After any dental procedure, infection is something a dentist will work to prevent. By using sterile procedures, instruments and educating the patient on what they can and can’t do after the procedure, can go a long way to prevent infection. However, when infection does occur, a quick response is necessary. Bacterial leakage around dental restorations can have a significant impact on the surrounding dental pulp. The dental pulp is the innermost part of the tooth and is a living tissue — it’s filled with blood vessels, nerves, and connective tissue. This is in part what makes dental work so painful. It’s critical for periodontists and dentists to choose dental materials for restoration that are compatible with the pulp. When the materials aren’t compatible, the surrounding area of the mouth can become irritated and inflamed, resulting in bacterial leakage. Bacterial leakage can cause infection and implant failure if not handled quickly.
Also known as a ball attachment, a ball abutment is a type of extracoronal attachment mechanism used with dental implants to retain an overdenture. It consists of a spherical shaped abutment, which fits into an attachment metal housing. Prior to the implant procedure, a patient must first experience full gingival healing. Following this, proper measurement of the tissue thickness must be taken to ensure the correct abutment fit. Once the right attachment diameter is selected, the abutment is properly threaded into place and adjusted using a driver. The attachment part of the mechanism is then seated into the base of the overdenture and the denture itself is affixed to the implant. These metal attachment housings can be exchanged for alternate sizes if needed to create a proper fit. Utilizing a ball abutment can also allow for easier replacement of components and is associated with less stress on the implant. Ball abutments come in a variety of materials and the one selected may depend on the nature of the procedure and the type of implant.
Basic Structural Unit (BSU)
A Basic Structural Unit (BSU) is essentially a building block. In anatomy, the basic structural unit of the body is the cell. All living organisms have cells, which start as the zygote — the single cell at the beginning of life, after a spermatazoon fertilizes an oocyte. In humans, the body has more than 200 different cell types. The human mouth contains bone cells, epithelial cells, endothelial cells, muscle cells, nerve cells, and cartilage cells. These make up four broader categories of tissue in the body: nerve tissue, muscle tissue, connective tissue, and nervous tissue. This means that the oral cavity involves nearly all the different types of tissue and basic structural units of the body. The innermost part of the BSU, or the nucleus, contains the genetic (DNA) information for the organism. Mitochondria provide energy to the cell to perform bodily functions, and the cell membrane functions as an outer wall.
X-ray technology works by utilizing a phenomenon known as “beam hardening.” When an x-ray passes through an object, two things occur: photons that have lower energy are absorbed, while photons with higher energy are left behind. This allows an image to be created of structures within the object that are of higher energy. Skin, for example, has a lower energy level than bone. Bone, however, has a lower energy level than metal. This results in varying shades of gray that can be seen on an x-ray — metal is typically opaque white, while bones are semi-translucent. Folds of skin may be seen, however, most often, soft structures of the body like skin and muscle are completely transparent. Beam hardening technology allows dental professionals to isolate and assess internal oral structures like dental implant screws, tooth roots, and underlying bone to determine the overall best approach for completing dental restorations.
Benign paroxysmal positional vertigo
Benign paroxysmal positional vertigo (BPPV) is a common cause of dizziness, or vertigo. It causes the sensation that your body is moving even when it’s not, or that your head is spinning. BPPV results in short but sometimes very intense episodes of vertigo. Usually, these episodes of dizziness are triggered by certain changes in head positioning, such as moving the head vigorously from side to side, leaning down for extended periods, or other sudden movement. The movement is said to cause calcium deposits in the inner ear to dislodge, which move across internal structures of the ear. This causes the ear to send signals to the brain that the body is in motion. Usually, benign paroxysmal positional vertigo (BPPV) is very bothersome for the patient but of little cause for concern other than protecting patients from falls due to loss of balance. One cause of BPPV is TMJ/TMD, or temporomandibular joint dysfunction.
Betamethasone is a type of glucocorticoid, or corticosteroid, with a long half-life. It can be taken orally, applied topically, or inhaled to achieve the required effect. Betamethasone is often used to treat skin conditions to reduce swelling, itching, redness, and irritation. This drug has also been found to have applications in the dental field by promoting healing and reducing swelling. Following more extensive dental procedures, patients often experience inflammation which leads to pain and a delay in the healing process. The use of betamethasone has been shown to lessen these complications. It is generally administered as a mouthwash with one soluble betamethasone tablet being dissolved in water. Patients usually experience a reduction in inflammation, swelling, and pain due to the effects of the drug. For oral lesions, betamethasone can also be administered via inhaler with the inhaler positioned in the mouth so that it is close to the site of the lesion.
A beveled flap is a small section of gingiva that has been surgically separated from its underlying tissues by incising at an acute angle. This allows for visibility to the root surface and bone structure of the patient.
A beveled flap can be classified based on how the bone is exposed after reflection of the flap — e.g. a mucoperiosteal (full thickness flap) or a mucosal (partial thickness) flap. The flap can also be classified based on how it is placed after surgery — e.g. a non-displaced or displaced flap, as well as classified on the management of papilla — e.g. a papilla preservation flap or a conventional flap.
A full thickness flap allows all soft tissue to be completely reflected to gain full visibility to bone structures, while a partial thickness flap only includes incision of the epithelium and some but not all of the underlying tissues. The periosteum remains in place over the bone, allowing for more limited visibility.
A bevel incision, or internal bevel incision, is a type of periodontal flap surgery that allows a periodontist to access to the bone and root surfaces of the teeth. A small incision is made in the gingiva to expose the root surfaces and in some cases, the gingiva can be relocated in patients who have mucogingival involvement. This is done to clean the roots of the teeth, remove the periodontal pocket lining, and treat alveolar bone irregularities. Then, the periodontal flap is laid back down and the bevel incision is closed. The procedure helps reduce the risk of infection and inflammation, and can significantly reduce the size of pockets. A bevel incision is typically made using a #15 or #15C surgical blade, and is made to the alveolar crest beginning about 1 mm or less away from the gingival margin. Sutures are placed after the flap is repositioned to allow for minimal, if any, scarring.
Bicortical stabilization can sometimes be difficult to achieve, however, is an advantageous surgical goal. Biocortical stimulation occurs when a surgeon engages more than a single cortical plate when placing a dental implant. Typically, this is done with the cortical bone of the base of the mandible or the floor of the maxillary sinus or nasal cavity and the crestal cortical bone of the edentulous ridge. However, it can also be done by engaging the lingual and facial cortices.
Biocortical stabilization can reduce maximum stress in the superior cortical plate, assuming no peri-implant defects have occurred. However, each surgeon must decide if the potential gains from this technique outweigh the increased risks that are needed to achieve implant placement with the engagement of more than one cortical plate. Ultimately, the advantages and disadvantages must be evaluated in each patient to determine the best surgical approach.
Bioabsorbable technology continues to grow with the refinement of bioabsorbable polymers for medical devices. At its base, bioabsorbable material was created to address potential problems with synthetic implants of all kinds, including but not limited to growth disturbance, migration of the implant, rigidity, and infection, since the body generally resorbs the material over time.
Bioabsorbable material is commonly used in the medical field where implants are necessary, including bioabsorbable stents for cardiac procedures and bioabsorbable screws for dental implants. Bioabsorbable screws material for dental implants is often referred to as resorbable alloplast, and like a bioabsorbable stent, it is designed to facilitate regeneration of natural tissues.
While some surgeons prefer to continue to use titanium implant material, the use of bioabsorbable material is growing in the field of periodontics. Surgeons and patients may see a reduction in post-operative complications when bioabsorbable screws are used during the dental implant process.