New Prophylactic Antibiotic Protocol
for Sinus Graft Procedures
For years, Augmentin (Amoxicillin-clavulanate) has been used as the first line antibiotic for the therapeutic and prophylactic treatment of sinus graft procedures because of its superior beta-lactamase coverage. With Penicillin allergy patients, the use of Fluoroquinolones (Levaquin, Avelox) were popular as alternative medications. The U.S. Food and Drug Administration (FDA) has recently revised their Boxed Warning (FDA’s strongest warning) for all Fluoroquinolones antibiotics because of possible disabling and potentially permanent side effects of the tendons, muscles, joints, nerves, and central nervous system. In addition, Fluoroquinolones have been linked to collagen damage in the aorta which may lead to aneurysms (bulges) and dissections (tears) in the wall of the aorta. A study published in the Journal of American Medical Association found a two-fold increase in the risk of dissection and aneurysm within 60 days of using Fluoroquinolones. Therefore, the following Fluoroquinolones have been removed from the Resnik Implant Institute Pharmacologic protocol for treatment of sinus related procedures.
Common Fluoroquinolones
- Avelox (Moxifloxacin)
- Cipro (Ciprofloxacin)
- Levaquin (Levofloxacin)
- Ofloxacin (Ofloxacin)
Because of the associated issues, the Resnik Implant Institute maxillary sinus pharmacologic protocol has been undated to include the following antibiotics.
Ceftin (Cefuroxime) is a bactericidal second-generation cephalosporin antibiotic with beta-lactamase coverage and highly active against gram-negative cocci, gram negative bacilli, anaerobes than gram-positive cocci and gram-positive bacilli.
Doxycycline (Adoxa, Doryx, Monodox, Morgidox, Vibramycin)is a tetracycline antibiotic which is broad spectrum and active against a wide variety of bacteria. Doxycycline is an acceptable alternative to amoxicillin/clavulanate because it is highly active against respiratory pathogens and has excellent pharmacokinetic/pharmacodynamic properties.
**continued**
NEW PROPHYLACTIC PROTOCOL
(Lateral Wall or Crestal Sinus Grafts)
FIRST LINE:
Augmentin (875 / 125 mg): 1 tab bid for six days starting one day prior to surgery
SECOND LINE:
Non-Anaphylactic: Ceftin (500 mg): 1 tab bid for six days starting one day prior to surgery
Anaphylactic: Doxycycline (100 mg): 1 tab bid for six days starting one day prior to surgery
NEWS RELEASE
Date Set for The Resnik Implant Institute
Hands-On-Course
Friday, November 2, 2018
New Jersey
REQUIREMENTS
- Dental License in any US Billing State
- Bring your own patient or patients will be provided
TYPES OF CASES
- Single Implants
- Multiple Implants
- Membrane Grafting
- Sinus Augmentation
- Dermal Fillers/Botox
** MORE DETAILS TO FOLLOW**
SURGICAL / PROSTHETIC PROGRAM SESSION 1
September 14-15, 2018
Caesar’s Palace Casino & Resort
Las Vegas, NV
All New Full Color Lecture
Handouts Of Lecture Slides
- Treatment Planning Principles
- Misch Implant Classifications
- Pre-Implant Prosthetics
- CBCT Radiographic Diagnostic Interpretation
- Evaluation of Bone Volume – Available Bone
- Extraction – Socket Grafting Techniques
- Basic Surgical Armamentarium
- Surgical Principles (flap design, periosteal reflection)
- Ideal Implant Positioning
- Division A Implant Surgery
- CBCT Templates and Guided Surgery
- Bone Density Surgical Modifications
- Implant Economics
All New Comprehensive Hands-On
Lab Sessions
- Implant Placement (freehand)
- Guided Surgery Implant Placement (pilot, universal, fully guided)
- Bone Density Surgical Protocol for all 4 Bone Densities
- Socket Grafting (4 & 5 wall defects)
- Periosteal Reflection (stretching tissue)
- Suturing Techniques
- Atraumatic Extractions
#1: CBCT PATHOLOGY QUESTION
Upon CBCT evaluation of a patient, you notice the following incidental finding which is generalized throughout the maxilla and mandible.
What systemic disease does this patient have?
#2: PROSTHETIC QUESTION
Cemented implant prostheses are popular in implant dentistry because of the low cost, relative simplicity, greater passivity, improved esthetics, and similarity to traditional prosthetics. However, they exhibit a significant disadvantage, the postoperative retention of cement. Retained cement has been shown to harbor bacteria and lead to peri-implant disease and implant failure.
What is the average time frame for the peri-implant disease to become problematic (from cementation to diagnosis)?
#3: LEGAL QUESTION
What is an “Excess Verdict” with respect to malpractice lawsuits?
IMPLANT STUDY OF THE MONTH
Monolithic Zirconia has become very popular in implant dentistry because of the material’s excellent mechanical properties, flexural strength, fracture toughness, and biocompatibility. One major concern with the use of monolithic zirconia as a restorative material is the abrasive nature against opposing enamel because of the inherent hardness and surface roughness.
Esquiuvel-Upshaw et. al (University of Florida) completed an in vivo research study evaluating the maximum wear of enamel opposing (1) Monolithic Zirconia, (2) Porcelain Fused to Metal, and (3) Enamel.
Which opposing material exhibited the most enamel (antagonistic) wear?
a. Monolithic Zirconia
b. Porcelain Fused to Metal
c. Enamel
Esquivel-Upshaw, J. F., et al. “Randomized clinical study of wear of enamel antagonists against polished monolithic zirconia crowns.” Journal of Dentistry 68 (2018): 19-27.
Glidewell Laboratories (Newport Beach, CA) is the largest dental laboratory in the world. They report a significant increase in implant cases being sent via digital intraoral scans (i.e. compared to conventional impressions). In May 2018, what is the total number of lab cases received by Glidewell Dental which were sent as digital intraoral scans?
a. 726
b. 1439
c. 1927
d. 26,035
ANSWERS:
#1: CBCT Pathology
OSTEOPOROSIS- cortical plates become “mottled” and thinner, trabecular bone loss is accelerated because of advanced demineralization
#2: Prosthetic
3 Years: Wilson’s pioneering study on retaining cement revealed the average amount of time from cementation to diagnosis is approximately 3 years. The range is from 4 months to 9.3 years.
Wilson Jr, T. G. (2009). The positive relationship between excess cement and peri-implant disease: a prospective clinical endoscopic study. Journal of periodontology, 80(9), 1388-1392.
#3: Legal
Jury awards in liability cases are often unpredictable and may exceed the doctor/defendant ’ s liability coverage. Most doctors do not realize they or their corporation are responsible for the excess verdict amount (i.e., reward amount above the maximum malpractice limits). For example, if the doctor has a $1 million policy limit and a judgment against the doctor is $2.5 million, the doctor is responsible for the excess $1.5 million. For doctors concerned about excess verdicts, policy limits may be raised to $3 million or $5 million. It is highly recommended that if a doctor/defendant has a case that may potentially result in an excess verdict, personal counsel should be retained to safeguard the interests of the defendant dentist.
Implant Study Of The Month Answer
All three materials exhibited the SAME amount of wear. Therefore, polished monolithic zirconia demonstrated the same wear as enamel vs. enamel.
Trivia Of The Month
d. 26,035 ; Yes, the total # of digital scans received by Glidewell in one month