Читать книгу Bone and Soft Tissue Augmentation in Implantology - Группа авторов - Страница 32

Patients often show early tooth loss due to nicotine use. This situation should be rehabilitated by correspondingly extensive therapies with a fixed prosthesis.⁵² Tobacco smoke passing through the oral cavity contains a mixture of hazardous substances that has cytotoxic and carcinogenic effects. This leads to a degeneration of the soft tissue, with a reduced perfusion and vascular supply, which, in a similar way to diabetes mellitus, can lead to surgical or long-term complications in implant therapy.⁴⁶

If patients show complete or partial tooth loss with pronounced or severe alveolar ridge atrophy at the end of the fourth decade of life, an evaluation of the interleukin-1 polymorphism can be made. This is synergistically known in smokers for chronic periodontal disease. At the same time, these patients also have an increased risk of peri-implantitis.^11,32 In order to clarify the long-term prognosis, simple swab tests are now commercially available that allow the pain-free diagnosis of an IL-1 mutation by polymerase chain reaction (PCR)-based methods.

In case of heavy nicotine consumption (more than 10 cigarettes per day), the extensive use of xenogenic bone substitute materials in combination with membrane techniques should be avoided, as wound healing complications are more likely to occur due to reduced vascularization and therefore loss of the augmented areas.⁶

Fig 2-3b Situation after an implant prosthetic restoration with three-unit FPDs after extensive reconstruction of the alveolar crest by autogenous grafting procedure.

Nicotine use is not a contraindication for bone augmentation, but patients should be aware of the overall increased risk of complications.³ For the surgical procedure, the focus should be on minimally invasive methods such as the tunnel technique or the vestibular incision technique (see Chapter 8 on risks and complications).