One of the primary concerns in implant dentistry is ensuring that there is enough bone at the implant site to support the implant. Without adequate bone support, it’s unlikely that proper osseointegration will occur. Periodontists can augment the size of the bone crest with bone grafting, guided bone regeneration, a ridge split technique for placement, and distraction osteogenesis. However, newer technology has been developed to help facilitate dental implant success for patients who have a narrow ridge, which is a ridge smaller than six millimeters. A narrow ridge implant, such as Hoissen SS implants, are specifically designed for patients with narrow ridges. The implant itself is shorter and has a smaller diameter, allowing it to fit better in a narrow ridge. Narrow ridge implants are often more affordable and don’t require as much of a time commitment for the patient versus complex procedures like bone grafting or guided bone regeneration.
The nasopalatine nerve is a part of the parasympathetic nervous system. It is a branch of the pterygopalatine ganglion which passes through the sphenopalatine foramen, across the roof of the nasal cavity to the nasal septum, and obliquely downward to and through the incisive canal. The nasopalatine nerve innervates the anterior part of the hard palate and the mucosa of the nasal septum. A nasopalatine nerve block may be used as local anesthesia for some dental procedures, though it is often painful for the patient. This is due to the resistance of the dense tissue of the palate which requires greater pressure to overcome. It causes significant pain and may lead to tissue trauma. Nasopalatine nerve damage may occur following some types of dental work or after surgery on the nasal septum. This damage often causes a reduction in the sensitivity of the front teeth or the hard palate. Nasopalatine nerve numbness may also be a side effect of the above procedures or of a nasopalatine canal cyst.
In some patients needing a dental implant, the periodontist will need to connect the natural teeth to the bone-supported dental implant using a periodontal ligament that allows for partial movement. This is often the case in partially edentulous patients who have a mixed bite, where natural teeth alternate between spaces that need to be restored with an implant. Some dentists are more reserved about the long-term efficacy of connecting implants and natural teeth, primarily because of the mobility difference between the two. Sometimes, complications can result from the use of a rigid or non-rigid connection between a dental implant and a natural tooth, one of which being the intrusion of the natural tooth, where the natural tooth “intrudes” on the dental implant, potentially causing failure. It’s important that periodontists evaluate the risk of natural tooth intrusion when using the existing dentition of patients to anchor the dental implant hardware.
Navigation surgery, or surgical navigation systems, play an important role in accurate and effective surgical procedures. Imaging is often integrated into these systems using CAS (computer-assisted surgery) technology, making surgery significantly safer in most cases. CAS was first developed in the 1980s by neurosurgeons and ENTs, but the technology has a substantially wide variety of applications in the medical field today. One of the most notable applications is within the field of dental health, or more specifically, during periodontal surgery. Dental implants, for example, are reported to have a lower failure rate when done with CAS technology versus traditional placement techniques. Surgical navigation systems help make surgical procedures less invasive and therefore reduces the risk of potential complications. In implant dentistry, surgeries that once required a flap to be made to expose the alveolar ridge for implantation of the screw can now be done with a small or even no incision.
An Nd:YAG laser, often simply referred to as a YAG laser, is a commonly used true pulse laser technology in many medical applications, including in optometry and dentistry. YAG lasers are close to an infrared wavelength of 1064 nm, which can be absorbed by pigment in living tissue, such as melanin and hemoglobin, and have superior biostimulatory properties. Photothermal interaction allows the laser energy to penetrate into the tissues, and the technology can be used as both non-contact and contact depending on the application or procedure being performed. In dentistry, YAG lasers are used primarily for gum disease or periodontal disease to disinfect and debride bacteria-filled periodontal pockets. This technology can also be used to seal treated pockets and support reattachment by acting as a scaffold, as well as for frenectomies, gingivectomies, and biopsies. They can help improve osteogenesis, help with clotting, and can help prevent alveolitis.
The word “necrosis” originates from the Greek word νέκρωσης, which refers to the act of death or decay. In the English language, necrosis is the result of cell injury that causes the premature death of living tissue cells via autolysis, or in simpler terms, the death of body tissue. When too little oxygenated and nutrient-rich blood reaches tissue, it begins to go through autolysis, or the process of self-digestion by its own enzymes. Necrosis can be caused by exposure to chemicals, radiation, and injury, and cannot be reversed. Once begun, tissue death can only be stopped — the destroyed tissue won’t regenerate without the help of a grafting procedure. In implant dentistry, necrosis of the jaw is a common obstacle to implant procedures. Tooth loss, periodontal disease, and other conditions can cause or contribute to the loss of bone in the jaw. A bone graft may be needed to support an implant.
In medical terminology, neoplasia is described as abnormal tissue growth as a result of the rapid division of mutated cells. Normally, the body’s cells multiply, divide, and extinguish in an orderly manner. Although cells normally divide quickly when the human body is growing, when it reaches adulthood, cells typically only do this as needed when cells die or become injured and require replacement. This is regulated by the body’s unique genetic code contained within the DNA. Neoplasms, or the abnormal tissue that is the result of neoplasia, are often seen in various forms of cancer as a malignant growth. The cells within a neoplasm have mutated and no longer respond to the instructions given by host DNA. They multiply rapidly and don’t die when they ought to, resulting in the unregulated growth of abnormal tissue — in other words, a tumor. While neoplasms are frequently seen with malignancy, they can also be benign or precancerous.
Nerve lateralization, also known as nerve repositioning or nerve transpositioning, is a surgical procedure whereby the course of the inferior alveolar nerve is redirected to allow the placement of longer implants in a mandible with extensive resorption of the posterior ridge. Nerve repositioning requires a portion of the lower jaw be opened to provide access to the nerve. To close this access, a bone graft is required following the placement of the implants. Nerve lateralization is considered a more aggressive procedure in implant surgery as the nerve can sustain long-term or even permanent damage. The inferior alveolar nerve provides feeling and sensation to the lower jaw, lip, and chin and most patients experience varying degrees of numbness following the surgery. Since there are other options for implant placements, such as blade implants, nerve repositioning surgery is generally not the first choice when dealing with patients with extensive posterior ridge resorption.
Nerve repositioning, also known as nerve lateralization or nerve transpositioning, is a surgical procedure whereby the course of the inferior alveolar nerve is redirected to allow the placement of longer implants in a mandible with extensive resorption of the posterior ridge. Alveolar nerve repositioning may also be done as part of a procedure to remove cysts or benign tumors of the mandible. For implant patients experiencing edentulous atrophy in posterior mandibles, repositioning of the alveolar nerve is often the only way a fixed prosthesis or implant can be properly placed. Due to the risks involved in repositioning the alveolar nerve, extreme care and precision must be demonstrated during surgical procedures to avoid damage to the nerve. Damage can cause short-term, long-term, or permanent issues and impair a patient’s ability to experience sensory information. It can also cause pain, numbness, and in some cases, paralysis. Nerve repositioning is done if there are not other suitable implant placement options.
Neurapraxia is the name given to a mild nerve injury that has been caused by either compression or retraction. In neurapraxia, there is no violation of the nerve trunk and no axonal degeneration and spontaneous recovery of the motor and/or sensory functions most often occurs within one to four weeks from the time of injury. Neurapraxia in dentistry is commonly caused by an injury to the inferior alveolar nerve or to the lingual nerve and may occur due to several possibilities including third molar extractions, anesthetic injections, oral disease, and surgical, orthodontic, and endodontic treatments or procedures. Neurapraxia symptoms include numbness, loss of sensation, motor paralysis, and tingling. Though neurapraxia typically does not require any specific treatment, patients should report their symptoms to their practitioner for monitoring and follow-up. In some cases, additional imaging may be needed to ensure there is not another underlying cause for the neurapraxia that must be addressed to promote healing.