Garg Zygoma Implants

Step by Step
1. Auflage 2023
ISBN: 978-1-64724-158-2
Verlag: Quintessence Publishing Co, Inc
Format: EPUB
Kopierschutz: Adobe DRM (»Systemvoraussetzungen)

E-Book, Englisch, 216 Seiten

With success rates ranging from 95% to over 98%, zygoma implants are the standard of care in the treatment of patients with severe maxillary bone atrophy who cannot be rehabilitated with surgical bone augmentation and/or the placement of conventional or tilted implants. Because patients who qualify as candidates for zygoma implant therapy usually get only one chance to regain their masticatory function, the stakes for this treatment are very high, and that is why Dr Arun K. Garg undertook this project. Written by distinguished authors with decades of clinical knowledge, the book equips the experienced implant surgeon with comprehensive knowledge of every facet of the surgical and prosthetic treatment protocols for zygoma implant therapy, from patient evaluation and selection to step-by-step procedures and the management of complications, building the reader's knowledge from start to finish. Learn the ins and outs of zygoma implant therapy so you too can deliver this life-changing therapy to your patients.

Arun K. Garg, DMD, served as a full-time professor of surgery and director of residency training in the Division of Oral and Maxillofacial Surgery at the University of Miami School of Medicine for nearly 20 years, where he received multiple Faculty Member of the Year awards. He has authored more than a 8 textbooks and over 150 scientific journal articles. He has trained thousands of dentists and dental specialists over the course of his career. Since 2006, he has devoted much of his time and energy to educating and training clinicians on bone grafting and dental implant surgery through Implant Seminars Inc, a company he founded. In addition, he maintains several private practices throughout South Florida. An early adopter and proponent of using dermal fillers and Botox to complement cosmetic dental treatments, in 2011, he cofounded DentaSpa Seminars, which provides education and clinical training in facial rejuvenation procedures designed specifically for dental practitioners.

Autoren/Hrsg.

Garg, Arun K.

Leseproben

1

Introduction to Orofacial Pain

Key Points

• Orofacial pain remains a prevalent and debilitating condition that exerts a significant social and economic impact on patients and the health care system.

• Many of the risk factors associated with temporomandibular disorders (TMDs) involve mechanical, chemical, or environmental stressors that increase the likelihood of developing and maintaining a chronic pathologic state.

• Sensitization and activation of trigeminal nerves and the subsequent development of peripheral and central sensitization are key pathophysiologic events leading to allodynia and hyperalgesia.

• Glial cells play an important role in the transition of acute to chronic pain by modulating the excitability state of nociceptive neurons in the trigeminal ganglion and spinal cord.

• Epigenetic influences on gene expression, mediated by our lifestyle and environment, significantly impact the progression of TMD and migraine pathology, necessitating comprehensive therapy.

• In March 2020, the National Commission on Recognition of Dental Specialties and Certifying Boards officially recognized Orofacial Pain as the dental profession’s 12th specialty.

• Discoveries from the Orofacial Pain Prospective Evaluation and Risk Assessment (OPPERA) study have helped to clarify specific risk factors and genes implicated in the development of TMDs.

• Given the complex multifactorial etiology of orofacial pain conditions, management may require multiple interventions, such as—but not limited to—pharmaceuticals, physical therapy, oral appliances, behavioral modifications, diet modifications, and forms of exercise that emphasize proper breathing and increasing flexibility.

• The COVID-19 pandemic has had a major impact on the healthcare community and has driven advances in digital technology such as the use of telemedicine, phone apps, and other electronic aids that will forever change the medical landscape.

The Spectrum of Orofacial Pain

Orofacial pain refers to pain disorders of the jaw, mouth, face, head, and neck. These anatomical regions comprise an array of widely diverse structures and tissues ranging from dental pulp to the meninges of the brain. Pain conditions associated with these structures may derive from local factors or involve systemic, autoimmune, infectious, traumatic, or neoplastic pathologies. These conditions include odontogenic and periodontal pains, musculoskeletal disorders such as temporomandibular disorders (TMDs), headache and neurovascular pains, vascular disorders, and neuropathic pains.

Underlying this kaleidoscope of pain possibilities is a unifying system, the trigeminal sensory complex, in which impulses from the head and neck are conveyed by the branches of the trigeminal and upper cervical nerves to the trigeminal sensory nucleus in the brain stem. These impulses are modified by input originating within the trigeminal system and from higher regions of the central nervous system (CNS). Multiple areas of the brain process and interpret this input, giving rise to the sensation of pain and facilitating physiologic/adaptive responses, including behavioral changes.1

The diversity and complexity of orofacial pain conditions have led to recognition of the need for a specialized field of dentistry and for collaboration among multiple fields of medicine to improve care for patients afflicted with these disorders.

The Specialty of Orofacial Pain

Orofacial pain as a specialty has made significant strides in recent years. In 2009, the Commission on Dental Accreditation (CODA) approved orofacial pain as an area of advanced education, and since 2011, multiple residency and fellowship programs have been accredited in the United States. The International Association for the Study of Pain (IASP) has recognized the need for orofacial pain education by developing a core curriculum on this subject for health care professionals.2 In March 2020, the National Academies of Sciences, Engineering, and Medicine released a consensus study report on TMD entitled Priorities for Research and Care.3 This study, which was supported by the National Institute of Dental and Craniofacial Research, recommended improvements to education and training on TMDs for health care professionals, stating that “Deans of health professional schools … should ensure that their schools’ curricula include attention to TMDs…” and “The Commission on Dental Accreditation (CODA) should amend the accreditation standards for predoctoral dental programs to include screening, risk assessment, and appropriate evidence-based interventions for TMDs.” In addition to these educational initiatives, the discipline of orofacial pain has been bolstered by the establishment of board certification processes and by increasing cooperation among advocacy groups, universities, professional organizations, and federal agencies. A landmark event occurred in March 2020 when the National Commission on Recognition of Dental Specialties and Certifying Boards officially recognized Orofacial Pain as the dental profession’s 12th specialty.

The material covered in this chapter represents a broad overview of findings reported in peer-reviewed publications spanning the spectrum of conditions at the root of orofacial pain and current management practices. It is intended for health care professionals who evaluate and treat patients with orofacial pain and face the daunting task of keeping up with the literature in the ever-evolving arena of pain management.

Pain

Understanding of orofacial pain conditions must be grounded in principles and concepts of pain in general. The IASP offers the following definition of pain (revised in 2020): “An unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage.”4 The IASP expands upon this definition with these six key notes:

1. Pain is always a personal experience influenced to varying degrees by biologic, psychologic, and social factors.

2. Through their life experiences, individuals learn the concept of pain.

3. A person’s report of an experience as pain should be respected.

4. Although pain usually serves an adaptive role, it may have adverse effects on function and social and psychologic well-being.

5. Verbal description is only one of several behaviors to express pain; inability to communicate does not negate the possibility that a human or a nonhuman animal experiences pain.

6. Pain and nociception are different phenomena; pain cannot be inferred solely from activity in sensory neurons.4

This final key note highlights an important distinction between the concepts of nociception and pain. Nociception has been defined as “information processing triggered by noxious stimuli … (which) may lead to withdrawal or vegetative responses and/or to the sensation of pain”.5 In simple terms, nociception refers to basic signaling in the nervous system, while pain involves the interpretation and perception associated with those signals.

Classifications of pain

Pain may be viewed through the lenses of different classification schemes, including what may be termed physiologic and anatomical classifications (Fig 1-1). A physiologic classification includes categories of nociceptive and inflammatory pain, as well as a third mechanistic descriptor recently adopted by the IASP and referred to as nociplastic pain. Nociceptive pain is momentary, nonpersistent pain that matches its stimulus (does not display an exaggerated response). It acts as a vital defense mechanism, stimulating behavioral and physiologic actions to prevent tissue damage in the face of a noxious stimulus. Inflammatory pain occurs in the setting of tissue damage (eg, due to mechanical trauma, heat, or infection).6 Tissue injury prompts release of a host of inflammatory mediators that interact with sensory neurons to increase the intensity and duration of nociceptive signaling, leading to persistent pain that, in contrast to the momentary experience of nociceptive pain, outlasts its stimulus. This persistence of inflammatory pain encourages protective behaviors (“vegetative responses” such as resting an inflamed body part) intended to limit further injury while healing occurs.7 Nociplastic pain is defined by the IASP as pain that arises from altered nociception despite no clear evidence of actual or threatened tissue damage causing the activation of peripheral nociceptors. The IASP differentiates nociplastic from neuropathic pain (discussed later) with the clarification that nociplastic pain displays no evidence for disease or lesion of the somatosensory system.4 This type of pain is characteristic of a group of disorders known as chronic overlapping pain conditions (COPCs) that includes, for example, fibromyalgia and irritable bowel syndrome (IBS).

Fig 1-1 Pain classification schemes and typical behaviors.

Anatomical classifications include categories of somatic pain and visceral pain (see Fig 1-1). Somatic pain encompasses both superficial (eg, cutaneous, mucosal) and deep (musculoskeletal) pain. A site of noxious stimulation in superficial somatic tissues is usually easy for an individual to precisely locate, due at least partly to a relatively high density of free nerve endings in dermal tissue relative to deeper...