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Treatment for horizontal semicircular canal bppv,natural cures for yeast infection itching yahoo,how to get rid of smell fish hands 07 - Plans On 2016

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A combination of biological and biomechanical factors is responsible for the failure of tooth-supported fixed prostheses. The most common implant-related complications are biomechanical problems that occur after the implant is loaded. Figure 4-1 The majority of implant failures occur within 18 months after prosthetic loading and are related to short implants or implants placed in poor-quality bone. The most common complications that do not lead to the failure of the implant are also biomechanical problems. Any complex engineering structure will fail at its “weakest link,” and dental implant structures are no exception. Figure 4-2 Excessive heat during osteotomy preparation can cause surgical failure of a healing implant.
An additional cause of surgical failure is micromovement of the implant while the developing interface is established (Figure 4-3).
Figure 4-3 Micromovement of a developing bone-implant interface may cause fibrous tissue to form around an implant rather than a bone-implant interface.
Occlusal forces applied to a removable prosthesis over a healing implant may also cause incision line opening of the soft tissue and delay soft tissue healing.26 These occlusal forces may also affect the marginal bone around the developing implant site. Figure 4-4 Premature occlusal contacts caused six of eight integrated implants to fail within 18 months. Early loading failure is worse for the implant clinician than when a surgical failure occurs, because the patient may blame the restoring dentist. Abutment screw loosening has been detected in an overall average of 6% of implant prostheses.7 Single-tooth crowns exhibited the highest rate of 25% in early screw designs and concepts (and as high as 45%). The height or depth of an antirotational component of the implant body also can affect the amount of the force applied to the abutment screw. Materials follow a fatigue curve, which is related to the number of cycles and the intensity of the force. Prosthesis screw fracture has been noted in both fixed partial and complete fixed prostheses, with a mean incidence of 4% and a range of 0% to 19%7 (Figure 4-6).
Figure 4-6 Prosthesis screw fracture has been observed for screw-retained fixed prostheses.
Figure 4-7 Abutment screw fracture occurs less often than prosthetic screw fracture, as they are larger in diameter.
Figure 4-8 Metal framework fracture has been reported with an average of 3% with implant-fixed prostheses. Uncemented restorations (or worse, partially uncemented prostheses) occur most likely when chronic loads are applied to the cement interface, or when shear forces are present (as found with cantilevers). Crestal bone loss has been observed around the permucosal portion of dental implants for decades. Figure 4-10 Marginal bone loss around the crestal portion of an implant often occurs during the first year of occlusal loading. The initial transosteal bone loss around an implant forms a V- or a U-shaped pattern, which has been described as ditching or saucerization around the implant. An understanding of the causes of marginal crestal bone loss around dental implants and early implant failure is critical in preventing such occurrences, fostering long-term periimplant health, and improving long-term implant success rates and, foremost, implant prosthesis success.
Over the years, the cause of marginal bone loss has kept the implant community busy with academic debates and clinical studies. Periosteal reflection causes a transitional change in the blood supply to the crestal cortical bone. Although crestal bone cells may die from the initial trauma of periosteal reflection, the blood supply is reestablished once the periosteum regenerates. The periosteal reflection theory would lead to a generalized horizontal bone loss of the entire residual ridge reflected, not the localized ditching pattern around the implant that typically is observed. Figure 4-11 At Stage II uncovery, the marginal bone level most often is similar to the initial day of surgery and may even have grown over the top of the implant. Preparation of the implant osteotomy has been reported as a causal agent of early implant bone loss.
However, if heat and trauma during implant osteotomy preparation were responsible for marginal crestal bone loss, the effect would be noticeable at the second-stage uncovery surgery 4 to 8 months later.
In a prospective study of 125 implants, Adell et al.38 reported 80% of implant sulcular regions were without inflammation.
Although the bacteria theory does not explain adequately the marginal crestal bone loss phenomenon, this does not mean that bacteria are not a major contributor to bone loss around an implant.
Figure 4-12 Exudate around an implant is more likely to be present when the probing depth is greater than 5 mm and an aerobic environment exists around the implant. For a natural tooth, an average biological width of 2.04 mm exists between the depth of the sulcus and the crest of the alveolar bone (Figure 4-13). Figure 4-13 The biological width of a natural tooth has a connective tissue zone that inserts into the cementum of the tooth.
Many surgical protocols recommend the placement of endosteal implants at or below the crest of the ridge during the first-stage surgery. Figure 4-14 The bone levels recede to at least 0.5 mm around an abutment to implant connection after the implant extends through the soft tissue, regardless of whether the implant is loaded.
Eleven different gingival fiber groups are observed around a natural tooth: dentogingival (coronal, horizontal, and apical), alveologingival, intercapillary, transgingival, circular, semicircular, dentoperiosteal, transseptal, periosteogingival, intercircular, and intergingival.
Figure 4-15 There are primarily two soft tissue fiber groups around an implant: circular fibers and crestal bone fibers. James and Keller64 were first to begin a systematic scientific study to investigate the biological seal phenomenon of the soft tissue around dental implants. The crevice between the cover screw and the implant body during initial healing is similar to the crevice of the abutment-implant connection. The biological width hypothesis cannot fully explain the several millimeters of marginal crestal bone loss, which also has been observed readily with onestage implants that extend through the tissue at the initial implant placement surgery and have no abutment-implant connections. It is true that, bone loss does occur around an exposed abutment-implant connection placed below the bone and is observed within 2 to 4 weeks, once the connection is exposed to the oral environment. The primary question remains, when the surgeon places the implant abutment connection below the bone, how much bone loss is from the implant biological width, and therefore out of the influence of the dental practitioner? The bone loss to the first thread observation implies the amount of bone loss is similar for different implant designs. This redirect was kept in order to preserve this page's edit history after its content was merged into the target page's content. Some aspects of the dental field emphasize the art form, as in dental esthetics, which deals with tooth color and shape to enhance a patient’s smile and overall appearance.
The four most common complications for three-unit fixed prostheses are (1) caries, (2) endodontic problems, (3) unretained prosthesis, and (4) porcelain fracture.5,6 The biological complications occur with greater frequency (11% to 22%), compared with the biomechanical (7% to 10%), but both aspects should be understood by the clinician. When implant complications are reported, the vast majority of problems are related to the implant sciences, rather than esthetics.7 But, unlike natural teeth, the biological aspects of implant dentistry have relatively few complications.
A literature review focusing on implant failure indicated these problems primarily occur within 18 months of initial implant loading.


Implant overdentures have problems of attachment fracture or complication (30%) and removable prosthesis fracture (12%). A general concept in engineering is to determine the causes of complications and develop a system to reduce the conditions that cause the problems. The primary causes of failure relate to excessive heat during the preparation of the osteotomy or excessive pressure at the implant-bone interface at the time of implant insertion21 (Figure 4-2). A fractured arm is immobilized to prevent movement at the fracture site to decrease the risk of a fibrous nonunion.
Transferring these forces to an overlying soft tissue-borne prosthesis may cause micromovement of the implant-bone interface, whether the implant is healing below or above the gingival tissues. Before failure, the implant appears to have rigid fixation, and all clinical indicators are within normal limits. Strings in the sulcus and excessive plaque accumulation caused no failure during this period. Although this is bad enough, in addition the restoring dentist spent two to five appointments restoring the implant and has a laboratory expense. Recent studies indicate this ratio has been reduced to an overall 8% average, with multiple-unit fixed prostheses at a 5% average and implant overdentures at 3% (Figure 4-5).
The higher (or deeper) the hex height, the less stress applied to the screw and a corresponding lower risk for abutment screw loosening.35,36 The platform dimension upon which the abutment is seated is even more important than the hex height dimension.
Abutment screws are usually larger in diameter and therefore fracture less often, with a mean incidence of 2% and a range of 0.2% to 8% (Figure 4-7).
It is most often related to parafunction and occurs with greater frequency for CP grade 1 titanium implants.
It has been described in the crestal region of successfully osteointegrated implants regardless of surgical approaches. The study also indicated greater magnitude and occurrence of bone loss during the first year of prosthesis loading, averaging 1.2 mm during this time frame, with a range of 0 to 3 mm. However, clinical consequences are such that all phases of implant dentistry, from diagnosis and treatment planning to the final stages of occlusion and prosthesis delivery, must focus on its reduction or elimination.
Ninety percent of the arterial blood supply and 100% of the venous return are associated with the periosteum in the long bones of the body.43 When the periosteum is reflected off the crestal bone, the cortical bone blood supply is affected dramatically, causing osteoblast death on the surface from trauma and lack of nutrition. Cutting cones develop from monocytes in the blood and precede new blood vessels into the crestal regions of bone. In addition, generalized bone loss already would be directly noticeable at the second-stage uncovery of the implant body, 4 to 8 months after Stage I implant placement surgery. Because the periosteum is reflected and bone is prepared to insert the implants, the cause of frequently occurring early crestal bone loss may not be related to the reflection of the periosteum or the osteotomy preparation.
The average bone loss of 1.5 mm from the first thread is not observed at Stage II uncovery.
Therefore if 2 mm of bone loss is found on one implant, and the next nine implants exhibit no bone loss, the average bone loss would be 0.2 mm.
Repeat studies demonstrate that bacteria are the causative element for vertical defects around teeth. Lekholm et al.51 found that deep gingival pockets around implants were not associated with crestal bone loss.
Threads and porous implant surfaces exposed to bacteria are reported to cause a more rapid loss of bone around an implant.51 Poor hygiene also is reported to accelerate the bone loss observed around endosteal implants52,53 (Figure 4-12).
The rete peg formation within the attached gingiva and the histologic lining of the gingiva within the sulcus are similar in implants and teeth. It should be noted the biological “width” is actually a height dimension with a greater range in the posterior region compared with the anterior, and may be greater than 4 mm in height. At least six of these gingival fiber groups insert into the cementum of the natural tooth: the dentogingival (coronal, horizontal, and apical), dentoperiosteal, transseptal, circular, semicircular, and transgingival fibers. Hemidesmosomes help form a basal lamina—like structure on the implant, which can act as a biological seal. Yet bone can grow over the cover screw, and therefore the crevice, in and of itself, may not be the cause of bone loss. For example, plate form (blade) implants, transosteal implants, pins, onepiece screw implants, and even subperiosteal implants demonstrate the marginal crestal bone loss phenomenon. However, the first thread is a different distance from the abutment margin for several implant designs.
Please do not remove the tag that generates this text (unless the need to recreate content on this page has been demonstrated) nor delete this page. However, the primary reason the term doctor is applied to the dental profession is because of the dental sciences.
These early implant loading failures occur most often in the softest bone types (16% failure) or the shortest implant lengths (17% failure).
In implant-supported fixed prostheses, acrylic resin veneer fracture (22%), abutment or prosthetic screw loosening (7% to 10%), porcelain fracture (7%), and prosthesis metal fracture (3%) are examples of common complications.7,15 In addition, implant components (2% to 4%) and even implant bodies may fracture (1% to 2%) (Box 4-1). The excessive pressure at implant insertion is observed most often with tapered screw-type body designs. Movement as little as 20 microns has been reported to cause a fibrous interface to form at the fracture site. However, once the implant is loaded, the implant becomes mobile within 6 to 18 months (see Figure 4-1).
The greater the stress applied to the prostheses (single tooth versus overdentures), the greater the risk of abutment screw loosening. Larger-diameter implants, with larger platform dimensions, reduce the forces applied to an abutment screw and change the arc of displacement of the abutment on the crest module. Metal framework fractures also have been reported in an average of 3% of fixed complete and overdenture restorations, with a range of 0% to 27% (Figure 4-8).
Zinc phosphate cement may resist a compressive force of 12,000 psi but can only resist a shear force of 500 psi.
It can range from loss of marginal bone to complete failure of the implant17,23,37,38 and dramatically decreases after the first year (Box 4-2). This report measured bone loss from the first thread as the 0-mm baseline, not from the original level of crestal bone at insertion, which was 1.8 mm above this baseline point. If the tissue shrinks as a consequence of the bone loss, the emergence profile of the crown elongates and the papilla may disappear next to the adjacent tooth or implant. These events have fostered the periosteal reflection theory as a cause for early bone loss around an endosteal implant. Osteoblasts then are able to remodel the crestal bone anatomy.44 Composite bone forms rapidly on periosteal surfaces to restore its original condition.
Yet generalized bone loss rarely is observed at the second-stage uncovery surgery (Figure 4-11). The implant osteotomy causes trauma to the bone in immediate contact with the implant, and a devitalized bone zone of about 1 mm is created around the implant. In fact, bone often has grown over the first-stage cover screw, especially when level or slightly countersunk below the bone (see Figure 4-11). Yet the marginal crestal bone loss to the first thread of screw-type implants is a common radiologic finding. To state that bacteria are never involved in marginal bone loss around an implant would be incorrect.


A free gingival margin forms around an implant with nonkeratinized sulcular epithelium, and the epithelial cells at its base are similar to the functional epithelial cells described with natural teeth.54 However, a fundamental difference characterizes the base of the gingival sulcus. In addition, some crestal fibers from the periodontal fiber bundles also insert into the cementum above the alveolar bone.57 However, in a typical implant gingival region, only two of these gingival fiber groups and no periodontal fibers are present (Figure 4-15).
The peri-implant probe penetrates the sulcus, junctional epithelial attachment, and most of the connective tissue zone.
The crevice between the implant and the abutment connection has been called a “microgap.” The actual dimension of this connection is usually 0 ?m and has a direct metal to metal connection. A smooth polished 4-mm collar below the bone has been associated with greater bone loss than a smooth 2-mm collar below the bone. Most recent reports indicate the surgical phase of implants form a successful interface more than 95% of the time, regardless of the implant system used.7 Hence, the biological aspect of the field is very predictable. Thus, the overall treatment plan should (1) assess the greatest force factors in the system and (2) establish mechanisms to protect the overall implant-bone-prosthetic system.
The insertion torque force on a tapered screw implant design may place excessive forces on the bone, which leads to resorption and implant failure.
On the other hand, multicenter clinical reports indicate an experienced surgeon may obtain rigid fixations after surgical placement 99% of the time.27 The surgical component of implant failure is often the least risk associated with the overall implant treatment. This has been called early loading failure by Misch and Jividen.9 The cause of early loading failure is usually excessive stress for the bone-implant interface.
Cantilevers also increase the risk of screw loosening, as they increase the forces in direct relationship to the length of the cantilever.35 The greater the crown height attached to the abutment, the greater the force applied to the screw, and the greater the risk of screw loosening.
Screw loosening also may be decreased by a preload force with a torque wrench on the screw. The wire coat hanger that is bent does not break the first time, but repeated bends will fracture the material—not because the last bend was more forceful, but because of fatigue.
Implant body fracture has the least incidence of this type of complication, with an occurrence of 1% (Figure 4-9). It is interesting to note that bone is also strongest to compression and 65% weaker to shear forces. Thus the actual first-year crestal bone loss averaged 3.3 mm around the implants observed (Figure 4-10). If the soft tissue does not shrink, the increase in pocket depth may be related to the presence of anaerobic bacteria and peri-implantitis.
In addition, the underlying trabecular bone is also a vascular source because its blood supply often is maintained in spite of crestal periosteal reflection. Therefore, the periosteal reflection hypothesis does not appear as a primary causal agent of marginal crestal bone loss around an implant.
A renewed blood supply and cutting cones are necessary to remodel the bone at the interface. Reports in the literature indicate different surgical trauma causes and numbers for bone loss. Therefore the implant osteotomy hypothesis for marginal crestal bone loss cannot be primarily responsible for this routinely observed phenomenon. If bacteria were the causal agent for the initial bone loss, why does most bone loss occur the first year (1.5 mm) and less (0.1 mm) each successive year?
It is unable, however, to constitute a junctional epithelial attachment component of the biological width similar to the one found with natural teeth. The implant biological width concept does not explain completely the total amount of vertical bone loss observed. Soft bone is too weak for the occlusal forces applied to the implants, or short implants have higher stresses at the bone-implant interface8–20 (Figure 4-1). Isidor allowed eight implants to integrate in monkey jaws.28 Crowns were attached to the healed implants with excessive premature occlusal contacts.
Therefore, prosthetic methods to decrease stress to the abutment screw or engineering approaches to decrease stress or increase thread tightening may be used to decrease the incidence of complications related to screw loosening. This condition is reported with more frequency in long-term fixed prostheses and may even account for the majority of long-term failures. A similar scenario relative to shear load is found with porcelain or other occlusal materials.
The greater the amount of trabecular bone under the crestal cortical bone, the less crestal bone loss is observed.45 To place the implant in sufficient available bone, an implant ridge is usually 5 mm or wider at the crest. The implant sulcus depth progressively increases from the early bone loss, impairing hygiene and making anaerobic bacteria more likely as the cause of bacteria-related bone loss.
However, when most bone loss occurs in the first year and less bone loss is observed afterward, the hypothesis of bacteria as the primary causal agent for the early crestal bone loss cannot be substantiated.
Wallace and Tarnow62,63 stated that the biological width also occurs with implants and may contribute to some of the marginal bone loss observed. Therefore the CT attachment around the abutment-implant connection cannot be compared with the CT attachment of a tooth. The amount of early crestal bone loss therefore seems unlikely to be solely the result of the remodeling of the hard and soft tissues to establish a biological width below an abutment connection. In addition, the amount of bone loss from the biological width occurs within 1 month, whether the implant is loaded or not, and is related to the crest module implant design and the position of the abutment-implant connection in relation to the bone but is unrelated to the density of the bone. As a consequence, the evaluation, diagnosis, and modification of treatment plans related to stress conditions are of considerable importance.
As a result, trabecular bone is readily available to assist in cortical blood supply and remodeling around the implants.
If bacteria are responsible for 1.5-mm early crestal bone loss, what local environmental changes occur to reduce their effect by 15 times after the first year?23 The bacteria autoimmune theory cannot explain the marginal bone loss condition when it follows the pattern most often reported. The biological width theory seems attractive to explain the lack of bone loss from the first stage of surgery and the early bone loss seen within the first year after the second-stage abutment placement.
No connective tissue attachment zone or components of the linear body are embedded into an implant. The concept does not explain why greater crestal bone loss often is observed in soft bone compared with denser bone after loading, nor does it explain the higher implant failure rates in lesser-quality bone after loading.
Collage of Medicine Thailand.Testing for Horizontal Canal BPPVThese video clips are recommended for use in conjunction with a course incorporating practical instruction. In these same animals, eight integrated implants with no occlusal loads had strings placed in the marginal gingiva to increase the amount of plaque retention. Therefore, once the implant dentist has identified the sources of additional force on the implant system, the treatment plan is altered in an attempt to minimize their negative impact on the longevity of the implant, bone, and final restoration. The cortical bone is remodeled to its original contour, without significant loss of height.
The surgical system or approach may influence these data, but usually this bone loss remains minimal.
However, it should be noted that the biological “width” in implants, as reported, often includes the sulcus depth, whereas the natural tooth biological width does not include the sulcus depth. The importance, amount, and mechanism for these anatomical structures require further investigation.



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