3 medical conditions and medications that may cause increased risk of implant failure:
1. Anxiety/Depression and use of serotonin uptake inhibitors (SSRIs). Common SSRIs are Paxil, Lexapro, Celexa, Zoloft, and Prozac.
2. GERD and use of proton pump inhibitors (PPIs). Common PPIs are Nexium, Protonix, and Prevacid.
3. Rheumatoid arthritis and use of methotrexate.
In some cases where ridge dimension is limited a stronger ceramic implant may be a consideration – Straumann® PURE Ceramic Implant
Straumann RC stock cementable single unit all-in-one kits:
Straumann NC stock cementable single unit all-in-one kits:
Progression of periodontal disease:
Decision making in determination of tooth extraction:
Anatomage can utilize full resolution DICOM CT scan data for 3D and 2D cross sections so no compromise is made at the expense of clinical accuracy. Anatomage gives you ability to plan with the highest level of accuracy for clinical success and patient safety.
SPEAR Study Club participation can help keep you up to date on the latest procedures and learn in a fun interactive group setting. The Bozeman Spear study club year typically runs from October to May. We meet the first Tuesday evening of the month in our office. Please contact us for more information.
Classification of Periodontal disease: The American Academy of Periodontology (AAP) has published the official proceedings from the 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions. These proceedings provide a comprehensive update to the previous disease classification established at the 1999 International Workshop for a Classification of Periodontal Diseases and Conditions.
Guidance on Staging and Grading with case examples: Dental Town Perio Diagnosis Article
Information pertaining to the use of lasers to treat periodontitis:
2018 American Academy of Periodontology best evidence consensus
statement on the efficacy of laser therapy used alone or as an
adjunct to non-surgical and surgical treatment of periodontitis
and peri-implant diseases
AADC Position Statement on Laser Periodontics – good review of laser periodontics research including LANAP
FDA approval/clearance through 510(k) requires only data showing safety of use; it does not require published clinical trials and/or related studies showing efficacy of treatment.
A good primer on laser periodontal treatment including LANAP – Cobb-Journal_of_Periodontology
Laser Periodontics – LANAP randomized split mouth controlled multi-center study
This is the only split mouth randomized control multi-center study available for LANAP. It compares: 1. Sc/RP with an attempt not to injure the connective tissue attachment; 2. Sc/RP with laser and surgical perforation of the PDL (LANAP); 3. Sc/RP with replaced flaps (modified Widman flap surgery) and 4. coronal scaling only. Unfortunately it does NOT compare LANAP to osseous surgery for defect elimination and apically positioned flaps or with regenerative therapy which are more commonly accomplished in our office. This Millenium supported study is not apparently published in any major dental journals – perhaps due to the findings. Findings seem to indicate all therapies produce similar clinical results with LANAP tending to be less comfortable than scaling and root planing.
A blood clot contains stem cells whether it was induced by laser or curette.
Other laser company supported studies demonstrate true regeneration with ONLY scaling and root planing which is likely due in part to the focus on mechanical disruption of gingival fibers to the bone crest – typically scaling and root planing is done to preserve this connective tissue attachment.
Additionally, during these LANAP studies there is a focus on eliminating occlusal trauma which is very important and beneficial in the treatment of periodontal disease. This is what is possible with elimination of occlusal trauma and no bone grafting and NO LANAP/laser:
Enamel matrix derivative (Emdogain) in periodontal regeneration – “In a long-term follow-up, most clinical outcomes were not significantly different between the two groups except for defect fill gain.” – periodontal defect fill improved 1/2 to 1 mm at 6-12 months – authors state longer studies are needed. JADA meta-analysis 2012
“Due to considerable heterogeneity of the published studies a clear beneficial effect of the EMD on the early wound healing outcomes after surgical treatment of periodontal intrabony defects cannot be confirmed.” – 2019 systematic review
Enamel matrix derivative in root coverage – “As the additional use of Emdogain together with coronally advanced flap technique for recession coverage showed no difference in the overall clinical outcome, there is no clear benefit to combine Emdogain with this surgical technique.”
My personal clinical experience with Emdogain 15 years ago is that surgical sites appeared slightly nicer at the 2 week follow up but appeared the same at the 6 week follow up with patients reporting similar levels of discomfort. I stopped using it due the additional cost to the patient that I felt was unwarranted.