November 20, 2008

Scheduling, Common Oral Conditions,
and Tissues Around Implants
As with all dental practices, we are experiencing interesting times and therefore we have continued to increase our focus on serving your patients well. The addition of Dr. Erik Badger to our practice is a continuation of our desire to treat your patients with a high level of care and skill. Many have already worked with him and experienced his emphasis on quality periodontal and implant therapy. Also in an effort to better care for your patients we recently have expanded our practice into Park City with a satellite clinic operating on Wednesdays and Fridays. Thank you for trusting us with the care of your patients. Recently we attended a conference regarding office scheduling and its importance in the success of a practice. In these times, efficient use of overhead and scheduling can decrease the level of stress in all practices. Taking a proactive and strategic approach when designing your scheduling system allows the doctor and team to manage patient flow rather than be managed by it. All doctors have different methods of practice determined by specific days and hours practiced, doctor’s experience and different types of dental services provided. The schedule is the center of all practice management systems. When well designed to fit an individual doctor, a scheduling system will significantly decrease stress because it is efficient and predictable. There is not one style of scheduling that fits all practices and we all need to adapt our manner of scheduling according to our desires. We have found that adaptation and constant evaluation of practice management strategies is important to provide quality care to patients and increase the satisfaction of practicing dentistry.
In our annual education session for dental hygienists, we taught out of the book
Treatment of Common Oral Conditions published by the American Academy of Oral
Medicine. This book includes etiology, clinical description, rationale for treatment and
treatment protocols including pharmaceutical prescriptions. We have found that the
simple and precise communications in this book have been very valuable in diagnosis and
treatment of our patients.
One common oral condition that presents itself rather frequently is the herpes simplex recurrent lesion (orofacial). The typical clinical manifestation of this type of viral lesion in the oral cavity is usually a single or small cluster vesicles that quickly rupture, forming painful ulcers. The lesion usually occurs on the keratinized tissue of the hard palate and gingiva. They can occur due to stress or after a recent dental procedure if the individual has a compromised immune system due to a medical condition or simply a common cold. Treatment should be initiated as early as possible in the prodromal stage with the objective of reducing the duration and symptoms of the lesion. Antiviral medications prophylactically as well as therapeutically may be considered when episodes are frequent. Valacyclovir (Valtrex) has been approved for the prevention and management of oral recurrent herpes simplex infections: Valtrex Caplets 500 mg Disp: 8 Caplets Sig: Take 4 caplets as soon as prodromal symptoms are recognized and then 4 caplets 12 hours later At the recent American Academy of Periodontology meeting in Seattle, a few standout issues were addressed. Those issues related to implant therapy and the fine-tuning of our treatment outcomes. The issue that was predominant in the lectures included the importance of tissue architecture surrounding the implant restoration. This includes both soft and hard tissue. The preservation of the osseous ridge after an extraction is essential so that the correct anglulation of the implant and proper crown dimensions can be achieved. If a buccal defect is present, even if minor, then an osseous graft should be placed prior to implant placement to enhance the ridge. If multiple implants are to be placed side by side then the space between them should be approximately 4-5 mm in order to have a positive osseous architecture in which the soft tissue papilla can be established. Also to establish a healthy papilla, it was mentioned that the under-contouring of an implant abutment would also create a thicker connective tissue bond around the implant resulting in better tissue architecture. In the anterior region, the final stage of implant surgery should include if possible a temporary crown. This provisional crown is important to the shaping of the soft tissue and should be started at the time of implant placement if adequate torque is obtained upon implant insertion. The provisional crown can also be under-contoured to enhance the soft tissue remodeling in this very esthetic area. Staggered implants in an edentulous anterior region will provide the best esthetic outcome. Implant bridges can be more esthetic then individual implants if multiple anterior teeth are missing. For example, if teeth # 7, 8, 9 and 10 are missing, consider placing implants in the # 7 and 10 area and the fabrication of an implant-supported bridge. The inter-implant papilla continues to be the biggest challenge in implant therapy. Proper spacing between anterior implants is crucial to have an esthetic success.


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