Dental Implant: Causes of Failure

Dental implants are designed to be a permanent replacement for a missing tooth or teeth and are also growing to be popular alternative to removable dentures or fixed bridges.

Still some patients do experience some complications. The following are a few of the possible causes and reasons behind dental implant failure:

Success Rates

The majority of the problems that occur after the implant placement are generally minor and easily resolved. If something goes wrong, consult your dentist or surgeon.

Osseo-Integration

Osseo-integration is the formation of functional and structural bond between bone and an artificial implant. This process takes place over several months after the implant is placed in the bone.

The failure of the jawbone to fuse together properly with the implant is considered to be a failed osseo-integration. An implant is failed if it is mobile, falls out of bone or shows signs of bone loss of more than 1 mm even after the first year.

For patients who don’t have adequate bone height, width or length, procedures such as a sinus lift or bone graft can help in increasing space and bone mass loss.

Peri-Implantitis (Infection)

Peri-implantitis, or infection, is a condition that involves inflammation of the gum and/or bone around the implant. A form of periodontal disease, peri-implantitis can cause bone loss and implant failure.

 

Nerve & Tissue Damage

When an implant is placed too close to a nerve, patients may experience chronic pain, tingling or numbness in their cheek, gums, tongue, lips or chin.

Some bleeding and pain is to be considered normal for a couple days after the surgery, but if the pain is extreme, the bleeding excessive or they it last longer than a few days, one should contact their dentist as soon as possible

Overloading

Immediate loading is a all-in-one stage treatment method where the crown and abutment are placed on the dental implant right after the implant placement.

The normal process consists of a two stages and provides time for the implant to integrate with the bone before adding the external components.

Overloading refer to failures caused by excessive pressure or forces placed on the protruding abutment and/or crown. These forces easily disrupt the osseo-integration process.

Sinus Problems

An oral surgeon may perform a sinus augmentation procedure, to develop a strong bone foundation. The goal is to create more bone in that area in order to support a dental implant.

Sometimes if the implant protrudes into the sinus cavity, that area can become infected and/or inflamed. Patients should always inform their oral surgeon about sinus related issues prior to the implant procedure.

Other Risks & Causes Of Failure

The following are other risks and causes are:

  • Foreign body rejection–it is possible that a patient’s body will reject the dental implant.
  • Failure of the implant itself–An implant can crack or fracture if it is subjected to excessive external force impact like a blow to the face or excessive pressure over a period of time like grinding teeth or an unbalanced crown.
  • Allergic reaction–While it is quite rare, some patients can have an allergic or inflammatory reaction to titanium.

Contraindications

  • Bruxism (tooth grinding or clenching)
  • Failure to locate a primary nerve in the lower jaw
  • Uncontrolled Type II diabetes
  • Insufficient bone height, width or length
  • Oral or intravenous bisphosphonates
  • Smoking

 

STERILIZATION AND DISINFECTION

We at DR. SACHDEVA DENTAL CLINIC AND IMPLANT CENTER practice the disinfection and sterilization procedures essential for the infection control and prevention. Our center follows sterilization monitoring procedures recommended by American Dental Association (ADA).

 

Our AIM is to spread awareness about the importance of sterilization of equipments and about the advanced techniques we use to give a clean and germ free environment for our patients.

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WHAT IS STERILIZATION?

Sterilization means any process that effectively kills or eliminates transmissible pathogenic agents (such as fungi, bacteria, viruses, spore forms, etc.) from a surface of equipment/instruments.

HOW IT’S DONE? AN OVERVIEW

  • We clean all the instruments thoroughly with hot water and then with spirit, kept wrapped in autoclave. Then instruments are kept in an ultrasonic cleaner to remove blood & fluid stains from inaccessible grooves.
  • All the cleaned equipment is sealed in a pouch.  Each pouch contains set of instruments required for single patient.
  • After Autoclave cycle, sealed pouches are kept in a UV chamber till they are taken out for use.  Ultraviolet rays in the chamber ensure that instruments remain in sterile condition when they are taken out for use on you.

WHAT SYSTEMS DO WE HAVE?

1.     SK 07 – AUTOCLAVE

  • TheSK07 is the latest generation produced with SMT technology. This technology allows minimizing energy and watering consumption and requires very little maintenance. 

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  • Integrated safety system to monitor every phase of the sterilization cycle and to inform the user about any possible failure.
  1. BIOSONIC UC125H
  • The new BioSonic Ultrasonic Cleaning Unit 125 is an advanced technology for the cleaning of equipments in an efficient way.
  • The cleaning unit is equipped with a solution tracking function to monitor the changing of cleaning solution when it’s completely exhausted.
  • There is an additional feature of degassing of the solution, i.e. air entrapments which hinder the cleaning process, will disappear.

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  • This technology provides the flexibility to efficiently clean and disinfect instruments, prostheses, and other items throughout the dental practice without compromising on OUR hygiene standard.

1.     AUTOCLAVE STERILIZATION POUCH BAGS

  • These pouch bags are applicable to every medical instrument such as surgical scissors, tweezers and disposable sterilized packaging of medical catheters, syringes, sterile dressing etc.

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  • Instruments are packed and sealed air tight in the sterilization packages after the cleaning and autoclaving process is complete and stored in UV chamber till the next use.

RECESSION OF GUMS

CAUSES, DANGERS AND TREATMENTS

The loss of Gingiva (gum tissue) resulting in the exposure of the roots of the teeth is called Gum recession or receding gums

Periodontal disease also commonly known as Gum Recession refers to an infection of the tissues supporting and surrounding the teeth mainly caused by the accumulation of bacteria from the dental plaque that inflames and damages the gums.

Receding gums affects people over the age of 40, can be present in younger ages as well. It may be generalized or localized depending upon the oral hygiene maintenance and it is generally progressive in most cases.

The first usual sign of gum recession is sensitivity to cold and hot drinks. The affected teeth appear longer and the roots start to get visible, a notch like depression can be felt near the gum line and spaces between teeth seem wider.

Commonly experienced symptoms are:

  • Red, Swollen And Tender Gums
  • Pus And Pockets Between Gums And Teeth
  • Receding Gums
  • Bleeding Gums During Or After Brushing Flossing Or Eating Hard Food,
  • Shifting Or Separating Teeth Creating Gaps
  • Persistent Bad Metallic Taste In Mouth And Bad Breath
  • Mouth Sores
  • Changes In The Fit Of Dentures And The Teeth Fit During Bites.

The Causes May Be:

  • Poor Oral Hygiene
  • Periodontal Or Gum Disease
  • Aggressive Brushing Technique
  • Trauma To The Gums
  • Systemic Illnesses Like Diabetes Or Cancer
  • Faulty Restorations
  • Malposition Of The Teeth
  • Hormonal Imbalances During Pregnancy And Menstruation
  • Regular Or Repetitive Teeth Grinding Or Clenching
  • Smoking And Chewing Tobacco
  • Hereditary Disorders
  • Medications Such As Contraceptives And Anticonvulsants

Why Is It A Serious Condition?

When the gums pull away from teeth, the roots of your teeth which were earlier covered are left bared and exposed and this puts your dental health at risk for decay and damage. If they are left untreated, receding gums will lead to functional and aesthetic problems.

What Are The Treatment Options?

  • Scaling and roots planning, stabilization of the teeth is first line of treatment if the recession is caused by periodontal disease. Oral hygiene maintenance is extremely important to avoid further gum recession and bone loss.
  • In case of overaggressive brushing, visit your dentist and he can help you by demonstrating the proper brushing technique and recommending the best oral hygiene tools according to your requirement.
  • By eating healthy, fibrous food, maintaining a balanced diet, smoking cessation and regular use of dental appliances for your grinding habit can also prevent the gingival recession.
  • In advanced gum recession cases, gum tissue regeneration and gingival grafting can be done by a Periodontist or an Oral surgeon.
  • If you experience hypersensitivity to cold and hot drinks or food, consult your dentist. If the damage to teeth is less, then it can be corrected by desensitizing agents, varnishes and dentine bonding agents. He may recommend specific toothpaste and mouthwash to reduce the sensitivity.

Bleeding Gums: Myths and Facts

1.Is it normal for gums to bleed?

Without proper dental hygiene, the bacteria present in the mouth forms plaque on the teeth surface. These bacteria cause gums to become inflamed, resulting in red, swollen, or bleeding gums. In some cases the inflammation is not so painful. If left untreated, gingivitis can worsen and lead to loss of teeth.

2.     What to do when Gums bleeding during brushing or flossing?

Bleeding gums, also known as gingivitis, is very common condition. People actually stop brushing and flossing after finding out blood, as a matter of fact, they should never cease to brush. Visit your dentist and follow the general oral hygiene practice.

3.     How should I clean my teeth effectively?

Always make sure that you use gentle, circular motions to clean your teeth and gums.

Make sure that you clean not only the teeth, but also the gums. A lot of bacteria are found at the junction of gum meeting the teeth and it needs to be cleaned.

Flossing is also very important, in those areas where your toothbrush alone just can’t get rid of to remove the bacteria, mainly in between the teeth. Many times patient’s gums start bleeding when they floss after not having flossed in a very long time. It’s because the gums are inflamed from bacteria not being removed for a longer period of time. Generally brushing twice a day and flossing once a day will make bleeding gums will go away within a week or so.

Without regular teeth cleanings with your dentist, dental tartar/calculus will harbor even more plaque bacteria, which can push the gum line below and lead to gum disease.

4.     What other health conditions could be related to gum diseases?

The bacteria present on the teeth and gums continuously release toxic substances that harm your healthy gums and can cause redness and swollen gums. If left untreated, the infection and the inflammation can damage your gums and even spread further down to your bone. Gradually it will lead to periodontitis and teeth loss.

In other cases, bleeding gums can be caused by numerous conditions such as severe vitamin deficiency, hormonal changes like pregnancy or menstruation, chemotherapy, some diseases like diabetes, certain medication like blood thinners, antiepileptic drugs.

Smoking also causes damage to your gums and makes the gum disease progress much faster.

5.     Are there any OTC medications that can be taken for bleeding gums?

The best treatment is to remove the sticky transparent film like plaque by brushing twice a day and flossing once a day that causes bleeding gum. When dental plaque builds up, it hardens and turns into tartar, a hard substance that gets attached to your teeth. Without regular teeth cleanings with your dentist, dental tartar or calculus will harbor even more plaque bacteria, which can push the gum line below and lead to gum disease.

6.     What other things I can do to prevent bleeding gums?

Visit your dentist. Your dentist will remove the soft and hard deposits by scaling and root planning treatment, which slows the process of gum disease down. Maintaining the oral hygiene is also important after getting cleaning done by the dentist.

In case of an advanced form of periodontal disease, periodontal therapy as seeing a periodontist, a gum disease specialist is recommended. In those cases, sometimes dental surgery may be needed to control the progression of the gum disease.

7.     Is there any advice for patients with gum disease?

Always brush and floss regularly. Get your teeth cleaned professionally with dentist every 3 to 6 months, depending on the condition of the gums, to prevent any disease in the future.

For further information, contact us at: Contact us at
• Phone : +919818894041,01142464041
• Our Websites:
• http://goo.gl/yI8lGv
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Root canal , Apicoectomy and Cancer

What Is Apicoectomy And Why It Is Done?

root canal procedure is a treatment to save a damaged, infected or badly decayed tooth.

Although root canal infections can be treated by conventional root canal therapy, but in some cases when the infection persists after root canal treatment or re-treatment, an APICOECTOMY is considered to be important to solve the infection and treat the problem.

  1. What Does Apicoectomy Mean?
  • Apicoectomy is a microsurgical treatment procedure where the very end of the tooth’s root (Apex) is removed along with the infection attached to the root tip. The apex is sealed with a filling to prevent micro leakage.

  1. What About Apicoectomy Procedure I Need To Know?
  • The endodontist gives local anesthetic to the already RCT treated tooth to numb the surgical site of the patient.
  • The gum and bone is cut and lifted to access and visualize the root tip/apex.
  • The root tip is resected and the infected tissue is curetted. The end part of root canal is cleaned and sealed with biocompatible sealer material. The endodontist then sutures the tissue back in the original place.

  1. Does The Procedure Hurt?
  • The endodontist will give local anesthesia to make sure that the treatment is painless and more comfortable.
  • Other than that, patients are prescribed with appropriate pain medications to help ease the discomfort.

  1. How Long Does The Apicoectomy Treatment Take?
  • The treatment is generally done in single sitting appointment.
  • The procedure takes about 1-2 hours depending upon the tooth location and complexity of the roots.

  1. If The Patient Doesn’t Want The Treatment?
  • If the patient is not willing for the treatment, then the tooth needs to be extracted and an implant can be surgically placed to replace the missing tooth.

Root Canal and Cancer

  • In new studies, Researchers found that patients had a 45% reduced risk of cancer with multiple endodontic treatments.

Till date, there is no valid, scientific evidence that proves any link between root canal-treated teeth and disease elsewhere in the body.

 A 2013 study published in a journal found that a patient’s risk of cancer doesn’t alter after a root canal therapy. Researchers also found that patients with multiple endodontic treatments had a 45% reduced risk of cancer.

There are also few myths about Root Canal Treatment shared by a large section of people onto which we would like to shed some light.

  1. MYTH –The Root canal treatment is painful.
  • TRUTH – In fact Root canal treatment doesn’t cause pain, it actually relieves it.
  1. MYTH – Root canal treatment makes you ill/sick.
  • TRUTH – There is no substantial, scientific valid proof which links root canal-treated teeth and disease elsewhere in the body.
  1. MYTH – An excellent substitute to root canal treatment is extraction of the tooth.
  • TRUTH – Saving your natural teeth, is always the ultimate best option if the tooth is not damaged beyond repair.
  1. MYTH – Root canal therapies often requires many visits, wasting your precious time.
  • TRUTH – Now due to introduction of advanced technologies, Root canal therapies can be completed in one or maybe two appointments.
  1. MYTH – If you’re not feeling any pain in your tooth, you do not need a root canal treatment.
  • TRUTH – Teeth are not always painful that require root canal therapy.

We at Dr. Sachdeva Dental Institute And Implant Center try to leave no question unanswered.

We practice endodontics with dental microscope which provides enhanced visualization and access to the most difficult angles of the teeth, mouth and jaws, and allows for a better and more accurate diagnosis and treatment.

It significantly improves quality of treatment and improved after treatment results.

For more information, contact us at: Contact us at
• Phone : +919818894041,01142464041
• Our Websites:
• http://goo.gl/yI8lGv
• http://goo.gl/DquAGr
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• Google+ link: https://goo.gl/vqAmvr
• Facebook link: https://goo.gl/tui98A
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10 Frequently Asked Questions about Caries

The world has almost 60–90% of teenagers and about 100% of adults suffering from dental cavities.

People often get confused about what to follow for their dental health and hygiene so here we present you some answers for the most often asked queries.

  1. None of my teeth hurt; does that mean I don’t have cavities?

There is no such evidence that proves relation between pain and cavity, which means that even though you might not experience any pain but cavities still are present. Smaller cavities are generally associated with sensitivity to cold or sweet as similarly with the wrong brushing techniques, teeth grinding, abrasive food or beverages etc. these conditions are present without any painful symptom but already in queue for dental care attention.

These conditions are treated with minimally invasive restorations at an early stage but if ignored, it is always going to deteriorate into a much painful and worse condition. It is always preferred to ask help from a dentist when a person suspects anything unusual and better get it treated earlier before you get more problems.

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  1. What happens inside cavity?

A cavity always starts with the enamel damage that gradually grows deeper into dentin. It takes a long time for an enamel damage to develop into a cavity. There is always time to prevent decay at initial stage.

When the decay reaches the deeper layers, it will form a cavity which needs to be cleaned and filled before it reaches pulp. If the pulp is affected, a person is going to have every symptom from sensitivity to cold, sweet, hot food to severe pain on biting.

  1. Does a decayed tooth ever heal by itself?

A cavity is a permanent destruction to the tooth surface caused by bacteria which will never heal by it-self. There’s one and only one thing a person can do is to visit your dentist and get it cleaned and filled to stop the further decay of the tooth. If a person wishes to wait to decide for the treatment, the caries would be progressing towards the pulp therefore creating more damage to the tooth.

In case if decay reaches the pulp, only one treatment is left which is root canal treatment in which the dentist removes the infected pulp and filling is done. If the damage is even more, then it goes for extraction.

  1. How a dentist treats a cavity?

Firstly the dentist cleans the decayed portion on the surface of tooth, after the surface is cleaned, the dentist fills the cavity with the filling material which are either self-hardening or cures (hardens) by light. Then the surface is shaped, finished and adjusted to a height which doesn’t hinder in biting.

  1. What does a dentist do to relive the pain?

A dentist always tries to num the pain using topical gel and sprays, followed by injections if needed. It is always advisable to tell your dentist about your discomforts and anxiety so that he could address them properly.

  1. What if a person has more than one cavity? How many appointment a person generally needs?

A filling normally takes about 20-30 minutes depending upon their size. It also depends on how a person is comfortable with opening their mouth for the time required for filling. The longer a person is comfortable with their mouth open, the less time it will take to fill the cavity

Also it depends on the number of cavities. A dentist always evaluates about the damage teeth has and the most damaged tooth is given the priority in such cases.

When crowns are concerned, they always take more than one appointment. In first appointment the tooth is shaped and prepared for the crown, and the impression is taken in that sitting and a temporary crown is given. One week later the new customized crown is ready to e bonded over the prepared tooth. Adjustments are done and patient is called for a follow-up and the patients if have any discomfort is corrected.

  1. Who needs a filling?

When a tooth has small fractures, it usually doesn’t require filling. May be polishing and minor shape adjustments are enough for that. Bigger fractures may require fillings and in some cases, crowns.

  1. Is the filling is as strong as natural tooth?

Small and mediums fillings are generally strong enough to withstand some amount of force. Bigger damaged tooth may require crown if adequate strength is needed. A big filling may also provide some strength but may not work well under tremendous pressure and might end up breaking and is some cases it breaks along with tooth. In such cases, the tooth is even more damaged than before. Therefore dentists generally prefer crown in such cases.

  1. Fillings last for how long?

Researches show that amalgam filling has survived over 12 years and composite fillings up to 9-10 years. Crowns and veneers can survive for at least 10-20 years and even longer depending upon the care taken. Studies have shown that a filling is safe after 8-12 years and crowns lasting for 30-40 years depending on the situation and the precautions taken.

  1. Should one expect soreness or pain after the treatment?

A person may feel slight discomfort for a few days after your tooth has gone under drilling and filling. The symptoms only last for few days or less.

The tooth may feel more sensitive if the cavity was large than usual. The symptoms will gradually fade away after certain time. In such cases monitoring the cavity is recommended for the symptoms and the healing.

Therefore it is important to visit your dentist regularly for dental check-ups and when you feel any discomfort and pain so that you can control the situation at the earliest to avoid the risk in future.

PORCELAIN LAMINATE VENEERS

Also called as PLV

Veneers are translucent ceramics bonded on the prepared surface of natural tooth/teeth by transparent luting resin.

They exhibit fluorescence and reflect and transmit light exactly as natural tooth structure.

STRENGTH

  • Normally they are weak in strength in comparison to porcelain fused to metal (PFM) or all ceramic crowns.
  • But once they are bonded to the prepared tooth surface, they integrate with the tooth structure and become extremely durable.
  • It also requires less invasive tooth preparation and the natural strength of the tooth is also maintained contributing to the longevity of the tooth and the veneer too.

LONGEVITY

The union of etched enamel and porcelain combined with the bonding composite resin luting agent with a silane coupling agent, enables the dentist to perform restorations that are solid as well as long lasting

93% success rate

 “The Smile Is The Reflection Of An Individual”

 Creating natural looking smile

A pleasing smile is important to the patient’s morale and self-esteem while the loss of it will have effects negatively.

Attention to the details examined by dentist is very crucial as it will help in getting the desired results from the technician too and appreciation from the patient.

The dentist’s skill, awareness and understanding the patient’s needs, personality and psychological state will lead to acceptance of the proposed treatment plan.

“Start-Up” Program in Implant Dentistry Mentoring

Mentoring by Surgical Master Dr.Rajat Sachdeva

If you are looking for a Mentor to help you with your dental implant career then we may be able to help.

Dr Rajat Sachdeva has mentored and trained many Dentists over the years through formal courses and individually on a one-to-one basis.

If you have no experience of dental implants then it may be helpful to take a look at the section http://www.sachdevadentalcare.com/implanto-dontia.html

where details of our courses can be found. These courses are a great way to get started with dental implants.

Alternatively if you already have experience with dental implants but want to increase your confidence in certain areas then individual mentoring with Dr.Sachdeva may be more appropriate. For example, if you have already completed a few cases but want help with overall treatment planning then one-to-one Interaction with Dr Rajat could be very beneficial. Or, if you place implants confidently but want help with bone grafting techniques, Dr Rajat will be pleased to assist you.

Basically we can tailor individual mentoring to whatever level or area you require.

If you want to consider being mentored by Dr Rajat Sachdeva contact him directly on 01142464041 for an informal chat.

Soft Tissue Grafting

This is in preposition of a treatment planning of an appropriate surgical technique for increasing the width of the attached mucosa in order to maintain Peri-implant health.

The soft tissue around gingival being divided into gingival and mobile alveolar mucosa, the gingival width varies individually as 2-9 mm.There is a time-point to distinguish the peri-implant mucosa from the gingival around the teeth:  The peri-implant connective tissue has less number of fibroblasts & more collagen fibers’ as compared to gingiva.  The junctional epithelium is more permeable with scarce number of blood vessels than that of around the tooth. 

The peri-implant connective tissue fibers’ run in a parallel direction to the implant or abutment surface without being attached rather being perpendicular to the root cementum.

It has been concluded that presence of non-elastic collagen fibers’ in the connective tissue is responsible for keratinization. Based on findings, >2 mm of keratinized tissue is required for maintenance of healthy gingival tissues.However,around the dental implants, the crucial role of an adequate width of keratinized /attached mucosa for the clinical success is still controversial.

Recent studies have shown that lack of adequate width of Keratinized alveolar mucosa around dental implants is associated with more plaque accumulation, inflammation, soft tissue recession, attachment loss.

Since implant surgery includes one or two stage bone augmentation procedures, displacement of the mucogingival Junction does occur.hence, in order to regulate the width of keratinized attached mucosa, two different peri-implant soft tissue augmentation procedures can be concluded:

Increase in soft tissue volume using a sub epithelial connective tissue graft or soft tissue replacement graft

Enlargement of keratinized mucosa width by means of an apically repositioned flap/vestibuloplasty.

How to overcome dental anxiety

Have a visit due to your dentist that you have been avoiding for a long time? Is there a general sense of fear associated with that dental chair and the various sounds and noises it produces? Do not worry. You are not the only one. The idea of going to a dentist can cause as much anxiety as the pain that a decayed tooth may be causing. The responses are not age related. Different people could have different reactions dealing with dental anxiety. Some may be calm and composed and some may be total wrecks. A lot depends on the dentist and the environment he/ she creates for the patients. Understanding the patients and their levels of anxiety could be crucial in assessing their levels of anxiety and help them overcome it.

Assessment of dental anxiety

There are numerous ways available to assess dental anxiety, both in children and adults. A five point scale that is reliable and quick to administer. It has cut-offs for mild, moderate, and phobic levels of anxiety.

Interventions for individuals with low levels of anxiety

 For children attending with low levels of dental fear, approaches that can be adopted include:

  • Rapport building: like use of a magic trick. The use of magic trick increases cooperation when compared to no intervention or the use of tell-show-do technique.
  • Voice control: using loud voice with deep tone is more effective in reducing disruptive behavior of a child & interaction more pleasurable than the normal voice level
  • Distraction: there are number of ways which can be used for distraction such as: the use of video-taped cartoons, audio-taped stories and video games. Distraction techniques are equally effective as relaxation-based techniques, and superior to no intervention.
  • Modeling: modeling has been used extensively with children and is generally most effective if the observed child is similar in age, gender and level of dental anxiety to the child watching, if the child enters and leaves the surgery without adverse consequences.
  • Environmental change: three studies have sought to make the dental environment more attractive to children attending the dental surgery.

Approaches can be used in patients with low dental fear:

  • Enhancing the sense of control: One of the most commonly used techniques to do this is the stop signal.  In this patient can raise the hand and give signal to the dentist.
  • Cognitive distraction: the patient is encouraged to think about something other than the dental situation, be in  a happy place or think of a less stress causing situation.
  • Environmental change: soothing smell of lavender in dental waiting area to reduce the immediate fear of the patient but it will not reduce the underlying cognitive factor.

Interventions for individuals with moderate levels of anxiety

 Patients with moderate levels of dental anxiety may benefit from the prior preparatory information.

  • Information about what will happen (procedural information)
  • Information about what sensations the individual will experience (sensory information)
  • Information about what the individual can do to cope with the situation (coping information).

Interventions for individuals with high levels of anxiety

Pharmacological management

This includes relative analgesia, conscious sedation and general anesthesia. These management techniques are not much used but there are ongoing needs for such services when patient is not regular to visit for treatment or to the point where they are in severe pain or with compromised oral health

Cognitive behavioural therapy

It is a synthesis of behaviour therapy and cognitive therapy and uses both behaviour modification techniques and cognitive restructuring procedures to change maladaptive beliefs and behaviours. Behavioural aspects of CBT include learning relaxation skills, conducting mini-experiments and systematic desensitization. An important principle underlying CBT is its focus on the ‘here and now’ as what started a problem is often not the same as what is keeping it going.

Ridge splitting for lateral ridge augmentation

An alternative method of augmenting a narrow ridge is by ridge splitting instead of onlay grafting. This technique can be applied in selected cases. It requires that the alveolar ridge has two cortical plates separated by a layer of cancellous bone in a preoperative CBCT image. This situation is normally confined to alveolar ridges featuring an orofacial thickness of more than 4mm.

Ridge splitting can be performed simultaneously with implant placement. This is the only way to obtain primary stability in this scenario is by engaging the bone at the apical region of the implant. In selected cases, it may be possible to stabilize the mobilized buccal plate with bone screws if required.

It is advisable to perform the splitting with minimal flap reflection to expose only the crestal region of the ridge. A somewhat higher level of surgical skill and experience is needed for flapless ridge splitting compared to conventional bone grafting .

The main indication for ridge splitting is to expand a horizontally reduced ridge in the maxilla and take advantage of elastic and cancellous quality of this bone and its peripheral type of blood perfusion.

Splitting a narrow mandibular ridge is possible but technically more difficult due to brittle, thicker, and more cortical nature of this bone .

A flapless approach in the maxilla offers the benefits that even small bone fragments remain attached to periosteum and are contained by the intact soft-tissue envelope. On balance, ridge expansion via splitting is effective but does have its limitations.

Onlay bone grafting, with addition to particulated grafts and a membrane for protection, is the more versatile and widely used approach

For more details, join the next batch of Advanced Implants Continuum: www.sachdevadentalcare.com or www.dentalcoursesdelhi.com

Regards :Dr.Prof.Rajat Sachdeva