Biomedical subjects
Publications and source records attributed to P A Schnitman.
Dental implants can dramatically change a patient's self-esteem and quality of life. But too few people receive implants because of the cost and lack of education in this growing field. More training, systems standardization and practice guidelines will improve implant treatment availability.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Analysis of epidemiologic studies reveals that even with advances in preventive dentistry, edentulism continues to be a pressing problem especially in a rapidly expanding senior population. As an alternative to traditional removable dentures, dental implants can provide fixed support for crowns and bridges. A recent National Institutes of Health Consensus Development Conference revealed significant growth in implant technology and established that, although a complex treatment alternative, implants can function for 10 years or more. Continued development in basic and clinical research, federal regulations, professional education, public awareness, insurance, and marketing will shape the future of the field.
Currently, relatively few dentists are qualified to practice implant dentistry; the demand for dental implants may soon exceed the profession's capacity to deliver this type of treatment. Accordingly, there is a salient need for national standards of education in the field. Implant education varies widely for practicing dentists, postdoctoral students, and predoctoral students. Although many schools are starting to teach implant dentistry in their predoctoral curricula, clinical and laboratory experience is limited. There are not enough trained professors, funding for new departments is limited, and change is often met with resistance. It is anticipated that within the decade, schools will establish departments, divisions, or sections dedicated to education in implant dentistry, despite these obstacles.
The optimal method of providing safe and effective sedation for outpatients undergoing lengthy dental operations is unclear. We provided monitored anesthesia care (conscious sedation) for 102 consecutive dental implant procedures, using intravenous midazolam and fentanyl as primary pharmacologic agents. Midazolam was administered by multiple, intermittent injection or via continuous infusion. The dose of midazolam required for the induction of sedation ranged from 3.4 +/- 1.6 mg to 4.0 +/- 2.0 mg. Maintenance of adequate sedation required a mean midazolam administration rate of 4.0 +/- 2.1 mg/h to 5.1 +/- 2.1 mg/h, and a mean fentanyl administration rate of 54 +/- 29 mcg/h to 60 +/- 27 mcg/h. Continuous monitoring allowed for rapid detection and treatment of 40 separate hemodynamic and respiratory problems. There was no evidence of patient injury, and all patients returned home on the day of surgery. A post-operative telephone survey revealed that 65% of patients had complete amnesia for operative events, 96% were satisfied with monitored anesthesia care, and 94% would desire a similar anesthetic technique for future procedures.
Restoring patients with implant-supported fixed-detachable bridges according to the protocol established by Brånemark necessitates a period of several months when complete dentures must be worn to allow for a stress-free healing period of the implants. For many patients, especially when they still have some natural teeth remaining, this is unacceptable. An approach was developed that overcomes these limitations, offering an alternative to the transitional removable approach. Five or six Nobelpharma fixtures were placed between and two additional fixtures were placed distolingual to the foramina. Abutments were connected at implant insertion to these two fixtures and to one fixture in the symphyseal region. The remaining fixtures were allowed to heal in the conventional manner. A previously constructed mandibular denture was converted to a fixed bridge supported by these three implants. This method was successfully applied in seven patients who were reconstructed with mandibular fixed-detachable bridges without ever wearing a removable prosthesis. The overall, long-term implant therapy was not adversely affected by this technique.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Ketamine (10mg/kg body weight) was administered intramuscularly in 10 baboons (Papio anubis). Subsequently, a combination of ketamine (10mg/kg body weight) and diazepam (7.5 mg) was administered intramuscularly. Results indicated that using diazepam concurrently with ketamine suppressed or eliminated the epileptoid movements characteristic of anesthesia with ketamine used alone.
Explore the source record for details and available documents.
Bone maintenance based on various attachment mechanisms is the key to tooth-root replacement safety and efficacy. The dental implant has broad applicability based on design, but demonstrates progressive peri-implant bone loss. The allogeneic tooth transplant, significantly less applicable because of size, is antigenic and rejected by bone-replacement root resorption. Since the predictability and survival times of these implant and transplant modalities are similar and there is less residual bone loss with the transplant, it is suggested that for clinical situations such as the fresh extraction socket, where there is room, the allotransplant, rather than implant, is the root-replacement of choice.
Explore the source record for details and available documents.