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Dental Implants and Abutment Screws

There seems to be some controversy over torquing down the abutment screw when placing dental implants.  Most of the dental implant crowns and bridges that I do involve torquing down the abutment and then cementing the crown or bridge.

In the past I used to just torque down the abutment screw to whatever the dental implant manufacturer recommends and then cement the crown or bridge.  My lab now recommends that I torque down the abutment and then wait ten minutes and then torque again.  Most of the dentists I know just torque down the abutment screw and leave it at that.  What are your protocols for this dental implant procedure?  Is torquing down the abutment screw a second time just a waste of time?

October 31, 2005 in Abutments, Dental Implant Materials | Permalink | Comments (5)

Dental Implants and Buyers Remorse

No matter how carefully we discuss the dental implant procedure with a patient, sometimes a patient has "buyers remorse" after the surgery. 

Incidentally, plastic surgeons deal with this situation alot and they minimize the resulting financial problems by having the patient prepay for the treatment. 

We also have alot of dental implant cases prepaid and I am very certain that there are offices that only do prepayment for dental implant cases. However, most of the world and most dental practices do not and simply cannot operate in this way.  What steps can be taken to help prevent "buyers remorse" and regret for having a dental implant procedure done? How can a practice minimize its financial risk from the surgery? There must be more that can be done aside from just informed consent. Any tips?

October 31, 2005 in Immediate Loading | Permalink | Comments (2)

The Academic Who Went to Market

Source: financialexpress-bd.com, Henry Tricks

An inspiring story of an academic, that developed a technique for measuring implant performance, and in 1998 founded a spin-off company with Imperial College London to exploit the idea commercially.

A decade ago, Neil Meredith believes, it would have been impossible to build the multinational business he has created in five years from a desktop computer on his kitchen table. His tiny product -- smaller than a rawlplug -- includes titanium parts produced in Scandinavia, gold parts manufactured in Switzerland and stainless steel parts made in Germany. His business partner, Fredrik Engman, lives in Sweden. Their main market is Germany, but the head office is in Harrogate, Yorkshire. On paper, it looks like a European Union (EU) bureaucrat's fantasy company but Neoss's products are as flesh and bone as they come.

They are implants that dentists drill into jawbones, on to which are screwed the crowns and bridges that most people are forced to endure at some time in their life, especially as they get older.It is estimated to be a $1.5bn-$2.0bn (£850m-£1.13bn) market, dominated by two heavyweights, Nobel Biocare of Sweden and Straumann of Switzerland. According to Goldman Sachs, it has expanded between 15 and 20 per cent recently.

So how has the 46-year-old British academic, who is visiting professor in dentistry at Bristol University and still practises as an implant specialist once a fortnight, muscled into such competitive territory?

Mr Meredith is a rare breed of academic who can take his ideas from the drawing board and into the market. As an academic, he developed a technique for measuring implant performance, and in 1998 he founded a spin-off company with Imperial College London to exploit the idea commercially. Two years later, he began experimenting by e-mail with Mr Engman on ways to simplify dental implants.He and Mr Engman, a dental implant innovator who had previously worked at Nobel Biocare, had collaborated before and were suited to doing business together. Their strengths offset each others' weaknesses, he says.

They were not the only specialists who saw the need for a better implant -- but they acted upon their curiosity. "A lot of people had the idea that something needed to be done. Fredrik and I sat down and did it," he says. Together, they designed an implant whose main virtue was simplicity.They engineered a single product that can embed itself in bone that, Mr Meredith says, can range from "as hard as teak to as soft as balsa wood" in the same mouth. He argues that other manufacturers have different implants for different types of bone, each with thousands of components. His has 100 and is small enough to be put in an envelope and couriered round the world.

After designing the product, the first challenge was persuading prototype manufacturers to take the idea seriously. Because Mr Meredith was a well-known academic and Mr Engman a proven technician, that was not as hard as it might have been. Then they tested the prototype by setting the hurdles high. They tested in Switzerland, a country where dentists have good technical knowledge and can explain their likes and dislikes lucidly. Mr Meredith gives the impression that the pair never scrimped on testing and genuinely welcomed feedback -- all with the goal of improving quality.

The seed capital up to this point was just £150,000. Egged on by colleagues, they decided to commercialise their idea. Mr Meredith says it was not easy to find venture capital funding, especially after the dotcom crash.He says also that venture capitalists tend to be wary of inventors because they often lack commercial sense. But after some months, Neoss found two VC partners, MMC Ventures and Delta Partners. MMC says it was impressed by the expertise of those involved and the prototype product, which was "beautifully engineered". They stumped up £1.0m.

But even with that money, Neoss remained "parsimonious," Mr Meredith says. It started with three staff and only recruited as the business expanded. The venture capitalists provided business expertise, including a former McKinsey consultant working with MMC who provided free advice. Neoss also used northern lawyers and accountants who made "virtual investments" in the business they charged low fees but these rose with Neoss. Mr Meredith and Mr Engman worked tirelessly with little financial reward. "There's a lot of sweated equity in this," Mr Meredith says.

Sales began two years ago, focused on Germany, where the dental implant market is Europe's biggest -- seven times the size of the UK market. Sales are rising at 200 per cent annually, he says, and within a year Neoss had a one per cent market share in Germany. It has won approval to enter the US market but Mr Meredith is wary of overexpansion. "It would appear sensible to go deeper into fewer markets, because that way you can manage your resources more carefully," he reasons. This means keeping all stock in the UK to keep close tabs on it, and getting to grips with the vagaries of working capital management in key markets. Germans, for example, pay by direct debit two days after being invoiced. Italians may take months, he says.

His VC partners have a five- to seven-year window before exiting and he too sees enough excitement in the business to stay put for now. He says: "VCs tend to be quite sensitive about academic founders. But thankfully they aren't looking to replace me."

October 31, 2005 in Dental Implant News | Permalink | Comments (0)

Periodontal Disease: Nine Risk Indicators for Tooth Loss

Source: American Academy of Periodontology

A study in the November Journal of Periodontology found that tooth loss due to periodontal disease is associated with the risk indicators of age, male gender, smoking, lack of professional maintenance, inadequate oral hygiene, diabetes mellitus, hypertension, rheumatoid arthritis and anterior tooth type.

"In this study we evaluated 1,775 patients who had 3,694 teeth extracted," said Dr. Khalaf F. Al-Shammari, Ministry of Health, Kuwait. "More teeth per patient were lost due to periodontal disease than for any other reason (those with periodontal disease lost 2.8 teeth versus 1.8 teeth lost for those without periodontal disease)."

Periodontal disease accounted for the majority of tooth extractions in patients older than 35 years (57 percent of teeth were lost for periodontal reasons compared to 43 percent lost for other reasons). Other findings are as follows:

  * The most common medical history finding in all patients was diabetes mellitus at 19.2 percent followed by hypertension at 13.6 percent.

  * A greater proportion of men lost their teeth due to periodontal reasons than women (33 percent for men versus 27 percent for women).

  * Current and past smokers accounted for almost 31 percent

  * 39 percent reported that they have never had a dental prophylaxis or periodontal maintenance visit.

  * Self-reported tooth brushing frequency of the patients was low with only 16 percent brushing their teeth twice or more daily,

  * Almost 60 percent either never brushed their teeth or used a toothbrush irregularly.

"Risk assessment is an important component of modern dental therapy," said Kenneth A. Krebs, DMD and AAP president. "Identification of subjects with the greatest risk for periodontal disease severity and progression is essential for the proper allocation of preventive therapeutic measures to those individuals who would benefit most from such measures."

Periodontal disease is one of the main causes of tooth loss worldwide. Periodontal therapy has proven to be effective in reducing the rate of tooth loss and establish the importance of patient compliance with maintenance therapy and proper oral hygiene measures.

 

October 29, 2005 in Dental Implant News | Permalink | Comments (0)

Dental Implants: Maxillary Canine

I have replaced some maxillary canines with regular platform implants.

I establish a progressive anterior disclussion with the lateral inicisor and first premolar before restoring the implant in the maxillary canine position. I then insure that the canine does not function in guiding the mandible. Has anybody had success using a single, free-standing implant in the maxillary canine position to function in canine guidance?

October 25, 2005 in Surgical Placement of Dental Implants | Permalink | Comments (4)

Dental Implants and Distal Extension

Has anybody tried using dental implants to support distal extension base removable partial dentures?

I have seen some cases where a mandibular bilateral distal extension removable partial denture base rests on healing abutments torqued into implant fixtures. The dental implants only provide support and do not provide retention or lateral stabilization.

October 17, 2005 in Techniques and Procedures | Permalink | Comments (10)

Dental Implant Abutments

The other day, we were looking at a case from another office, and wondering why the abutments were much smaller, or stepped back from the dental implant itself.

This was quite an old case , so we know that this was not intentional. But what was so interesting was that there was no bone loss in this case.  There are other recent studies that have shown no bone loss with an abutment that was step backed from the implant itself.  What does that tell us? Some manufacturers have already been offering these types of abutments for quite some time.  Is this the future direction for abutments? Feel free to add your feedback below.

October 17, 2005 in Abutments | Permalink | Comments (39)

Medications and Dental Implant Placement

Medications have a profound effect on a patient's oral condition.

For instance, beta blockers and calcium channel blockers can cause gingival problems. Now we have other drugs, such as Fosamax (helps women with osteoporosis), to contend with. We are told and read that you should not remove a tooth for a woman on Fossomax because of possible bone necrosis.

How do these medications effect the implant planning process? Do we have to worry about dental implant placement with these medications and what, if any, medications do we have to consider? Feel free to leave your comments below.

Note: For a full discussion of these topics, please click here. This is a blog which discusses in full many viewpoints regarding Oral Bisphosphonates, Osteonecrosis, and Dental Implants

October 17, 2005 in Oral Bisphosphonates | Permalink | Comments (3)

Cone Beam CT Scanning for Dental Imaging

We recently posted an interview about Cone Beam CT Scanning. You can access the interview here by clicking here. In the Interview, the CEO of Imaging Sciences, stated that, "There are many advantages over traditional CT scans...The single most groundbreaking advantage of the i-CAT is easy, convenient and low-cost access to this imaging modality for the patient and the dentist. When this machine is in-office and the dentist has made the capital investment, superior and invaluable diagnostic information is produced for the patient whenever warranted, without the obstacles that forced compromises in the past." What are you thoughts on Cone Beam CT Scanning as it relates to implant dentistry? Click Here to share your opinion.

October 11, 2005 in CT Scanning | Permalink | Comments (17)

Dental Implants: Pneumatic Handpieces in Implant Dentistry

Has anybody tried to remove cemented crowns or bridges with a pneumatic handpiece? If you used a provisional cement, it should be relatively easy to break the cement layer and deliver the crown or bridge without much force.

I personally have never tried this and am worried about damaging or loosening the dental implant. When I have a problem, I cut off the crown or bridge and redo it. We are curious about others experiences with pneumatic handpieces as it relates to implant dentistry. Post your comments below.

October 11, 2005 in Techniques and Procedures | Permalink | Comments (2)