The Agony and Ecstasy of Buying Cone Beam Technology Part 1: The Ecstasy

Padmanabhan et al technique consistently showed increased crestal to traditionally treated sites during the first 60 bone loss and gingival bleeding in comparison to days of healing. While the cytokine findings of traditionally treated sites. this study are a convenient explanation for the elevated crestal bone loss and gingival bleeding CONCLUSION seen with the osteotome expansion technique, this was a short term clinical trial with few subjects. In contrast to the authors’ study hypothesis, Accordingly, additional studies evaluating the the results of this pilot study show that dental host inflammatory response to conventionally implant sites treated with the osteotome and osteotome expansion delivered implants expansion technique have elevated levels of may be warranted. the pro-inflammatory cytokine IL-1 in relation Disclosure ankylosed teeth : Stereologic and periodontitis. A cross sectional study. The authors report no conflicts of interest histologic observations in cynomolgus J Clin Periodontol 1992; 19: 53–7. with anything mentioned in this article. monkeys (Macaca fascicularis). J 15. Panagakos F, Aboyoussef H, Periodontol 1993; 64(6): 529–37. Dondero R, Jandinski Jj. Detection References 8. Schou S, Holmstrup P, Stoltze K, and measurement of inflammatory 1. Callan D, O’Mahony C, Cobb C. Loss Hjorting–Hansen E, Kornmann K. cytokines in implant crevicular fluid: Ligature induced marginal inflammation a pilot study. Int J Oral Maxillofac of crestal bone around dental implants: around osseointegrated implants and Implants 1996; 11(6): 794-9. A retrospective study. Implant Dent ankylosed teeth: Stereologic and 16. Salcetti J, Moriarty J, Cooper L, 1998, 7(4): 258– 66. histologic observations in cynomolgus Smith F, Collins J, et al. The clinical, 2. Summers R. A new concept monkeys (Macaca fascicularis). Clin microbial, and host response in maxillary implant surgery: the Oral Implants Res 1993; 4(1): 12–22. characteristics of the failing implant. osteotome technique. Compendium 9. Neiders M, Chen P, Suido H. Int J Oral Maxillofac Implants 1997; 1994;15(2):152-8. Heterogenity of virulence among 12: 32–42. 3. Leblebicioglu B, Ersanli S, Karabuda strains of Bacteriodes gingivalis. 17. Olmedo M, Landry P, Sadasivan C, Tosun T, Gokdeniz H. Radiographic Journal of Periodontal Research, 1989, K, Albright J, Meek W, et al. Evaluation of Dental Implants Placed 24(3): 192- 98. Regulation of osteoblast levels during Using an Osteotome Technique. 10. Genco R. Host responses in bone healing. J Orthop Trauma Journal of Periodontology 2005, 76 : 1999;13(5):356-62. 385-90. periodontal diseases: Current 18. Tobón-Arroyave S, Jaramillo-González 4. Lamster I. Evaluation of components of concepts. J Periodontol 1992; 63(4): P, Isaza-Guzmán D. Correlation gingival crevicular fluid as diagnostic 338-55. between salivary IL-1beta levels and tests. Ann Periodontol 1997; 2(1): 11. Dinarello C. Interleukin-1. Dig Dis Sci periodontal clinical status. Arch Oral 123-37. 1988; 33(3 Suppl): 25S-35S. Biol 2008; 53(4):346-52. 5. Lang N, Bragger U, Walther D, Beamer 12. Charon J, Luger T, Mergenhagen S, 19. Duarte P, de Oliveira M, Tambeli B, Kornmam K. Ligature – induced Oppenheim J. Increased thymocyte- C, Parada C, Casati M, Nociti peri implant infection in cynomolgus activating factor in human gingival F. Overexpression of interleukin- monkeys. I. Clinical and radiographic fluid during gingival inflammation. 1beta and interleukin-6 may play findings. Clinical Oral Implants Res Infect Immun1982; 38(3):1190-5. an important role in periodontal 1993; 4(1): 2–11. 13. Masada M, Persson R, Kenney J, Lee breakdown in type 2 diabetic 6. Lindhe J, Berglundh T, Ericsson I, S, Page R, Allison R. Measurement of patients. J Periodontal Res 2007; Liljenberg B, Marinello C. Experimental interleukin–1 A and interleukin–1 B in 42(4):377-81. breakdown of peri implant and gingival crevicular fluid: implications 20. Orozco A, Gemmell E, Bickel M, periodontal tissues. A study in the for the pathogenesis of periodontal Seymour GJ. Interleukin-1beta, beagle dog. Clin Oral Implants Res disease. J Periodontal Res 1990; 25: interleukin-12 and interleukin-18 1992; 3(1): 9–16. 156-63. levels in gingival fluid and serum 7. Schou S, Holmstrup P, Reibel j, Juhl 14. Wilton J, Bampton J, Griffith G. of patients with gingivitis and M, Hjorting–Hansen E, Kornmann K. Interleukin–1 beta levels in gingival periodontitis. Oral Microbiol Immunol Ligature induced marginal inflammation crevicular fluid from adults with 2006; 21(4):256-60. around osseointegrated implants and previous evidence of destructive The Journal of Implant & Advanced Clinical Dentistry 99



Current Clinical Review 2007 American Heart Association Guidelines for Prevention of Infective Endocarditis (IE) Gregory D. Naylor, DDS, ABOM1 The American Heart Association (AHA) has body of literature and clinical evidence made recommendations for the prevention concerning IE following dental procedures and of infective endocarditis (IE) since 1955 removed from the list many heart conditions and the March 2007 AHA guidelines represent previously thought to put patients at high risk for the 10th iteration. The primary reasons for IE. The current cardiac conditions associated this revision include: (1) IE is much more likely with high risk for IE are listed in Table 1. to result from frequent exposure to random bacteremias associated with daily activities than The goal of the AHA committee was to from bacteremia caused by a dental procedure; provide prophylaxis for high risk patients and to (2) Prophylaxis may prevent an exceedingly decrease the incidence of antibiotic-associated small number of cases of IE, if any, in individuals adverse events and the development of drug who undergo a dental procedure; (3) The risk resistant organisms. of antibiotic-associated adverse events exceeds the benefit, if any, from prophylactic antibiotic The AHA Committee reviewed the literature therapy; (4) Maintenance of optimal oral health and the data suggest that transient streptococcal and hygiene may reduce the incidence of bacteremia may result from dental procedures bacteremia from daily activities and is more that involve perforation of the oral mucosa, the important than using prophylactic antibiotics for manipulation of gingival tissue, or manipulation reducing the risk of IE from a dental procedure. of the periapical region of teeth. Therefore, antibiotic prophylaxis is recommended for The AHA Committee reviewed the existing patients listed in Table 1 who undergo a dental procedure as described above. The following 1. Dental Consultant, Metropolitan Life Insurance Company The Journal of Implant & Advanced Clinical Dentistry 101

Current Clinical Review procedures and events do not need prophylaxis: is another treatment alternative. routine anesthetic injections through non-infected In order to decrease the incidence of tissue, taking dental radiographs, placement of removable prosthetic or orthodontic appliances, prosthetic valve endocarditis, it is highly adjustment of orthodontic appliances, placement recommended that a preoperative dental of orthodontic brackets, shedding of deciduous evaluation be performed and necessary treatment teeth, and bleeding from trauma to the lips or provided prior to any cardiac valve surgery or oral mucosa. repair of congenital heart disease. Antibiotic prophylaxis should be administered Patients on anticoagulant therapy should in a single dose 30 to 60 minutes prior to dental not be given intramuscular (IM) injections for IE procedures. If the antibiotic is inadvertently not prophylaxis. Whenever possible, an oral regimen administered prior to the procedure, the dosage should be administered for these patients. may be taken up to 2 hours after the procedure. The antibiotics of choice for dental procedures There is no evidence that coronary bypass are directed against the viridans group of graft surgery is associated with long-term risk streptococci. It is extremely important to be for infection. Therefore, antibiotic prophylaxis aware of the possibility of cross-allergenicity, so for dental procedures is not needed for these the use of cephalosporins is not recommended patients. for patients that have a history of anaphylaxis, angioedema, or urticaria as the result of the Conclusion administration of a penicillin derivative. It is also Dentists play a critical role in patient education very important to understand that the use of concerning the current AHA IE prophylaxis antibiotics is not risk free and may be associated guidelines since many patients will no longer with allergic reactions, adverse drug effects, and require coverage prior to dental treatment. With promotion of antibiotic resistance. these new guidelines, fewer patients will need prophylaxis. This will result in fewer adverse The current antibiotic regimens recommended events and decreased antibiotic resistance. by the AHA for IE prophylaxis for dental procedures are provided as Table 2. Correspondence [email protected] Special Situations Patients already taking a penicillin derivative References for another illness should be administered an Prevention of infective endocarditis: guidelines from the Ameri- alternate antibiotic due to the development of can Heart Association: a guideline from the American Heart antibiotic resistance. Cephalosporins should Association Rheumatic Fever, Endocarditis, and Kawasaki not be used in these instances due to their cross Disease Committee, Council on Cardiovascular Disease in resistance with penicillin. Also, waiting at least the Young, and the Council on Clinical Cardiology, Council 10 days after completion of the antibiotic therapy on Cardiovascular Surgery and Anesthesia, and the Quality before administering the prophylactic antibiotics of Care and Outcomes Research Interdisciplinary Working Group. Wilson W, Taubert K, Gewitz M, et al. Circulation. 2007; 116(15): 1736-54. 102 Vol. 1, No. 1 March 2009

Current Clinical Review 2007 American Heart Association Guidelines for Prevention of Infective Endocarditis (IE) Gregory D. Naylor, DDS, ABOM Table 1: Cardiac Conditions Associated With High Risk of IE Prosthetic cardiac valve Repaired CHD with residual defects at the Previous IE site or adjacent to the site of a prosthetic Congenital heart disease (CHD)* patch or prosthetic device which inhibits endothelialization Unrepaired cyanotic CHD, including those Cardiac transplantation recipients who with palliative shunts and conduits develop cardiac valvulopathy Completely repaired CHD with prosthetic *Except for conditions listed above, antibiotic prophylaxis is material or device by surgery or catheter no longer recommended for any other form of CHD intervention during the rst 6 months after the procedure** **Prophylaxis is recommended because endothelialization of prosthetic material occurs within 6 months of procedure Table 2: Regimens for a Dental Procedure Situation Agent Regimen Single Dose 30-60 minutes before procedure Oral Adults Children Unable to take Amoxicillin 2gm 50 mg / kg oral medication Ampicillin 2 gm IM or IV 50 mg / kg IM or IV Oral OR 1 gm IM or IV 50 mg / kg IM or IV (Allergic to penicillins or Cefazolin or Ceftriaxone ampicillin) Cephalexin**^ 2 gm 50 mg / kg Allergic to penicillins or OR 600 mg 20 mg / kg ampicillin and unable to 500 mg 15 mg / kg Clindamycin take oral medication OR Azithromycin or Clarithromycin Cefazolin or Ceftriaxone^ 1 gm IM or IV 50 mg / kg IM or IV OR 600 mg IM or IV 20 mg / kg IM or IV Clindamycin * IM – intramuscular, IV - intravenous ^ Cephalosporins should not be used in an individual with a history of anaphylaxis, angioedema, or urticaria with ** or other first or second generation oral cephalosporin in penicillins or ampicillin equivalent adult or pediatric dosage The Journal of Implant & Advanced Clinical Dentistry 103 The Journal of Implant & Advanced Clinical Dentistry



The Journal of Implant & Advanced Clinical Dentistry ATTENTION PROSPECTIVE AUTHORS JIACD wants to publish your article! Do you have an article ready for up to 20 high quality color photos and a short publication? If so, consider submitting description of the case. Please note any specific your manuscript to The Journal of Implant products that were used during the case. and Advanced Clinical Dentistry (JIACD). All articles submitted to JIACD are peer JIACD welcomes original, unpublished articles reviewed by the editor-in-chief, executive editor, that focus on implant and advanced clinical and members of the JIACD manuscript review dentistry topics including: dental implants, esthetic panel. Manuscript review commences once restorative dentistry, endodontics, periodontics, JIACD receives all text files, photographs, prosthodontics, oral & maxillofacial surgery, oral & pictographs, fully signed (all authors) conflict maxillofacial radiology, oral medicine, orthodontics, disclosure form, and fully signed (all authors) orofacial pain management, sedation management, transfer of copyright form associated with the CAD/CAM dental technology, and dental laboratory submitted manuscript. The JIACD manuscript technology. JIACD articles emphasize clinical review process typically takes thirty (30) days techniques, critical reviews, case reports, and from the date of complete submission. Upon topics that can immediately benefit the modern manuscript review completion, the author will actively practicing dental professional. receive communication from JIACD regarding acceptance or rejection of the submitted The JIACD “Case of the Month” is a unique manuscript. picture based article format that should include For complete details regarding publication in JIACD, please refer to our author guidelines at the following link: http://www.jiacd.com/authorinfo/author-guidelines.pdf or email us at: [email protected] The Journal of Implant & Advanced Clinical Dentistry 105

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