Читать книгу Bone and Soft Tissue Augmentation in Implantology - Группа авторов - Страница 38

Today, many people self-medicate to improve their physical and psychologic wellbeing. These medications are often not declared at the anamnesis, even though they may have an impact on the outcome of implant therapy. How these medications impact implant therapy has not yet been evaluated for all medications, and many patients assume that their medication history is not relevant for the dentist. Patients receiving proton pump inhibitors (PPI) to treat gastritis or serotonin reuptake inhibitors to stabilize depression episodes exhibit higher rates of implant failure.⁴⁵ In these patients, the duration and number of drugs should be investigated before considering implant treatment.⁴⁵

For other medications such as glucocorticoids and NSAIDs, conflicting results have been reported regarding their effect on implant treatment outcomes.²⁶ However, due to the risk of serve wound healing disturbances, the possibility of a drug holiday should be checked with the responsible physician regarding long-term or high-dose glucocorticoid treatment.

Table 2-1 ASA physical status classification system (last approved by the ASA House of Delegates on 15 October 2014)⁴⁰

ASA PS classification	Definition	Examples (including, but not limited to)
ASA I	A normal healthy patient	Healthy, non-smoking, no or minimal alcohol use
ASA II	A patient with mild systemic disease	Mild diseases only, without substantive functional limitations. Examples include (but are not limited to): current smoker, social drinker of alcohol, pregnancy, obesity, well- controlled DM/HTN, mild lung disease
ASA III	A patient with severe systemic disease	Substantive functional limitation; one or more moderate to severe diseases. Examples include (but are not limited to): poorly controlled DM or HTN, COPD, morbid obesity (BMI ≥ 40), active hepatitis, alcohol dependence or abuse, implanted pacemaker, moderate reduction of ejection fraction, ESRD undergoing regularly scheduled dialysis, premature infant PCA < 60 weeks, history (> 3 months) of MI, CVA, TIA or CAD/stents
ASA IV	A patient with severe systemic disease that is a constant threat to life	Examples include (but are not limited to): recent (< 3 months) MI, CVA, TIA, or CAD/stents, ongoing cardiac ischemia or severe valve dysfunction, severe reduction of ejection fraction, sepsis, DIC, ARD or ESRD not undergoing regularly scheduled dialysis
ASA V	A moribund patient who is not expected to survive without the operation	Examples include (but are not limited to): ruptured abdominal/thoracic aneurysm, massive trauma, intracranial bleed with mass effect, ischemic bowel in the face of significant cardiac pathology or multiple organ/system dysfunction
ASA VI	A declared brain-dead patient whose organs are being removed for donor purposes