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Surgical Articles

bone graft, socket debridement, mechanical debridement, postextraction treatment - Scott Froum, DDS

Postextraction treatment: Did your bone graft fail, or did you fail your bone graft?

Patients who are about to undergo dental treatment, especially surgery, will often inquire as to the success rate of the procedure to be performed. When we look at the etiology of poor bone fill or bone-graft integration postextraction, many factors can influence the outcome, including medical history, medications, social factors, etc. Perio-Implant Advisory’s Editorial Director Scott Froum, DDS, says there are also iatrogenic factors, including sterility of the procedure, surgical technique, and—one of the most important and often-overlooked factors—complete debridement of the postextraction socket.

Have infection, will travel: Paving the path to dental implant failure by Scott Froum, DDS - dental implants - pathology - dental infection

Have infection, will travel: Paving the path to dental implant failure

Why did this dental implant fail? You did everything right during your implant treatment. You properly diagnosed and treatment planned the patient’s implant therapy. The implant was surgically placed in a prosthetically driven orientation. You (or the restorative dentist) placed the abutment and crown on the implant with the correct contours, perfect fit, and (if not screw retained) without excess cement. The patient adhered to the follow-up appointments and had good oral hygiene. Follow-up visits showed good bone levels around the implant . . . and then one day there was implant infection and loss of integration. In his clinical tip, Perio-Implant Advisory’s Editorial Director Scott Froum, DDS, talks about one huge oversight that—if detected early and treated properly—is highly preventable and can change the entire outcome of your case.

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.

Restorative Articles

malpositioned dental implants, Steven Pigliacelli, CDT, MDT - dental implant prosthetics

Correcting malpositioned dental implants: Where do we go from here?

An unfortunate occurrence in dental implant prosthetics is malpositioned implant placement. Steven Pigliacelli, CDT, MDT, offers insight into the various restorative options available as well as their drawbacks. He says, “The team concept of oral surgeon, restoring dentist, and lab technicians is most crucial at the planning stages rather than the final restoration stage. By using scans and implant placement software, we can preplan the final restoration and carry out our plan with no late surprises to the patient or restoring doctor as far as lab fees or final esthetics.”

surgical guides for ridge augmentation, dental implant restoration, Peter Mann, DDS, FICOI, FAGD

A cost-effective method of creating a dental implant surgical guide for ridge augmentation

Peter Mann, DDS, FICOI, FAGD, says, “Building the ideal ridge form via hard- and soft-tissue ridge augmentation makes ideal implant placement possible. However, creating surgical guides for ridge augmentation—even though it is just as important as implant surgical guides—is not usual practice.” Study his step-by-step technique that describes a cost-effective, easy-to-manufacture surgical guide for ridge augmentation that you can easily implement into your practice.

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.

Dental Practice Management Articles

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

Antibiotic resistance and periodontitis by Duane C. Keller, DMD, FAGD - antibiotic resistance, periodontitis, periodontal disease, wound care

Antibiotic resistance and periodontitis

Bacteria dividing every 20 minutes can form more than 5,000 billion, billion bacteria in 24 hours, and this number of divisions fosters the possibility of mutations, some of which can enable the bacteria to produce enzymes that inactivate antibiotics while other mutations protect the bacteria from the antibiotic—for example, modifying the entry point on the bacteria. The New York Times recently reported on infectious bacteria resistant to all antibiotics, and the CDC has long raised awareness that antibiotic resistance is a danger, calling it the “public health’s ticking time bomb.” Duane C. Keller, DMD, FAGD, details how antibiotic resistance acts in the sulcus, making treatment of periodontitis extremely difficult, and talks about what you can do to overcome the challenges.

oral-systemic, periodontal disease, salivary diagnostic testing, salivary diagnostics

Oral-systemic links and tests we never thought about

Oral-systemic interconnections—typically understood to mean the impact of periodontal disease and periodontal pathogens on a variety of systemic diseases and conditions—have been studied intensely for generations. The consensus is that they are now accepted in both the dental and medical professions, although the strength of the various relationships is still being investigated. An equally impactful oral-systemic link that has quietly proceeded largely unnoticed by many dental professionals is the use of saliva to detect the presence of an incredible number of diseases and conditions by evaluation of biomarkers of disease. Richard H. Nagelberg, DDS, discusses the advancements in salivary diagnostic testing and explains how the effects of this technology on health care and the dental profession in particular will be profound.

Perio Protect Perio Trays, periodontal disease, dental implants, salivary diagnostics

Improving traditional nonsurgical methods for peri-implant disease: A new adjunctive therapy

Peri-implant disease is an increasingly common challenge with multiple nonsurgical and surgical treatment options. The pathogens that cause periodontal disease can be hard to manage between office visits due to the recolonization of bacteria after surgical or hygiene procedures. One adjunct to treatment that can help with nonsurgical periodontal and dental implant procedures as well as improve home care is tray delivery of hydrogen peroxide gel. Jeffrey N. Goldstein, DMD, presents a case example of how prescription trays were used to reduce diseased tissue around dental implants and teeth to avoid more invasive surgery.

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!

  Contact the Editor
 
 

Scott Froum, DDS, editorial director
   

   

 

Clinical Tips from the Editor

medication-induced bleeding, anticoagulant medications, vitamins and supplements, herbal supplements

Medication-induced bleeding when your patient 'doesn't take any medication'

It is estimated that $28 billion per year is spent on herbal medications and supplements, and more than 29,000 different types of these medications exist. It is, therefore, safe to say that many patients you encounter will be taking or will have taken over-the-counter (OTC) medications. Patients often do not consider this type of vitamin and/or herbal supplementation to count when you ask, “Are you currently taking any medication?” Unfortunately, treating dentists and patients are not always familiar with all of these OTC herbal medications and supplements and their effects on hemostasis. Perio-Implant Advisory Editorial Director Scott Froum, DDS, lists his top five medications in this category in terms of popularity of patients’ use, explains their anticoagulation effects, and discusses what you can do to ensure that they don’t wreak havoc on your dental treatment plans.

bone graft, socket debridement, mechanical debridement, postextraction treatment - Scott Froum, DDS

Postextraction treatment: Did your bone graft fail, or did you fail your bone graft?

Patients who are about to undergo dental treatment, especially surgery, will often inquire as to the success rate of the procedure to be performed. When we look at the etiology of poor bone fill or bone-graft integration postextraction, many factors can influence the outcome, including medical history, medications, social factors, etc. Perio-Implant Advisory’s Editorial Director Scott Froum, DDS, says there are also iatrogenic factors, including sterility of the procedure, surgical technique, and—one of the most important and often-overlooked factors—complete debridement of the postextraction socket.

Have infection, will travel: Paving the path to dental implant failure by Scott Froum, DDS - dental implants - pathology - dental infection

Have infection, will travel: Paving the path to dental implant failure

Why did this dental implant fail? You did everything right during your implant treatment. You properly diagnosed and treatment planned the patient’s implant therapy. The implant was surgically placed in a prosthetically driven orientation. You (or the restorative dentist) placed the abutment and crown on the implant with the correct contours, perfect fit, and (if not screw retained) without excess cement. The patient adhered to the follow-up appointments and had good oral hygiene. Follow-up visits showed good bone levels around the implant . . . and then one day there was implant infection and loss of integration. In his clinical tip, Perio-Implant Advisory’s Editorial Director Scott Froum, DDS, talks about one huge oversight that—if detected early and treated properly—is highly preventable and can change the entire outcome of your case.

Editor's Picks

antidepressants - nutraceuticals - oral-systemic health - dental implants - periodontal health

Antidepressant medications and nutraceuticals: Effects on the success of dental implants

Kevin Oberlander, RPh, says, “As a pharmacist working closely with the dental profession, I read with great interest the recent pilot study conducted by the University of Buffalo that brings to light fresh concerns over the adverse effects in dental implant patients taking antidepressants.” In this article, he discusses research concerning the value of supplementing with nutraceuticals—specifically Vitamin D and magnesium—for patients with dental implants who are taking medications that cause deficiencies affecting bone health.

malpositioned dental implants, Steven Pigliacelli, CDT, MDT - dental implant prosthetics

Correcting malpositioned dental implants: Where do we go from here?

An unfortunate occurrence in dental implant prosthetics is malpositioned implant placement. Steven Pigliacelli, CDT, MDT, offers insight into the various restorative options available as well as their drawbacks. He says, “The team concept of oral surgeon, restoring dentist, and lab technicians is most crucial at the planning stages rather than the final restoration stage. By using scans and implant placement software, we can preplan the final restoration and carry out our plan with no late surprises to the patient or restoring doctor as far as lab fees or final esthetics.”

surgical guides for ridge augmentation, dental implant restoration, Peter Mann, DDS, FICOI, FAGD

A cost-effective method of creating a dental implant surgical guide for ridge augmentation

Peter Mann, DDS, FICOI, FAGD, says, “Building the ideal ridge form via hard- and soft-tissue ridge augmentation makes ideal implant placement possible. However, creating surgical guides for ridge augmentation—even though it is just as important as implant surgical guides—is not usual practice.” Study his step-by-step technique that describes a cost-effective, easy-to-manufacture surgical guide for ridge augmentation that you can easily implement into your practice.

Oral-Systemic Articles

medication-induced bleeding, anticoagulant medications, vitamins and supplements, herbal supplements

Medication-induced bleeding when your patient 'doesn't take any medication'

It is estimated that $28 billion per year is spent on herbal medications and supplements, and more than 29,000 different types of these medications exist. It is, therefore, safe to say that many patients you encounter will be taking or will have taken over-the-counter (OTC) medications. Patients often do not consider this type of vitamin and/or herbal supplementation to count when you ask, “Are you currently taking any medication?” Unfortunately, treating dentists and patients are not always familiar with all of these OTC herbal medications and supplements and their effects on hemostasis. Perio-Implant Advisory Editorial Director Scott Froum, DDS, lists his top five medications in this category in terms of popularity of patients’ use, explains their anticoagulation effects, and discusses what you can do to ensure that they don’t wreak havoc on your dental treatment plans.

Antibiotic resistance and periodontitis by Duane C. Keller, DMD, FAGD - antibiotic resistance, periodontitis, periodontal disease, wound care

Antibiotic resistance and periodontitis

Bacteria dividing every 20 minutes can form more than 5,000 billion, billion bacteria in 24 hours, and this number of divisions fosters the possibility of mutations, some of which can enable the bacteria to produce enzymes that inactivate antibiotics while other mutations protect the bacteria from the antibiotic—for example, modifying the entry point on the bacteria. The New York Times recently reported on infectious bacteria resistant to all antibiotics, and the CDC has long raised awareness that antibiotic resistance is a danger, calling it the “public health’s ticking time bomb.” Duane C. Keller, DMD, FAGD, details how antibiotic resistance acts in the sulcus, making treatment of periodontitis extremely difficult, and talks about what you can do to overcome the challenges.

oral-systemic, periodontal disease, salivary diagnostic testing, salivary diagnostics

Oral-systemic links and tests we never thought about

Oral-systemic interconnections—typically understood to mean the impact of periodontal disease and periodontal pathogens on a variety of systemic diseases and conditions—have been studied intensely for generations. The consensus is that they are now accepted in both the dental and medical professions, although the strength of the various relationships is still being investigated. An equally impactful oral-systemic link that has quietly proceeded largely unnoticed by many dental professionals is the use of saliva to detect the presence of an incredible number of diseases and conditions by evaluation of biomarkers of disease. Richard H. Nagelberg, DDS, discusses the advancements in salivary diagnostic testing and explains how the effects of this technology on health care and the dental profession in particular will be profound.

PIA Videos

Team Treatment Planning Articles

dental implants - man shrugging - man talking on the phone

How to answer the top 7 questions from the dental implant shopper

The most likely questions that potential patients will ask about dental implants during an initial call to a dental office fall into seven categories. It is critical for your front desk staff to be trained and understand how to handle these delicate conversations. Kyle L. Summerford, editorial director of one of our family newsletters, Dental Assisting and Office Manager Digest, offers suggested dialogue and tips to address each question that will help your team provide exceptional customer service and build a protocol within your practice that will increase production and collections.

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.”

 

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Complications Articles

Have infection, will travel: Paving the path to dental implant failure by Scott Froum, DDS - dental implants - pathology - dental infection

Have infection, will travel: Paving the path to dental implant failure

Why did this dental implant fail? You did everything right during your implant treatment. You properly diagnosed and treatment planned the patient’s implant therapy. The implant was surgically placed in a prosthetically driven orientation. You (or the restorative dentist) placed the abutment and crown on the implant with the correct contours, perfect fit, and (if not screw retained) without excess cement. The patient adhered to the follow-up appointments and had good oral hygiene. Follow-up visits showed good bone levels around the implant . . . and then one day there was implant infection and loss of integration. In his clinical tip, Perio-Implant Advisory’s Editorial Director Scott Froum, DDS, talks about one huge oversight that—if detected early and treated properly—is highly preventable and can change the entire outcome of your case.

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.