by Gordon J. Christensen, DDS, MSD, PhD
In this monthly feature, Dr. Gordon Christensen addresses the most frequently asked questions from Dental Economics readers. If you would like to submit a question to Dr. Christensen, please send an email to [email protected].
Question ...
Because of conflicting opinions from the surgeons I use, I have been unable to decide when an implant is indicated and when a fixed prosthesis would be best. What are the guidelines to determine when an implant instead of a prosthesis is indicated in a maxillary lateral incisor area?
Answer from Dr. Christensen ...
For most situations, general dentists should be able to make decisions about the desirability of implants. In fact, I believe general dentists should be able to place implants in acceptable bone in healthy patients. The following are my criteria for placement of an implant in a maxillary lateral incisor area, or any similar area, without the presence of major nerves or blood vessels.
Bone density and quantity should be analyzed from both the mesial-distal and the facial-lingual aspects. It is easy to measure the bone present in a mesial-distal aspect by observing the bone amount from the periapical radiograph, which is the actual amount of bone present. How much is necessary? I suggest a minimum of 1 mm of bone more than the actual diameter of the implant on both the mesial and the distal sides of the implant, or 2 mm more than the diameter of the smallest implant. The smallest standard implants are about 3.25 mm in diameter. Therefore, about 5.25 mm of bone is the minimum amount of bone necessary from the mesial-distal dimension. Do not be misled by panoramic radiographs, which are enlarged by 25 percent or more over actual anatomical features.
How can the amount of bone in the facial-lingual dimension be estimated? Unless laminographic radiographs are used, I suggest the use of a measuring caliper — Salvin Dental Specialties, (800) 535-6566. The facial and lingual aspects of the involved site are anesthetized, and the needle-like caliper is used to actually measure the bone present. The same amount of bone is necessary for the facial-lingual dimension as for the mesial-distal dimension, or about 5.25 mm of bone minimum. Of course, more bone would be desirable. If the minimum amount of bone is not present, bone-grafting from other sites is possible.
I recently completed a video on a related subject that has answered many implant questions: V2392, "Prosthodontics for Implants Simplified." For more information, call (800) 223-6569 or visit www.pccdental.com.
Question ...
I have not taken the time to monitor blood pressure for my patients. Is this time-consuming procedure necessary from either a practical or a legal viewpoint?
Answer from Dr. Christensen ...
Most dentists do not measure blood pressure on a routine basis. I am sorry to report that fact, because I feel strongly that a routine blood-pressure measurement should be taken at the initial diagnostic appointment, as well as on each subsequent appointment for every patient who on the diagnostic appointment had a diastolic reading of 90 or higher.
Why do I believe this is necessary? The average life expectancy of humans has significantly increased in developed countries. Many patients are over age 65. Many have high blood pressure, have had a stroke or heart attack, or suffer from congestive heart failure. Blood-pressure measurement helps to determine proper oral therapy.
The accurate use of a sphygmomanometer requires routine use and experience. Most dentists and dental staff will not take the time to learn to use these instruments well; therefore, I suggest the use of more simple electronic devices. There are many electronic blood-pressure devices in the professional and lay marketplaces. For years, I have used an electronic blood-pressure monitor that is placed on the patient's arm. It registers systole, diastole, and pulse, and it makes a printout containing that information. You may obtain one from SmartPractice®, (800) 522-0800. Additionally, there are many wrist blood-pressure monitors available for minimum cost. From both practical and legal standpoints, it appears to be mandatory to include blood-pressure recording as a routine procedure in dental practices.
A related video in our series is V3973, "Easy Management of Medical Emergencies." For more information, call (800) 223-6569, or visit www.pccdental.com.
Dr. Christensen is a practicing prosthodontist in Provo, Utah. He is the founder and director of Practical Clinical Courses, an international continuing-education organization for dental professionals initiated in 1981. Dr. Christensen is a co-founder (with his wife, Rella) and senior consultant of Clinical Research Associates, which, since 1976, has conducted research in all areas of dentistry and publishes its findings to the dental profession in the well-known CRA Newsletter. He is an adjunct professor at Brigham Young University and the University of Utah. Dr. Christensen has educational videos and hands-on courses on the above topics available through Practical Clinical Courses. Call (800) 223-6569 or (801) 226-6569.
Dr. Christensen's views do not necessarily reflect the opinions of the editorial staff at Dental Economics.
