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PERI IMPLANTITIS MORE PREVALENT IN SMOKERS AND THOSE WITH PERIO DISEASE

2011-11-03T10:22:00.001-04:00

A recent publication out of sweden showed a positive correlation between peri implantitis and previous perio disease and smoking. the abstract is post here:

Swed Dent J. 2010;34(2):53-61.

Peri-implantitis in a specialist clinic of periodontology. Clinicalfeatures and risk indicators.

CarcuacO, JanssonL.

Source

Department of Periodontology at Kista-Skanstull, Folktandvården i StockholmsIän AB, Stockholm, Sweden.

Abstract

Implant therapy has become a widely recognizedtreatment alternative for replacing missing teeth. Several long term follow-upstudies have shown that the survival rate is high. However, complications mayappear and risk indcators associated with early and late failures have beenidentified. The purpose of the present retrospective clinical study was todescribe some clinical features of patients with clinical signs ofperi-implantitis and to identify risk indicators of peri-implantitis in apopulation at a specialist clinic of Periodontology. In total,the materialconsisted of 377 implants in 111 patients with thediagnosis peri-implantitis. The mean age at the examination was found to be56.3 years (range 22-83) for females and 64.1 years (range 27-85) for males.The mean number of remaining teeth was found to be 10.5 (S.D. 8.89) and themean number of implants was 5.85 (S.D. 3.42). Fora majority of the subjects, more than 50% of the remaining teeth had a marginalbone loss of more than 1/3 of the root length. Forty-sex percent of thepatients visited regularly dental hygienists for supportive treatment. Thepercentage of implants with peri-implantitis wassignificantly increased for smokers compared to non-smokers (p = 0.04). In thegroup of non-smokers, 64% of the implants had thediagnosis peri-implantitis, while the corresponding relative frequency forsmokers was 78%. A majority of the individuals had a Plaque index and Bleedingon probing index >50%. The median of the follow-up time after implantplacement was 7.4 years and the observation period was not significantlycorrelated to the degree of bone loss around the implants.Among the subjects with a mean bone loss >6 mm at implantswith peri-implantitis, more than 70% had a mean marginal bone loss > 1/3 ofthe root length of the remaining teeth. A positive and significant correlationwas found between the degree of marginal bone loss in remaining teeth and thedegree of bone loss around implants withperi-implantitis. In conclusion, the results of the present study indicate thatsmoking as well as previous history of periodontitis are associated withperi-implantitis and may represent risk factors for this disease

MIX ACETOMINOPHEN AND IBUPROFEN FOR BEST RESULTS

2011-11-01T15:10:00.001-04:00

Dr. Richard L. Wynn is Professor of Pharmacology at the University of Maryland Dental School. He holds a BS degree in Pharmacy and a PhD degree in Pharmacology. He chaired the Department of Pharmacology at the University of Maryland Dental School from 1980 to 1995. He is the lead author of the Drug Information Handbook for Dentistry, a co-author on many other dental drug publications, an author of over 300 refereed scientific journal articles, a consultant to the Academy of General Dentistry, a featured columnist, and a featured speaker presenting more than 500 courses in continuing dental education. One of his primary interests continues to be keeping dental professionals informed of all aspects of drug use in dental practice.

Over-the-Counter Ibuprofen and Acetaminophen in Combination are Superior to Each Agent Alone in Treating Postoperative Pain

The first two reports (Derry, et al and Toms, et al) describe the efficacy of single doses of ibuprofen and single doses of acetaminophen for postoperative pain, compared to placebo in well-controlled trials. The third report (Mehlisch, et al) describes the analgesic benefits of the combination of the two agents (compared with each drug alone), again in well-controlled trials. These studies provide further evidence-based information for the rational use of over-the-counter pain relievers for postoperative dental pain.
Study #1 Assessing the efficacy of single dose over-the-counter ibuprofen
Derry C, Derry S, Moore RA, et al, "Single Dose Oral Ibuprofen for Acute Postoperative Pain in Adults," Cochrane Database Syst Rev, 2009, July 8, (3) CD001548.
The objective of this study was to assess the analgesic efficacy of ibuprofen in single oral doses for moderate and severe postoperative pain in adults. The method was to search the Cochrane Library, CENTRAL, MEDLINE, EMBASE, and the Oxford Pain Relief Database for studies to May, 2009. Selection of studies considered for review was based on randomized, double-blind, placebo-controlled trials of single-dose orally administered ibuprofen in adults with moderate to severe acute postoperative pain. Pain relief or pain intensity data were extracted and converted to outcomes of numbers of participants with at least 50% pain relief over 4 to 6 hours, from which relative risk and number-needed-to-treat-to-benefit (NNT) were calculated. The number of participants using rescue medication over specified time periods, and the time to rescue medication, were sought as additional measures of efficacy. Finally, information on adverse events and withdrawals was collected.
Results of the Derry, et al, study
The studies reviewed totaled 72 and included 9,186 participants, in which ibuprofen was compared to placebo. The majority of the studies used ibuprofen at 200 mg and 400 mg doses.
For at least 50% pain relief compared with placebo, the number-needed-to-treat-to-benefit for ibuprofen 200 mg (2,690 participants) was 2.7 (2.5 to 3.0) and for ibuprofen 400 mg (6,475 participants) it was 2.6 (2.4 to 2.6).
The proportion with at least 50% pain relief was 46% with 200 mg ibuprofen and 54% with 400 mg ibuprofen. Remedication within 6 hours was less frequent with higher doses, with 48% remedicating with 200 mg and 42% remedicating with 400 mg. The median time to remedication was 4.7 hours for 200 mg and 5.4 hours for 400 mg.
The studies using dental impaction pain models and soluble ibuprofen salts (liquid gel capsule formulations) produced better efficacy estimates. Adverse events were uncommon and no different from placebo.
The authors concluded a substantial amount of high quality evidence demonstrated that over-the-counter ibuprofen is an effective pain reliever in treating postoperative pain.
Study #2 Assessing the efficacy of single dose over-the-counter acetaminophen
Toms L, McQuay HJ, Derry S, et al, "Single Dose Oral Paracetamol (Acetaminophen) for Postoperative Pain in Adults," Cochrane Database Syst Rev, 2008, Oct 8, (4) CD004602.
The objective of this study was to assess the efficacy of single dose oral acetaminophen for the treatment of acute postoperative pain. The method was to search the Cochrane Library, MEDLINE, EMBASE, the Oxford Pain Relief Database, and reference lists of articles to update data from an existing version of the review. Selection of studies considered for review was based on randomized, double-blind, placebo-controlled trials of acetaminophen for acute postoperative pain in adults.
Area under the "pain relief versus time" curve was used to derive the proportion of participants with acetaminophen or placebo experiencing at least 50% pain relief over 4 to 6 hours, using validated equations. Number-needed-to-treat-to-benefit was calculated. The proportion of participants using rescue analgesia over a specified time period and time to use were sought as measures of duration of analgesia. Information on adverse events and withdrawals was also collected.
Results of the Toms, et al, study
Fifty-one studies with 5,762 participants were included; of those who took acetaminophen or placebo, 3,277 participants were treated with a single oral dose of acetaminophen and 2,425 with placebo. About half of the participants treated with acetaminophen at standard doses achieved at least 50% pain relief over 4 to 6 hours compared with about 20% treated with placebo.
Number-needed-to-treat-to-benefit for at least 50% pain relief over 4 to 6 hours following a single 500 mg dose of acetaminophen was 3.5 (2.7 to 4.8); following a single 600 to 650 mg dose it was 4.6 (3.9 to5.5); following a single dose of 975 to 1000 mg it was 3.6 ( 3.4 to 4.0).
About half the participants taking acetaminophen needed additional analgesia over 4 to 6 hours compared with about 70% with placebo.
Five people would need to be treated with 1000 mg acetaminophen, the most commonly used dose, to prevent one needing rescue medication over 4 to 6 hours, who would have needed it with placebo.
Reported adverse events were mild and transient, and occurred at similar rates with 1000 mg acetaminophen and placebo. No serious adverse events were reported.
The authors concluded that a single dose of acetaminophen provided effective analgesia for about half of the patients with acute postoperative pain for a period of about 4 hours and is associated with few, mainly mild, adverse events.
Study #3 Assessing the efficacy of the combination of over-the-counter ibuprofen and acetaminophen
Mehlisch DR, Aspley S, Daniels SE, et al, "Comparison of the Analgesic Efficacy of Concurrent Ibuprofen and Paracetamol With Ibuprofen or Paracetamol Alone in the Management of Moderate to Severe Acute Postoperative Dental Pain in Adolescents and Adults: A Randomized, Double-blind, Placebo-controlled, Parallel-group, Single-dose, Two-center, Modified Factorial Study," Clin Ther, 2010, 32:882-95.
This study was done to test the hypothesis that combination analgesics may offer improved analgesic efficacy, particularly for moderate to severe pain. The authors evaluated the analgesic benefits of concurrent ibuprofen and paracetamol (acetaminophen), compared with each drug used alone, in the management of acute postoperative dental pain.
Methods
The study enrolled healthy patients, ages 16 to 40 years, undergoing surgical removal of 3 to 4 impacted molars. The protocol was a randomized, double-blind, placebo-controlled, parallel-group, single-dose, two center study. Patients were randomly assigned to ibuprofen 400 mg/acetaminophen 1000 mg combination, ibuprofen 200 mg/acetaminophen 500 mg combination, ibuprofen 400 mg alone, acetaminophen 1000 mg alone, or placebo when the postoperative pain reached moderate to severe intensity.
The primary endpoint of efficacy was the sum of pain relief and pain intensity differences from 0 to 8 hours. Secondary endpoints included total pain relief, sum of pain intensity differences, and sum of pain intensity differences on the visual analog scale at various time endpoints. Other analgesic measures included peak effect, onset and duration of effect, and patients' overall assessment of treatment. The tolerability of study medicines was also assessed in terms of frequency and nature of adverse events.
Results of the Mehlisch, et al, study
A total of 234 patients were randomly assigned to treatment and included in the intent-to-treat population.
Results for the primary endpoint
For the sum of pain relief and pain intensity differences, the group receiving the combination of ibuprofen 400 mg/acetaminophen 1000 mg had significantly better mean scores compared with ibuprofen 400 mg alone, acetaminophen 1000 mg alone and the combination of ibuprofen 200 mg/acetaminophen 500 mg.
For the sum of pain relief and pain intensity differences, the group receiving the combination of ibuprofen 200 mg/acetaminophen 500 mg had significantly better mean scores compared with acetaminophen 1000 mg alone, but not compared to ibuprofen 400 mg alone.
Results for secondary endpoints
Ibuprofen 400 mg/acetaminophen 1000 mg was associated with significantly better scores than was single agent therapy for total pain relief, sum of pain intensity differences, and sum of pain intensity differences on the visual analog scale at all time intervals, and for sum of pain relief and pain intensity differences from 4 to 6 hours.
A breakdown of the Mehlisch, et al, data showed the following:
Time to the first confirmed perceptible pain relief for each treatment was:
Ibuprofen 400 mg/acetaminophen 1000 mg: 23 minutes
Ibuprofen 200 mg/acetaminophen 500 mg: 22 minutes
Ibuprofen 400 mg: 49 minutes
Acetaminophen 1000 mg: 25 minutes
Placebo: 98 minutes
Time to the first meaningful pain relief for each treatment was:
Ibuprofen 400 mg/acetaminophen 1000 mg: 94 minutes
Ibuprofen 200 mg/acetaminophen 500 mg: 74 minutes
Ibuprofen 400 mg: 124 minutes
Acetaminophen 1000 mg: 141 minutes
Placebo: 133 minutes
Time to pain half gone for each treatment was:
Ibuprofen 400 mg/acetaminophen 1000 mg: 70 minutes
Ibuprofen 200 mg/acetaminophen 500 mg: 86 minutes
Ibuprofen 400 mg: 114 minutes
Acetaminophen 1000 mg: 135 minutes
Placebo: 229 minutes
There were significant differences in favor of all active treatments versus placebo for all efficacy endpoints. Adverse events were similar across treatments, with the most frequent being nausea [26.1% (61/234)], vomiting [18.8% (44/234)], headache [10.3% (24/234)], and dizziness [8.1% (19/234)].
The authors concluded that concurrent ibuprofen and acetaminophen appeared to provide significantly better analgesic efficacy compared with either drug alone for management of acute postoperative dental pain.

Drug information is constantly changing. Promote medication safety in your practice with Lexicomp Online for Dentistry.

PERI-IMPLANTITIS AND ITS MANAGEMENT

2011-10-26T13:10:00.003-04:00

Review of the treatment protocols for peri-implantitis

Oct 12, 2011

By Scott Froum, DDS

Peri-implantitis is an inflammatory process affecting the soft and hard tissues surrounding an implant. This disease is associated with loss of supporting bone, bleeding on probing, and occasionally suppuration. The etiopathogenesis of peri-implantitis is complex and related to a variety of factors that affect the peri-implant environment. Peri-implantitis can be influenced by three factors:

Patient-related factors including systemic diseases (e.g, diabetes, osteoporosis) and prior dental history (periodontitis)
Social factors such as inadequate oral hygiene, smoking, and drug abuse
Parafunctional habits (bruxism and malocclusion).

In addition to the above, iatrogenic factors such as faulty restorations, cement left following restoration delivery, and/or loose components can also play a significant role in the development of peri-implantitis.

Although restorations of endosseous implants have demonstrated a very high survival rate¹, one study suggested that over a five-year period, 0 to 14.4% of dental implants demonstrated peri-implant inflammatory reactions associated with crestal bone loss.²

Many methods of treating peri-implantitis have been documented in the literature and most focus on removal of the contaminating agent from the implant surface. These treatments include:

Administration of systemic antibiotics alone
Mechanical debridement with or without systemic antibiotic treatment³
Mechanical debridement with or without localized drug delivery and chlorhexidine oral rinses^3a
Mechanical debridement combined with LASER decontamination⁴
Surgical debridement, and more recently ...
Surgical debridement with guided bone regeneration (GBR) for reparation of bony and soft-tissue defects.⁵

To date, GBR using a bone graft and membrane has had the best success as in demonstrating bone fill of the defects associated with peri-implantitis as described in the literature.⁶

Because there are biologic differences between teeth and implants, the progression of infection around implants is different than natural teeth. The inflammatory cell infiltrate around implants was reported to be larger and extend more apically when compared to a corresponding lesion in the gingival tissue around natural teeth. In addition, the tissues around implants are more susceptible to plaque-associated infections that spread into the alveolar bone.⁷

Implant surface bacterial decontamination is essential in treating peri-implantitis infections. Systemic administration of antibiotics has been used in the treatment of peri-implantitis, resulting in a reduction of inflammation. However, the efficacy of antibiotic therapy as a sole therapy has limited efficacy due to bacterial recolonization of the implant surface.⁸

Because nonsurgical treatment approaches failed to promote the reosseointegration of the exposed implant sites,⁹additional surgical interventions have been used in order to minimize the risk for a reinfection of the peri-implant pocket. Some of the treatment modalities suggested for peri-implantitis are:

Mechanical/ultrasonic debridement with localized drug delivery; i.e., antimicrobial minocycline spheres (Arestin^®)
Laser treatment with and without flap access
Open flap debridement
Open flap debridement with guided bone regeneration

Renvert et al. (2006) compared the combination of mechanical debridement and topical application of minocycline microspheres to the combination of mechanical debridement and 1% chlorhexidine gel application in peri-implant lesions. The results obtained after a follow-up period of 12 months showed that with the chlorhexidine group, only a limited reduction in bleeding on probing was achieved and the mean peri-implant probing depth (PD) remained unchanged (3.9 mm). On the other hand, in the minocycline group, the reduction of bleeding on probing was greater and an improvement in mean peri-implant PD (from 3.9 mm to 3.6 mm) was seen. These results suggest that the topical application of chlorhexidine provides limited or no adjunctive clinical improvement when treating shallow peri-implant lesions as compared with using mechanical debridement alone.¹⁰

Schwarz et al. (2005, 2006a) compared the efficacy of the Er:YAG laser with that of the combination of mechanical debridement (using plastic curettes) and antiseptic (0.2% chlorhexidine digluconate) administration for the treatment of peri-implantitis. In both studies, the results obtained six months after therapy suggested that the treatment modalities were equally effective in improving peri-implant probing pocket depth (PPD) and clinical attachment level (CAL). However, at 12 months, the mean values for both groups of peri-implant PPD and CAL were not statistically significantly different from the corresponding values at baseline. Therefore, the results of the Er:YAG laser seem to be limited to a six-month period, particularly for advanced peri-implantitis lesions.

Leonhardt et al. evaluated the five-year outcome of a combined surgical (open flap) and antimicrobial treatment of peri-implantitis in humans. Leonhardt studied the effect of systemic antimicrobial therapy (amoxicillin and metronidazole) together with an open flap procedure and in conjunction with mechanical debridement of the implant surface for decontamination. The treatment was successful in 58% of the implants treated during follow-up for five years. Smoking was found to be a negative risk factor for treatment success.¹¹

Schwarz et al. (2006b) evaluated and compared the efficacy of two bone regenerative procedures for the treatment of moderate intrabony peri-implantitis lesions that included a greater than 6 mm probing depth and an intrabony component of 3 mm as detected on radiographs. The defects were randomly treated either with a surgical debridement and filled with nanocrystalline hydroxyapatite, or surgical debridement and filled with bovine-derived xenograft (Bio-Oss^®, Geistlich, Wolhusen, Switzerland) combined with a bioresorbable porcine-derived collagen membrane (Bio-Gide^®, Geistlich, Wolhusen, Switzerland). After two years, the study showed that the combination of bovine bone mineral and the collagen membrane seemed to yield greater improvements in clinical parameters, showing 0.9 ± 0.2 mm more in PD reduction and 1.0 ± 0.3 more clinical attachment gain.^12,13

Conclusion
The ideal management of peri-implant infections should focus both on infection control of the lesion, detoxification of the implant surface, and regeneration of lost support. Treatment options can be surgical or nonsurgical. To date, studies suggest that nonsurgical treatment of peri-implantitis is unpredictable, and the use of chemical agents such as chlorhexidine has only limited effects on clinical and microbiological parameters. Adjunctive local or systemic antibiotics have shown to reduce bleeding on probing and probing depths in combination with mechanical debridement. Beneficial effects of laser therapy on peri-implantitis have been shown, but this approach needs to be further evaluated. Implant surface bacterial decontamination is essential in treating peri-implantitis infections. Most studies suggest that establishing an adequate healthy peri-implant tissue environment proves to be difficult since inflammation is still present in a significant number of patients. New treatment modalities need to be evaluated using long-term randomized-controlled studies to identify predictable and successful treatment of peri-implantitis.

Author bio
Scott Froum, DDS, is a periodontist and co-editor of Surgical-Restorative Resource e-newsletter. He is a clinical associate professor at the New York University Dental School in the Department of Periodontology and Implantology. He is in private practice in New York City. You may contact him by email at drscottfroum@yahoo.com.

References
1. Albrektsson T et al. Osseointegrated oral implants — A Swedish multicenter study of 8139 consecutively inserted Nobelpharma implants. J Periodontol 1988;5 9:287-296.
2. Berglundh T et al. A systematic review of the incidence of biological and technical complications in implant dentistry reported in prospective longitudinal studies of at least 5 years. J Clin Periodontol 2002; 29:197-212.
3. Renvert S. (2008), Nonsurgical treatment of peri-implant mucositis and peri-implantitis: a literature review. J Clin Periodontol. Sept. 2008; 35(8 Suppl):305-315.
3a. Rosenberg ES et al. Microbial differences in two clinically distinct types of failures of osseointegrated implants. Clin Oral Implants Res 1991; 2:135-144.
4. Schwarz F et al. (2006a). Nonsurgical treatment of moderate and advanced peri-implantitis lesions: a controlled clinical study. Clinical Oral Investigations 10, 279–288.
5. Klinge B et al. A systematic review of the effect of anti-infective therapy in the treatment of peri-implantitis. J Clin Periodontol 2002; 29:213-220.
6. Grunder U et al. Treatment of ligature-induced peri-implantitis using guided tissue regeneration: a clinical and histologic study in the beagle dog. Int J Oral Maxillofac Implants 1993; 8:282-292.
7. Lindhe J et al. (1992). Experimental breakdown of peri-implant and periodontal tissues. Clin Oral Impalnts Res 1992; 3:9-16.
8. Mombelli A, Lang NP. Antimicrobial treatment of peri-implant infections. Clin Oral Implants Res 1992; 3:162-168.
9. Schwarz F et al. (2006). Influence of different treatment approaches on nonsubmerged and submerged healing of ligature-induced peri-implantitis lesions: an experimental study in dogs. Journal of Clinical Periodontology Aug. 2006; 33(8):584-595.
10. Renvert S. Topical minocycline microspheres versus topical chlorhexidine gel as an adjunct to mechanical debridement of incipient peri-implant infections: a randomized clinical trial. J Clin Periodontol. May 2006; 33 (5): 362-369.
11. Leonhardt A. (2003). Five-year clinical, microbiological, and radiological outcome following treatment of peri-pmplantitis in man. J Periodontol 2003; 74:1415-1422.
12. Schwarz F et al. (2006b). Healing of intrabony peri-implantitis defects following application of a nanocrystalline hydroxyapatite (Ostim^®) or a bovine-derived xenograft (Bio-Oss) in combination with a collagen membrane (Bio-Gide). A case series. Journal of Clinical Periodontology 33; 491–499.
13. Schwarz F et al. (2008). Two-year clinical results following treatment of peri-implantitis lesions using a nanocrystalline hydroxyapatite or a natural bone mineral in combination with a collagen membrane. Journal of Clinical Periodontology 35; 80–87.

Source:

DentistryIQ

New CT technology promises much loser radiation doses

2011-09-24T13:10:00.000-04:00

GE Introduces Veo Low-Dose CT Image Reconstruction Technology in Canada

by Wouter Stomp on Jul 26, 2011 • 7:33 am

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GE Healthcare has just introduced in Canada the Veo, a new low-dose CT image reconstruction technology. Veo uses a model of the scanning system itself to improve image quality. As was apparent during last year’s RSNA, CT radiation dose reduction while maintaining or improving image quality is a hot topic with CT manufacturers. For decades, the standard CT image reconstruction algorithm has been filtered back projection, which uses mathematical methods to reconstruct tomographic images from the projections that are obtained by the circling detectors. More recently, a new reconstruction algorithm, adaptive statistical iterative reconstruction (ASIR), has been introduced that performs modeling of the noise distribution, cutting radiation dose by up to 80% for many applications.
Model-based iterative reconstruction (MBIR), employed by Veo, goes a step further by incorporating a physical model of the CT system into the reconstruction process to characterize the data acquisition phase, including noise, beam hardening, and scatter. It has the potential to cut radiation doses even more but is computationally more demanding, leading to longer reconstruction times (which will gradually become less of a problem with ever increasing computing power). It may potentially deliver lower noise, increased resolution, improved low contrast detectability and fewer artifacts. Veo is available on the GE Discovery CT750 HD system, and is suitable for use throughout the body. Veo is already available in Europe and much of Asia, and is still awaiting FDA clearance.

Experts: Unhealthy gums can end in heart attacks

2011-09-21T09:51:00.001-04:00

More and more evidence of a definite link between periodontal disease and systemic disease is accumulating. Here is the latest in a growing body of evidence.

You better start taking your oral health seriously because the trouble in your mouth could be a subtle indicator of something as grave as diabetes or even heart attack.
City doctors revealed many such facts on the occasion of World Oral Health Day on Monday. Other than diabetes and heart disorders, they said mouth-related diseases could also be symptoms of hypertension, breathing problems, weakening of bones and even hint at a probable miscarriage in pregnant women.
“Several studies have been done in the west in this regard. Women with poor gum hygiene are more likely to have miscarriages,” said Dr Achuth Baliga, head of the department of dental sciences in Manipal Hospital.
He said pregnant women with gum diseases are seven times more likely to have a baby that is born prematurely or underweight. He added that these women’s babies might be born with physical anomalies.
“The circulating bacteria from the mouth can harm the foetus,” he explained.
There is more that poor health of gums suggests. Dr CD Dwarakanath, director of postgraduate studies and head of the department of periodontics (a field of specialisation in dentistry) at Oxford Dental College and Hospital, said gum diseases might lead to heart attack.
He said in people suffering from periodontitis (a gum disease), the bacteria might enter the bloodstream while chewing or brushing and the bacteria could contribute to formation of clots in the arteries, thereby causing heart attack.
He said research had shown that people with gum diseases are almost twice as likely to suffer from coronary artery disease when compared with people with healthy gums.
Unhealthy gums have more warning about an unhealthy heart.
Dr Baliga said tooth decay and gum disease for a long time could lead to inflammation of the inner lining of the heart’s chambers and heart valves.
He said it could start with fever, anaemia and lead to formation of a blood clot.
Oral health has a connection with diabetes too. Dr Dwarakanath said gum disease is often considered the sixth complication of diabetes. Diabetics are prone to have periodontal disease if their condition is not under control, he added.
Osteoporosis—characterised by weak bones, decrease in the bone density—is another complication that is reflected in poor oral health.
Dr Dwarakanath said loose teeth, severe gum disease and even difficulty in eating and speaking could be a sign of decreasing bone density, an advanced stage of osteoporosis. Osteoporosis’s symptoms often go unnoticed until a major fracture occurs.
However, your dentist may be able to detect the early signs of osteoporosis during a regular dental exam.
Studies show that the top oral health complaints in India comprise tooth decay, gum problems and bad breath. The oral health experts say a lot of people suffer from such complaints without being aware of it, letting the complication affect their quality of life.

Published: Tuesday, Sep 13, 2011, 12:34 IST
By Soumita Majumdar | Place: Bangalore | Agency: DNA

Are antibiotics of any use in implant therapy?

2011-08-28T23:12:00.000-04:00

Many times in implantology we perform procedures based on anecdotal evidence or on dogma. One subject that often come up is whether or not to use antibiotics prophylactically either before or after surgery. This evidence based review seems to indicate that the administration of a single dose of amoxicilling prior to surgery may be of benefit.

Evidence-Based Dentistry (2008) 9, 109–110. doi:10.1038/sj.ebd.6400612

Do preoperative antibiotics prevent dental implant complications?

Does giving antibiotics at the time of dental implant placement prevent complications?

Address for correspondence: Luisa M Fernandez Mauleffinch, Cochrane Oral Health Group, MANDEC, School of Dentistry, University of Manchester, Higher Cambridge Street, Manchester M15 6FH, UK. E-mail: luisa.fernandez@manchester.ac.uk

Ben Balevi¹

¹Private practitioner, affiliated with Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada

Esposito M, Grusovin MG, Talati M, Coulthard P, Oliver R, Worthington HV. Intervention for replacing missing teeth: antibiotics at dental implant placement to prevent complications. Cochrane Database Syst Rev 2008, issue 3

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Abstract

Data sources

The Cochrane Oral Health Group's Trials Registry, the Cochrane Central Register of Controlled Trials, Medline and Embase were consulted to find relevant work. Searches were made by hand of numerous journals pertinent to oral implantology. There were no language restrictions.

Study selection

Randomised controlled clinical trials (RCT) with a followup of at least 3 months were chosen. Outcome measures were prosthesis failures, implant failures, postoperative infections and adverse events (gastrointestinal, hypersensitivity, etc.).

Data extraction and synthesis

Two reviewers independently assessed the quality and extracted relevant data from included studies. The estimated effect of the intervention was expressed as a risk ratio together with its 95% confidence interval (CI). Numbers-needed-to-treat (NNT) were calculated from numbers of patients affected by implant failures. Meta-analysis was done only if there were studies with similar comparisons that reported the same outcome measure. Significance of any discrepancies between studies was assessed by means of the Cochran's test for heterogeneity and the I2 statistic.

Results

Only two RCT met the inclusion criteria. Meta-analysis of these two trials showed a statistically significantly higher number of patients experiencing implant failures in the group not receiving antibiotics (relative risk, 0.22; 95% CI, 0.06–0.86). The NNT to prevent one patient having an implant failure is 25 (95%CI, 13–100), based on a patient implant failure rate of 6% in people not receiving antibiotics. The following outcomes were not statistically significantly linked with implant failure: prosthesis failure, postoperative infection and adverse events (eg, gastrointestinal effects, hypersensitivity).

Conclusions

There is some evidence suggesting that 2 g of amoxicillin given orally 1 h preoperatively significantly reduces failures of dental implants placed in ordinary conditions. It remains unclear whether postoperative antibiotics are beneficial, and which is the most effective antibiotic. One dose of prophylactic antibiotics prior to dental implant placement might be recommended.

DO SHORT IMPLANTS WORK???

2011-08-28T23:01:00.000-04:00

Much has been published about implants with a length 10mm or over enjoying greater success than their shorter counterparts. However, Misch et al have published in an evidence based manner to cast some doubt on this. here is the abstract:

Carl E. Misch, Jennifer Steigenga, Eliane Barboza, Francine Misch-Dietsh, Louis J. Cianciola & Christopher Kazor

Background:
Implants <10 mm long in the posterior regions of partially edentulous patients have a higher failure rate in many clinical reports. The purpose of this case series study was to evaluate implant survival when a biomechanical approach was used to decrease stress to the bone-implant interface.

Methods:
A retrospective evaluation of 273 consecutive posterior partially edentulous patients treated with 745 implants, 7 or 9 mm long, supporting 338 restorations over a 1- to 5-year period was reviewed from four private offices. Implant survival data were collected relative to stage I to stage II healing, stage II to prosthesis delivery, and prosthesis delivery to as long as 6 years follow-up.

A biomechanical approach to decrease stress to the posterior implants included splinting implants together with no cantilever load, restoring the patient with a mutually protected or canine guidance occlusion, and selecting an implant designed to increase bone-implant contact surface area.

Results: Of the 745 implants inserted, there were six surgical failures from stage I to stage II healing. All five failures were with a one-stage surgical approach (240 implants). There were two failures from stage II healing to prosthesis delivery. No implants failed after the 338 final implant prostheses were delivered. A 98.9% survival rate was obtained from stage I surgery to prosthetic follow-up.

Conclusions:
Short-length implants may predictably be used to support fixed restorations in the posterior partial edentulism. Methods to decrease biomechanical stress to the bone-implant interface appear appropriate for this treatment.

INCREASING IMPLANT SURFACE AREA AT NANO LEVEL SPEEDS HEALING

2011-07-27T09:25:00.000-04:00

Recent research out of the University of Gothenberg indicates that increasing surface roughness of implants at the nano level speeds the integration process.

Increasing the Active Surface of Dental Implants at Nano Level Quickens Healing

Published on June 15, 2011 at 7:35 AM

By Cameron Chai

Researchers at the University of Gothenburg have conducted studies on the surface arrangement of dental implants both at the micro and nano level to enable speedy healing of patients.

Johanna Löberg from the Department of Chemistry at the University of Gothenburg stated that by causing an increase of the active surface area at the nano scale and altering the implant’s conductivity, the biomechanics of the body is influenced in such a way as to avoid discomfort and to speed up the healing process.

Scanning electron microscope images taken on the titanium samples with (from left), turned, sanded and blasted surfaces treated with oxalic acid and dilute sulfuric acid

It was evident that the surface of dental implants is often associated with the level of roughness, from the superimposed nanostructures to the thread. When the implant is placed in the bone, the bone tissue experiences a mechanical force known as biomechanical stimulation, which leads to the formation of new bone. Although roughness is not the only factor that influences healing, it is crucial for new bone formation. It is also necessary to measure and illustrate the appearance of the surface in detail.
Johanna Löberg has formulated an approach that explains the topography of the implant from nanometre to micrometre scale. This approach enables theoretical estimation of placing the implant in the bone by diverse surface topographies. It can be used to develop new dental implants and to enable optimization of properties for quick healing and increased bone formation. The results demonstrate that a small increase in conductivity delivers improved cell response and quick deposition of minerals that are essential for bone formation. Surfaces with a clearly defined nanostructure feature a larger active area and react faster to the deposition of bone-forming minerals.
The project was performed by the University of Gothenburg in collaboration with the Astra Tech AB in Mölndal, and has scope for further study.
Source: http://www.science.gu.se/

AVASTIN- ANOTHER DRUG ASSOCIATED WITH ONJ

2011-07-23T10:35:00.000-04:00

As you know, intravenous bisphosphonates and to a lesser extent oral bisphosphonates like fosamax have been associated with an increased rick of osteonecrosis of the jaw (ONJ). Recently, Dr. Richard Wynn at the University of Maryland published on a human monoclonal antibody, bevacizumab (Avastin), used in treating metastatic carcinoma, that also appears to be associated with an increased incidence of ONJ.

About the Author

Bevacizumab (Avastin®): Another Drug Associated With Osteonecrosis of the Jaw

First it was the intravenous bisphosphonates, zoledronic acid (Zometa®) and palmidronate (Aredia®), then the oral bisphosphonates (the Fosamax® family of drugs), then the anti-RANKL drug, denosumab (Prolia®, Xgeva®). Now it's a human monoclonal antibody known as bevacizumab (Avastin) that is associated with osteonecrosis of the jaw (ONJ) syndrome.
Bevacizumab (Avastin) belongs to a class of drugs known as antiangiogenic agents, used with increasing frequency in treating cancer. Bevacizumab is indicated for the treatment of metastatic colorectal cancer, and metastatic nonsquamous, nonsmall cell lung cancer. Angiogenesis in tumor cells involves the formation and growth of new blood vessels which help tumor growth. Bevacizumab acts to block angiogenesis through inhibition of cell proliferation and vessel sprouting, as well as by decreasing circulating vascular endothelial growth factor (VEGF) levels. This action is similar to the antiangiogenic action ascribed to the bisphosphonates. There are literature reports on patients receiving bevacizumab who developed ONJ. These reports are described in this month's newsletter.
A case of ONJ associated with bevacizumab exposure was reported in a letter to the editor in 2008 (Greuter S, Schmid F, Ruhstaller T, et al, "Bevacizumab Associated Osteonecrosis of the Jaw," Ann Oncol, 2008, 19(12):2091-2).
A 63-year old woman was treated for breast cancer. Bone scans were normal and she had never taken bisphosphonates. While being treated with liposomal doxorubicin and bevacizumab, the patient experienced left-sided maxillary pain after one-month therapy. A tooth infection was diagnosed and numbers 25 and 26 were extracted. One month later, a mouth-antrum fistula was surgically revised and occluded. Soon afterward, the patient suffered from a trigeminal neuralgia. Imaging showed maxillary sinusitis and signs of ONJ. The jaw lesion was extirpated and the sinus drained. Histology verified the clinical diagnosis of ONJ and an infiltration from the cancer was excluded. At 3 months of follow-up, the patient remained free of lesions and symptoms.
The authors commented that bevacizumab acts to block angiogensis through inhibition of cell proliferation and vessel sprouting, as well as by decreasing circulating vascular endothelial growth factor (VEGF) levels. This action is similar to the antiangiogenic action described for the bisphosphonates.
The authors stated that this was the third published case of ONJ associated with bevacizumab therapy. The doxorubicin the patient was taking is an anthracycline antineoplastic agent that has been on the market for many years and has never been known for causing ONJ. The authors suspected that bevacizumab, which hampers wound healing and possibly bone remodeling, was the causative agent in this case.
The other two published cases were included in a report by Estilo, et al (Estilo CL, Fornier M, Farooki A, et al, "Osteonecrosis of the Jaw Related to Bevacizumab," J Clin Oncol, 2008, 26(24):4037-8).
A 51-year-old female with a history of infiltrating ductal carcinoma of the right breast was diagnosed in late 2001 and treated with mastectomy in 2002. She subsequently underwent treatment with chemotherapy, doxorubicin, cyclophosphamide, and letrozole for various cycles over a 3-year period. Since 2006, she underwent additional chemotherapy, capecitabine therapy, and radiation. In late December 2006, she was started on bevacizumab at a dose of 15 mg/kg every 3 weeks for a total of 8 doses, the last dose given in May 2007. Six weeks after the last dose, the patient presented with a 2-month history of complaints of lower jaw discomfort and protruding bone in the lower jaw. Examination revealed an area of bone exposure in the left posterior lingual mandible approximately 1 X 1 mm in diameter. The area appeared necrotic. The surrounding tissue had no evidence of infection. The exposed bone was smoothed with a bone file and the patient prescribed chlorhexidine 0.12% oral rinse. The bevacizumab and capecitabine were then discontinued. The area of exposed bone had resolved within a few weeks. The overlying mucosa appeared normal. At that time, a new area of exposed bone appeared in the right posterior lingual mandible of 1 X 1mm in area. Histology showed devitalized necrotic bone with a scalloped "moth eaten" appearance. Bacterial colonies occupied the demineralized areas.
The other case was a 33-year-old woman with a history of glioblastoma multiforme diagnosed in November 2006. She underwent surgery followed by radiation therapy and temozolomide from December 2006 through January 2007. The patient started bevacizumab therapy in Feb 2007 at a dose of 10 mg/kg every 2 weeks. Thirteen weeks later, she was referred to the dental clinic for evaluation of a 2-week history of spontaneous mucosal breakdown overlying her right mandible. The patient complained of gingival pain. On examination, there appeared a 1 X 2 cm dehiscence at the junction of the unattached/attached gingiva in the mucobuccal fold overlying the lower right first and second premolar and first molar teeth. There was exposed necrotic bone visible through the dehiscence extending inferiorly and posteriorly. There was no evidence of infection. Other than that, the oral mucosa appeared healthy with intact dentition. The patient continued on biweekly bevacizumab. In August 2007, she returned with a small mucosal defect posterior to the original lesion. There was soft tissue dehiscence with no evidence of exposed bone.
The authors commented that the clinical features of bone exposure in the two cases were compatible with ONJ in patients exposed to bisphosphonate therapy. The two patients had no history of bisphosphonate use. The authors suggested that bevacizumab contributed to the oral mucosal breakdown with exposed necrotic mandibular bone in the two patients. The antiangiogenic property of bevacizumab could compromise microvessel integrity in the jaw and lead to subclinical compromise of the osteonecrosis. Trauma from tooth brushing or chewing could also increase the demand on this compromised bone to repair itself and result in localized bone necrosis, periosteal death, and eventual exposed necrotic bone.
Estilo et al went on to explain that angiogenesis is a critical step in tumor growth, invasion, and metastasis. VEGF is a family of cytokines that exert important functions in tumor angiogenesis. VEGF is overexpressed in various human tumors and overexpression of VEGF is associated with tumor progression. VEGF is also essential for osteogenic differentiation and bone formation. Thus bevacizumab, used as a VEGF inhibitor to suppress tumor progression, could also suppress the osteogenic differentiation and bone formation. This could result in failure to repair bone trauma.
In the two patients described, additional factors possibly contributing to the development of ONJ were the advanced cancer and chemotherapy. The authors cautioned that clinicians involved in the care of patients treated with bevacizumab should be aware of the potential complication of ONJ.

Antiangiogenic Agents and the Risk of ONJ

Christodoulou et al reported that a combination of bisphosphonates and antiangiogenic factors induces ONJ more frequently than bisphosphonates alone (Christodoulou C, Pervena A, Klouvas G, et al, "Combination of Bisphosphonates and Antiangiogenic Factors Induces Osteonecrosis of the Jaw More Frequently Than Bisphosphonates Alone," Oncology, 2009, 76(3):209-11). Their introduction in the report stated that antiangiogenic agents may add to the risk of ONJ, especially when used in combination with bisphosphonates. The purpose of the study was to do a back review of data of patients receiving bisphosphonates with or without antiangiogenic factors for osseous metastases from various tumors between June 2007 and June 2008.
Among 116 patients being treated for various malignancies, 25 received concurrent treatment with antiangiogenic agents at some point. Twenty-two were taking bevacizumab, two were taking a drug called sunitinib, and one was taking a drug called sorafenib. The median duration to exposure to bisphosphonates was 28.5 months for the 25 patients taking the antiangiogenic drugs and 24 months for those not taking any antiangiogenic drugs. There were no significant differences between the two groups regarding treatment duration with the bisphosphonate.
Of the 25 patients receiving concurrent treatment with bisphosphonates and the antiangiogenic drug, 4 developed ONJ (incidence of 16%). Of the 91 patients receiving bisphosphonates without antiangiogenic factors, 1 developed ONJ (incidence 1.1%). This difference was statistically significant.
In this study, the diagnosis of ONJ was according to the clinical diagnoses made by dentists specializing in treating cancer patients and consisted of pain in the jaw with exposed, necrotic bone, some with purulent discharge. The authors commented that bisphosphonates have also been reported to possess antiangiogenic activity, particularly zoledronic acid (Zometa®) — a widely popular bisphosphonate used as an adjunct agent in cancer treatment.
Greuter et al (above) summed it up best by stating "if more cases of bevacizumab-associated ONJ are reported, special dental management (jaw x-ray, optimal dental health, and good oral hygiene) should become standard before patients start bevacizumab."

Dental Management to Reduce the Risk of ONJ

The importance of special dental management to reduce the risk of ONJ in patients taking bevacizumab was shown in a recent report (Francini F, Pascucci FF, Francini E, et al, "Osteonecrosis of the Jaw in Patients with Cancer Who Received Zoledronic Acid and Bevacizumab," J Am Dent Assoc, 2011, 142(5):506-13). They looked at cancer patients on zoledronic acid and chemotherapy combined with bevacizumab who underwent a dental exam before starting treatment. They found that none of the patients developed ONJ.
The study included 59 patients with either breast cancer or nonsmall cell lung cancer who received 4 mg zoledronic acid I.V. every 4 weeks and 15 mg per kg bevacizumab every 3 weeks. The median time of receiving zoledronic acid was 18 months and the median time of receiving bevacizumab was 16 months. All subjects received a dental exam and panoramic x-rays before starting treatment and every three months thereafter until the patient died or was lost to follow-up. If needed, patients received periodontal disease treatment and underwent tooth extraction before they received any drug.
None of the patients required dentoalveolar surgery while undergoing cancer treatment. After a median follow up of 19.7 months, none of the participants developed ONJ. The conclusion was that a bisphosphonate combined with an antiangiogenic drug did not predispose to ONJ in participants with cancer that metastasized to the bone, who underwent a baseline dental examination and preventive dental measures.

Indications for Bevacizumab (Avastin®) Approved by FDA:

Treatment of metastatic colorectal cancer; treatment of unresectable, locally advanced, recurrent or metastatic nonsquamous, nonsmall cell lung cancer; treatment of metastatic HER-2 negative breast cancer (who have not received chemotherapy for metastatic disease); treatment of progressive glioblastoma; treatment of metastatic renal cell cancer (not an approved use in Canada).
Note: For the treatment of metastatic breast cancer, effectiveness is based on improvement in progression-free survival; not indicated for the treatment of breast cancer with metastatic disease that has progressed following anthracycline and taxane treatment. For the treatment of glioblastoma, effectiveness is based on improvement in objective response rate.

Unlabeled/Investigational Use:

Treatment of recurrent ovarian cancer; recurrent cervical cancer; soft tissue sarcomas (angiosarcoma or hemangiopericytoma/solitary fibrous tumor); age-related macular degeneration (AMD).

Drug information is constantly changing. Promote medication safety in your practice with Lexicomp Online for Dentistry.

EVER WONDER WHAT TO CHARGE FOR AN IMPLANT???

2011-07-20T10:11:00.000-04:00

A recent survey was done and asked this very question. here are the results.

EVER WONDER WHAT TO CHARGE FOR AN IMPLANT???

2011-07-20T10:06:00.001-04:00

In our teaching courses, we are often asked by beginning implatologists what to charge for implant placement. Here is a recent survey which asked that very question.

Philadelphia's Implant Information Central!: STEM CELLS WHAT ARE THEY, AND HOW CAN THEY HELP?

2011-07-19T11:09:00.000-04:00

Philadelphia's Implant Information Central!: STEM CELLS WHAT ARE THEY, AND HOW CAN THEY HELP?: "Dr. Bruce Freund recently wrote a brief summary about stem cells and what they can do for us in dentistry and in implantology. They certain..."

STEM CELLS WHAT ARE THEY, AND HOW CAN THEY HELP?

2011-07-19T11:08:00.000-04:00

Dr. Bruce Freund recently wrote a brief summary about stem cells and what they can do for us in dentistry and in implantology. They certainly hold a great deal of promise for the future. The article can be accessed here:

http://www.dentistryiq.com/index/display/article-display/5736127195/articles/dentisryiq/clinical/2011/07/Stem_cells_and_dentistry__answers_to_seven_questions.html

GENETICS CAN BE A RISK FACTOR FOR DENTAL IMPLANTS!

2011-07-09T09:56:00.000-04:00

A recent article in the Journal of Oral Implantology has identified a combination of genes that when present may adversely affect dental implants. This could change the way we evaluate patients for dental implant reconstruction.

gary l henkel dds magd

horsham dental elements

www.horshamdentalelements.com

ghenkel@pinerundental.com

Gene combination identified as risk factor in success of dental implants

Jun 29, 2011

Journal of Oral Implantology — The health of the surrounding tissue affects the success of a dental implant. Identifying and reducing risk factors is therefore a key step in the implant process. Now a combination of genes has been identified as a possible indicator of greater tissue destruction, leading to negative outcomes for implants.
The authors of an article in the current issue of the Journal of Oral Implantology report on a study of individuals with the combination of interleukin (IL)-1 allele 2 at IL-1A^-889 and IL-1B⁺³⁹⁵⁴. These people are “genotype positive” and are susceptible to increased periodontal tissue destruction.
Peri-implantitis, or the process of tissue inflammation and destruction around failing implants, is very similar to periodontal disease. The researchers sought to find any association of these genotypes with the severity of peri-implantitis progression and the effect of this combination on treatment outcomes.
This study compared two groups of patients, all of whom had implants. The first group consisted of 25 patients with peri-implantitis, while the second group of 25 patients had healthy tissue. Seventeen patients from the first group and five from the second group were genotype positive.
Patients in the first group, those with peri-implantitis, took part in a treatment and maintenance program. The genotype-positive patients in this group experienced greater periodontal tissue destruction and, increased discharge from tissues. The genotype-negative patients responded better to treatment. Statistically significant differences were noted between the groups.
The combination of these two alleles in patients with inflamed periodontal tissues denotes a risk factor that can lead to further tissue destruction. Patients with the specific genotype can have exaggerated local inflammation. Gene polymorphism may affect the outcomes of treatment for peri-implantitis in genotype-positive people and affect the long-term success of implants.
Full text of the article, “The Effect of Interleukin-1 Allele 2 Genotype (IL-1a^-889 and IL-1b⁺³⁹⁵⁴) on the Individual’s Susceptibility to Peri-Implantitis: Case-Control Study,” Journal of Oral Implantology, Vol. 37, No. 3, 2011, is available by clicking here.
The Journal of Oral Implantology is the official publication of the American Academy of Implant Dentistry and of the American Academy of Implant Prosthodontics. It is dedicated to providing valuable information to general dentists, oral surgeons, prosthodontists, periodontists, scientists, clinicians, laboratory owners and technicians, manufacturers, and educators. The JOI distinguishes itself as the first and oldest journal in the world devoted exclusively to implant dentistry. For more information about the journal or society, click here.

Source:

DentistryIQ

Philadelphia's Implant Information Central!: INVISALIGN CAN MOVE TEETH MILES!!!!!!

2011-06-25T10:15:00.000-04:00

Philadelphia's Implant Information Central!: INVISALIGN CAN MOVE TEETH MILES!!!!!!: "Almost unbelievable, a tornado carried a set of invisalign retainers well over a hundred miles!! Invisalign can sure move things long dista..."

INVISALIGN CAN MOVE TEETH MILES!!!!!!

2011-06-25T10:14:00.000-04:00

Almost unbelievable, a tornado carried a set of invisalign retainers well over a hundred miles!! Invisalign can sure move things long distances! check out the full story here:

http://www.dailymail.co.uk/news/article-2007858/Tornado-victims-dental-braces-blown-100-miles-away-man-lost-home-earthquake.html

LINGUAL ARTERIES IN THE ANTERIO MANDIBLE VARIANT

2011-05-10T18:09:00.000-04:00

There was a question posed on osseonews about the potential for bleeding in the anterior mandible region. Drs. Ganz and Flanagan, gave excellent responses and i encourage all to read them at http://www.osseonews.com/implants-in-the-anterior-mandible-hemorrhage-a-significant-risk/?utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3A+Osseodaily+%28OsseoNews%29

Gary L Henkel DDS MAGD

PERIODONTAL DISEASE LINKED TO ANEMIA!

2011-05-04T10:30:00.001-04:00

Recently published in the journal of Periodontology, a link has been discovered between the incidence of anemia and periodontal disease. This, combined with previous correlations of gum disease with cardiovascular disease, low birth weight, diabetes, and other conditions, provides further evidence that we must be more diligent than ever in treating periodontitis.

Gary L. Henkel DDS MAGD

Horsham Dental Elements

www.horshamdentalelements.com

Gum Disease Linked To Anemia

28 Apr 2011

A new study suggests that severe gum disease (chronic periodontitis) may cause a reduction in red blood cells and haemoglobin leading to the blood disorder anemia.

The research, published in the Journal of Periodontology (1),found that over a third of people suffering from severe gum disease had hemoglobin levels below normal concentrations. Following a six month course of treatment to improve their oral health, all patients had improved levels of red blood cells, haemoglobin and all other clinical measures used to assess the health of the blood.

The research also suggested that women with severe gum disease had a higher risk of anaemia, compared to men. Less than three in ten men had anemia, compared to over four in every ten women.

Dr Nigel Carter, Chief Executive of the British Dental Health Foundation, said: "There have been several previous studies which have drawn a link between gum disease and anemia (2). This latest work confirms that chronic periodontitis can contribute to the development of anemia.

"The research suggests that the defense chemicals produced by the body as a result of inflammation of the gum can have the negative effect of lowering hemoglobin levels and other factors important to a healthy blood system.

"The good news is that treatment of gum disease appears to have a positive effect on the severity of the anaemia, especially in women. Treatment, over a relatively short time frame of three to six months, improves haemoglobin levels and red blood cell counts.

"Many people continue to underestimate the importance of good oral health to the body's general health. Prevention is the key and it is really important that everyone adopts a simple but effective oral health regime to help stay fit and healthy. Brushing for two minutes, twice a day with a fluoride toothpaste and cleaning between the teeth, good eating habits, having sugary food and drinks less often and regular dental check-ups can help prevent most dental problems.", advised Dr Carter.

Notes

1. Journal of Periodontology, 2011, Vol. 82, No. 3, Pages 388-394. Anemia of Chronic Disease and Chronic Periodontitis: Does Periodontal Therapy Have an Effect on Anemic Status? A. R. Pradeep, Sharma Anuj, and Arjun Raju P. Department of Periodontics, Government Dental College and Research Institute, Bangalore, Karnataka, India. Bangalore Medical College and Research Institute, Bangalore, Karnataka, India.

2. Siegel EH. Total erythrocyte, leucocyte and differential white cell counts of blood in chronic periodontal disease. J Dent Res 1945;24:270-271.

Lainson PA, Brady PP, Fraleigh CM. Anemia, a systemic cause of periodontal disease? J Periodontol 1968;39:35-38. [Medline]

Chawla TN, Kapoor KK, Teotia SPS, Singh NK. Anaemia and periodontal disease - A correlative study. J Indian Dent Assoc 1971;43:67-78. [Medline]

Gokhale SR, Sumanth S, Padhye AM. Evaluation of blood parameters in patients with chronic periodontitis for signs of anemia. J Periodontol 2010;81:1202-1206.

Source:
British Dental Health Foundation

Article URL: http://www.medicalnewstoday.com/articles/223650.php
Main News Category: Dentistry
Also Appears In: Blood / Hematology,

oral tongue cancer rates rising in young white women

2011-04-20T17:33:00.000-04:00

Oral Tongue Cancer Rates Rising in Young White Women

Roxanne Nelson

Authors and Disclosures

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March 22, 2011 — The incidence of oral tongue squamous cell carcinoma has been rising in young white American women, according to a new report. For the past 3 decades, the incidence has been increasing in white men and white women 18 to 44 years of age, but the trend is most pronounced in young white women.
In a report published online March 7 in the Journal of Clinical Oncology, the authors found that the incidence of oral cavity squamous cell carcinoma was declining for all age groups. The incidence of oral cavity and tongue cancer also was decreasing for nonwhite individuals.
However, among people 18 to 44 years of age, the incidence of oral tongue cancer climbed 28% between 1975 and 2007. Among white people in this age group, the incidence increased 67%. The rising rates were most dramatic for white women, with a jump of 111%.
"Lately, we have been seeing more oral tongue cancer in young white women in our clinic. So we looked at the literature, which reported an increase in oral tongue squamous cell carcinoma in young white individuals, but couldn't find any information about gender-specific incidence rates, so we decided we should take a look at the SEER [Surveillance, Epidemiology, and End Results] data," said lead author Bhisham Chera, MD, assistant professor in the Department of Radiation Oncology at the University of North Carolina School of Medicine, Chapel Hill.
The authors note that historically, cancer of the oral cavity was considered to be associated with older men with histories of significant tobacco and alcohol use. But during the past 30 years, the incidence of oral cavity squamous cell carcinoma has been declining while the incidence of oropharyngeal squamous cell cancer has been increasing. These trends, note the authors, might be explained by the decreased use of tobacco and the association between the carcinogenic strains of human papillomavirus (HPV) and cancer of the oral cavity.
Not HPV Associated
Unlike cancers of the tonsil and base of tongue subsites within the oropharynx, oral cavity and oral tongue squamous cell carcinomas are rarely associated with HPV infection, according to the authors. The demographics of HPV-related head and neck malignancies differ from those associated with HPV. Those with HPV-associated head and neck cancers generally tend to be white men who are nonsmokers. At Dr. Chera's institution, the young patients with head and neck squamous cell carcinomas who are nonsmokers and nondrinkers are most likely to be white women with oral cavity squamous cell carcinoma.
"Our findings suggest that the epidemiology of this cancer in young white females may be unique and that the causative factors may be things other than tobacco and alcohol abuse," Dr. Chera said. "Based on our observations and the published data, it appears that these cases may not be associated with the human papillomavirus. We are actively researching other causes of this cancer in this patient population."
They have examined the HPV status of their young white female patients with oral tongue tumors and have not found an association. Other reports have shown similar findings — a higher number of oral tongue squamous cell carcinomas in women and an absence of detectable HPV DNA.
It is possible that they are being caused by a different virus or another subtype of HPV, he told Medscape Medical News. "There are over 100 subtypes but only handful are associated with malignancy, and we only test for the high-risk types."
"Could it be that another type is associated? . . . Basically, we don't know yet," Dr. Chera added.
In their study, Dr. Chera and colleagues analyzed the incidence and survival data from the SEER Program from 1975 to 2007 for oral cavity squamous cell carcinoma and oral tongue squamous cell carcinomas. Specifically, they looked at 3 cohorts: patients of all ages, patients 18 to 44 years of age, and patients 44 years and older. The patients were also stratified by sex and/or race.
Possible Emerging Clinical Entity
During that time period, SEER data showed 32,776 cases of oral cavity squamous cell carcinoma, with 2223 of those occurring in young adults. The ratios for male/female and white/black or other races were 2.2:1.0 and 8.5:1.0, respectively. For all age groups, there were a total of 6,810 cases of oral tongue squamous cell carcinoma, with 814 in the 18 to 44 year age group. For all age groups, the male/female ratio was 1.6:1.0; stratified by race, 424 were white (82%), 50 (6%) were black, and 96 (12%) were other.
Because it is not usually associated with HPV, the authors note that oral tongue squamous cell carcinoma in young white women "may be an emerging and distinct clinical entity, although future research is necessary before broad conclusions can be drawn." Specifically, further investigation is needed to examine the sources of the observed variation, they write.
"Dentists and primary care physicians should be more cognizant of oral tongue squamous cell carcinoma in this group of patients," said Dr. Chera. "At this point, the incidence is very small, and widespread screening may not be cost effective."
"I would say that if a young white person has complaints of a persistent sore on their tongue, cancer should be moved up higher on the differential, based on our study," he added. "Dentists should not only examine dental health but also examine the tongue. They are in a position to provide effective screening."
The authors have disclosed no relevant financial relationships.
J Clin Oncol. Published online March 7, 2011. Abstract

NEW UPDATED LIST OF CONE BEAM UNITS RELEASED

2011-04-12T11:26:00.000-04:00

www.conebeam.com just released a new updated summary of available cone beam tomography units. great place to look to compare units. it can be downloaded in excel, chart, or pdf form.

summary of cbct units for 2011

Gary L. Henkel DDS MAGD
Horsham Dental Elements
www.horshamdental elements.com
www.facebook.com/horshamdentalelements
www.twitter.com/horshamdentist

Tooth scout app for ipad can make choosing denture teeth easier

2011-03-30T11:24:00.000-04:00

there is a new app out for the ipad and iphone called Tooth Scout that can help in choosing appropriate denture teeth. it is a freebie, so check it out.

http://www.toothscout.com/index.php?id=952

gary

Teenagers and Dental Implants | Dear Doctor - Dentistry & Oral Health

2011-03-30T11:12:00.000-04:00

Teenagers and Dental Implants | Dear Doctor - Dentistry & Oral Health

Determining when it is appropriate to place implants in the adolescent is a subject of much controversy. Here is an article from Dr. Frank Celenza discussing this very important topic.

gary

new drill stops patented to prevent overdrilling

2011-03-30T09:23:00.000-04:00

share

Dr. Emil Verban in Bloomington, Ill., has developed a drill stop system to prevent overdrilling an osteotomy and has received a patent. check it out here.

http://www.pantagraph.com/lifestyles/health-med-fit/article_80c68f92-45c9-11e0-b528-001cc4c03286.html

gary

QUESTION PATIENTS ASK ABOUT DENTAL IMPLANTS

2011-03-23T13:30:00.000-04:00

This from the Wealthy Dentist Forum. they recently conducted a survey of dentists and patients, and found that the most common questions patients wanted answered are not exactly what the doctor had in mind.

The top 5 questions dental patients ask -

How much do dental implants cost?
How long do dental implants last?
Are implants painful?
How long will it take to get my new teeth?
Does dental insurance cover implant surgery?

Versus . . .
The top 5 questions dentists want patients to ask -

Am I a good candidate for implants?
What are the potential complications of dental implant therapy?
How much implant experience does the doctor have?
What is the healing time for my implants?
Can implants improve my appearance?

It is imperative that doctors address the patient's concerns, especially in terms of cost and discomfort. We need to reassure our patients that implant surgery need not be painful, and provide financial solutions to make it affordable.

Gary L Henkel DDS MAGD

3 swipes are the charm for smooth surface disinfection

2011-03-22T16:44:00.000-04:00

this article was recently posted in infection control today. they found that the number of swipes was almost more important than the disinfectant for smooth surface disinfection. check it out at http://www.infectioncontroltoday.com/news/2011/03/three-swipes-are-the-charm-for-ridding-surfaces-of-bacteria.aspx

best in implantology

gary l henkel dds magd
horsham dental elements

IMPLANTS DON'T HAVE TO BE SILVER METAL ANYMORE!

2011-03-11T11:46:00.002-05:00

Gary L. Henkel DDS MAGD

Horsham Dental Elements ( Pine Run Dental and Implant Center)

301 Horsham Rd

Horsham, Pa. 19044

2156726666

Philadelphia Center City Office

1601 Walnut St. Suite 1501

Philadelphia, Pa. 19102

215 5639769

www.horshamdentalelements.com

ghenkel@pinerundental.com

www.facebook.com/horshamdentalelements

www.twitter.com/horshamdentist

http://philadelphiaimplants.blogspot.com/

Philadelphia's Implant Information Central!: Name that implant!

2011-03-07T15:53:00.000-05:00

Philadelphia's Implant Information Central!: Name that implant!: "How many times have you seen a patient, or been asked by a colleague to view a radiograph, and have tried to identify an implant based on it..."

Name that implant!

2011-03-07T15:51:00.000-05:00

How many times have you seen a patient, or been asked by a colleague to view a radiograph, and have tried to identify an implant based on its xray shadow? very difficult task indeed.

But there is help available. Two very excellent radiographic databases have been assembled and are online. one simply goes through in logical order, and can narrow the possible choices considerably.

you owe it to yourself to check out http://www.osseosource.com/dental-implants/
and www.whatimplantisthat.com. both are excellent, and as a profession we owe the creators a big thank you for making our jobs easier.

gary

7 myths about dental implants

2011-02-24T10:27:00.000-05:00

We often hear from patients who are candidates for implants that they have read or gotten information from friends and colleagues that causes them to have reservations about proceeding with dental implants. unfortunately, many times the basis for their opinion is flawed. this excellent article was recently published on the world dental organization website. it lists the seven most common misconceptions that patients report. Take a look. This information is in agreement with what implant patients have reported to us over the past 30 years.

Gary L Henkel DDS MAGD
Horsham Dental Elements
Pine Run Dental and Implant Center

Oral Sex Increases Risk Of Oral Cancer

2011-02-21T09:45:00.000-05:00

Oral Sex Increases Risk Of Oral Cancer

PERIODONTAL DISEASE AND HEART DISEASE LINKED

2011-02-16T10:11:00.000-05:00

There is mounting evidence that periodontal disease and heart disease are related. This article was recently published in the Tampa Bay newspaper.

5th Annual Dental Expo hosted by Harcum

2011-02-14T17:08:00.000-05:00

BRYN MAWR, PA – February 8, 2011 – The 5th Annual Dental Expo, hosted by Continuing Studies at Harcum College, will be held Saturday, March 5, 2011 from 8:30 am to 4:00 pm on Harcum’s Bryn Mawr campus.

This year’s Expo will feature several new and informative courses presented by local as well as national experts in the field of dentistry. Topics will cover advances in restorative procedures, pharmacology review for local anesthesia, and the treatment of dental disease, among others. Meetings of the Pennsylvania EFDA Association and Sigma Phi Alpha, the Dental Hygiene National Honor Society, will take place in the afternoon while information from exhibitors and sponsors will be available during breaks and the time allotted for lunch and networking.

Attendees will be given the option to participate in two three-hour approved courses, one morning session and one afternoon session. “The idea is to select one class from each session that fits your particular area of expertise,” says Theresa Groody, Director of Professional Studies at Harcum College. “For example, one member of the dental team may find a course about integration of dental technologies benefits their personal skill set more than anesthesia review. Then, summaries of all courses can be shared back in the office.”

Recognized as one of the leading providers of dental healthcare education in the Delaware Valley, Harcum will be hosting this professional conference for the fifth year in a row. As in past years, the Expo will continue to provide the most up-to-date techniques, findings and strategies for all attendees as well as members of the dental community, including Expanded Function Dental Assistants (EFDAs), Hygienists, Dentists, Office Managers, Assistants and current Harcum College students and alumni.

To register, or for more detailed course descriptions, please call 610-526-6083 and request a registration form, or go online to register at www.myharcum.com/2011expo. Early registration is encouraged.

Using the CAS sinus lift system in the mandible

2011-02-13T01:29:00.000-05:00

NO EVIDENCE ONE IMPLANT SYSTEM IS BETTER THAN ANOTHER

2011-01-23T08:52:00.000-05:00

Often times at professional meetings, i am presented by well meaning colleagues with anecdotal reports of how and why the implant system they use is superior to others. But, as dentists, we need to look carefully at such claims, and evaluate things in an evidence based manner. The Cochrane review recently looked at this issue, and concluded that there may be evidence of some differences between smooth and rough surface implants, but no evidence to support the superiority of one system over another. Here is an abstract from the study.

Summary
Interventions for replacing missing teeth: different types of dental implants

There is limited evidence showing that implants with relatively smooth surfaces are less prone to lose bone due to chronic infection (perimplantitis) than implants with rougher surfaces. On the other hand implants with a turned (smoother) surface might be at greater risk to fail early than implants with roughened surfaces. There is no evidence showing that any particular type of dental implant has superior long-term success.

Missing teeth can sometimes be replaced with dental implants into the jaw, as bone can grow around the implant. A crown, bridge or denture can then be attached to the implant. Many modifications have been developed to try to improve the long-term success rates of implants, and different types have been heavily marketed. More than 1300 types of dental implants are now available, in different materials, shapes, sizes, lengths and with different surface characteristics or coatings. However, the review found there is not enough evidence from trials to demonstrate superiority of any particular type of implant or implant system.

This is a Cochrane review abstract and plain language summary, prepared and maintained by The Cochrane Collaboration, currently published in The Cochrane Database of Systematic Reviews 2011 Issue 1, Copyright © 2011 The Cochrane Collaboration. Published by John Wiley and Sons, Ltd.. The full text of the review is available in The Cochrane Library (ISSN 1464-780X).

This record should be cited as: Esposito M, Murray-Curtis L, Grusovin MG, Coulthard P, Worthington HV. Interventions for replacing missing teeth: different types of dental implants. Cochrane Database of Systematic Reviews 2007, Issue 4. Art. No.: CD003815. DOI: 10.1002/14651858.CD003815.pub3

Editorial Group: Oral Health Group

This version first published online: October 21. 2002
Last assessed as up-to-date: August 10. 2007

new non breathing version of CPR

2010-06-02T11:36:00.000-04:00

The mayo clinic recently modified cpr protocol to eliminate breathing, checking for pulse, and performing chest compressions only at the rate of 100 per minute. view this simplified technique here:

http://www.youtube.com/watch?v=E5huVSebZpM

for zirconia abutments, internal metal may be best

2010-02-06T09:03:00.000-05:00

a recent study concluded that there was a lower incidence of fracture when internal hex zirconia abutments were used that maintained metal connections vs. a full zirconia engagement. here's the reference:

Int. Journal of Oral and Maxillofacial Implants
Vol. 24 No. 5 pp 850-858

2009-11-13T10:36:00.000-05:00

An innovative and imho long needed implant simulation device is being beta tested at the university of georgia dental school in conjunction with nobel biocare. it allows for students to learn proper protocol on simulated jaws. more can be found at this link: http://http://www.sciencedaily.com/releases/2009/06/090611084130.htm

gary

www.pinerundental.com
ghenkel@pinerundental.com

how important is smoking

2009-11-01T22:49:00.000-05:00

10 The effects of smoking on the survival of smooth and rough-surface dental implants		Related articles: smoking [15] success/survival rates [64] surface topography [25] Authors and reference: Balshe A. Eckert S. Koka S. Assad D. Weaver A. December 2008 Int. Journal of Oral and Maxillofacial Implants Vol. 23 No. 6 pp 1117-1122 Correspondence to: abalshe@hotmail.com
Dental Implant Summaries: Volume 17, Number 4, January/February 2009
Cutaneous vasoconstriction with subsequent decrease in tissue microperfusion and flow rate, together with a decrease in white cell function and number may be responsible for impairment in wound healing which has been demonstrated as more prominent in smokers. Smoking has been shown to decrease the success rates for the integration of oral implants, particularly in the maxilla. Much of the previous research in this area has been on groups treated with smooth surface implants. Advancements in surface technology have led to the introduction of rough surface implants which in their various manifestations appear to show earlier histomorphometric healing. While some studies have shown no survival risk for rough surface implants in smokers, this study aimed to identify any correlation between survival rates of smooth and rough surface implants placed in smokers and non smokers. Material and Methods A retrospective review of the records of 1498 consenting patients treated in one clinic, who were labelled as either smokers or non smokers was undertaken over two distinct time periods. The first involved 593 patients who received 2182 smooth surface implants (Brånemark System, Nobel Biocare) while the second involved 905 patients who received 2425 rough surface implants (TiUnite, Nobel Biocare). Various data parameters such as age, gender, jaw etc. were recorded and the correlation between these variables determined. Results were gathered and survival time from placement to failure or review calculated. Failure was defined as the absence of an inserted implant at the time of review. The results were adjusted using hazard models and subjected to statistical analysis. Results In the smooth surface group, 17.5% were smokers, 54.3% were female and the mean age (SD) was 51.3 (±18.5) years. 111 implant losses were identified in 65 patients and the survival rate was 94.0% at 5 years. Smoking was found to be significant in implant failure (P<0.001). Of the rough surface group, 10.5% were smokers, 59.6% were female and the mean age (SD) was 48.2 (±17.8) years. 85 implant losses were identified in 64 patients and the survival rate at 5 years was 94.5%. Smoking was not found to be significant in implant failure (P=0.68). Among smokers in the study, implant losses in the smooth surface group was more than three times that of the rough surface group, especially within the first year. In both smokers and non smokers, the intraoral location of the rough surface implants was not significantly (P=0.45) associated with their loss. Conversely the intraoral location of smooth surface implants did significantly affect their survival, P=0.004, but only in smokers. Overall, the survival rate was lowest in the posterior maxilla of smokers who had received smooth surface implants. Discussion and Conclusion Smoking has long been associated with an increased risk of failure for smooth surface titanium implants. The advent of a new generation of dental implants with rough surface characteristics has been found to improve early integration and bone to implant contact, such that overall success rates are comparable between smokers and non-smokers, regardless of jaw and location. The results of the current study reinforce this. The surface characteristics of rough surface implants allow for a greater initial bone to implant contact encouraging osseoconductive bone formation at the implant surface. Optimized platelet attraction and propagation on the rough surface precedes effective osteogenic differentiation and osteogenesis. The efficiency of this process on rough surface implants may outweigh the suppressive effects of smoking on healing and osseointegration. In contrast, the decreased bone to implant contact and subsequent impact on the effectiveness of integration alongside the decreased healing ability in smokers may be responsible for the reduced success rates found with smooth surface implants particularly when placed in areas of lower bone density such as the posterior maxilla. In conclusion, while the results of this study are significant in corroborating previous findings, they incorporate many variables which necessitate further prospective studies to reinforce these conclusions.

a frequently asked question is how much of an effect smoking has on the success rates for dental implants. here is a recent publication that suggests success rates may be similar for smoking and non smoking populations of implant patients.

2009-09-24T18:55:00.000-04:00

i'm at philadelphia airport headed for atlanta to present an all day presentation on bone grafting prior to implant procedures. we present this course about once a month all over the u.s. and canada. check the schedule at www.perio.com for a time and place convenient to you.

Finally, good news on the economic front for the dental implant community:

According to Millennium Research Group's (MRG's) new US Markets for Dental Implants 2009 report, although the current economic crisis is resulting in lower procedural growth in the short term, the US dental implant market will recover after 2010 and exceed $1 billion by 2013.

This correlates well with what i've been hearing from the

community. Hang in there, relief is on the way.

gary

Gary L. Henkel D.D.S. M.A.G.D.

Pine Run Dental and Implant Center

301 Horsham Rd.

Horsham Pa. 19044

215 6726666

2009-09-18T15:46:00.000-04:00

i will be conducting a mini implant course on the 30th of september for osstem (hiossen) dental implant company at their facility in jenkintown pa. and we have an entry level course starting in october for the regular implant, which culminates in participants placing their first implant under direct supervision. if you should have interest in either of these, please contact karen lee at 215 9889435.

gary

the weather outside is frightful

2009-08-21T21:22:00.000-04:00

just completed the socket grafting presentation for the perio institute in columbus, ohio. great set of dentists who were very knowledgeable and ask a lot of very pertinent questions. unfortunately, i'm still here as there is severe weather in western pa. and all flights were cancelled.

2009-08-09T21:53:00.000-04:00

Dr. Henkel will be teaching the first ever North American mini implant course for Osstem corporation at their Jenkintown, Pa. headquarters Sept. 29. Contact our office at 215 6726666 or info@pinerundental.com for more information. Course will be a single day with hands on model based procedures.

Welcome

2009-07-28T10:12:00.000-04:00

Welcome to our newly created dental blog to allow for frank and open discussion of the world of dental implantology. whether you are a patient or a dentist starting out in the area of dental implants, we welcome your participation. we have 30 years of experience in this area, have in house cbct scanning, teach implantology actively at least once a month, and thus feel we are able to guide a discussion of dental implants. we welcome all.

Philadelphia's Implant Information Central!

PERI IMPLANTITIS MORE PREVALENT IN SMOKERS AND THOSE WITH PERIO DISEASE

Peri-implantitis in a specialist clinic of periodontology. Clinicalfeatures and risk indicators.

Source

Abstract

MIX ACETOMINOPHEN AND IBUPROFEN FOR BEST RESULTS

Over-the-Counter Ibuprofen and Acetaminophen in Combination are Superior to Each Agent Alone in Treating Postoperative Pain

PERI-IMPLANTITIS AND ITS MANAGEMENT

Review of the treatment protocols for peri-implantitis

New CT technology promises much loser radiation doses

GE Introduces Veo Low-Dose CT Image Reconstruction Technology in Canada

Experts: Unhealthy gums can end in heart attacks

Are antibiotics of any use in implant therapy?

Summary Review/Restorative Dentistry

Do preoperative antibiotics prevent dental implant complications?

Abstract

Data sources

Study selection

Data extraction and synthesis

Results

Conclusions

DO SHORT IMPLANTS WORK???

INCREASING IMPLANT SURFACE AREA AT NANO LEVEL SPEEDS HEALING

Increasing the Active Surface of Dental Implants at Nano Level Quickens Healing

Researchers at the University of Gothenburg have conducted studies on the surface arrangement of dental implants both at the micro and nano level to enable speedy healing of patients.

AVASTIN- ANOTHER DRUG ASSOCIATED WITH ONJ

About the Author

Bevacizumab (Avastin®): Another Drug Associated With Osteonecrosis of the Jaw

Antiangiogenic Agents and the Risk of ONJ

Dental Management to Reduce the Risk of ONJ

Indications for Bevacizumab (Avastin®) Approved by FDA:

Unlabeled/Investigational Use:

EVER WONDER WHAT TO CHARGE FOR AN IMPLANT???

EVER WONDER WHAT TO CHARGE FOR AN IMPLANT???

Philadelphia's Implant Information Central!: STEM CELLS WHAT ARE THEY, AND HOW CAN THEY HELP?

STEM CELLS WHAT ARE THEY, AND HOW CAN THEY HELP?

GENETICS CAN BE A RISK FACTOR FOR DENTAL IMPLANTS!

A recent article in the Journal of Oral Implantology has identified a combination of genes that when present may adversely affect dental implants. This could change the way we evaluate patients for dental implant reconstruction.

gary l henkel dds magd

horsham dental elements

www.horshamdentalelements.com

ghenkel@pinerundental.com

Gene combination identified as risk factor in success of dental implants

Philadelphia's Implant Information Central!: INVISALIGN CAN MOVE TEETH MILES!!!!!!

INVISALIGN CAN MOVE TEETH MILES!!!!!!

LINGUAL ARTERIES IN THE ANTERIO MANDIBLE VARIANT

PERIODONTAL DISEASE LINKED TO ANEMIA!

Gary L. Henkel DDS MAGD

Horsham Dental Elements

www.horshamdentalelements.com

Gum Disease Linked To Anemia

oral tongue cancer rates rising in young white women

Oral Tongue Cancer Rates Rising in Young White Women

MEDSCAPE'S FREE MOBILE APP

NEW UPDATED LIST OF CONE BEAM UNITS RELEASED

Tooth scout app for ipad can make choosing denture teeth easier

Teenagers and Dental Implants | Dear Doctor - Dentistry & Oral Health

new drill stops patented to prevent overdrilling

QUESTION PATIENTS ASK ABOUT DENTAL IMPLANTS

3 swipes are the charm for smooth surface disinfection

IMPLANTS DON'T HAVE TO BE SILVER METAL ANYMORE!

Philadelphia's Implant Information Central!: Name that implant!

Name that implant!

7 myths about dental implants

Oral Sex Increases Risk Of Oral Cancer

PERIODONTAL DISEASE AND HEART DISEASE LINKED

5th Annual Dental Expo hosted by Harcum

Using the CAS sinus lift system in the mandible

NO EVIDENCE ONE IMPLANT SYSTEM IS BETTER THAN ANOTHER

new non breathing version of CPR

for zirconia abutments, internal metal may be best

how important is smoking

the weather outside is frightful

Welcome