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Dental Implants: 3-Unit Fixed Denture

Dr. Croll asks us:

I just inherited a patient with a 3-unit fixed partial denture on 3 well integrated dental implants #19, 20, 21 positions.

All of the porcelain has shattered off #21.  The FPD is intact and the porcelain is intact on #19, 20.  It is cement retained.  I am planning on doing an overcoping to replace the porcelain on #21.  How much space do I need for an overcoping with metal framework and porcelain surface?  Any recommendations for luting medium?  I am planning on using a base metal alloy for increased strength and ridigity and a high fusing porcelain.  Any recommendations on any aspect of my intended treatment plan?

March 27, 2006 in Treatment Planning & Complications | Permalink | Comments (10)

Dental Implant Impinged On Nerve

Dr. James asks us:

I have a patient where dental implants were placed at the lower left first molar and first premolar positions three months following extraction of the posterior teeth.  Unfortunately, the anterior dental implant (12mm Straumann RN) slightly impinged the anterior loop of the mental nerve.

Initially the patient reported numbness of the area, but in the days following, developed and electrical current, TENS type pain.  Assessment of the site via OPG and CT occurred at 10 and 14 days, and the offending dental implant was removed at 14 days.  The discomfort has proven quite debilitating.  The patient was placed on Lyrica by his medico, (neuropeptide blocker)  and whilst this improved the pain, the side effects are intolerable. 

At five month review there has been some resolution in sensory perception, but pain continues.  We are currently investigating surgical exploration of the site, and possible pain management with Acupuncture.  Any suggestions?

March 27, 2006 in Treatment Planning & Complications | Permalink | Comments (26)

Nobel Replace Select Implants

Dr. Furst asks us:

I had Nobel Biocare Replace Select Regular Platform implants placed in #8,9 sites 3 months ago.

When I went to torque down the abutment in #9 it rotated and it produced pain (i.e., a spinner).  I had to administer local anesthesia.  The radiograph does not show any bone loss around #9 dental implant other than the normal die-back.  I am planning on connecting the two abutments with a dental implant bridge.  What should I do at this point? Should I wait for more integration or should I just insert the abutments and bridge?

March 21, 2006 in Treatment Planning & Complications | Permalink | Comments (52)

Dental Implant Complications

Maria, a patient, asks us:

I had dental implant surgery on Wednesday of this week. Teeth 9/10, 9 was missing and 10 was removed. I got very swollen on Wednesday night and Thursday.

Now, I have discomfort right under my front tooth. I wore a dental flipper the first night as told. My
lip still feels stiff in this area. Number 9 had a bone graft.

Is this normal? My periodontist who did the work only works at my dental office on Wednesday's. This Wednesday I get the stitches out. I also feel the discomfort whenever I eat and I've been eating soft foods that don't require much chewing. Is this discomfort normal? I can't raise the lip much in this area yet. Wondering if all this is part of the pain and discomfort with grafting and implants at the same time. If anyone can share their thoughts with dental implants and the pain and stiffness that
goes with it, I'd appreciate it alot. Thank you for any help you can provide.

March 21, 2006 in Treatment Planning & Complications | Permalink | Comments (14)

CT Scans for Dental Implant Treatment

Dr. Tsanis asks:

Is it imperative to take CT scans for all of our dental implant patients? Somebody might say "case selection", but what does this mean?

For example you might want to place dental implants on posterior side of mandible of a patient. The OPG might suggest  adequate height of bone and good distance from alveolar nerve.

I would say in that case you do not need a CT scan which is expensive etc, but do you? But if you prescribed for a CT scan, you would have seen that the undercut underneath the mylhoid ridge is too wide and there is no place for dental implants. So which are the criteria that suggest us to take a CT scan when providing dental implant treatment?

March 17, 2006 in CT Scanning | Permalink | Comments (44)

Loading Protocols

Dr. Maynard asks:

How aggressive are you in your loading protocols, and are you getting predictable outcomes? 

Do you believe the surface on the dental implant allows you to be more aggressive or is it just a case of acheiving primary stability?

March 17, 2006 in Techniques and Procedures | Permalink | Comments (11)

Dental Implant Complications

Asher, a dental implant patient, comments:
Hi...all Doc's ... I am a recipient of at least 12 more like 15 but who is counting dental implants. I do not know which type. I will find out as I go back again to  my dentist to find out what the heck is causing my swollen throat, nasal problem, ears burning...

My guess would be the dental implants that are now exposed from the top of the screw (abutment I think) down into my bone which I also see. (Troubling for the end user) What I do know is some dental implants work some don't.  I today am in a mess...$120,000.00 later and still trying to find a way. I am 48 years old and started this process at 40. I suppose I should be happy I had 5 years of no problems but this technique (excuse me for lack of clinical lingo) is costly, not physically painful, but certainly emotional and psychologically because of its recurrent problems. Dental Implants themselves don't seem to cause to much of a problem day to day however the side effects that occur are a major concern. One can get infection and not know resulting in many ENT problems. Can anyone help me? Provide any insight. Thanks.

March 14, 2006 in Treatment Planning & Complications | Permalink | Comments (10)

Restoring Full Arch Cases

There are times when multiple dental implants for a full arch fixed prosthesis do not have ideal angulation. The ideal of course would be to have all dental implants in the arch parallel to one path of insertion.   

In an atrophic mandible, even with distraction osteogenesis or grafting, the angulation of dental implant fixtures may have to be off an ideal vertical path of placement because of the morphology of bone volume.  Does anybody have any recommendations for restoring full arch cases in an atrophic mandible when dental implant alignment is less than ideal?

March 14, 2006 in Treatment Planning & Complications | Permalink | Comments (8)

Mini Implant Abutments

Dr. Lim asks us:

I would like to know what abutments other dentists are using for their IMTEC mini dental implant cases?

I have several cases already and I have ask my laboratory to cast abutments for me. Can we use any type of abutments in these cases or are some choices better than others? Thanks.

Please leave your comments below. For additional discussion on Mini Dental Implants, please click here.

March 7, 2006 in Treatment Planning & Complications | Permalink | Comments (5)

Insertion Torque and Osseointegration

Dr. Nimchuk asks:

It has been purported that excessive insertion torque may lead to ineffective osseointegration due to bone compression and necrosis at the cellular level.

While most references refer to an optimum insertion torque of about 45 newtons it has been my experience personally and observation of others that many times substantially more force than this is commonly applied particularly with tapering dental implant systems. 

Is there any real evidence of what may be considered excessive insertion torque and is there any true clinical relationship to insertion torque forces and integration?  I have a feeling this is another one of those rationalizations that have taken on a state of dogma and is not really substantiated. I'd be interested to hear what other experience in the field has been and what opinions are on this matter.  Please leave your comments below.

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March 2, 2006 in Techniques and Procedures | Permalink | Comments (17)