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Implant complications associated with systemic disorders and medications 39

presents with an infection associated with dental
implants, antibiotic therapy combined with incision,
drainage, and débridement is the treatment of choice.
However, the patient’s overall health status may prevent
immediate surgical débridement owing to a risk of bleed-
ing or dissemination of infection. In those cases, antibiotic
therapy may have to be used alone until the patient is
stable enough for surgery, and patients may need to be
managed in a controlled environment to allow appropri-
ate assessment and treatment. Intravenous antibiotics
and hospitalization may be required.
The major complication associated with radiation
therapy is ORN (Fig. 2.16a, b). Treatment of ORN should
be performed by a surgeon comfortable with managing
such patients. In general, careful débridement of necrotic
tissues is combined with antibiotic use to prevent infec-
tion (235). Débridement may result in loss of previously
placed dental implants. The site must be allowed to heal
completely and may require grafting before any attempt
to place implants again. There is strong evidence that
hyperbaric oxygen improves the treatment of ORN, and
should be considered in such cases (236).
Take-home hints
l Patient selection is the critical factor for implant
success and survival in any medically complex
situation.
l When medical conditions are managed wisely
most patients with diseases discussed in this
chapter have improved overall health with
fixed replacements as opposed to removable
appliances.
l Exceptional care must be taken so that any
implants placed will be successful and safe for
the clinician and the patient.
l It is essential to routinely review the literature
and expect that protocols for patients with sys-
temic diseases or taking medications will be
regularly updated as our knowledge of dental
implants advances.
References
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(b)
(a)
Fig. 2.16 Osteoradionecrosis: 53-year-old African–American male with his-
tory of squamous cell carcinoma of the tongue. The patient was treated with
surgical removal of the lesion followed by 62 Gy of radiation to the right
mandible, tongue, and floor of mouth. (a) Patient presented with pain and
exposed bone in right posterior mandible; osteoradionecrosis arose spontane-
ously, with no precipitating trauma or dental treatment; (b) radiograph shows
diffuse radiolucency in right posterior region. The patient responded poorly to
treatment and eventually required mandibular resection. (Courtesy of Dr
Wendell Edgin, San Antonio, Texas.)
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