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Atlantis Abutments

Dr. Croll asks us:

I use Atlantis custom abutments for cement retained crowns and bridges and usually the fit on single units is excellent.

Occasionally for multiple units I have found the fit of bridges to be a little tight.  Are any of you using die relief to create space for the cement?  I am thinking of telling my lab to use 6 coats of die spacer.  Has anybody tried this already?

February 27, 2006 in Abutments, Restoration of Dental Implants | Permalink | Comments (3)

Infections and Dental Implants

Lucy, a dental implant patient asks us:
I am a patient and was given two different opinions about treatment.  I am having my molar extracted, tooth grafted and a dental implant placed.

There is an infection in the area.  The first  opinion I received was of having the dental implant done immediately, as the dentist goes in, does the extraction and grafts.  The second opinion was to do the extraction, graft and then wait for the infection to heal before putting the dental implant in.  What do you suggest is the best way?  Should I wait for the area to heal, or should the dental implant be done right away and why?  What are the pros and cons?  What is the success rate in each case?  Is there statistical data to support this?

February 24, 2006 in Treatment Planning & Complications | Permalink | Comments (28)

Oral Bisphosphonates, Osteonecrosis, and Dental Implants

Dr. Gold submits:

About 80 million people in the US alone take bisphosphonates for cancer, osteoperosis, etc. It is clear that patients who have received IV bisphosphonates are at high risk for osteonecrosis in the mandible and maxilla.

What is not clear is the situation for patients who have taken bisphosphonates via the oral route. Not as much data has been collected on oral bisphosphonates and osteonecrosis and dental implant failure. However, the evidence for is mounting daily that orally administered forms of bisphosphonates may lead to osteonecrosis. What does this imply for dental implant placement in these cases?

Are you familiar with any anecdotal case reports of patients who have take oral bisphosphonates and experienced osteonecrosis associated with dental implant failure? What are your thoughts on the connection between Oral Bisphosphonates, Osteonecrosis, and Dental Implants? Please leave your comments below.

Note: For additional discussion on this topic, please also see Dental Implant Contraindications where we discuss IV bisphosphonates in greater length.

February 19, 2006 in Dental Implant Contraindications, Oral Bisphosphonates | Permalink | Comments (56)

Breakdown Over the Head of the Dental Implant / Cover Screw

Richard, a dentist from the UK, asks us:
I have the following situation on my hands. The tooth in question is an upper canine (cuspid). I used an immediate delayed approach ( 8 weeks post-extraction) and placed a NobelReplace tapered groovy 16mm x 4.3(RP). The 1st stage surgery was done 10 days ago.

The dental implant is to be used as the mesial abutment for a 3 unit bridge. I placed a similar dental implant of 10mm length in the 2nd pre-molar (bi-cuspid) position at the same time. This was submerged and has healed over fine after 10 days.

For the cuspid, there appears to have been some wound breakdown over the head of the dental implant /cover screw, confined to the palatal side as far as I can see. The collar microthreads (remember this has ti-unite and microthreads right to the top of the implant head) are exposed for about 1.0-1.5mm. On the bucccal side and partly over the cover screw, the soft tissue flap (which looks pink and healthy) is concealing the full situation.

Since there is no machined collar on this type of dental implant I am considering my options:

• Option 1: Remove the dental implant as soon as possible assuming I will be able to unsrew it  say 2-3 weeks post op? and immediately replace it with a 13mm fixture set a little deeper and then advance flaps and get primary closure?

• Option 2: Leave the dental implant, re-open flaps to expose, if only the palatal aspect is exposed then take a fine bur to the palatal surface to remove superfical ti-unite and close-up leaving a polished area exposed.

• Option 3: As above but in addition use citric acid or tetracycline to decontaminate and then locally scraped bone chips and a resorbable membrane (Bio-Oss) cover the exposed area

Any other option anyone cares to suggest !!

All advice gratefully accepted.

Richard

February 19, 2006 in Treatment Planning & Complications | Permalink | Comments (14)

Dental Implants: Thin Ridge Placement

Hi,i have a patient with Oligodontia. My  problem that his ridge is very thin, about 2mm? How do I improve this? Onlay graft , gbr technique or something else? Any help would be appreciated. Please leave your comments below.

February 18, 2006 in Treatment Planning & Complications | Permalink | Comments (11)

Micro Dental Implant Failures

Dr. Leon asks us:

I'm a student in orthodontics and was wondering if there is any mechanical failure with microimplants for anchorage in orthodontics not made of titanium and, if they exist, of Al/Vanadium?

Have an answer for Dr. Leon? Please leave your comments below. For additional thoughts on the Metal Composition of Dental Implants, please click here.

February 13, 2006 in Treatment Planning & Complications | Permalink | Comments (4)

Natural Tooth to Dental Implant

Dr. Smolen asks us:

Where might I find the statistics or any article in the literature relevant to connecting a natural tooth to a dental implant?

Have an answer for Dr. Smolen? Please leave your comments below. For additional thoughts on Connecting Dental Implants to Natural Teeth, please click here.

February 13, 2006 in Techniques and Procedures | Permalink | Comments (2)

Canine Protected Occlusion

Dr. Kahn from the UK asks us:

What are the functions of canine protected occlusion and what percentage of people have it?
Have an answer for Dr. Kahn. Please leave your comments below.

For additional thoughts on Patterns of Occlusion and dental implants, please click here.

February 13, 2006 in Treatment Planning & Complications | Permalink | Comments (2)

Dental Implants: Overdentures with ERA Attachments

Dr. Gold asks us:
I have been making overdentures with ERA attachments.

I have heard a lot of positive comments about Locator and ERA-VKS SG attachments.  Have any of you used these for your dental implant supported overdenture cases?  What are the other alternatives? Is there anything specific to watch out for? Also I am looking for a dental implant system that be used for removable partial dentures. Any suggestions or comments?

February 13, 2006 in Techniques and Procedures | Permalink | Comments (12)

Peritomes

  Eliminate the fibrous attachment thru cutting rather than tearing! The NEW Osseous Technologies of America (OTA) Periotomes offer a completely new approach to Atraumatic exodontia. Available in set of 3 periotomes for only $110!
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February 13, 2006 in Dental Implant Systems | Permalink | Comments (0)