Theories and Techniques of Oral Implantology (vol.1) (published 1970)   Dr. Leonard I. Linkow

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Evaluating the implant candidate 227

the arteries, results when the walls of the blood vessels thicken. As they thicken, they become infiltrated with fatty materials and excessive amounts of minerals, thus becoming less elastic. The progress of the disease is slow, and the gross symptoms of the disorder—including numbness or coldness of the extremities and a tendency to tire easily   may not develop until after the age of 60.

Arteriosclerosis may be mild or severe. Most older people have some mild form of the disease, and such patients are advised to rest and watch their diets, restricting their intake of cholesterol and other fatty materials. Patients with more severe forms of the disease should follow a strict dietary routine and avoid hard work or exercise and stressful situations. The great danger in arteriosclerosis is that a small particle may break away from one of the deposits on the arterial walls. This particle, or embolus, may lodge in a smaller vessel leading to the heart, brain, or kidneys, with serious consequences.

Patients with milder forms of arteriosclerosis are usually suitable implant candidates; in fact, their dietary habits may be improved with a fixed denture that allows them to masticate a wider range of nutritious foods. Most people with severe forms of the disease are also acceptable candidates, for the same reason. There is little danger of promoting situations that would complicate their underlying condition during the implant procedure.

Hypertension. When his blood pressure is high even during rest, an individual is said to have hyper-tension. This condition may result from a loss of elasticity of the arterial walls, disturbances of the adrenal glands, kidney disease, and nervous tension, to name a few of the causes known to increase arterial resistance. Many people in the United States have high blood pressure, particularly older people, and the disorder is said to account for up to 20c of all deaths after the age of 50.

High blood pressure may be controlled or reduced by low sodium diets and plenty of rest and relaxation. Strenuous exercise and nervous tension should be avoided. Although patients with high blood pressure may live several years, secondary changes usually occur in the body as a result of pro-longed arterial restriction. If these changes occur in the heart, brain, or kidney, the outcome is serious, if not fatal.

Unless the patient is confident in the outcome of an implant procedure, it may be wise to avoid it. An extremely nervous patient is always a poor risk, particularly when he has a history of hypertension.

Coronary thrombosis. If the patient has had a coronary thrombosis—also called a "heart attack," myocardial infarction, or coronary occlusion—his implant candidacy may very well depend upon three main factors: his attitude toward implantation, his ability to take an anesthetic, and the medication used to control his condition.

A coronary thrombosis usually occurs in an aggressive, high-keyed, active individual, and three out of four sufferers are men, usually over the age of 50. The condition results when one of the two coronary arteries becomes plugged, cutting off circulation to part of the heart. The attack may be sudden and severe or mild, depending on the location of the clot, or thrombus.

The patient requires bed rest until the healthy artery can take over the work of the occluded artery and until the wounded heart muscle heals. This often takes several weeks. The patient may gradually resume near-normal activities, but he should avoid overeating and obesity, strenuous exercise, and emotionally charged situations or nervous tension.

Today most patients receive some form of anti-coagulant to prevent further clot formation. Because an implant intervention involves bleeding, the patient's doctor should be asked if the anticoagulant can be safely suspended temporarily for surgical procedures. Generally it is advisable to administer only a local anesthetic. If this will not be sufficient to make the patient comfortable and put him at ease, an implantation may be contraindicated.

Bacterial endocarditis. When the thin serous membrane lining the cavities of the heart becomes infected with any of several different types of bacteria, the condition is bacterial endocarditis. The bacteria reach the heart if they have entered the body in large numbers or have proliferated in infections elsewhere. Usually these invaders are destroyed by white blood cells, but the body's resistance may be low and the white blood cells insufficient in number to combat them.

Individuals with heart defects are particularly prone to bacterial endocarditis. Whether or not the heart is normal in structure, it is poorly equipped to fight infection. Unlike other tissues, the heart and blood vessels cannot build up a tissue wall around an infected area and isolate the bacteria until they can be destroyed by white blood cells. Instead, the bacteria spread unchecked, proliferating rapidly. In the acute form of the disease, the patient dies within a few days unless massive doses of antibiotics can control the infection. In the subacute form, the




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