Biomedical subjects
Dennis Flanagan
Publications and source records attributed to Dennis Flanagan.
Implant-supported fixed prosthetic treatment using very small-diameter implants: a case report.
A case report is presented where an edentulous mandibular anterior site is restored with very small- or mini-diameter (1.8-mm) dental implants. The surgical and prosthetic use of very small-diameter dental implants is discussed. Such implants can be successfully used in appropriate sites where there is adequate bone density for immediate implant stability and an implant-protected occlusal scheme.
The use of osteotomes in dental implant surgery.
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Arterial supply of maxillary sinus and potential for bleeding complication during lateral approach sinus elevation.
There are 3 arteries that supply the maxillary sinus (i.e., the posterior superior alveolar, infraorbital, and posterior lateral nasal arteries), any of which may be encountered during lateral approach sinus elevation surgery. These arteries are ultimate branches of the maxillary artery. Although it has not been reported, there is a theoretical potential for severing an intraosseously located artery during a vigorous curettage for sinus lining elevation in the posterior medial wall of the sinus. Techniques for cessation of bleeding are discussed, such as electrocautery and endoscopic ligation. Head elevation can significantly decrease blood flow to the area.
An overview of complete artificial fixed dentition supported by endosseous implants.
The construction of a complete restoration of the dentition by the surgical placement of endosseous titanium implants that support a fixed prosthesis in each jaw is possible. The positionings of the implants and teeth in the prostheses are important factors for a successful long-term result. Distribution of the occlusal biting forces over as many implants as possible is important. Off-axial occlusal biting forces should be diverted to the anterior jaws where the forces are not as great. The posterior teeth should be designed with flat occlusal surfaces that separate during excursionary mandibular chewing movements. Medial mandibular flexure caused by the contraction of the medial pterygoid muscle can be addressed by constructing the prosthesis in segments, so as not to have a rigid entity encased in flexing bone that may induce stress in the bone, potentially leading to loss of implant integration and failure. Segmenting also ensures an appropriate fit of the prosthesis with respect to casting and porcelain firing distortion. Lip support by means of a flange in the prosthesis may be necessary when there has been a large amount of bone loss from edentulous resorption. Cleaning and routine maintenance of the prostheses every 3-6 months is essential.
Complete artificial dentition supported by endosseous implants: a case report of total in-office treatment.
This case report demonstrates the construction of a complete restoration of the dentition by the surgical placement of endosseous titanium implants that support a fixed prosthesis in each jaw. The positioning of the implants and teeth in the prostheses are important factors for a successful long-term result. Distribution of the occlusal biting forces over as many implants as possible is important. Off-axial occlusal biting forces should be diverted to the anterior prostheses, where the forces are not as great and the posterior teeth are designed with flat occlusal surfaces that separate during excursionary chewing movements. Medial mandibular flexure caused by the contraction of the medial pterygoid muscle can be addressed by constructing the prosthesis in segments. This is so as not to have a rigid entity encased in flexing bone that may induce stress to the bone, leading to loss of implant integration and failure. Segmenting also insures an appropriate fit of the prosthesis with respect to casting and porcelain firing distortion. Lip support by means of a flange in the prosthesis may be necessary when there has been a large amount of bone loss from edentulous resorption. Cleaning and maintenance of the prostheses every 3 to 6 months is essential.
Comparison of triazolam and zaleplon for sedation of dental patients.
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Labyrinthine concussion and positional vertigo after osteotome site preparation.
An incident of positional vertigo associated with osteotome technique for installation of multiple maxillary dental implants is reported. The symptoms resolved after 2 weeks with restricted physical activity and prohibition of lifting. There is a discussion of labyrinthine concussion and treatments. Suggestions for prevention are to use small sizes of osteotomes first and then progress to larger sizes and to avoid neck extension head position during osteotome use.
Oral triazolam sedation in implant dentistry.
Triazolam can be helpful for sedating dental implant patients when administered orally or sublingually in low dosages of 0.125 or 0.25 mg, but not exceeding 0.5 mg. It is a fast- but short-acting benzodiazepine with few side effects, and it has a long record of successful use. Its effects can be reversed with incremental intravenous flumazenil, although there is a risk of seizure. Triazolam has not been shown to be carcinogenic, and it has a low potential for abuse and addiction. It is contraindicated in patients who are pregnant, breast-feeding, and those concomitantly taking ethanol, macrolid antibiotics, some protease inhibitors, psychotropic medications, ketoconazole, itraconazole, nefaxodone, or other medications that impair oxidative metabolism mediated by cytochrome P450 3A (CYP 3A). Triazolam should be used with caution in patients taking grapefruit juice, cyclosporine, and other drugs such as calcium channel blockers including nifedipine, verapamil, and diltiazem. The lowest effective dose should be used.
External and occlusal trauma to dental implants and a case report.
Dental implants subjected to traumatic forces can survive. Cortical bone seems to provide a protective energy-absorbing mechanism in the collagen polymer that helps to prevent microcracking and fracture of bone. The collagen polymer has cross-linking bonds that break and absorb the energy of a traumatic impact so as not to cause damage to the main polymer chain. A case reported demonstrates that a traumatic force damaged the implant prosthetic crown, but not the bone encasing the implant or the integration of the implant.
Important arterial supply of the mandible, control of an arterial hemorrhage, and report of a hemorrhagic incident.
Penetration of the mandibular cortex during dental implant surgery may damage 3 important arteries and could lead to life-threatening circumstances. To lessen the likelihood of lateral angulations and cortical perforations, dental implants of less than 14 mm may be considered for the mandible. The courses of the inferior alveolar, facial, and lingual arteries and their branches are reviewed. Management of hemorrhage from a branch of the lingual or facial arteries may require an extraoral approach for ligation, because the mylohyoid, sublingual, and submental arteries can anastomose and be anatomically variable as well. A violation of 1 of these may be difficult to manage and lead to a compromise of the airway. A cortical perforation may be avoided by studying the anatomy of the ridge being treated. This article discusses what procedures to perform to obtund bleeding from 1 of these arteries and the technique of performing an emergency tracheotomy.
Delayed onset of altered sensation following dental implant placement and mental block local anesthesia: a case report.
A case of a delayed-onset post-operative altered sensation of the mental nerve is reported with speculations as to etiology. There is a discussion concerning intraoperative radiographs and osteotomy positioning. When postoperative altered sensation occurs, etiologic considerations should always include local anesthetic administration technique. The importance of pulp testing from the first molar to the contralateral lateral incisor is key to determining whether the deficit is in the mandibular nerve or only the mental nerve, which may be a result of mental block local anesthetic administration and not implant placement. This differentiation may be important in treatment and/or legal exposure. The altered sensation was probably caused by the mental block anesthetic technique. The partial anesthetic area in this case was probably a result of crossover innervation from the contralateral mental nerve.
An incision design to promote a gingival base for the creation of interdental implant papillae.
A surgical flap method that promotes reproduction of the interdental papilla for endosseous dental implant treatment is described. This incision design allows lifting of the gingiva without disrupting the periosteum and its blood supply.
Apical (retrograde) peri-implantitis: a case report of an active lesion.
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US Supreme Court decisions, expert testimony, and implant dentistry.
There have been 3 US Supreme Court decisions in the last 8 years that have established new rules of admissibility of expert witness testimony. These will have great bearing on the practice of oral implantology now and in the future.
Guidelines for expert testimony in implant dentistry.
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Cortical bone spreader osteotome and method for dental implant placement.
This article describes an osteotome designed for placement of dental implants in narrow sites with less dense bone.