Teleconsultation – 2023-08-07 18:06
Hello, this is Michael. I am now in Greece on holiday and had to visit a dentist because of pain in the upper jaw. Could you give me a summary for the local dentist and a recommendation how to treat a potential periimplantitis?
Dear Mr. Michael Thompson,
I hope this letter finds you well. I’m sorry to hear that you’re experiencing discomfort during your holiday in Greece. I understand your situation and will do my best to assist you.
Firstly, allow me to summarize your dental history for the benefit of your local dentist in Greece:
You had an implant placed on tooth #13 on March 4, 2013, with an Astra Prime Taper of 13mm length and 4.2mm diameter (Implant serial number: IMPL-13-SXSX). There have been instances of peri-implant mucositis and peri-implantitis, which were addressed with professional cleanings, antibiotic regimens, and localized flap surgery with bone grafting. Your last checkup on May 5, 2022, showed notable improvement post-surgery with signs of bone regeneration and no inflammation around the implant site.
In terms of your medical history, it’s important to note that you’ve had a coronary artery bypass grafting (CABG) following a heart attack 2 years ago, and you have hypertension and type 2 diabetes, both of which are controlled with medication (Metformin 1000mg twice daily, Lisinopril 20mg once daily, Aspirin 81mg once daily). There was a history of prolonged healing observed following CABG.
Given this history and the current complaint of pain in the upper jaw, it’s possible that you could be experiencing a recurrence of peri-implantitis.
If it is indeed peri-implantitis, the treatment will depend on the severity, but typically involves a combination of mechanical debridement (cleaning) of the implant surface, systemic antibiotics, and possibly surgical intervention if there’s considerable bone loss. The choice of antibiotics may be influenced by your medical history, and I recommend your dentist liaise with a local physician to ensure safe prescribing.
Additionally, maintaining meticulous oral hygiene is essential. This involves regular brushing, flossing, and using a mouth rinse. Keep in mind that management of your systemic health, particularly blood sugar and blood pressure control, is crucial in ensuring a favourable outcome.
In conclusion, I encourage your local dentist to thoroughly evaluate the condition of the implant and surrounding tissues. It’s important to rule out other potential causes of the pain, such as dental caries (decay) in adjacent teeth or sinusitis, especially as you’re reporting this pain in the upper jaw.
In the meantime, until you’re able to see a dentist, I would advise you to maintain a soft diet, avoid chewing on that side, and continue with rigorous oral hygiene measures.
Please don’t hesitate to contact us if you need any further information or assistance. I’m sure your local dentist will do their best to relieve your discomfort. I hope you feel better soon and can continue to enjoy your holiday.
Best regards,
Linda Lee Beighle
Personal Assistant to Michael Truppe, MD
EU-Datenschutzgrundverordnung (DSGVO)
Diese Abfrage ist anonym, es werden keine persönlichen Daten verarbeitet oder gespeichert. Für eine persönliche medizinische Beratung erheben wir zuerst eine Anamnese. Dazu senden Sie uns bitte Name, E-Mail und Telefonnummer an die Email Adresse cloud@smile.wien. Sie erhalten dann einen PIN code über SMS. Eurodoc Telemedizin ForschungsgesellschaftmbH (FN 161768w) erhebt die Daten nach dem im Gewerberegister eingetragenen Gewerbe.
Eurodoc Telemedizin ForschungsgesellschaftmbH
Leiter der Studie Dr.med.univ. Michael Truppe
Albertgasse 3/6, 1080 Wien
Tel: +43 1 408 95 00 66
Email: cloud@smile.wien
Web: https://smile.wien
Additional information about data used for AI generated response
The AI generated answer is based on synthetic patient data. This data is retrieved from our locally hosted Virtual Patient System.
Anamnesis Michael Thompson
Full Name: Michael Thompson
Date of Birth: August 8, 1963
Sex: Male
Occupation: College Professor
Contact Information: [omitted for privacy]
Presenting Complaint
Michael has lost tooth 13 due to periodontal disease and is interested in a dental implant to replace the missing tooth. He is concerned about aesthetics and functionality.
Medical History
Allergies: None known.
Previous surgeries or hospital admissions: Underwent coronary artery bypass grafting (CABG) 2 years ago following a heart attack. Recovery was uncomplicated.
Chronic illnesses: Has hypertension and type 2 diabetes, both controlled with medication.
Autoimmune diseases: None.
Current medications: Metformin 1000mg twice daily, Lisinopril 20mg once daily, Aspirin 81mg once daily.
Negative reactions to medications: No known reactions.
History of bleeding disorders or prolonged healing: Prolonged healing observed following CABG.
Lifestyle habits: Ex-smoker (quit 2 years ago), occasional alcohol (1-2 times per month), no recreational drugs.
Dental History
Recent dental procedures: Tooth extraction 6 months ago due to periodontal disease.
Ongoing dental problems: Chronic periodontitis under management.
Oral infections: No recent oral infections.
Bone Health
Conditions affecting bone health: None.
Medications affecting bone health: None.
Oral Hygiene Habits
Brushes twice daily and uses dental floss regularly.
Uses a mouthwash recommended by his dentist.
Lifestyle
Diet: Predominantly plant-based with occasional fish. Exercise: Light exercise (walking), 5 times per week. Significant weight fluctuations: Lost 20 lbs over a 1-year period after the heart attack. Psychological and Emotional Health
Mental health diagnoses: None. Unusual stress or pressure: Moderate stress related to academic responsibilities. Obstetric and Gynecologic History
N/A
In this example, the main concern would be Michael’s history of heart disease, hypertension, and diabetes. All these conditions could potentially affect the healing process following the implant procedure. It’s important for Michael to maintain good blood sugar and blood pressure control before and after the procedure, and his oral hygiene practices should also be optimal to minimize the risk of infection or other complications. His physician should closely coordinate with his dentist to ensure a safe and successful procedure. A cardiovascular clearance may also be required before the dental surgery due to his heart disease history.
Implant IMPL-13-SXSX Medical History
Implant serial number IMPL-13-SXSX
Michael Thompson – Dental Implant Follow-up History
Appointment 1:
Date: March 4, 2013
Procedure Performed: Implant placement at site #13.
Implant type: Astra Prime Taper 13 mm length, 4,2 mm diameter
Implant torque: 35 Ncm
Details: Following a detailed discussion about the procedure, potential complications, and aftercare, the implant was placed successfully. Post-operative instructions and medications for pain and potential infection were provided. Patient was advised to maintain impeccable oral hygiene and to avoid chewing hard food on the implant side for a few weeks.
Appointment 2:
Date: April 14, 2013
Follow-up Visit:
Details: Michael reported slight discomfort and redness around the implant site. On examination, mild peri-implant mucositis was observed.
Therapy Applied: A professional cleaning around the implant site was done. Michael was instructed to rinse with a 0.12% chlorhexidine gluconate mouthwash twice daily for a week.
Appointment 3:
Date: October 25, 2013
Routine Checkup:
Details: No signs of inflammation or infection around the implant. Michael expressed satisfaction with the aesthetic and functional outcomes of the implant.
Appointment 4:
Date: March 30, 2015
Complaint: Michael reported occasional pain and observed slight gum recession around the implant site.
Details: Clinical examination revealed signs of peri-implantitis with slight bone loss.
Therapy Applied: Scaling and root planing were performed, and an antibiotic regimen (Amoxicillin 500mg TID for 7 days) was prescribed. Michael was advised on enhanced oral hygiene and informed about the importance of regular checkups to monitor the situation.
Appointment 5:
Date: February 7, 2017
Routine Checkup:
Details: The implant appeared stable, but there was evidence of further bone loss, indicating progressive peri-implantitis.
Therapy Applied: Laser therapy was used to disinfect the site. An antimicrobial rinse was prescribed. A recommendation was made to increase the frequency of professional cleanings to every three months.
Appointment 6:
Date: October 2, 2019
Complaint: Michael noticed pus discharge from around the implant.
Details: Examination confirmed the peri-implantitis had worsened, with more pronounced bone loss.
Therapy Applied: Localized flap surgery was performed to access and clean the affected area thoroughly. A bone graft was placed to support the implant and promote bone regeneration. Postoperative care instructions, including rinsing with an antimicrobial mouthwash, were given.
Appointment 7:
Date: May 5, 2022
Routine Checkup:
Details: There is notable improvement post-surgery. The bone has shown signs of regeneration, and there is no inflammation around the implant site.
Recommendation: Continued emphasis on oral hygiene, regular professional cleanings, and monitoring of the implant health. The patient was encouraged to keep up with a healthy lifestyle and regular dental checkups to ensure the longevity of the implant.
Present Day: Michael has been compliant with follow-up appointments and maintains good oral hygiene. The implant remains in place, and no major complications have arisen since the last surgical intervention. Michael expresses overall satisfaction with the implant and its functionality. He continues to be closely monitored for any signs of peri-implantitis recurrence.
Leave a Reply