Glossary

An access hole in implant dentistry is an opening in the artificial tooth (crown) of a screw-retained dental implant. This opening provides access to the abutment or screw prosthesis, hence its name. Typically, the access hole is placed on the lingual or occlusal surface, but may be placed elsewhere depending on the preference of the attending surgeon. Because the access hole easily allows food and bacteria to become trapped inside the implant, it must be covered after the completion of the dental implant procedure. If this isn’t done properly, bacteria can cause the implant to become infected, which is likely to result in rejection and potentially bone loss if the underlying jawbone is affected. Many dental professionals use plumber’s tape or cotton pellets, however, plumber’s tape is often considered the better choice. It is self-adhering, so it packs down onto itself easily and forms a tight seal that protects the implant.

The principle maxillary sinus ostium (PMO) and accessory sinus ostium (i.e., accessory ostium) are the anatomical structures of the middle meatus that are referred to as the osteomeatal complex. This complex contributes to the final drainage pathway of the anterior ethmoidal, maxillary and the frontal sinuses. The principle maxillary sinus ostium is present throughout the population; however, the accessory ostium is not. The accessory ostium only occurs in 30 to 40 percent of the population.

Typically, the maxillary sinus is located close to the alveolar ridge of the first molar and second premolars; therefore, it is not uncommon to find the roots of the first and second molars in the maxillary antrum. However, when these teeth are lost, the sinus expands into the remaining alveolar bone. As time passes, the floor of the sinus becomes the crest of the remaining alveolar ridge; thus, the level of the bone and the floor of the nasal cavity may be nearly identical. In a case such as this, before dental implants can be placed, bone grafts may be necessary.

See: Ostium (maxillary sinus)

Accessory ostium, also referred to as accessory sinus ostium or just sinus ostium, are a common anatomical variation in humans. However, they may be due to a sinusal disease.They are described as bony dehiscences that are covered with mucosa that allow nasal fluids to leak into other areas of the sinus. Despite this, no connection has been found between the presence of accessory ostium and the increase in rhinitis or sinusitis symptoms in patients who have them. The cause of accessory sinus ostium may also be attributed to maxillary sinusitis, obstruction of the primary ostium, or anatomical or pathological abnormalities in the middle meatus. These conditions may cause the rupture of membranous areas, resulting in accessory ostium. Knowledge of the structures within the maxillary sinus is important in determining whether the patient will need a bone graft prior to the implant. In rare cases, implant hardware can become displaced in the sinus cavity.

This term refers to some form of biological material that is lacking intact cells, not divided into cells or devoid of cells. Consider that an acellular vaccine contains cellular material; however, the cells are not complete. In dentistry, acellular dermis is frequently used to address issues related to gingival tissue. Acellular dermis is biomaterial that is derived from animal or human tissue. This tissue is processed in such a way as to remove cells, while retaining some of the extracellular matrix (ECM). The ECM consists of a collection of extracellular molecules that are secreted by support cells. These cells provide biochemical and structural support to surrounding cells. Although the structure of an extracellular matrix depends on where the tissue originated, all ECMs consist of proteoglycans, collagen fibers and multi adhesive proteins.

Functions of the ECM include:

• Segregating tissues
• Controlling the communication that occurs between the cells
• Forming a support structure for the cells
• Regulating various cell processes (e.g., migration, growth and differentiation)

An allogeneic skin graft is derived from donated human skin. Grafts are used for a variety of soft tissue applications including gingival augmentation, visible root coverage, soft tissue ridge augmentation as well as to address soft tissue augmentation around dental implants. When a gingival graft is necessary, these grafts can be used to eliminate the need for an autograft.

Some acellular dermal allografts are processed using detergent and a sodium chloride solution, which removes the viable dermal cells as well as the epidermis while preserving the skin’s original dermal collagen matrix. By removing the cells, the likelihood of graft rejection or inflammation decreases. The tissue is disinfected with a solution consisting of detergents that have antiseptic and acidic reagents to ensure it passes the sterility standards as set forth by the United States Pharmacopeia Standard 71 (USP <71>). Once it is sterile, the tissue is freeze-dried, then cut to size and packaged using terminally sterilized materials. These acellular dermal allografts are available in a variety of sizes and thicknesses: These pieces of tissue just need to be rehydrated and they are ready to use.

An acellular dermal matrix graft is similar to the cellular dermal allograft in that they are both derived through the process of removing cells from animal or human tissues while retaining portions of the extracellular matrix (ECM). However, unlike traditional xenografts and allografts, an acellular dermal graft is usually completely devoid of cells. The main components of ADM are elastic fibers and collagen bundles.

There are a variety of acellular dermal graft products available: For example, a regenerative tissue matrix is processed in such a way as to preserve the tissue’s biologic components while maintaining the structure of the dermis itself. Acellular dermal matrix graft products differ in the processing methods used to create them as well as in their size and thickness.

Grafts can be used for numerous soft tissue applications, including:

• Soft tissue ridge augmentation
• Gingival augmentation
• Soft tissue augmentation around implants
• Exposed root coverage

If a gingival graft is required, an acellular dermal graft can be used as an alternative to an autograft.

Acetaminophen reduces inflammation, which makes it ideal for dental implant care. This medication is an antipyretic and nonopioid analgesic that consists of p-aminophenol and acetic acid. While the actual mechanism responsible for providing the pain relieving and fever reducing benefits of acetaminophen is unknown, it is believed that this medication reduces the amount of prostaglandins the body produces: Prostaglandins are the chemicals produced in the brain that cause inflammation. Many patients choose to use acetaminophen for dental implant care following their procedure; however, unless directed by a physician, this medication should not be taken for a period longer than 10 days. Acetaminophen can be administered orally or rectally.

Adult dosage of acetaminophen for dental pain depends on the formula being used:

• Immediate release formulations of acetaminophen – 325 mg to 650 mg every 4 hours
• Extended release caplets – 1300 mg every 8 hours
• Maximum adult daily dosage of acetaminophen is 4 grams

An acid-etched implant is similar to a sandblasted implant in that acid etching creates a textured surface, versus the smooth surface of traditional implants. Acid-etching and sandblasting are done to improve the biological response to dental implants and increase the chances of implant success. By using an acid-etched dental implant, a periodontist can decrease the total treatment time required for the implant by minimizing the healing time for osseointegration establishment. The implant hardware is the first component during the dental implant process to interact with the patient, making it critical to ensure that the implant is well received. The possibility of implant rejection remains with any dental implant procedure, however, by using an acid-etched implant or an implant that has been otherwise treated to improve surface texture, the risk of rejection can be reduced. This helps shorten and improve the implant procedure overall, creating a positive patient experience.

An activating tool is a special tool used during the dental implant process to ensure that the fingers on abutments and impression copings are in the proper position before placing the implant. When in the correct position, the impression copings and abutments should “click” into place. An activating tool is typically marked in such a way to indicate where to activate the abutments on one end and the impression copings on the other end. The tool can also be used to deactivate the fingers of an abutment or an impression coping in the event that there’s no finger retention when the abutment is inserted and removed from the analog during waxing, finishing, or the application of porcelain. Once the crown or custom abutment has been completed, the fingers of the impression copings and abutments need to be reactivated. Once the clicking sound is heard, the component is considered seated.