clinical and academic perspective to the world of implants, periodontics, restorative, and practice management dentistry. Articles cover complex care with interdisciplinary management, but the emphasis is on periodontal and implant-related issues. The intent is to make Perio-Implant Advisory a chairside resource for the entire dental team.

Our e-newsletter is distributed monthly on the third Thursday of the month. Subscribe here.

We appreciate your support and readership!

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Scott Froum, DDS, editorial director
   

   

 

Clinical Tips from the Editor

So you shot a lion and you are public enemy No. 1: Now what do you do? by Scott Froum, DDS

So you shot a lion and you are public enemy No. 1: Now what do you do?

During the summer of 2015, Dr. Walter Palmer, a dentist from Bloomington, Minnesota, sparked both national and international outrage when he killed a lion in Zimbabwe named Cecil. This tragic event led to a public outcry calling for Dr. Palmer’s dental license to be revoked, forced the closing of his office for more than a month, led to death threats against him and his family, and a barrage of negative reviews against his private and professional life. This event raises the question of what steps a person (in this case, a dentist) who relies on public sentiment should take when a negative event occurs in order to “mitigate a crisis.” In his clinical tip of the month, Perio-Implant Advisory Editorial Director Dr. Scott Froum lists some key elements of post-crisis management that must not be ignored, according to Matthew Berritt, a New York City-based publicity executive and director of the Lifestyle Division at EVINS Communications.

how much do you guarantee a dental implant for?

'If I choose the dental implant option, how long do you guarantee it?'

This question can be a tough balancing act for the dentist being that you do not want to give patients false expectations, but at the same time, you do not want to have your patients forgo treatment they need or go to another dental office. Perio-Implant Advisory’s Editorial Director Dr. Scott Froum posed this question to 100 different dentists of varying years in practice, in various locations throughout the United States, of those who place dental implants. Here is a sample of responses from some of the leaders in the dental implant industry.

anxious girl - Dreamstime.com

It's 10 p.m.; do you know where your patient's hemostasis is?

If you are a dentist who performs surgical treatment, such as extractions and/or implant therapy, a dreaded phone call can be from your emergency service regarding a patient you treated earlier in the day who now has uncontrollable bleeding. This is of greater concern if the patient has a medical history that warrants anticoagulation medication and the physician did not let your patient go off medication prior to surgery. Dr. Scott Froum, editorial director of Perio-Implant Advisory, introduces the feature article on hemostasis that will help you answer pertinent questions prior to surgery.

Editor's Picks

Surgically Facilitated Orthodontic Therapy (SFOT): Maximizing case outcome by Michael E. Curry, DDS, and Richard D. Roblee, DDS, MS

Surgically Facilitated Orthodontic Therapy (SFOT): Maximizing case outcome

Modern science is making disruptive advancements in medicine and dentistry. In dentistry specifically, Surgically Facilitated Orthodontic Therapy (SFOT) is an advanced procedure that pinpoints the underlying problems of insufficient alveolar bone and compromised arch forms to optimally enhance functional and esthetic concerns. A major advantage to patients is that SFOT can significantly decrease the amount of treatment time by more than 50% and then, combined with clear aligner therapy, can increase case acceptance. Michael E. Curry, DDS, and Richard D. Roblee, DDS, MS, present a case in which SFOT was used with a high-tech clear aligner to address hard- and soft-tissue deficiencies and severe maxillary and mandibular arch constriction.

Localized aggressive periodontitis: All-On-4 oral rehabilitation case report by Alphonse Gargiulo, DDS, MS; Rachel Degen, RDH; and Mark Val, CDT

Localized aggressive periodontitis: All-On-4 oral rehabilitation case report

Alphonse Gargiulo, DDS, MS, Rachel Degen, RDH, and Mark Val, CDT, present a case report of a 20-year-old African American female who was diagnosed at puberty with localized aggressive periodontitis, which developed into a generalized form of the disease as the patient entered late adolescence. The authors show how the All-On-4 procedure was used to restore the patient’s confidence and enthusiasm about living her life without dental complications.

Etiology, prevention, and treatment of screw loosening and fracture by Andrew Mackie, BDS, DClinDent, MFGDP, RCS, MRACDS

Etiology, prevention, and treatment of screw loosening and fracture

Prosthodontist Andrew Mackie, BDS, DClinDent, from New Zealand explains the etiology, prevention, and treatment of loose screws and screw fracture of dental implants. He explains often-misunderstood, important concepts such as the physics and technique.

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Team Treatment Planning Articles

Nonsurgical endodontic retreatment with the aid of cone beam (CBCT) imaging by Brian McCormack, DDS

Nonsurgical endodontic retreatment with the aid of cone beam (CBCT) imaging

Endodontic therapy under current treatment protocol shows long-term clinical success rates of 86% to 92%. Even with the high clinical success rate of initial endodontic treatment, it’s obvious to see this leaves clinicians with a 14% incidence (on the high side) of encountering post-treatment disease. Dr. Brian McCormack presents a case that was treated with the aid of CBCT imaging and a surgical operating microscope. 

Are you screening for sleep apnea when treatment planning occlusal guards? by Iman Sadri, DDS

Are you screening for sleep apnea when treatment planning occlusal guards?

There has been much buzz recently about the dentist’s role in the treatment of obstructive sleep apnea (OSA). Most of the attention has centered around oral appliance therapy as a treatment modality to replace the CPAP in the absence of severe OSA. Dr. Iman Sadri says, “Treatment planning an occlusal guard to treat the bruxism that is a result of OSA is not addressing the source of the pathology. If left untreated, sleep apnea can lead to significant health problems in patients.”

 

sedation chart for Dr. Bertrand Bonnick and Hayden Piersol arrticle

Sedation patients are not your average patients: How they leave the dental practice

There is no denying that many patients face dental anxiety and severe dental phobia. Millions of Americans avoid seeing the dentist due to some level of dental fear. No matter how minor the fear, some patients will attempt to avoid any contact with the dentist, even if that means sacrificing their oral health. Dr. Bertrand Bonnick and Hayden Piersol noticed a trend in their dental office and decided to conduct a survey to find out why sedation patients were leaving their office.

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Complications Articles

peri-implant bone loss

Understanding and managing peri-implant bone loss

Although a high survival rate of implants has been documented in numerous long-term studies, peri-implant bone loss presents a problem that can compromise—or even result in the loss of—a successful dental implant restoration. Dr. Stuart J. Froum offers an in-depth look at how the dental professional can diagnose and prevent bone loss, and maintain a successful implant restoration.

Don't use permanent cement for implants by Chris Salierno, DDS

For the love of everything holy, don't use permanent cement for implants

Whether you prefer screw-retention or cement retention, I think we can all agree that the ability to retrieve the restoration is very important. If there is a fracture of restorative material, such as porcelain or acrylic, then it’s nice to be able to remove the thing and have the lab fix it. I would also urge you to consider how certain contours of the prosthesis can hinder hygienic access, so periodically removing some restorations can significantly aid peri-implant maintenance procedures. But when it comes down to the bitter end, let’s all make a pact together: no more permanent cement for implant restorations.

pumpkin on a toothpick by Stacey Simmons, DDS

Pumpkin on a toothpick

Should mini implants be used for crown and bridge restorations on implants? Dr. Stacey Simmons shares a case study and discusses why these clinical situations should probably be left to regular diameter implants.