Dr Chow on Allergy to Grafts used in oral implantology

Dr K. F. Chow May 14th, 2009

Theoretically, an individual can be allergic to anything because anything can be an allergen i.e. a substance that is considered by the immune system as a foreign body. Once the immune system identifies a foreign body, it responds basically 4 different possible ways…..4 types of hypersensitivity mediated either by B cells of T cells.

Your patient’s sounds like the 4th type….T cell mediated delayed hypersensitivity……allergic contact dermatitis likely due to your gloves..powder….ointment or something that touched your patient’s face.

Treatment is usually steroids systemic or topical or both. If things are getting better, that means things are getting better and no drastic treatment like removing the grafts etc. is necessary. Just make a note on your patient’s record and avoid the possible causes in the future.

Cheers!

Excess cement oozing out at the crown abutment margin below the gumline for the sake of aesthetics has been an ongoing enigma in oral implantology. Thankfully, so far there seems to be few reported cases where this excess cement has stayed, strayed and caused chronic inflammation and even failure of the implant. Or maybe they have not been reported. Or maybe nobody has dared tried doing such a study because it might throw a spanner into the fast spinning wheels of the implant business. Nevertheless, the “critical margin” in oral implantology is an issue that must be addressed and I believe will be solved. The solutions so far offered are like not using cements at all like in screw-retained, friction-grip like in Bicon. And if cements are used…….blow them away before they set….ultrasonic excess away……scrape them away…..Xray to see if radio-opaque cement is used….and then do something aggressivelike to solve the problem…etc. Acessibility is a key problem here because you canna eyeball ‘em. An whatcha canna eyeball…yoou musta guessta…seeee! Boils down to some commonsense shoot what you can and God and the immune system take care of the rest…ah. One of my mentors said use good old Zinc Phosphate Cement cuz they ultimately dissolve away after some time…the excess I mean. Of course…use yer ‘ead and try to place just enough only so there will hardly be any oooooze…oK. And you can always place the critical margin above ground….I mean above gum so that you can inspect everything all round and knock of any dem old naughty inflammatory causing excess irritants. But there goes dag dem aesthetiks! Unless you have those nifty chameleon-like Zirconias!Ha Ha!
Lastly, you can always place the critical margin exactly flush with the gum level and you can scale them all around off and maintain them regularly by running a floss all round like a hangman’s noose. Nuff said!

Cheers!

Dr Chow on "the critical margin" in oral implantology

Excess cement oozing out at the crown abutment margin below the gumline for the sake of aesthetics has been an ongoing enigma in oral implantology. Thankfully, so far there seems to be few reported cases where this excess cement has stayed, strayed and caused chronic inflammation and even failure of the implant. Or maybe they have not been reported. Or maybe nobody has dared tried doing such a study because it might throw a spanner into the fast spinning wheels of the implant business. Nevertheless, the “critical margin” in oral implantology is an issue that must be addressed and I believe will be solved. The solutions so far offered are like not using cements at all like in screw-retained, friction-grip like in Bicon. And if cements are used…….blow them away before they set….ultrasonic excess away……scrape them away…..Xray to see if radio-opaque cement is used….and then do something aggressivelike to solve the problem…etc. Acessibility is a key problem here because you canna eyeball ‘em. An whatcha canna eyeball…yoou musta guessta…seeee! Boils down to some commonsense shoot what you can and God and the immune system take care of the rest…ah. One of my mentors said use good old Zinc Phosphate Cement cuz they ultimately dissolve away after some time…the excess I mean. Of course…use yer ‘ead and try to place just enough only so there will hardly be any oooooze…oK. And you can always place the critical margin above ground….I mean above gum so that you can inspect everything all round and knock of any dem old naughty inflammatory causing excess irritants. But there goes dag dem aesthetiks! Unless you have those nifty chameleon-like Zirconias!Ha Ha!
Lastly, you can always place the critical margin exactly flush with the gum level and you can scale them all around off and maintain them regularly by running a floss all round like a hangman’s noose. Nuff said!

Cheers!