Misch's Contemporary Implant Dentistry

Front Cover
	IFC
MISCH’S CONTEMPORARY IMPLANT DENTISTRY
MISCH’S CONTEMPORARY IMPLANT DENTISTRY
Copyright
Contributors
Foreword
	Dedication
About the Authors
Preface
Acknowledgments
Contents
I -Scientific Basis
	1 - Rationale for Dental Implants
		Increasing Demand for Dental Implants
			Patients Living Longer
			Age-Related Tooth Loss
			Patients More Socially Active and Esthetic Conscious
			Higher Prevalence of Partial and Complete Edentulism
				Partial Edentulism
				Total Edentulism
					Anatomic Consequences Of Edentulism
			Conventional Prosthesis Complications
				Fixed Partial Denture Morbidity
				Removable Partial Denture Morbidity
				Complete Denture Morbidity
			Advantages of Implant-Supported Prostheses
				Maintenance of Bone
				Occlusion Stability
				Occlusal Awareness
				Masticatory Efficiency
				General Health
				Higher Success in Comparison To Other Treatments
				Increased Biting Force
				Nutrition
				Phonetics
				Psychological Health
		The Future of Implant Dentistry
			Techniques
			Technology
			Materials
	2 - Terminology in Implant Dentistry
		Generic and Proprietary Terminology
		Osseointegration
			Determination of Stability
		Types of Dental Implants
			Endosseous Implants
			Blade Implants
			Cylinder Implants
			Screw-Shaped Implants
				One-Piece versus Two-Piece
				Small Diameter Implants
				Bone-Level versus Tissue-Level Implants
		Implant Macrostructure
			Implant Threads
			Microthreads
		Implant Surfaces
		Implant Platforms and Connections
			Connection Type
			Platform Switched versus Platform Matching
		Surgical Protocols
			Immediate Placement after Extraction versus Placement in Healed Sites
			Bone Grafting
				Materials for Grafting
				Bone Augmentation Techniques
				Sinus Augmentation
				Bone Graft Properties
		Surgical Instrumentation
			Implant Drills
			Drivers
			Implant Mounts
			Wrenches
			Implant Components
			Guided Surgery
		Implant Restorations
			Loading Protocols
			Standardized and Custom Components
			Impression Procedures
			Impression Techniques
			Screw-Retained versus Cement-Retained Restorations
			Implant Overdenture
		Peri-implant Disease
		Other Types of Implants
			Eposteal Implants
			Transosteal Implants
			Zygomatic and Pterygoid (Tubero-Pterygo-Maxillary) Implants
		Conclusion
		References
	3 - Functional Basis for Dental Implant Design
		Function and Implant Design
			Occlusal Forces and Implant Design
				Force Type
				Force Magnitude
				Force Direction
				Force Duration
			Implant Geometry
				Implant Shape
				Implant Diameter
				Implant Length
		Implant Features
			Implant Collar
			Implant Prosthetic Connection
			Implant Threads
			Thread Pitch
			Thread Shape
			Thread Depth
			Implant Apical Region
		Implant Materials
			Biocompatibility
			Strength
			Corrosion Resistance
			Modulus of Elasticity
			Functional Basis for Dental Implant Design
		Summary
		References
	4 - Bone Physiology, Metabolism, and Biomechanics
		Osteology
			Differential Osteology of the Maxilla and Mandible
			Temporomandibular Articulation
		Bone Physiology
			Specific Assessment Methodology
				Mineralized Sections
				Polarized Light
				Fluorescent Labels
				Microradiography
				Microindentation, Backscatter Imaging, and Microcomputed Tomography
				Autoradiography
				Nuclear Volume Morphometry
			Classification of Bone Tissue
				Woven Bone
				Lamellar Bone
				Composite Bone
				Bundle Bone
		Skeletal Adaptation: Modeling and Remodeling
		Cortical Bone Growth and Maturation
			Cutting and Filling Cones
				Structural and Metabolic Fractions
		Bone Metabolism
		Calcium Conservation
			Diet
			Endocrinology
		Skeletal Compromise
			Metabolic Bone Disease
		Biomechanics
		Sutures
		Implant-Anchored Orthodontics
			Retromolar Implant Anchorage
			External Abutment Mechanism
			Internal Abutment Mechanism
			Mini-Implants for Orthodontic Anchorage
		Summary
		Acknowledgments
		References
	5 - Biomaterials for Dental Implants
		Compatibility of Surgical Biomaterials and the Role of Synthetic Materials
		Bulk Properties
			History of Materials and Designs
			Research and Development
		Physical, Mechanical, and Chemical Requirements for Implant Materials
			Physical and Mechanical Properties
			Corrosion and Biodegradation
			Stress Corrosion Cracking
			Toxicity and Consideration
		Metals and Alloys
			Titanium and Titanium-6 Aluminum-4 Vanadium
			Cobalt-Chromium-Molybdenum–Based Alloy
			Iron-Chromium-Nickel–Based Alloys
			Other Metals and Alloys
		Ceramics and Carbon
			Aluminum, Titanium, and Zirconium Oxides
			Bioactive and Biodegradable Ceramics Based on Calcium Phosphates
				Bone Augmentation and Replacement
				Endosteal and Subperiosteal Implants
				Advantages and Disadvantages
				Bioactive Ceramic Properties
				Forms, Microstructures, and Mechanical Properties
				Density, Conductivity, and Solubility
				Current Status and Developing Trends
			Carbon and Carbon Silicon Compounds
			Zirconia
				Zirconia Chemical Composition
				Types of Zirconia Implants
				Zirconia Implant Success Studies
		Polymers and Composites
			Structural Biomedical Polymers
			Composites
			Inserts and Intramobile Elements
		Future Areas of Application
		Surface Characteristics
		Surface Characterization and Tissue Interaction
			Tissue Interactions
			Integration With Titanium and Alloys
			Cobalt and Iron Alloys
			Ceramics
			Hydroxyapatite
			Porous and Featured Coatings
				Titanium Plasma Sprayed
				Hydroxyapatite Coating
			Other Surface Modifications
			Surface Cleanliness
			Surface Energy
			Passivation and Chemical Cleaning
			Sterilization
		Summary
		Acknowledgments
		References
II -Biomechanical Properties of Dental Implants
	6 - Clinical Biomechanics in Implant Dentistry
		Loads Applied to Dental Implants
		Mass, Force, and Weight
		Forces
		Components of Forces (Vector Resolution)
		Three Types of Forces
			Stress
			Deformation and Strain
			Stress-Strain Relationship
			Impact Loads
		Force Delivery and Failure Mechanisms
		Moment Loads
		Clinical Moment Arms
			Occlusal Height
			Cantilever Length
			Occlusal Width
			Fatigue Failure
		Moment of Inertia
		Summary
		References
	7 - Stress Treatment Theorem for Implant Dentistry
		Biomechanical Overload
			Surgical Failure
			Early Loading Failure
		Impact of Occlusal Overload on Mechanical Components
			Screw Loosening
			Implant Component Biomechanical Complications
		Marginal Bone Loss
			Occlusal Trauma: Bone Loss
			Periosteal Reflection Hypothesis
			Implant Osteotomy Hypothesis
			Autoimmune Response of Host Hypothesis
			Biological Width Hypothesis
			Occlusal Trauma
			Cellular Biomechanics
			Engineering Principles
			Bone Mechanical Properties
			Animal Studies
			Clinical Reports
			Discussion
			Bone Physiology
			Implant Design Biomechanics
		Biomechanical Stress Effects on Treatment Planning
			Prosthesis Design
			Patient Force Factors
			Bone Density
		Key Implant Positions and Implant/Abutment Number
			Key Implant Positions
			Splinting
			Implant Size
			Available Bone
			Implant Design
		Summary
		References
	8 - Treatment Planning: Force Factors Related to Patient Conditions
		Bite Force
		Parafunction
			Bruxism
				Diagnosis
				Fatigue Fractures
				Occlusal Guards to Determine Direction of Force
			Clenching
				Diagnosis
				Fatigue Fractures
			Treatment Planning for Bruxism and Clenching (Table 8.2)
				Progressive Bone Loading
				Greater Surface Area
				Occlusion
				Prosthesis Design
				Occlusal Guard
		Tongue Thrust and Size
			Treatment Planning for Tongue Thrust and Size
		Crown Height Space
			Biomechanic Consequences of Excessive Crown Height Space
			Excessive Crown Height Space
		Masticatory Dynamics (Patient Size, Gender, Age, and Skeletal Position)
		Arch Position
		Opposing Arch
		Summary
		References
	9 - Dental Implant Surfaces
		Introduction
		Surface Roughness
		Review of Implant Surfaces
			Subtractive Processes
				Etching with Acid
				Blasting with an Abrasive Material
				Treatment with Lasers
			Additive Processes
				Hydroxyapatite Coating and Titanium Plasma Spraying
				Oxidation or Anodization
		Biological Responses and Interaction with the Implant Surface
		Role of Surface Roughness in Peri-implant Disease
		Future Directions
			Bisphosphonate Surfaces
			Statins
			Antibiotic Coating
		Functionalization with Biologically Active Substances
			Usage of Biologically Active Peptides
			Zirconia Implants
		Biomimetic Formation of Hydroxyapatite on the Implant Surface
		Summary
		References
III -Fundamental Science
	10 - Medical Evaluation of the Dental Implant Patient
		Medical Evaluation
		Medical History
			Extraoral and Intraoral Examinations
			Vital Signs
				Blood Pressure
				Pulse
				Temperature
				Respiration
				Height
				Weight
		Laboratory Evaluation
			Urinalysis
			Complete Blood Cell Count
			White Blood Cell Count
			Red Blood Cell Count
			Hemoglobin
			Hematocrit
			Bleeding Tests
				Physical Examination
				Clinical Laboratory Testing
			Biochemical Profiles (Serum Chemistry)
				Normal Range
				Serum Glucose
				Serum Calcium
				Inorganic Phosphorus
				Alkaline Phosphatase
				Lactic Dehydrogenase
				Bilirubin
				Aminotransferases
				Creatinine
				Estimated Glomerular Filtration Rate
				Blood Urea Nitrogen
		Systemic Disease and Oral Implants
			American Society of Anesthesiologists Physical Status Classification
			Cardiovascular Diseases
				Hypertension
				Angina Pectoris
				Myocardial Infarction
					Dental Implant Management
				Congestive Heart Failure
				Subacute Bacterial Endocarditis and Valvular Heart Disease
				Cerebrovascular Accident
					Dental Implant Implications
			Treatment Summary
				Additional Cardiovascular Disorders
			Endocrine Disorders
				Diabetes Mellitus
			Diabetes and Dental Implant Healing
				Implant Failure
					Dental Implant Management
			Treatment Summary (Diabetes)
				Thyroid Disorders
				Dental Implant Management
					Hypothyroidism
				Adrenal Gland Disorders
				Hyperparathyroidism
					Dental Implant Management
				Xerostomia
					Dental Implant Management
				Pregnancy
				Additional Endocrine Disorders and Treatment Implications
			Hematologic System
				Erythrocytic (Red Blood Cell) Disorders
					Dental Implant Implications
			Treatment Summary
				Anemia
					Dental Implant Implications
				Leukocytic Disorders
				Platelet Disorders
				Additional Hematologic Disorders and Treatment Implications
			Pulmonary System
				Chronic Obstructive Pulmonary Disease
				Additional Pulmonary Disorders and Treatment Implications
			Digestive System
				Liver Disease (Cirrhosis)
				Stomach Ulcers
				Inflammatory Bowel Disease
				Additional Digestive Disorders and Treatment Implications
			Bone Diseases
				Osteoporosis
					Dental Implant Implications
				Fibrous Dysplasia
					Dental Implant Implications
			Treatment Summary
				Vitamin D Disorders (Osteomalacia)
				Hyperparathyroidism
				Osteitis Deformans (Paget Disease)
					Dental Implant Implications
			Treatment Summary
				Multiple Myeloma
				Osteomyelitis
					Dental Implant Implications
			Treatment Summary
				Osteogenesis Imperfecta
				Cemento-Osseous Dysplasia
				Ectodermal Dysplasia
				Radiation
					Dental Implant Implications
				Additional Bone Diseases
		Systemic Autoimmune Diseases
			Sjögren Syndrome
				Dental Implant Implications
			Systemic Lupus Erythematosus
				Dental Implant Implications
			Scleroderma
				Dental Implant Implications
			Rheumatoid Arthritis
				Dental Implant Implications
			Human Immunodeficiency Virus
				Dental Implant Implications
			Miscellaneous
				Sleep Apnea
				Elderly (Increased Age)
					Dental Implant Implications
				Adolescent (Decreased Age)
					Dental Implant Implications
				Smoking
					Dental Implant Implications
			Treatment Summary
				Alcohol
					Dental Implant Implications
				Psychological
		Medications of Interest to Implant Dentistry
			Bisphosphonates
				Diagnosis of Drug-Induced Osteonecrosis of the Jaw
				Active Lesions
				Testing
					Drug Holiday Recommendation125
					Additional Recommendations
			Treatment Summary
			New Therapies for Osteoporosis
				Monoclonal Antibodies
		Immunosuppressive Drugs
			Glucocorticoids (Long-Term Use)
			Cytostatics
				Tamoxifen
				Aromatase Inhibitors
				Treatment Summary of Immunosuppressive Drugs
			Biologics
			Common Disorders Using Biologics for Treatment
				Age-Related Macular Degeneration
				Psoriatic Arthritis
				Rheumatoid Arthritis
				Polymyalgia Rheumatica
				Eczema (Atopic Dermatitis)
				Multiple Sclerosis
				Fibromyalgia
				Breast Cancer
			Treatment Summary for Biologic Medications
		Oral Antithrombotic Medications
			Warfarin Sodium
				Medication Modification
				Medical Consultation
			Aspirin
				Studies
				Recommendations
			Plavix (Clopidogrel)
			Novel Oral Anticoagulants
				Bleeding
				Treatment Summary
			Herbal Supplements
			Selective Serotonin Reuptake Inhibitors
				Treatment Summary
		Allergies
			Treatment Summary
		Medical Consultation and Clearance
		References
	11 - Radiographic Evaluation in Oral Implantology
		Imaging Objectives in Oral Implantology
			Phase 1
			Phase 2
			Phase 3
		Presurgical Imaging (Phase 1)
		Radiographic Modalities Used in Oral Implantology
			Periapical Radiograph
				Uses in Oral Implantology
			Panoramic Radiograph
				Use in Oral Implantology
			Magnetic Resonance Imaging
				Use in Oral Implantology
		Cone Beam Tomography (CBCT)
			Types of Computed Tomography Scanners
				Medical
					Effective Dose Range of Cone Beam Computed Tomography
					Bone Density
			Scanning Technique
			Artifacts
			Incidental Findings
				Complication Prevention
		Normal Radiographic Anatomy
			Mandibular Anatomy
				Mandibular Canal and Associated Anatomy
				Mental Foramen
				Incisive Canal
				Anterior Loop
				Accessory and Double Foramina
				Hypomineralization of the Mandibular Canal
				Mandibular Ramus (Donor Site for Autogenous Grafting)
				Lingual Concavities (Posterior)
				Retromolar Canal/Foramen
				Mandibular Symphysis (Implant Placement and Bone Donor Site)
			Maxillary Anatomy
				Premaxilla
				Nasopalatine Canal/Incisive Foramen
				Infraorbital Foramen
				Paranasal Sinuses
				Nasal Cavity
				Maxillary Sinus Membrane
				Ostiomeatal Complex
				Maxillary Ostium
				Uncinate Process
				Hiatus Semilunaris
			Anatomic Variants
				Concha Bullosa
				Paradoxical Middle Turbinate
				Deviated Septum
				Haller Cells
				Agger Nasi Cells
				Maxillary Sinus Septa
				Maxillary Sinus Hypoplasia
				Inferior Turbinate and Meatus Pneumatization (Big-Nose Variant)
				Buccal Thickness of Bone in Premaxilla
				Intraosseous Anastomosis
				Canalis Sinuosus
				Calcified Carotid Artery Atheroma
			Pathologic Conditions in the Paranasal Sinuses
				Odontogenic Rhinosinusitis (Periapical Mucositis)
				Acute Rhinosinusitis
				Chronic Rhinosinusitis
				Allergic Rhinosinusitis
				Fungal Rhinosinusitis (Eosinophilic Fungal Rhinosinusitis)
				Pseudocysts (Mucous Retention Cyst)
				Retention Cysts
				Primary Maxillary Sinus Mucocele
				Postoperative Maxillary Cyst
				Squamous Cell Carcinoma and Adenocarcinoma
				Maxillary Sinus Antroliths
			Radiology Reports
				Images Provided
				Diagnostic Objectives
				Radiographic Findings
				Radiographic Impression
				Recommendations
				Radiologist Name and Signature
					Level 4: Clinical Significance. This is critical patient record information
				Typical Radiographic Descriptions
			Radiographic Findings
				Maxilla
				Sinuses
				Nasal Cavity
				Air Space
				TMJ
				Other Findings
				Dental Findings
			Reporting Implant information
				Existing Implants
				Implant Measurements
				Alternative Report Style for “Incidental Radiographic Findings”
				Styles of Radiology Reports
			Intraoperative Imaging
				Immediate Postsurgical Imaging
				Abutment and Prosthetic Component Imaging
			Postprosthetic Imaging
				Recall and Maintenance Imaging
				Evaluation of Alveolar Bone Changes
			Legal Issues and Cone Beam Computed Tomography
				To Take a Scan or Not
				Technical Parameters
				Field of View
				Interpreting the Scan
				Referral to Radiologist
				Waiver of Liability
			Summary
			References
	12 - Applied Anatomy for Dental Implants
		Surgical Anatomy of the Maxilla as an Organ
			Muscles Attached to the Maxilla
				Orbicularis Oris Muscle
				Incisivus Labii Superioris Muscle
				Buccinator Muscle
				Levator Labii Superioris Muscle
				Levator Anguli Oris (Caninus) Muscle
			Sensory Innervation of the Maxilla
				Posterior Superior Alveolar (Dental) Nerve
				Infraorbital Nerve
				Middle Superior Alveolar (Dental) Nerve
				Anterior Superior Alveolar (Dental) Nerve
				Palatine Nerve
				Nasopalatine (Sphenopalatine) Nerve
			Arterial Supply to the Maxilla
			Venous Drainage of the Maxilla
			Lymphatic Drainage
		Surgical Anatomy of the Mandible
			Muscle Attachment to the Mandible
				Lingual or Medial Attachments
				Buccal or Facial Muscle Attachments
			Innervation of the Lower Jaw and Associated Structures
				Inferior Alveolar (Dental) Nerve
				Lingual Nerve
				Nerve to the Mylohyoid
				Long Buccal Nerve
		Blood Supply to the Maxilla and Mandible
			General Concepts
				Maxilla
				Mandible
		References
	13 - Dental Implant Infections
		Introduction
		Overview of Oral, Head, and Neck Infection and Spread
			Signs and Symptoms of Oral Infection
			Spread of Head and Neck Infection
			Fascial Spaces of the Neck
		Microbiology of Dental Implant Infection
		Causes and Risks of Dental Implant Infection
		Infection Before the Implant Placement
			Active Infection Site
			Periodontal Disease
			Chronic Periodontitis
			Immediate Loading in Periodontal Disease
		Perisurgical Infection
		Severe Postsurgical Infection
			Osteomyelitis
			Medication-Related Osteonecrosis of the Jaws
			Biologics
		Peri-implant Disease
			Peri-mucositis and Peri-implantitis
			Biofilm
		Prophylactic Antibiotics
		References
	14 - Pharmacology in Implant Dentistry
		Antimicrobials
			Antibiotics
				Prophylactic Antibiotics
				Complications of Antibiotic Prophylaxis
				Antibiotics Used in Implant Dentistry
				Macrolides
				Clindamycin
				Tetracyclines
				Fluoroquinolones
				Metronidazole
			Prophylactic Antibiotics in Oral Implantology
		Therapeutic Use of Antibiotics: Postoperative Infections
			Therapeutic Antibiotics in Implant Dentistry
			Chlorhexidine
				Use of Chlorhexidine in Oral Implantology
			Miscellaneous
				Citric Acid
		Management of Postoperative Inflammation
			Nonsteroidal Antiinflammatory Drugs
			Glucocorticosteroids
				Mechanism of Action
				Adrenal Suppression
				Timing
				Glucocorticoid Use in Implant Dentistry
				Contraindication to Glucocorticosteroids
				Cryotherapy
		Postsurgical Pain Management
			Mechanism of Pain
		Protocols Postoperative Pain
			Preemptive Analgesia
			Postoperative Medications
				Nonopioid Medications
				Narcotics (Opioids)
		Combination Analgesic Therapy for Postoperative Pain
			Analgesic Agents in Oral Implantology
				Mild Pain
				Moderate Pain
				Severe Pain
		Control of Postoperative Surgical Pain
		Pain Control Protocol
			Preoperative Evaluation
			Development of a Pain Control Protocol
			Local Anesthetics
				Lidocaine
				Mepivacaine
				Articaine
			Long-Acting Anesthetics
			Local Anesthetic Overdosage
			Post-Surgical Anesthetic Use
		Sedative Agents
			Benzodiazepines
				Diazepam (Valium)
				Midazolam (Versed)
				Triazolam (Halcion)
			Additional Sedative Anxiolytics
				Fentanyl
				Propofol (Diprivan)
				Reversal Agents
		Comprehensive Pharmacologic Protocol
		Possible Drug Interactions in Oral Implantology
		References
IV -Treatment Planning Principles
	15 - Interactive Computed Tomography and Dental Implant Treatment Planning
		Evaluation and Determination of the Ideal Implant Position Prior To Obtaining a CBCT
			Fabrication of Radiographic Template (Scanning Template)
			Radiopaque Material
				Flapless Template Techniques
				Scanning Process
		Obtaining a Cone Beam Computed Tomography Scan
			Medical Scan vs. Cone Beam Computed Tomography
		Obtain Dataset
		Integrate Dataset Into Specialized Software
		Reconstruction (Manipulation of Data to Formulate a Treatment Plan)
			Determination of Panoramic Curve
			Mandibular Canal Identification
				Methods for Identifying the Mandibular Canal
			Evaluation of Bone Density
			Virtual Implant Placement
			Safety Zone
			Bone Graft Simulation
		Treatment Plan to Surgical Placement
		Surgical Template Fabrication
			Commercial
			In-Office
		Surgical Implant Placement With Surgical Template
			Surgical Restriction Templates
				Non-limiting Design
				Partial-Limiting Design
				Complete-Limiting Design
			CBCT Templates by Support
				Tooth-Supported Guides
					Indications
					Requirements (one of the following)
				Bone-Supported Guides
					Indications
				Soft Tissue–Supported Guides
					Indications
						Requirements
		CBCT by Drill Guidance (Fig. 15.23)
			Pilot Guide (Fig. 15.24)
			Universal Guide (Fig. 15.25)
			Fully Guided (Fig. 15.26)
		Requirements of a Surgical Template
		Surgical Template Fabrication
			Additional Types of Templates (Guides)
				Stereolithographic Models
				Surgical Guidance Templates and Navigation Systems
				Studies
				Stackable Templates for Provisional Restorations (Immediate Smiles)
		Digital Technology
			Optical Impressions
			Digital Systems
			Digital Scanner Process
			Implant Treatment Planning
			Restorative Implant Applications
			Laboratory Implant Applications
		Materials
		Surgical Template Complications
			Overheating the Bone
			Inadequate Access
			Difficulty in Template Seating
		Summary
		References
	16 - Available Bone and Dental Implant Treatment Plans
		Literature Review
		Implant Size
			Implant Width (Diameter)
			Implant Height (Length)
		Measurement of Available Bone
			Available Bone Height
			Available Bone Width
			Available Bone Length
			Available Bone Angulation
		Divisions of Available Bone
			Division A (Abundant Bone)
			Division B (Barely Sufficient Bone)
				Bone Spreading
			Division C (Compromised Bone)
				Treatment Options
			Division D (Deficient Bone)
		Summary
		References
	17 - Prosthetic Options in Implant Dentistry
		Completely Edentulous Prosthesis Design
		Partially Edentulous Prosthesis Design
			Prosthetic Options
			Fixed Prostheses
				FP-1
				FP-2
				FP-3
			Removable Prostheses
				RP-4
				RP-5
		Summary
		References
	18 - Bone Density: A Key Determinant for Treatment Planning
		Influence of Bone Density on Implant Success Rates
		Etiology of Variable Bone Density
		Bone Classification Schemes Related to Implant Dentistry
		Misch Bone Density Classification
		Determining Bone Density
			Location
			Radiographic Evaluation
			Tactile Sense
		Scientific Rationale of a Bone Density–Based Treatment Plan
			Bone Strength and Density
			Elastic Modulus and Density
			Bone Density and Bone–Implant Contact Percentage
			Bone Density and Stress Transfer
		Treatment Planning
		Summary
		References
	19 - Treatment Plans Related to Key Implant Positions and Implant Number
		Key Implant Positions Rules for a Fixed Implant Prosthesis
			Rule # 1: Minimize Cantilevers
			Rule # 2: Limit the Number of Adjacent Pontics
			Rule # 3: Implant Positioned in Canine Site
			Rule # 4: Implant Positioned in Molar Site
			Rule # 5: Implant Positioned in Each Arch Segment
		Implant Number
		Additional Treatment Planning Principles
			Independent Prosthesis
			Splinted Implants
			Treatment Planning Should Not Be Dictated by Finances
		Summary
		References
V -Edentulous Site Treatment Planning
	20 - Treatment Plans for Partially and Completely Edentulous Arches in Implant Dentistry
		Partially Edentulous Arches
			History
			Classification of Partially Edentulous Arches
			Treatment Planning: Class I
				Division A Treatment Plans
				Division B Treatment Plans
				Division C Treatment Plans
				Division D Treatment Plans
			Treatment Planning: Class II
				Division A Treatment Plans
				Division B Treatment Plans
				Division C Treatment Plans
				Division D Treatment Plans
			Treatment Planning: Class III
				Division A Treatment Plans
				Division B Treatment Plans
				Division C or Division D Treatment Plans
			Treatment Planning: Class IV
				Division A Treatment Plans
				Division B Treatment Plans
				Division C and D Treatment Plans
		Classification of Completely Edentulous Arches
			Type 1
				Division A
				Division B
				Division C
			Type 2
			Type 3
		Summary
		References
	21 - Preimplant Prosthodontic Factors Related to Surgical Treatment Planning
		Overall Evaluation
		Maxillary Anterior Tooth Position
		Existing Occlusal Vertical Dimension
			Methods to Evaluate Occlusal Vertical Dimension
			Subjective Methods
			Objective Methods
		Mandibular Incisor Edge Position
		Existing Occlusal Planes (Posterior Maxillary and Mandibular Planes of Occlusion)
		Specific Criteria
			Lip Lines
			High Lip Line
			Mandibular Lip Line
		Maxillomandibular Arch Relationship
		Existing Occlusion
		Crown Height Space
			Excessive Crown Height Space
			Reduced Crown Height Space
		Temporomandibular Joint
		Extraction of Teeth with Hopeless or Guarded Prognosis
			Caries
			Endodontic Therapy
			Periodontal Disease
		Existing Prostheses
		Arch Form
		Natural Teeth Adjacent to Implant Site
			Abutment Options
			Adjacent Bone Anatomy
			Cantilevers
		Attaching Implants to Teeth
			Etiology
				Existing Tooth Mobility
				Prosthesis Movement
				Implant Mobility
				Guidelines for Joining Implants to Teeth
				Natural Tooth with No Clinical Mobility
				Rigid Connectors Are Contraindicated
				Nonrigid Connectors Are Contraindicated
			Pier (Intermediary) Abutments
			Natural Abutment Evaluation
				Abutment Size
				Crown/Root Ratio
				Tooth Position
				Parallelism
				Caries
				Root Configuration
				Root Surface Area
				Endodontic Evaluation
				Periodontal Status
		Soft Tissue Support
		Pretreatment Prostheses
			Fixed Treatment Prostheses
			Removable Treatment Prostheses
		Postimplant Placement Transitional Prosthesis
			Occlusal Vertical Dimension
			Esthetic Assessment
	22 - Single and Multiple Tooth Replacement: Treatment Options
		Tooth Replacement
		Single Missing Tooth
			No Treatment
				Advantages
				Disadvantages
			Removable Partial Denture
				Advantages
				Disadvantages
			Resin-Bonded Fixed Partial Denture
				Advantages
				Disadvantages
			Fixed Partial Denture
				Advantages
				Disadvantages
			Single-Tooth Implant
				Advantages
				Disadvantages
		Specific Single-Tooth Implant Indications
			Anodontia
		Single-Tooth Implant Size Specifics
			Anterior Teeth Replacement
				Mandible
				Maxillary
			Posterior Teeth Replacement
				Premolar Replacement
		Multiple Missing Teeth
			No Treatment
				Advantages
				Disadvantages
			Removable Partial Denture
			Implant-Supported Multiple Crowns (Fig. 22.18)
				Disadvantages
		Types of Prostheses
			Screw-Retained Restorations
				Advantages
				Disadvantages
			Cement-Retained Restorations
				Advantages
				Disadvantages
			Miscellaneous Restorations
				Angulated screw channel
				Screw-cementable (combination) prosthesis
			Ideal Positioning for Screw and Cement-Retained Prosthesis
		Abutment Options
			Abutments for Cement-Retained Restorations
				Standardized (Stock) Abutments
				Custom Abutments
			Abutments for Screw-Retained Restorations
		Restorative Materials
			Zirconia
				Lithium Disilicate and Lithium Silicate
				Metal-Ceramic
				Gold Alloy
				Polymethylmethacrylate
		References
	23 - Treatment Planning for the Edentulous Posterior Maxilla
		Inherent Disadvantages of Posterior Maxilla Treatment
			Poor Bone Density
			Decreased Available Bone
			Increased Pneumatization of the Maxillary Sinus
			Resultant Increased Crown Height Space
			Lingual Oriented Ridge Position
			Anatomic Location
			Increased Biting Force
			Requirement of Greater Surface Area Diameter Implants and Minimized Occlusal Forces
			Maxillary Sinus Has High Incidence of Pathology
		Treatment History
			Treatment of the Posterior Maxilla—Literature Review
		Sinus Graft Options for the Posterior Maxilla
			Misch-Resnik Maxillary Posterior Classification
				Subantral Option 1: Conventional Implant Placement
				Subantral Option 2: Sinus Lift and Simultaneous Implant Placement
				Subantral Option 3: Sinus Graft with Immediate Endosteal Implant Placement
				Subantral Option 4: Sinus Graft Healing and Extended Delay of Implant Insertion
		References
	24 - The Edentulous Mandible: Fixed Versus Removable Prosthesis Treatment Planning
		Mandibular Treatment Planning Principles
			Anteroposterior Spread
			Mandibular Flexure
				Medial Movement
				Torsion
		Implant Overdentures Advantages (RP-4 and RP-5)
			Enhanced Soft Tissue Support
			Increased Chewing Efficiency Compared with Conventional Dentures
			Less Expense/Implants
			Esthetics
			Ease of Hygiene
			Parafunctional Habits
			Less Food Impaction
		Review of the Overdenture Literature
		Mandibular Overdenture Treatment Planning (RP-4 and RP-5)
			Anatomy of the Mandible
			Mandibular Implant Site Selection
			Overdenture Treatment Options
				Overdenture Option 1
				Overdenture Option 2
				Overdenture Option 3
				Overdenture Option 4
			Division C−h Anterior Mandibles
			Patient Education on Various Mandibular Overdenture Options
		Fixed Prosthesis
			Fixed Prosthesis Advantages
				Psychological
				Improved Speech
				Decreased Soft Tissue Irritation
				Increased Biting Force
				Less Bone Resorption
				Less Soft Tissue Extension
				Less Long-Term Expenses
				Less Interocclusal Space Requirement
				Patients with Limited Dexterity
				Increased Chewing Efficiency
			Mandibular Fixed Prosthesis (FP-1, FP-2, and FP-3)
			Implant Treatment Options for Fixed Restorations
				Treatment Option 1: The Brånemark Approach
				Treatment Option 2: Modified Brånemark Technique
				Treatment Option 3: Anterior Implants and Unilateral Posterior Implant
				Treatment Option 4: Anterior Implants and Bilateral
				Treatment Option 5: All-on-Four Protocol
		Summary
		References
	25 - The Edentulous Maxilla: Fixed versus Removable Treatment Planning
		Treatment Planning Factors
			Smile Line
			Lip Support
			Ridge Position
			Soft Tissue
			Crown Height Space (Interocclusal Space)
		Literature Review
		Fixed Maxillary Treatment Plans
			Maxillary Fixed Prosthesis Treatment Option 1 (Box 25.1)
			Maxillary Fixed Prosthesis Treatment Option 2
			Maxillary Fixed Prosthesis Treatment Option 3
			Maxillary Fixed Treatment Option 4: All-on-Four
		Removable Maxillary Treatment Plans
			Maxillary Removable Implant Overdenture Treatment Options
				Option 1: Removable Maxillary RP-4 Implant Overdenture
				Option 2: Removable Maxillary RP-5 Implant Overdenture
		Summary
		References
VI -Implant Surgery
	26 - Basic Surgical Techniques and Armamentarium
		Flap Design
			Maintain Blood Supply
			Flap Design to Provide Access
			Full-Thickness Reflection
			Minimize Trauma to Tissue
			Vertical Release Incisions
			Maintain Flap Margins Over Bone
			Prevent Desiccation of Tissue
			Flap Mobility
		Types of Flaps
			Flapless
			Papilla Sparing
			Envelope
			Triangular and Trapezoidal
			Vestibular
		Proper Incision Technique
			Proper Incision Positioning
			Use of a Sharp Scalpel Blade
			Scalpel Technique
			Avoid Vital Structures
			Proper Scalpel Grip
				Pencil Grip
				Fingertip Grip
				Palm Grip
		Surgical Armamentarium
			Instrument to Incise Tissue
				Scalpel/Surgical Blades
			Instruments to Reflect Tissue
			Instruments to Grasp Tissue
			Instruments to Remove Bone/Tissue
				Rongeur forceps
				Surgical burs
				Bone file
		Instruments to Remove Tissue From Extraction Sockets or Bony Defects
			Bone-Grafting Instruments
				Bone scrapers
				Grafting spoon and condenser
			Surgical Scissors
			Hemostats
			Instruments to Retract Tissue
			Instruments to Hold Mouth Open
			Instruments to Hold Drapes
			Handpieces/Motors
			Osteotomes
			Sinus Curettes
		Aseptic Technique
			Sterile Field
			Surgical Scrub
		Utilization of Ideal Suturing
			Materials and Techniques
		Suture Type
			Absorbable
			Nonabsorbable
		Suture Qualities
			High Tensile Strength
			Low Tissue Reactivity
			Absorbable
			Treatment Implications
		Suture Size
		Suture Needle
		Suturing Technique
			Interrupted
			Continuous
			Horizontal/Vertical Mattress
		Suturing Instruments
			Tissue Pickups
			Needle Holders
			Suture Scissors
		Suturing Knots
			Treatment Implications
		References
	27 - Implant Placement Surgical Protocol
		Pre-Implant Placement Protocols
			Flap Design
			Surgical Approaches
		Dental Implant Osteotomy Preparation
			Decreasing Heat During Osteotomy Preparation
				Irrigation versus No Irrigation
				Graduated versus One-Step Drilling
				Drilling Speed
				Drilling Time
				Drilling Pressure
				Intermittent versus Continuous Drilling
				Insertion Torque
		Bone Density Factors Related to Implant Preparation
			Literature Review
				Bone Density Classifications
				Osseodensification
		Generic Drilling Sequence
			Step 1: Pilot Drill
			Step 2: Position Verification
			Step 3: Second Twist Drill
			Step 4: Final Shaping Drills
			Step 5: Crest Module and Bone Tap Drills
			Step 6: Implant Insertion
		Dental Implant Surgical Protocol 1 (D1 Bone)
			Dense Cortical (D1) Bone
				Advantages of D1 Bone
				Disadvantages of D1 Bone
				Implant Osteotomy Drilling Sequence
			Bone Healing
		Dental Implant Surgical Protocol 2 (D2 Bone)
			Dense-to-Thick Porous Cortical and Coarse Trabecular Bone (D2)
				Advantages of D2 Bone
				Implant Osteotomy Surgical Sequence
				Healing
		Dental Implant Surgical Protocol 3 (D3 Bone)
			Thin Porous Cortical and Fine Trabecular Bone (D3)
				Advantages of D3 Bone
				Disadvantages of D3 Bone
				Implant Osteotomy Surgical Sequence
				Healing
		Dental Implant Surgical Protocol 4 (D4 Bone)
			Fine Trabecular Bone (D4)
				Disadvantages of D4 Bone
				Implant Osteotomy Drilling Sequence
				Healing
		Primary Stability
			Periotest
			Resonance Frequency Analysis
		One-Stage versus Two-Stage
			Two-Stage Surgery
			One-Stage Surgery
		Summary
		References
	28 - Ideal Implant Positioning
		“X”-Axis (Mesial-Distal) Positioning
			Insufficient Implant–Tooth Distance (Apical)
				Ideal Positioning
				Pretreatment Evaluation
				Complications
				Treatment
			Insufficient Implant–Tooth Distance (Coronal)
				Ideal Positioning
				Pretreatment Evaluation
				Prevention
				Complications
				Treatment
			Excessive Implant–Tooth Distance (Coronal)
				Ideal Positioning
				Pretreatment Evaluation
				Complications
				Treatment
			Lack of Implant–Implant Distance
				Ideal Positioning
				Pretreatment Evaluation
				Complications
				Treatment
		Buccolingual Positioning(“Y-Axis”)
			Ideal Positioning (Faciopalatal Ridge Dimensions)
				Pretreatment Evaluation
				Ideal Positioning (Faciopalatal Angulation)
		Faciopalatal Positioning
			A. Angulation with Respect to Prosthesis Type
				1. FP-1 & FP-2 Prosthesis
				Complications
				FP-3 Prosthesis
				Complications
					Malpositioning
			Apicocoronal (Z-Axis)
				Ideal Positioning
		Excessive Depth
			FP-1, FP-2, and FP-3
			Treatment
		Inadequate Depth
			Treatment
		RP-4 and RP-5
			Treatment
				Complications: Less than 15 mm
			Treatment
			Implant Position with Respect to Vital Structures
				Inferior Alveolar Nerve Canal or Mental Foramen
				Inferior Border of Mandible
				Nasal Cavity
				Distance from the Maxillary Sinus (Inferior Border)
		Prevention of Implant Malposition
			Ideal Treatment Planning
			Ideal Available Bone
			Understanding the Prosthesis Type and Associated Ideal Positioning
			Soft Tissue Evaluation
			Condition of the Adjacent Teeth
			Presence of Pathology
			Good Surgical Technique
			Poorly Dense Bone
				Understand the True Location of Vital Structures
			Use of Surgical Templates
				Non-Limiting Design
				Partial Limiting Design
				Complete Limiting Design
			Use of CBCT Surgical Guides
		Summary
		References
	29 - Maxillary Anterior Implant Placement
		Maxillary Anterior Implant Placement
			Maxillary Anterior Implant Studies
			Maxillary Anterior Teeth Evaluation
				Maxillary Tooth Size
				Tooth Shape
				Soft Tissue Drape
			Anatomic Challenges
				Natural Tooth Size Versus Implant Diameter
				Compromised Bone Height
				Compromised Mesiodistal Space
				Compromised Faciopalatal Width
				Selection of the Implant Size
				Implant Position
				Facial Implant Body Angulation
				Cingulum Implant Body Angulation
				Ideal Implant Angulation
			Soft Tissue Incision: Surgical Protocol
			Soft Tissue Closure
			Transitional Prosthesis
			Complications
				Interdental Papilla Deficiency
		Nasopalatine (Incisive) Foramen and Canal
			Anatomy
			Surgical Approaches to the Nasopalatine Canal
				Bone Grafting the Nasopalatine Canal with Delayed Implant Placement
				Removal of the Canal Contents + Implant Placement
				Positioning the Implant Away From the Nasopalatine Canal
			Complications of Nasopalatine Implants
				Migrated Implant
				Excessive Bleeding
				Neurosensory Impairment
				Tissue Regeneration
		Implants in Approximation to the Nasal Cavity
			Anatomic Considerations
		Maxillary Anterior Anodontia
			Congenitally Missing Lateral Incisor Treatment Protocol
				Orthodontic
				Spacing Requirements
				Postorthodontic Retention
				Final Prosthesis
		Summary
		References
	30 - Mandibular Anatomic Implications for Dental Implant Surgery
		Mandibular Anterior
			Hourglass Anterior Mandibles
				Clinical Relevance
			Median Vascular Canal
				Clinical Relevance
			Severely Angled Anterior Mandible
				Clinical Relevance
			Lack of Keratinized Tissue
				Clinical Relevance
			Inadequate Width of Bone
				Clinical Relevance
		Mandibular Posterior
			Lack of Bone Height
				Vertical Bone Augmentation (With Simultaneous or Delayed Implant Placement)
				Shorter Implants
			Mandibular Deformation (Flexure of the Mandible)
				Etiology
				Prevention
				Treatment
			Bony Anatomic Areas
				Posterior Lingual Undercut
				Clinical Relevance
		Vascular Considerations
			Incisive Canal Vessels
				Clinical Relevance
			Inferior Alveolar Artery
				Clinical Relevance
			Buccal Artery
				Clinical Relevance
			Facial Artery
				Clinical Relevance
		Neural Considerations
			Lingual Nerve
				Clinical Relevance
			Inferior Alveolar Nerve
		Radiographic Considerations
			Two-Dimensional Radiography
			Three-Dimensional Radiography
		Anatomic Considerations
			Inferior Alveolar Canal
				Inferior-Superior Plane
				Buccal-Lingual Plane
			Mental Foramen
				Visualization of the Mental Nerve
				Technique to Expose Mental Foramen
				Mental Nerve Variants
			Surgical Principles to Decrease Neurosensory Complications
				Safety Zone
				Always Take Into Account the Y Dimension of the Implant Burs
				Use Drill Stop Burs to Prevent Overpreparation
				Understand Bony Crest Anatomy
				Maintain Total Control of the Handpiece
				Do Not Place Bone Graft Material in Close Approximation to Nerve
				Use Copious Amounts of Irrigation
				Avoid Incision-Related Injuries
				Avoid Flap/Retraction–Related Injuries
				Use Special Care When Releasing Periosteum Over Mental Foramen
				Careful Suturing
				Verify Correct Positioning of CBCT SurgiGuides
			Surgical Procedures That Increase Neurosensory Complications
				Immediate Implants in the Mandibular Premolar Area
				Drill Until the Superior Cortical Plate Is “Felt”
				Infiltration Technique
				Placing Implants Lingual to the Inferior Alveolar Nerve Canal or Foramen
				Place Implants at the Depth of the Adjacent Root Apexes
				“As Long as There Is Not Excessive Bleeding, the
				Replacing Second Molars
				Nerve Repositioning
				Conclusion
		References
	31 - Dental Implant Complications
		Intraoperative Complications
			Malpositioned Initial Osteotomy Site
				Prevention
				Treatment
			Facial Dehiscence After Implant Placement
				Treatment
			Loss of Facial Plate When Placing an Implant
				Prevention
				Treatment
			Overheating the Bone
				Prevention
				Treatment
			Implant Pressure Necrosis
				Prevention
				Treatment
			Injury to Adjacent Teeth
				Prevention
				Treatment
			Swallowing/Aspiration of Implant Components
				Prevention
				Treatment
			Air Emphysema
				Prevention
				Treatment
			Electric Handpiece Burns
				Prevention
				Treatment
			Monopolar Electrosurgery Units
				Prevention
				Treatment
			Salivary Gland Injury
				Prevention
				Treatment
		Bleeding-Related Complications
			Prevention/Treatment of Bleeding
			Incision/Reflection of Tissue
			Anatomy/Anatomic Variants
				Mandibular Anterior: Intraosseous Vessels
				Mandibular Anterior: Extraosseous Vessels
				Mandibular Posterior: Extraosseous Vessels
				Maxilla: Lateral Wall/Nasal Bleeding
		Postoperative Bleeding Control
			Patient Education
			Techniques to Decrease and Control Bleeding
				Mechanical Methods
				Pharmacologic Techniques
					Active Hemostatic Agents
					Mechanical
		Postoperative Complications
			Edema (Postoperative) Surgical Swelling
				Etiology
				Prevention
				Treatment
			Ecchymosis (Bruising)
				Etiology
				Prevention
				Treatment
			Dental Implant Periapical Lesions (Retrograde Peri-implantitis)
				Etiology
				Prevention
				Treatment
			Titanium Allergy/Hypersensitivity
				Etiology
				Prevention
				Treatment
		Incision Line Opening
			Classification of Incision Line Opening Complications
			Morbidity Consequences of Incision Line Opening With Implants and Bone Grafting
			Prevention of Incision Line Opening
				Good Surgical Technique
				Decreasing “Dead Spaces”
				Decrease Inflammation
				Transitional and Interim Prosthesis Design
				Atraumatic Suture Removal
			Management of Incision Line Opening
				Resuturing Protocol
		Biomechanical Complications
			Screw Loosening
				Etiology
				Prevention
				Treatment
					Abutment Screw Movement
			Screw Fracture
				Etiology
				Prevention
				Treatment
		Neurosensory Impairment
			Specific Anatomic Areas Susceptible to Nerve Injury
				Inferior Alveolar Nerve
				Lingual Nerve
				Nasopalatine Nerve
				Anterior Superior Alveolar Nerve
				Infraorbital Nerve
			Etiology of Nerve Injuries
				Administration of Local Anesthesia
			Soft Tissue Reflection
				Implant and Implant Drill Trauma
			Nerve Healing Physiology
				Degeneration
				Regeneration
			Neurosensory Deficit Classification
			Treatment
				Nerve Impairment at Time of Surgery
				Postoperative Nerve Impairment
		Fractured Implant
			Etiology
			Prevention
			Treatment
		Explantation of Dental Implants
			Potential Complications
			Treatment
				Mobile Implant
				Nonmobile Implant
		References
	32 - Immediate Implant Placement Surgical Protocol
		Advantages of Immediate Implant Placement
			Decreased Treatment Time and Cost
			Decreased Need for Bone Augmentation
			Preservation of the Soft Tissue Drape
			Improved Implant Positioning
		Disadvantages of Immediate Placement
			Site Morphology
			Surgical Technique Is More Complicated
			Anatomic Limitations
			Lack of Primary Closure
			Presence of Acute/Chronic Pathology
			Consequences of Implant Failure
		Immediate Implant Studies
		Treatment Planning Considerations
			Available Bone
				Bone Height
				Bone Width
				Bone Length
				Bone Angulation
			Esthetic Risk
			Type of Prosthesis
			Bone Density
			Existing Crown Form
			Anatomic Location
			Tissue Thickness
			Buccal Bone Thickness
			Implant Position
		Requirements for Immediate Implant Placement
		Immediate Implant Placement Technique
			Step 1: Clinical and Radiographic Examination
			Step 2: Atraumatic Tooth Extraction
			Step 3: Curetting the Extraction Socket
			Step 4: Evaluating the Extraction Socket for Remaining Walls
				Classification of Bony Defects
			Step 5: Immediate Implant Placement Technique
				Flap Design
				Implant Osteotomy
				Ideal Positioning
				Implant Design
				Implant Stability
				Grafting/Membrane
				Closure
				Immediate Load or Staged Treatment
			Immediate Implants Into Infected Sites
		Complications
			Not Recognizing 4-Wall Socket
			Not Understanding Specific Anatomical Factors
			Inability to Obtain Primary Stability
				Prevention
				Treatment Options
			Postoperative Complications
				Transitional Prosthesis Impingement
				Neurosensory Impairment
		Conclusion
		References
	33 -Immediate Load/Restoration in Implant Dentistry
		Immediate-Loading Terminology
		Advantages of Immediate Load Protocol
		Disadvantages of Immediate Load Implants
		Prerequisites for Immediate-Loading Protocol
		Rational for Implant Immediate-Loading Protocol
		Histologic Evaluation of Immediate-Loaded Implants
		Immediate Occlusal Loading: Factors That Decrease Risks
		Immediate-Loading Protocol: Partially Edentulous Patients
		Partially Edentulous (Greater Than One Edentulous Space)
		Completely Edentulous Arches
		All-on-4 Surgical/Prosthetic Protocol
		Advanced Fully Guided Immediate Placement/Loading Protocols (Box 33.6,Box 33.7, Fig. 33.18)
		Immediate Loading: Postoperative Instructions
		Immediate Loading: Postoperative Complications
		Summary
		References
VII -Soft and Hard Tissue Rehabilitation
	34 - Atraumatic Tooth Extraction and Socket Grafting
		Extraction Socket Healing
		Atraumatic Tooth Extraction
		Socket Grafting of the Extraction Site
		Socket Graft Healing
		Socket Grafting Contraindications
		Socket Graft Complications
		Conclusion
		References
	35 - Bone Substitutes and Membranes
		Terminology for Bone Repair and Regeneration
		Mechanisms of Bone Repair and Regeneration
		Ideal Bone Graft Substitute
		Ideal Membrane Material
		Classification of Bone Graft Substitutes and Membranes
		Oversight
		Sterility
		Proprietary Sterilization Methods
		End-User Responsibilities
		Allograft Source, Processing, and Distribution
		Xenograft Source, Production, and Distribution
		Alloplast Production and Distribution
		Graft Descriptions50-60
			Allograft
			Xenograft
			Alloplast
			Membranes
		Comparing Bone Graft Substitutes and Membrane Characteristics
		Looking to the Future
		Summary
		Acknowledgments
		References
	36 - Particulate Membrane grafting/Guided Bone Regeneration
		Indications for Bone Grafting
		Cellular Bone Regeneration Process
		Treatment Planning in the Compromised Edentulous Ridge
			Edentulous Site Assessment
		Bony Defect Morphology Considerations and Classification
			Bony Defect Classification
				Depression
				Concavity
				Trough
				Elevation/Prominence
				Vertical (Height)
				Buccal/Lingual (Palatal)
				Complex/Multi-Dimensional
		Soft Tissue Considerations
		Guided Bone Regeneration Protocol
			Step 1: Incision and Flap Design
			Step 2: Flap Reflection and Site Preparation
				Full-Thickness Reflection
			Step 3: Removal of Residual Soft Tissue and Pathology
			Step 4: Recipient Bed Preparation
			Step 5: Tissue Release
				Tissue Release Technique
			Step 6: Membrane Selection and Placement
				Types of Membranes
				Sizing and Positioning of Membranes
				Initial Placement of Membrane
			Step 7: Space Maintenance
				Space Maintenance Options
				Tent Screw Technique
			Step 8: Bone Graft Placement
				Layer # 1: Autograft (Optional)
					Ramus Graft Harvest
				Layer # 3: Final Implant Placement
				Bone Growth Factors
			Step 9: Closure
		Postoperative Treatment
			Provisional Restoration
		Development of Ideal Bone Density in Regeneration Sites
		Graft Maturation Healing Times
		Bone-Grafting Complications
			Incisive Canal Involvement in Regeneration Sites
			Releasing the Tissue Flap From Underlying Tenting Screws
			Exposure of the Bone Fixation Screw During the Healing Process
			Incision Line Opening in Bone-Grafting Sites
			High Mucogingival Junction Following Ridge Augmentation
			Graft Infection
			Ultrasonic Piezosurgery-Related Tissue Injury
		Summary
		References
	37 - Maxillary Sinus Anatomy, Pathology, and Graft Surgery
		Maxillary Sinus Anatomy
			Development and Expansion of the Maxillary Sinus
			Bone Resorption Process
			Resultant Poor Bone Density
			Bony Walls
				Anterior Wall
				Superior Wall
				Posterior Wall
				Medial Wall
				Lateral Wall
				Inferior Wall
			Ostiomeatal Complex
			Blood Supply and Sensory Innervation
				Extraosseous Anastomosis
				Intraosseous Anastomosis
				Posterior Lateral Nasal Artery
				Sphenopalatine/Infraorbital Arteries
			Maxillary Sinus Mucosa
			Maxillary Sinus Mucociliary Clearance
			Maxillary Sinus Bacterial Flora
		Maxillary Sinus: Clinical Assessment
		Maxillary Sinus Radiographic Evaluation
			Cone Beam Computerized Tomography
		Normal Anatomy
			Maxillary Sinus Membrane (Schneiderian Membrane)
			Ostiomeatal Complex
			Nasal Cavity
		Maxillary Sinus: Anatomical Variants
			Nasal Septum Deviation
			Middle Turbinate Variants
			Uncinate Process Variants
			Supplemental Ostia
			Maxillary Hypoplasia
				Inferior Turbinate and Meatus Pneumatization (Big-Nose Variant)
		Maxillary Sinus Pathology
			Inflammatory Disease
				Odontogenic Rhinosinusitis (Periapical Mucositis)
				Mild Mucosal Thickening (Nonodontogenic)
				Acute Rhinosinusitis
				Chronic Rhinosinusitis
				Allergic Rhinosinusitis
				Fungal Rhinosinusitis (Eosinophilic Fungal Rhinosinusitis)
		Cystic Lesions
			Pseudocysts (Mucous Retention Cyst)
				Etiology
				Radiographic Appearance
				Treatment
			Retention Cysts
				Etiology
				Radiographic Appearance
				Treatment
			Primary Maxillary Sinus Mucocele
				Etiology
				Radiographic Appearance
				Treatment
			Secondary Maxillary Sinus Mucocele (Postoperative Maxillary Cyst)
				Etiology
				Radiographic Appearance
				Treatment
			Neoplasms
				Etiology
				Radiographic Appearance
				Treatment
			Antroliths and Foreign Bodies
				Etiology
				Radiographic Appearance
				Differential Diagnosis
				Treatment
		Miscellaneous Factors That Affect the Health of the Maxillary Sinus
			Smoking
		Relative and Absolute Contraindication to Maxillary Sinus Graft Procedures
		Reduction of Sinus Graft Complications
			Prophylactic Medications
				Systemic Antimicrobial Medications
				Local Antibiotic Medications
				Oral Antimicrobial Rinse
				Glucocorticoid Medications
				Decongestant Medications
				Analgesic Medications
				Cryotherapy
				Aseptic Technique
		Surgical Treatment of the Maxillary Sinus: History
		Treatment Classifications for the Posterior Maxilla
		Surgical Technique
			Subantral Option One: Conventional Implant Placement
				Required Bone Dimensions
			Subantral Option Two: Sinus Lift and Simultaneous Implant Placement
				Rationale
				Incision and Reflection
				Osteotomy and Sinus Elevation (SA-2)
				Modified SA2 Techniques
				Complications
			Subantral Option Three: Sinus Graft with Immediate Endosteal Implant Placement
				Anesthesia
				Surgical Approaches
			Subantral Option Four: Sinus Graft Healing and Extended Delay of Implant Insertion
				Vascular Healing of Graft
				Postoperative Instructions
				Implant Insertion
		Intraoperative Complications Related to Sinus Graft Surgery
			Membrane Perforations
			Antral Septa
				Management of Septa Based on Location
			Bleeding
		Short-Term Postoperative Complications
			Incision Line Opening
			Nerve Impairment
				Complication
				Management
		Revision Surgery
			Treatment Implications
		Edema
			Prevention
			Cryotherapy
		Ecchymosis
			Etiology
			Prevention
		Pain
		Oroantral Fistulae
			Management
		Post-Operative Infection
			Graft Site Infections
				Etiology of Graft Site Infection
				Diagnosis
				Treatment
			Acute Rhinosinusitis Infections
				Etiology of Acute Rhinosinusitis
				Diagnosis
				Treatment
			Combination (Graft Site Infections/Acute Rhinosinusitis)
				Etiology
				Diagnosis
				Treatment
		Spread of Infection
		Implant Penetration Into the Sinus
		Overfilling of the Sinus
		Postoperative Cone Beam Computerized Tomographic Mucosal Thickening (False Positive for Infection)
		Migration of Implants
			Etiology
			Prevention
			Management
		Postoperative Fungal Infection
			Diagnosis
			Management
		Summary
		References
	38 - Intraoral Autogenous Bone Grafting
		History of Autogenous Bone Grafts
		Preoperative Evaluation of Recipient Site
			Preparation of Recipient Site
		Selection of Intraoral Donor Site
			Mandibular Symphysis Donor Site
				Anatomy
				Radiographic Evaluation
				Anesthesia
				Incision and Reflection
				Donor Site Osteotomy Harvest
				Block Removal
				Closure
				Alternative Symphysis Procedures
			Mandibular Ramus Donor Site
				Anatomy
					Anatomic Surfaces
					Anatomic Borders
					Anatomic Processes
				Radiographic Evaluation
				Incision and Reflection
				Donor Site Osteotomy Harvest
				Alternative Ramus Procedures
			Tuberosity Donor Site
				Anatomy
				Radiographic Analysis
				Incision and Reflection
				Donor Site Osteotomy Harvest
		Block Graft Preparation
			Fixation of the Block Graft
				Soft Tissue Preparation
				Preparation of the Recipient Site
				Fixation of the Block Graft
				Membranes and Block Grafts
				Maturation and Integration of Block Grafts
		Comparison of Intraoral Bone-Grafting Donor Sites
		Postoperative Care and Instructions
		Complications
			Symphysis Graft Complications
				Incision Line Opening
				Neurosensory Impairment
				Bleeding Episodes
				Ptosis
			Ramus Graft Complications
				Neurosensory Deficit
			Bone Graft Complications
				Incision Line Opening in Bone-Grafting Sites
				Mobility of the Block
				Soft Tissue Irritation From an Overextended Fixation Screw
		Implant Placement
		Summary
		References
	39 - Extraoral Bone Grafting for Implant Reconstruction
		Introduction
		Extraoral Donor Bone Graft Sites
			Calvarial Graft
				Anatomy and Technique
				Complications
				Case Study
			Iliac Crest Bone Graft
				Anatomy and Technique
				Complications
				Case Study 1: Corticocancellous Morcellized Graft
				Case Study 2: Corticocancellous Block Grafts
			Tibial Bone Graft
				Anatomy and Technique
				Complications
				Case Study
			Vascularized Composite Graft: The Fibula
				Anatomy and Technique
				Complications
				Case Study 1: Fibula Reconstruction with Immediate Placement and Loading of Implants
				Case Study 2: Double-Barrel Fibula Graft with Immediate Placement of Implants
		Summary
		References
	40 - The Use of Botox and Dermal Fillers in Oral Implantology
		Injectable Neurotoxin (Botulinum Toxin)
			Mechanism of Action
			How Supplied and Preparation
				Generalized Botulinum Toxin Type A Injection Technique/Dose
			Duration of Action
		Botulinum Toxin Type A Uses in Implant Dentistry
			Parafunctional Habits
				Masseter Muscle Hyperactivity
				Temporalis Muscle
			Temporomandibular Joint Syndrome (TMJ)/Temporomandibular Dysfunction (TMD) Pain
				Temporomandibular Dysfunction/Temporomandibular Joint Technique
			Excessive Tissue Display (Gummy Smile)
				Etiology
				Injection Technique
		Generalized Botulinum Toxin Type A Postoperative Instructions
		Generalized Contraindications to Botox
		Generalized Complications to Botox
		Injectable Fillers
			Mechanism of Action
			How Supplied and Preparation
			Indications
			General Technique
			Injection Technique
			Duration of Action
			Permanent Fillers
		Dermal Filler Use in Implant Dentistry
			Black Triangles
				Etiology
			Lips
				Anatomy
				Most Common Lip Issues
				Injection Technique
				Lip Injection Complications Complications
			Face
				Goal of Facial Fillers
				Nasolabial Folds/Nasolabial Crease
				Marionette Lines
				Angular Cheilitis
		Reversals for Dermal Fillers
		Complications With Dermal Fillers
		Complications48
		Conclusion
		References
VIII -Dental Implant Maintenance
	41 - Peri-Mucositis and Peri-Implantitis Diagnosis, Classification, Etiologies, and Therapies
		Peri-implant Disease
			The Role of Biofilm in Peri-Implant Disease
		Peri-implant Mucositis
			Etiology
			Prevention
			Management
				Professional Mechanical Debridement
				Ultrasonic Devices
				Antimicrobials
				Patient At-Home Mechanical Debridement
		Peri-implantitis
			Etiology
				Biofilm
				Occlusal Stress
				History of Periodontitis
				Smoking/Tobacco Use
				Diabetes
			Prevention
				Home Care
				Professional Care
				Prosthetic Design
				Cementation Technique
				Control of Parafunctional Forces
			Management
				Nonsurgical Management of Peri-Implantitis
				Surgical Management of Peri-Implantitis
					Regenerative Technique
					Protocol
		Suzuki-Resnik Peri-Implant Disease Protocol
			PROTOCOL 1
				Treatment
			PROTOCOL 2: (Peri-Implant Mucositis)
				Treatment
			PROTOCOL 3: (Peri-Implantitis)
				Treatment
			PROTOCOL 4: Implant Mobility
				Treatment
		Peri-Implant Disease Treatment Regimen
			Treatment Regimen A: Mechanical Closed Debridement (Acceptable Instrumentation)
			Treatment Regimen B: Antiseptic Therapy
			Treatment Regimen C: ANTIBIOTICS
			Treatment Regimen D: SURGERY (Access, Open Debridement, Bone Graft, Closure)
			Treatment Regimen E: IMPLANT REMOVAL
		Lack of Keratinized Tissues
			Management of Lack of Keratinized Tissue
				Presurgical Augmentations
				Concurrent Augmentation
				Post-implant Tissue Augmentation
		Retained Cement Peri-implant Disease
			Etiology
			Prevention
			Techniques
			Removal of Retained Implant Cement
				Nonsurgical
				Surgical
			Peri-implant Mucosal Hyperplasia
			Etiology
			Prevention
			Management
		Implant Quality Scale
			Group I: Optimum Health
			Group II: Satisfactory Health
			Group III: Compromised Survival
			Group IV: Clinical Failure
		Conclusion
		References
	42 - Implant Maintenance: Long-Term Implant Success
		Anatomy of Peri-implant Hard and Soft Tissues
			Soft Tissue Differences
			Tooth Versus Implant Movement
		Maintenance Protocol
			Medical and Dental Histories
				Medical History
				Dental History
			Clinical Evaluation of the Implant(s)/Prosthesis
				Soft Tissue Assessment
				Assessment of Home Care
				Probing
				Presence of Keratinized Tissue
				Mobility of Implant/Prosthesis
				Pain/Sensitivity
				Occlusion
				Prosthesis
			Radiographic Evaluation of the Implant and Prosthesis
				Radiograph Type
				Radiograph Accuracy
				Radiograph Timing
				Radiographic Crestal Bone Loss
		Diagnosis of Peri-implant Disease
			Healthy Condition
			Peri-implant Mucositis
			Peri-implantitis
		Frequency of Maintenance Visits
		Patient Home Care
			Specific Dentifrices
				Manual and Electromechanical Devices
				Toothpaste/Gel
				Interproximal Brushes
				Floss Aids
				Oral Irrigator
				Antimicrobial Rinses
		In-Office Debridement
		Conclusion
		References
Treatment Plan Options
	Edentulous Maxilla
	Edentulous Mandible
	Single Tooth Missing
	Multiple Missing Teeth
Index
	A
	B
	C
	D
	E
	F
	G
	H
	I
	J
	K
	L
	M
	N
	O
	P
	R
	S
	T
	U
	V
	W
	X
	Y
	Z
	IBC