Clinical Articles

When we speak of early loading protocol, it should be understood this refers to placement of a provisional or permanent restoration prior to the time of conventional loading but after the time considered immediate loading.

There have been a number of clinical studies on Astra Tech implants, with a follow-up range of one-five years, showing good clinical results with survival rates of almost 100% in early loading situations of single implants, and partial or full arch restorations —whether placed in maxilla or mandible— and located in anterior or posterior locations.

Published data from one-year studies have shown predictable results for implants placed in extraction sockets and early loaded.

Also reported, when using an early loading protocol, is high rates of patient satisfaction.

When immediate loading is spoken of, we understand it speaks to situations where implant placement and loading take place at the same visit or within 48 hours.

Immediate loading offers many potential advantages, like reduced number of surgical procedures and an aesthetic solution within 48 hours.

Clinical studies with the Astra Tech Implant System using a one-stage surgical protocol followed by immediate loading have shown safe, predictable results.

These studies covered implants placed in different regions and indications: i.e., mandible and maxilla; atrophic maxilla; single-tooth restorations; total fixed prostheses, and immediate installation in extraction sockets.

We offer a wide variety of implant solutions including cad/cam framework design and production from the ISUS system as well as custom zirconia and other abutments from Astra™ Atlantis™ system.

We can provide you with Atlantis CAD/CAM patient-specific abutments for all major implant systems with exemplary customer service and lab/surgery communication, fast turn-around and timely delivery as well as a 5 year guarantee on all of our work.

If you have any questions or comments for the dental lab, don’t hesitate to get in touch! Feel free to leave your thoughts here, or get in touch with me on social media:

Michael Joseph on Twitter

Biterite on Facebook

Image courtesy of Astra Atlantis

I believe, and I hope you’d agree, communication between dentist and patient is of the paramount importance for a good outcome.

With this in mind, I’d like to present an amalgam (If you’ll pardon the pun!) of what a patient should be or will ask ahead of implants.

What To Tell:

Implant dentistry gives teeth that look and feel like your very own.

They also rid you of the embarrassment of loose dentures and enable you to enjoy the simple pleasures of unrestricted eating.

Dental implants give you the confidence to pursue an active business and social life with an attractive, cosmetic smile.

Consider what a plus that would be for you!

The Q&A:

Are dental implants safe and how long do they last?

Today’s dental implants are not only safe, they consistently show success rates of more than 95%.

Implants are one of the most predictable forms of dental treatment and, in most cases, a life-long solution.

Am I suitable?

We will take x-rays to see if you have sufficient quality and quantity of bone.

Disease, such as uncontrolled diabetes, can affect the bone growing onto the implant and will need careful assessment. In general, though, most people are good candidates for implants.

Does it hurt?

A small operation will be necessary, and some patients do experience one or two days of discomfort after the procedure, usually related to stitches.

Is it expensive?

In general, implant treatment is not much more expensive than a bridge or new dentures. The big difference lies with the long term success. Your implants can be with you for the rest of your life.

Should I wait until I’m older?

Conventional dentures usually lead to accelerated bone loss. The ages of implant patients range from early teens to people in their 90’s. The sooner have the implants placed, the less bone loss will occur.

I hope you find this helpful, but more importantly, I hope you have something to add!

If you have a question your implant patients are always asking you, send it in, and I’ll update the list. Soon we’ll have a handy, crowd-sourced Q&A!

Make a submission by leaving a comment here, or you can suggest them on social media:

Michael Joseph on Twitter

Biterite on Facebook

Every year, about a half-million people develop cancer in this country (based on 2000 estimates).

Sites in the oral cavity and pharynx (throat) account for about 2% of all cancers. More than 95% of oral cancers occur in individuals aged 35 and older.

The overall five-year survival rate for people with oral and pharyngeal cancers is 52 percent, which is worse than that for cancers of the prostate, corpus and uterus, breast, bladder, cervix, colon, and rectum.

Compared to patients with other types of cancer, oral and pharyngeal cancer patients who survive have the highest rate of development of new cancers in the mouth or in other parts of the body.

Males have higher incidence rates than females. Oral and pharyngeal cancers are the seventh most common cancer among white males and the fourth most frequently diagnosed cancer among black males.

Overall, the incidence rate for oral cavity and pharyngeal cancers is decreasing and there are wide variations in the incidence of site-specific cancers.

The largest annual declines in incidence were noted for lip cancer; this is for the years 1973 to 1996, the most recent data now available.

In contrast, the incidence of tongue cancer, the most common form of oral and pharyngeal cancer, may be increasing among young men.

Tobacco-related Lesions

Tobacco use has been estimated to account for more than 90% of cancers of the oral cavity and pharynx and the greatest single preventable risk factor for oral cancer.

Both smoking and chew (smokeless) tobacco are associated with a number of other oral conditions, including oral mucosal lesions that may progress to oral cancer.

The prevalence of tobacco-related lesions increased with increasing duration and frequency of spit tobacco use.

Oral Herpes Simplex Virus Infections

The prevalence of recurrent herpes lesions is estimated to be between 15 and 40 percent. Presence of antibodies and occurrence of herpes lesions vary by age.

Frequency of recurrence also varies greatly, ranging from once to several times per year.

Infection with the oral herpes simplex virus has been related to socioeconomic factors, with 75-90% of individuals from lower socioeconomic populations developing antibodies by the end of the first decade of life.

In comparison, only 30-40% of individuals from middle and upper socioeconomic groups evidence antibodies by the middle of the second decade of life.

Recurrent Aphthous Ulcers

Various epidemiologic studies of recurrent aphthous ulcers have indicated that the prevalence in the general population can vary from 5 to 25 percent.

In selected population groups, the prevalence of recurrent aphthous ulcers can be as high as 50 to 60 percent.

Other Mucosal Lesions

Other mucosal conditions contribute to the burden of oral diseases. The following are among the most common:

—Oral candidiasis (commonly called thrush) is a particular problem for individuals with impaired immune function. It is estimated that 3.6 percent of full denture wearers have candidiasis.

—Denture stomatitis, a condition in which the mucosa underneath a denture becomes inflamed and sometimes painful, affects some 25% percent of people aged 18 and older who have two full dentures.

—Oral human papilloma virus infections, oral and genital papillomas (or condyloma acuminata, also called venereal warts), are especially common among HIV-positive patients. Human papilloma viruses may be associated with some oral leukoplakias with a high risk for malignant transformation.

I hope this information is helpful. If you have any comments or questions, feel free to leave them here or find me on social media:

Michael Joseph on Twitter

Biterite on Facebook

At the turn of the twentieth century, most people could expect to lose their teeth by middle age.

That situation began to change with the discovery of  fluoride, and the observation that people who lived in communities with naturally fluoridated drinking water had far less dental caries than people in comparable communities without fluoride in their water supply.

Community water fluoridation remains one of the great achievements of public health —an inexpensive means of improving oral health which benefits a community young and old, rich and poor alike.

Additional disease prevention measures also exist for dental caries and for many other oral diseases and disorders —measures that can be used by individuals, health care providers, and communities.

There can be no denying that the growth of biomedical research since WWII has brought about extraordinary advances in the health and well-being.

These advances have been particularly remarkable in the case of oral health, where we have gone from a nation plagued by the pains of toothache and tooth loss to a nation where most people can smile about their oral health.

The impetus for change was driven by the challenge of addressing oral diseases as well as the many other health problems that shorten lives and diminish well-being.

Beginning in the 1940s, research initially focused on dental caries and studies demonstrating the effectiveness of fluoride in preventing dental caries.

It was this research that ushered in a new era of health promotion and disease prevention.

This new focus on oral health led to the discovery of fluoride, which was soon complemented by research which showed both dental caries and periodontal diseases were bacterial infections that could be prevented by a combination of individual, community, and professional actions.

These and other applications of research discoveries have resulted in continuing improvements in the oral, dental, and craniofacial health.

Despite the advances in oral health that have been made over the last half century, there is still much work to be done.

Great progress has been made in reducing the extent and severity of common oral diseases.

However, not everyone is experiencing the same degree of improvement.

I’d like to open up the discussion and ask: Which area of oral health care requires the most improvement in modern dentistry?

I invite you to leave a comment here, or if you like, contact me on social media:

Michael Joseph on Twitter

Biterite on Facebook

A successful implant system cannot be determined by one single feature alone.

As with nature, many interdependent features must work together to create a cohesive whole.

Biterite, a facility certified in utilizing the Astra Tech Implant System™, directly integrates aesthetics into the implant system design.

This system works together with nature supporting the natural healing process, not interfering with it.

You and your patients can rely on the Astra Tech implant system today, tomorrow and beyond.

More bone, faster
The Astra Tech implant system builds on the proven success of TiOblast™ with the addition of OsseoSpeed™ — the first and only implant in the world with a chemically modified titanium surface providing unique nano-scale topography stimulating early bone healing as well as speeding up the bone healing process.

Biomechanical bone stimulation
The neck of Astra Tech implants are designed with MicroThread™— minute threads offering optimal load distribution and lower stress values.

This design is based on a thorough understanding of bone physiology, which is vital to optimal implant design.

Bone tissue, as we in the dental profession are aware, is designed to carry loads, and dental implants must be developed to mechanically stimulate the surrounding bone in order to preserve it.

At the same time, it must be taken into consideration the critical point of the implant-bone interface is located at the marginal cortical bone where peak stresses occur.

Together with MicroThread™ on the implant neck, OsseoSpeed provides true growing power for more reliable and effective treatment as a result of the micro-roughened titanium surface treated with fluoride increasing bone formation and stronger bone-to-implant bonding.

Clinical benefits of OsseoSpeed are proven and well-documented.

A strong and stable fit
The Conical Seal Design™ is a conical connection below the marginal bone level that transfers the load deeper down in the bone, thereby reducing peak stresses and preserving the marginal bone.

It also seals off the interior of the implant from surrounding tissues, minimizing micro-movements and micro-leakage.

Conical Seal Design simplifies maintenance and ensures reliability in all clinical situations.

The tight and precisely fitting implant-abutment relation of the Conical Seal Design makes abutment connection a quick and simple procedure.

Since the abutment is self-guiding and the installation procedure is non-traumatic, this eliminates the risk of bone damage.

Increased soft tissue contact zone and volume
The Connective Contour™ is the unique contour that is created when you connect the abutment to the implant.

This contour allows for an increased connective soft tissue contact zone both in height and volume, which integrates with the transmucosal part of the implant, sealing off and protecting the marginal bone.

If you have any questions or comments about Biterite’s broad range of implant options, including Astratech, I welcome you to get in touch. Feel free to leave a comment here, or find me on social media:

Michael Joseph on Twitter

Biterite on Facebook

Oral health can be a reflection of general health, and vice versa

Studying the diseases and disorders affecting craniofacial tissues can provide scientists with models of systemic pathology.

Because some craniofacial tissues such as bones, mucosa, muscles, joints, and nerve endings have counterparts in other parts of the body and these tissues are often more accessible to research analysis than deeper-lying tissues.

Researchers studying craniofacial tissues can gain valuable insights into how cancer develops, the role of inflammation in infection and pain, effects of diet and smoking, consequences of depressed immunity, and the changes arising from mutated genes.

Other craniofacial tissues—teeth, gingiva, tongue, salivary glands, and the organs of taste and smell—are unique to the craniofacial complex.

Study of the diseases affecting these tissues has revealed a wealth of information about their special nature as well as the molecules and mechanisms normally operating for the protection, maintenance, and repair of all the oral, dental, and craniofacial tissues.

When factors disturb these nurturing elements, the oral health scale can tip toward disease.

When those factors stem from systemic diseases or disorders, the mouth can sometimes mirror the body’s ill health.

Similarly underscoring the connection between oral and general health are studies suggesting that poor dental health may heighten the risk for both cardiovascular disease and stroke independently of factors such as social class and established cardiovascular risk factors.

The interplay between craniofacial and systemic health and disease has become a lively focus of interest and research. This will be discussed in later articles

FINDINGS:

• Microbial infections, including those caused by bacteria, viruses, and fungi, are the primary cause of the most prevalent oral diseases. Examples include dental caries, periodontal diseases, herpes labialis, and candidiasis.
• The aetiology and pathogenesis of disorders affecting the craniofacial structures are multifactorial and complex, involving interplay among genetic, environmental, and behavioural factors.
• Many inherited and congenital conditions affect the craniofacial complex, often resulting in disfigurement and impairments involving many body organs and systems.
• Tobacco use, excessive alcohol use, and inappropriate dietary practices cause many diseases and disorders. In particular, tobacco use is a risk factor for oral cavity and pharyngeal cancers, periodontal diseases, candidiasis, and dental caries, among other diseases.
• Some chronic diseases, such as Sjögren’s syndrome, present with primary oral symptoms.
• Oral-facial pain conditions are common and often have complex aetiologist.

I hope you find this article to be enlightening, as it’s my hope to expand the horizons of oral health discussion.

If you have any suggestions, questions, or other comments, feel free to leave them here or find me on social media:

Michael on Twitter

Biterite on Facebook

Today I’d like to look at a few disorders which are chronic and can cause a variety of pains or disabilities. 

Oral, dental, or craniofacial signs and symptoms play a critical role in autoimmune disorders such as Sjögren’s syndrome and in a number of similar conditions.

Sjögren’s syndrome is one of several autoimmune disorders in which the body’s own cells and tissues are mistakenly targeted for destruction by the immune system and is more prevalent among women.

The disease occurs in two forms: Primary Sjögren’s involves the salivary and lachrymal (tear) glands; Secondary Sjögren’s, where the glandular involvement is accompanied by the development of a connective tissue or collagen disease.

The glandular involvement causes a marked reduction in fluid secretion, resulting in xerostomia and xerophthalmia (dry eyes) and constant oral dryness that causes difficulty in speaking, chewing, and swallowing. There is currently no cure for Sjögren’s.

Clinically, the reduction in salivary flow changes the bacterial flora, which, in addition to the reduction in salivary protective components, increases the risk of caries and candidiasis.

Recent studies have indicated there is a reduction in masticatory function and an increased prevalence of periodontal disease.

In advanced stages the salivary glands may swell because of obstruction and infection or lymphatic infiltration.

Acute and Chronic Oral-Facial Pain

Since the nineteenth century, when two dentists, Horace Wells and Frederick Morton, demonstrated the analgesic powers of nitrous oxide and ether, oral health investigators have been recognized leaders in the field of pain management worldwide.

Their analyses of the cells, pathways, and molecules involved in the transmission of pain have given rise to a growing variety of medications, often combined with other approaches, which can control acute and chronic pain.

Atypical Facial Pain

Atypical facial pain is characterized by a continuous dull ache on one or both sides, most frequently in the region of the maxilla (the upper jaw).

The pain tends to be episodic and is aggravated by fatigue, worry, or emotional upset.

Tic Douloureux

The most frequently encountered of oral facial neuralgias is tic douloureux, or trigeminal neuralgia, a disease of unknown aetiology, affecting one, two, or all three branches of the trigeminal nerve.

The pain is highly intense, of a stabbing nature that lasts for a few seconds.

Temporomandibular Disorders

Various etiological factors, including trauma, can give rise to pain and dysfunction in the temporomandibular joint and surrounding muscles, conditions collectively called temporomandibular disorders (TMDs).

The pain may be localized or radiate to the teeth, head, ears, neck, and shoulders. Abnormal grating, clicking, or crackling sounds, known as crepitus, in the joint often accompany localized pain.

Pain is also found in response to clinical palpation of the affected structures.

I welcome anyone with firsthand experience of dealing with these disorders to get in touch and discuss how they’ve handled them in their dental practice.

Feel free to leave a comment here or get in touch on social media:

Michael on Twitter

Biterite on Facebook

A patient managing their diabetes properly presents a much reduced risk to their own dental health

Dentists will be no stranger to how to a systemic condition can affect a patient’s overall health, and they may be familiar with how it can affect their oral health too.

Today I’m going to talk about the unique challenges presented by a patient with diabetes mellitus.

Type 1 (insulin dependent) and Type 2 (non-insulin dependent) diabetes mellitus 

Patients with undiagnosed or poorly-controlled diabetes mellitus have particular susceptibility to periodontal diseases.

On the other hand, most well-controlled diabetic patients can maintain periodontal health and should respond favourably to periodontal therapy.

Treatment considerations for patients with periodontitis associated with diabetes should include:

1.  Identification of signs and symptoms of undiagnosed or poorly controlled diabetes.

2.  Consultation with the patient’s physician as necessary.

3.  Consideration of diagnosis and duration of diabetes; level of glycemic control; medications and treatment history.

4.  Consideration of adjunctive systemic antibiotics for periodontal procedures if the diabetes is poorly controlled.

5.  Preparation to diagnose and manage medical emergencies associated with diabetes.

It’s also worth mentioning, while we’re on the subject of systemic conditions affecting the mouth, pregnancy.

Hormonal fluctuations in the female patient may alter the status of periodontal health. Such changes may occur during puberty, the menstrual cycle, pregnancy, or menopause.

Changes may also occur with the use of oral contraceptives.

The most pronounced periodontal changes occur during pregnancy and treatment considerations for pregnant patients with periodontal disease include:

1.  Consultation with the patient’s physician as necessary.

2.  Consideration of postponement of periodontal treatment during the first trimester.

3.  Performance of emergency periodontal treatment at any time during pregnancy.

4.  Consideration of deferral of periodontal surgery until after parturition.

5.  Performance of periodontal maintenance as needed.

6.  Administration of antibiotics and other drugs with caution.

7.  Use of local anaesthesia in preference to general anaesthesia or conscious sedation.

If you treat patients experiencing either of these conditions, I welcome your response to this article.

Feel free to leave a comment here or find me on social media:

Michael on Twitter

Biterite on Facebook

In my dedication to discussing and expanding the horizons of dental discussion, today I’d like to talk about more systemic conditions.

It’s a fact a significant portion of the population must deal with a systemic condition, and their access to dental care is as valuable as those without.

A comprehensive periodontal evaluation of your patient should be performed with regard to conditions suggestive of systemic disorders, such as:

Physical disabilities;

• Signs or symptoms of xerostomia, mucocutaneous lesions, gingival overgrowth, excessive gingival haemorrhage, or other indicators of undetected or poorly-controlled systemic disease;
• Therapeutic drug use;
• Signs or symptoms of smoking, chemical dependency, and other addictive habits;
• History of recent or chronic diseases;
• Evidence of psychological/emotional factors;
• History of familial systemic disease.

You should also request laboratory tests as appropriate and, when warranted, referral to or consultation with other health care providers should be made.

Your therapeutic goal should be to achieve a degree of periodontal health consistent with the patient’s overall health status.

Treatment outcome in the patient with contributing systemic factors may be directly affected by the control of the systemic condition.

The systemic and psychological status of the patient should be identified to reduce medical risks that may compromise or alter the periodontal treatment.

A patient with systemic conditions that contribute to progression of periodontal diseases can successfully be treated utilizing well-established periodontal treatment techniques.

You should be aware, though, the systemic/psychological status of your patient may cause a change of the therapy planned and may also have an adverse affect on the treatment outcomes.

As ever, I welcome any discussion on this topic. Feel free to leave a comment here, or get in touch on social media:

Biterite on Twitter

Biterite on Facebook

Recently, while discussing implant treatment assessment and procedures, we looked at a problematic female patient.

Today, let’s look at a 45 year old man with a maxillary fixed partial denture which is failing. The patient expresses a desire to have a new prosthesis in the same manner as the original, but with “more teeth showing.”

A semi-professional singer, he is quite concerned about the aesthetic and phonetic outcome.

He will not tolerate a removable prosthesis, but wants a prosthetic design which closely simulates his natural teeth.

Diagnostic examination revealed that the four remaining maxillary teeth are salvageable and can be incorporated into the new prosthesis.
Although it was possible to construct a fixed partial denture on the remaining teeth, it was explained this was inadvisable with regard to long term prognosis, especially with increased tooth length.

Use of dental implants in conjunction with the remaining teeth was discussed. Available bone seemed adequate in the anterior region, but questionable in the posterior region due to the presence of large maxillary sinuses.

The mandibular fixed partial denture extends to the area of the second bicuspids, so molar occlusion was not necessary. All other factors were positive.
Implants in the anterior edentulous spaces, as well as in the posterior maxilla distal to the natural abutments were proposed. A prosthesis supported by natural abutments, as well as implant abutments, was ultimately chosen.

Contingencies and alternative treatments were discussed, and the patient elected to follow the proposed treatment plan.

The surgical phase proceeded with the placement of five implant fixtures. Six months after placement, all five implants were found to be integrated. The prosthodontic phase was completed over a three month period.

The patient was pleased with the appearance of longer teeth, and the resulting phonetics.

Biterite has a huge variety of implants available to your practice. If you’d like to discuss the possibilities for your patients, feel free to get in touch. Leave a comment here, or find me on social media:

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