Contraindications of Dental Implants (Absolute, Relative and Local)

1- ABSOLUTE CONTRAINDICATIONS

Implants can not be placed in these situations:

Heart:
• Heart diseases affecting the valves (valvulopathy)
• Recent infarcts
• Severe cardiac insufficiency, cardiomyopathy

Miscellaneous:
• Active cancer, certain bone diseases (osteomalacia, Paget’s disease, brittle bones syndrome, etc.),
• Certain immunological diseases, immunosuppressant treatments, clinical AIDS, awaiting an organ transplant,
• Certain mental diseases,
• Strongly irradiated jaw bones (radiotherapy treatment),
• Treatments of osteoporosis or some cancers by bisphosphonates

Age:
• Children: not before the jaw bones have stopped growing (in general 17-18 years).
On the other hand advanced age does not pose problems if the patient’s general condition is good.

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2- RELATIVE CONTRAINDICATIONS

The indication to place implants will be evaluated on a case-by-case basis, with the greatest caution:

• Diabetes (particularly insulin-dependent),
• Angina pectoris (angina),
• Seropositivity (absolute contraindication for clinical AIDS),
• Significant consumption of tobacco (read pdf)
• Certain mental diseases,
• Radiotherapy to the neck or face (depending on the zone, quantity of radiation, localisation of the cancerous lesion etc.),
• Certain auto-immunes diseases,
• Drug and alcohol dependency,
• Pregnancy.

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3- RELATIVE LOCAL CONTRAINDICATIONS

The indication to place implants will be evaluated on a case-by-case basis, with caution:

• An insufficient quantity of bone.
• Certain diseases of the mucous membranes of the mouth.
• Periodontal diseases (loosening of the teeth); it is necessary to clean up the gums and stabilise the disease first.
• Severe grinding or clenching of the teeth.
• An unbalanced relationship between the upper and lower teeth.
• Infections in the neighbouring teeth (pockets, cysts, granulomas), major sinusitis.
• Poor hygiene of the mouth and teeth.

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Blue Sclera "Definition and Diseases"

Definition:

Blue sclera is characterized by localized or generalized blue coloration of sclera because of thinness and loss of water content, which allow underlying dark choroid to be seen.

Diseases and Disorders:

1. Associated with high urine excretion:A. Folling syndrome (phenylketonuria)
B. Hypophosphatasia (phosphoethanolaminuria)
C. Lowe syndrome (oculocerebrorenal syndrome; chondroitin-4-sulfate-uria)

2. Associated with skeletal disorders:A. Brachmann-de Lange syndrome
B. Brittle cornea syndrome (blue sclera syndrome)-recessive
C. Crouzon disease (craniofacial dysostosis)
D. Hallermann-Streiff syndrome (dyscephalia mandibulooculofacial syndrome)
E. Marfan syndrome (dystrophia mesodermalis congenita)
F. Marshall-Smith syndrome
G. McCune-Albright syndrome (fibrosus dysplasia)
H. Mucopolysaccharidosis VI (Maroteaux-Lamy syndrome)
I. Osteogenesis imperfecta (van der Hoeve syndrome)
J. Paget syndrome (osteitis deformans)
K. Pierre Robin syndrome (micrognathia-glossoptosis syndrome)
L. Robert syndrome
M. Silver-Russell syndrome
N. Werner syndrome (progeria of adults)

3. Chromosome disorders:A. Trisomy syndrome
B. Turner syndrome

4. Ocular:A. Congenital glaucoma
B. Myopia
C. Repeated surgeries
D. Scleromalacia (perforans)
E. Staphyloma
F. Trauma

5. Miscellaneous:A. Ehlers-Danlos syndrome (fibrodysplasia elastica generalisata)
B. Goltz syndrome (focal dermal hypoplasia syndrome)
C. Incontinentia pigmenti (Bloch-Sulzberger syndrome)
D. Lax ligament syndrome
E. Minocycline-induced
F. Oculodermal melanocytosis (nevus of Ota)
G. Pseudoxanthoma elasticum (Grönblad-Strandberg syndrome)
H. Relapsing polychondritis

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Indications and Contraindications of the Maryland Bridge

Indications:
• Periodontal Splinting
• Replacement of missing teeth
• Prosthodontic splinting
• Combination with Removable Partial Denture
• Changes in Occlusal table
• Strengthening Natural Teeth

Contraindications:
• Sensitivity to base metal alloys
• Changes in facial esthetic of abutments (Long spans - Inadequate enamel for bonding)
• Poor quality enamel
• Short clinical crowns
• Narrow embrasures
• Incisors with thin buccal lingual dimensions
• Pathologic occlusion (i.e.- bruxism)
• Malocclusion
• High caries rate or high caries risk

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Bronchial (Pharyngeal) Arches

:: 1st Pharyngeal Arch (also called "mandibular arch") ::

Muscular contributions

Muscles of mastication, anterior belly of thedigastric, mylohyoid, tensor tympani, tensor veli palatini

Skeletal contributions

Maxilla, mandible (only as a model for mandible not actual formation of mandible), the incus, and the malleus of the middle ear, also Meckel's cartilage

Nerve

Trigeminal nerve(V2 and V3)

Artery

Maxillary artery, external carotid artery

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:: 2nd Pharyngeal Arch (also called the "hyoid arch") ::
Muscular contributions

Muscles of facial expression, buccinator,platysma, stapedius, stylohyoid, posterior belly of the digastric 

Skeletal contributions

Stapes, temporal styloid process, hyoid (lesser horn and upper part of body), Reichert's cartilage 

Nerve

Facial nerve (VII)

Artery

Stapedial artery, hyoid artery

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:: 3rd Pharyngeal Arch ::

Muscular contributions

Stylopharyngeus

Skeletal contributions

Hyoid (greater horn and lower part of body), thymus, inferior parathyroids

Nerve

Glossopharyngeal nerve (IX)

Artery

Common carotid, internal carotid

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:: 4th Pharyngeal Arch ::

Muscular contributions

Cricothyroid muscle, all intrinsic muscles of soft palate (including levator veli palatini) except tensor veli palatini

Skeletal contributions

Thyroid cartilage, superior parathyroids, epiglottic cartilage

Nerve

Vagus nerve (X),superior laryngeal nerve

Artery
Right 4th aortic arch:subclavian artery
Left 4th aortic arch: aortic arch

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:: 6th Pharyngeal Arch ::

Muscular contributions

All intrinsic muscles of larynx except the cricothyroid muscle

Skeletal contributions

Cricoid cartilage, arytenoid cartilages, corniculate cartilage, cuneiform cartilages

Nerve

Vagus nerve (X), recurrent laryngeal nerve

Artery

Right 6th aortic arch: pulmonary artery
Left 6th aortic arch: pulmonary artery and ductus arteriosus

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Muscles of the Face and Scalp

- Those muscles receive motor innervation from branches of the facial nerve (CN VII).

- Rather than inserting into bone, these muscles insert into the dermis of the skin, thus their orchestrated contractions convey various shapes to the face that we interpret as emotions.

Scalp

Muscle	Location	Origin
Frontalis	Forehead	Procerus, corrugator, orbicularis oculi
Occipitalis	Back of the head	Mastoid process and superior nuchal line
Temporoparietalis	Temple	Temporal fascia

Ear

Muscle		Location	Origin
Auricularis anterior	Anterior to ear		Temporal fascia
Auricularis superior	Above ear		Temporal fascia
Auricularis posterior	Behind ear		Mastoid process

Nose

Muscle	Location	Origin
Procerus
Nasalis
Depressor septi

Eye

Muscle		Location	Origin
Orbicularis oculi	Around the orbit		Nasal process of frontal bone, frontal process of maxilla, medial palpebral ligament, and lacrimal bone
Corrugator	Deep to the orbicularis oculi		Medial aspect of superciliary arch

Mouth

Muscle		Location		Origin
Levator labii superioris	Upper lip		Zygoma and maxilla just above infraorbital foramen
Levator labii superioris alaque nasi	Upper lip and side of nose		Maxilla, frontal process
Levator anguli oris	Corner of mouth		Canine fossa of maxilla
Zygomaticus major	Cheek and corner of mouth		Temporal process of zygoma
Zygomaticus minor	Cheek and corner of mouth		Maxillary process of zygoma
Risorius	Cheek		Masseteric fascia
Depressor labii inferioris	Lower lip		Oblique line of mandible
Depressor anguli oris	Corner of mouth		Oblique line of mandible
Mentalis	Chin		Incisive fossa of mandible
Orbicularis oris	Circumscribes the mouth		Muscles in the vicinity, maxilla, nasal septum, mandible
Buccinator	Cheek		Pterygomandibular raphe, alveola arches of mandible and maxilla

Neck

Muscle		Location		Origin
Platysma	Neck and chin		Pectoral and deltoid fascia

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Aguesia (Loss Of Tongue's Taste Buds)

Definition:
It's the complete loss of tongue's taste buds .. so that the patient feels nothing of the taste of food ...

Prognosis:
It's not good enough.

Treatment:
1- Artificial saliva and pilocarpine
2- altering the treatment if the cause is a certain therapy.
3- zinc supplements if there is deficiency.
4- zinc infusion with chemotherapy is the patient is treating from cancer.
5- Alpha lipoic acid.

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Rarefaction (Definition and Examples)

Definition: A decreased density of bone such as a decrease in weight per unit of volume

Examples of Systemic diseases causing generalized jaw rarefaction

1- Rickets/Osteomalacia
2- Sickle Cell Anemia
3- Cushing syndrome
4- Hypophosphatasia
5- Hypophosphatemia
6- Massive osteolysis (vanishing bone disease)
7- Osteoporosis

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Differences between 3M ESPE (Z350 XT, Z350, Z250 and P60) Composites

The Differences between the 3M EPSE products is about the shading, color and mechanical properties ...
So that the indications for the use of each products differs according to those criteria ... for example:

Z350 XT Indications:
- Direct anterior and posterior restorations (including occlusal surfaces)
- Core build-ups
- Splinting
- Indirect restorations (including inlays, onlays and veneers)

Z350 Indications:
- Direct anterior and posterior restorations
- Sandwich technique with glass ionomer resin material
- Cusp buildup
- Core buildup
- Splinting
- Indirect anterior and posterior restorations including inlays, onlays and veneers

Z250 Indications:
- Direct anterior and posterior restorations
- Sandwich technique with glass ionomer resin material
- Cusp buildup
- Core buildup
- Splinting
- Indirect anterior and posterior restorations including inlays, onlays and veneers

P60 Posterior Composite Indications:
- Direct posterior restorations
- Sandwich technique with glass ionomer resin material
- Cusp buildup
- Core buildup
- Splinting
- Indirect posterior restorations including inlays and onlays.

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Choose the Product you want for the certain case you want to treat ...
It's not about filling with composite, actually it's all about with which composite you fill ... !!!

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