298 Theories and techniques of oral implantology

ensure uneventful healing. Some European implantologists also use antibiotic ointments.

Plaster of Paris

Sterile plaster of Paris mixed with a sterile saline solution has been used by Linkow when placing implants in large sockets. The plaster is mixed to a heavy cream consistency and poured directly into the socket to promote osteogenesis.

Fibrochrome

Sometimes the tissue surrounding an implant be-comes inflamed and edematous because the implant is loose or because the patient is not practicing good oral hygiene. Many of these implants can be saved as long as the bone around the implant has not re-sorbed beyond the limitations required for successful treatment.

Fibrochrome injected very slowly and directly into the inflamed tissue has proved helpful. Before injection, the inflamed tissue is cleansed thoroughly with an astringent. Any excessively inflamed tissue is either removed or carefully put back into its proper position. A 10-ml. vial of fibrochrome is then injected slowly in small spurts into many areas of the inflamed tissue.

In time the inflamed tissue reorganizes. The long, irregular columns of epithelium become shorter and more even. The basal membrane be-comes reconstituted. The hypervascularized connective tissue characteristic of inflammation becomes less vascularized, and the cells have small nuclei. Eventually, there is a total absence of inflammatory infiltration. Because fewer blood vessels form in the conjunctival tissue, more minerals are deposited.

Fibrochrome may also be used to prevent inflammation when placing an implant in an open socket. Before the tooth is extracted, the surrounding area is injected with fibrochrome. This appears to reduce complications.

COMPLICATIONS

A well-planned intervention that is carefully controlled as it proceeds usually results in no complications, but they can occur. These will necessitate additional steps to control the situation or to alleviate the condition.

Pain

Although very little pain or discomfort usually occurs immediately after implant interventions if the implants have been positioned properly, a postoperative treatment plan for the patient should be in

cluded. The relief of pain, or the prevention of it, is probably the most gratifying favor the dentist can do for the patient. A list of pain killers can be found on p. 296. Because pain may be symptomatic of an operative error or of a postoperative complication, its specific remedies will be discussed under the appropriate topics.

Swelling

Surgical trauma, an allergic reaction, hemorrhaging, local anesthesia, salivary gland obstruction, infection, and other factors may cause swelling during or after an implant insertion. The alleviation of the symptoms requires treating the underlying cause.

Surgical trauma commonly results in swelling. The operator should take preventive measures to avoid trauma, and the patient should be instructed about how to reduce swelling. Pressure dressings, if applied early, help limit postsurgical swelling. Intermittent cold applications to the site, such as holding an ice cube in the mouth, are advisable for the first 24 hours. These applications should be frequent, with the cold applied about 30 minutes of every waking hour. When swelling has reached its maxi-mum, usually after 24 hours, frequent intermittent moist heat in the form of hot isotonic saline rinses is used to increase circulation and to aid in the dissipation of the edema. Petroleum jelly should be applied to the skin over the swollen area to prevent drying and chapping.

The various enzyme preparations suggested for the treatment of postoperative swelling should not be used routinely. Such agents do not prevent edema but rather redistribute the fluid over a wider area by breaking down connective tissue and fibrin barriers. Some degree of localized swelling may be a desirable physiologic response to tissue injury. In addition, disturbance of the tissue barriers may predispose the area to infection.

Postoperative swelling caused by infection should be treated with antibiotics, cold applications on the outside of the face over the swollen area (15 minutes on, 15 minutes off, for about 2 hours), and warm saline mouth rinses as often as possible.

If swelling results from an allergy, 0.5 ml. of 1:1,000 epinephrine should be injected subcutaneously to control the reaction. This should be followed by an intramuscular injection of an injectable anti-histamine or of a quick-acting soluble cortisone preparation. Finally, every 4 to 6 hours the patient should take an antihistamine tablet.

Swelling in the floor of the mouth, which some-times interferes with the patient's respiration, can be