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Best Block Graft Technique?

Dr. Mongkuk asks:
I am treatment planning a dental implant case in which I will be replacing a mandibular second premolar, first molar and second molar.  I think I need to do a block graft. 

How can I best avoid traumatizing the mental nerve?  My flap will be extending to the mental nerve area.  What is the best technique for doing this kind of graft?

August 28, 2006 in Bone Grafting, Surgical Placement of Dental Implants | Permalink | Comments (18)

Numbness After Implants

Dr. Joglekar, a dental implant patient, asks us:

I had dental implants last year for missing  teeth. Within hours of the placement of mandibular dental implants, I developed profound numbness on the right half of lower lip.

Being a doctor (general surgeon),I realised there was nerve injury & requested the implantologist
to unscrew/remove the dental implants (x-ray showed one of the  dental implants touching the roof of the inferior alveolar canal). However, the  doctor said, "Everything will be OK." Nevertheless, eventually after 3 weeks he replaced the dental implants.

Fast forward one year, and my numbness has not gone away completely. Do you think the dental implants should have been removed right away? Is this why I am still feeling the numbness? What is the cause of the numbness now? Nerve Damage? Would Dental CT, which was never advised, be necessary now and would it change the management of this case? Kindly advise. Thanks.

August 28, 2006 in CT Scanning, Patient Questions | Permalink | Comments (63)

BioHorizons Gets Acquired

Last week, HealthpointCapital, LLC (“HealthpointCapital”) announced the purchase of BioHorizons Implant Systems, Inc. (“BioHorizons” or “Company”). BioHorizons designs, produces and distributes oral reconstructive devices including dental implants and tissue regeneration products. BioHorizons, located in Birmingham, Alabama, is one of the fastest-growing companies in the dental industry. Terms of the transaction were not disclosed.

“The dental implant market represents one of the fastest growing sectors in the medical technology industry,” stated Mortimer Berkowitz III, President and Managing Director of HealthpointCapital. “Dental implants offer patients superior clinical outcomes and improved esthetics compared to traditional treatments such as bridges and dentures. BioHorizons has a legacy of providing superior product quality and unmatched clinical service.”

Steve Boggan, President and CEO of BioHorizons, commented that, “We are extremely pleased with the outcome for our shareholders, employees and customers. Our management team is excited about the opportunity to partner with HealthpointCapital and expand our growth prospects in this attractive market.”

Mr. Berkowitz becomes the Chairman of the Board and Mr. Boggan will continue as President, Chief Executive Officer and Director of the Company. BioHorizons plans to expand its headquarters in Birmingham and the management team will remain important shareholders.

BioHorizons Implant Systems, Inc.

BioHorizons was founded in 1994 and has grown into one of the largest dental implant companies in the world with 112 employees. The Company has a strong product offering of dental implants including internal hex, external hex, overdenture and one-piece implants. BioHorizon’s flagship External Implant System, a patented system of dental implants and related products, was launched in 1997. BioHorizons has signed exclusive distribution agreements with LifeCell Corp. and Osteotech, Inc. to market their allograft regeneration products to the dental community. The Company has a direct sales force in the U.S., Canada, Germany, Spain and United Kingdom. Products are distributed in the rest of the world via a network of independent distributors.

HealthpointCapital, LLC

HealthpointCapital is a values-driven, research-based private equity firm focused on the orthopedic industry. The Firm’s purpose is to capitalize upon the unique investment opportunity in orthopedics due to demographics and explosive growth of technology and innovation. HealthpointCapital has $500 million of institutional capital under management.

August 28, 2006 in BioHorizons, Dental Implant News | Permalink | Comments (2)

Bridge on Narrow Platform Implants?

Mitchell, a dentist, ask us:
I have a patient with a severely atrophic mandible. I planned to have 6 regular platform dental implants placed to support a bridge.

Even with a CT scan we could only get 5 narrow platform dental implants (3.25/10) in the mandibular anterior. Most of the bone is cortical. Do you still think I can do a bridge or fixed-detachable (hybrid) on 5 narrow platform dental implants?

August 28, 2006 in Narrow Platform Implants, Restoration of Dental Implants | Permalink | Comments (3)

Immediate Loading in the Anterior Aesthetic Zone?

Dr. Polson asks: I have discussed a number of dental implant cases where I want to do a one-piece, single stage, immediate provisionalization at the time of tooth extaction in the anterior aesthetic zone.

My periodontist will extract the tooth and place the dental implant. The patient will then come to the office for provisionalization. What has been you experience with dental implant cases like this?

August 28, 2006 in Immediate Loading, Restoration of Dental Implants | Permalink | Comments (6)

Free-Standing Implants To Retain Overdentures?

Larry, a dentist, asks us:

I am hearing more and more about using free-standing implants to retain overdentures both in the maxilla and mandible. In the mandible, two dental implants in the canine areas appears to be the most frequent design. In the maxilla four dental implants in the canine and second premolar areas appears to be the most frequent design. Bars seem to be on the way out.

My understanding is that bar retained overdentures are really RP4 designs in that they provide most of the support for the overdenture instead of the traditional denture bearing areas. In terms of maximizing chances of success, I think bars are a poor choice unless they have multiple dental implants for support and stability. I think the RP5 design using free- standing dental implants for retention and bearing areas for support provides the best overall treatment plan. What are you all doing? Are Bars in or Out? Thanks for any comments.

August 28, 2006 in Overdentures, Restoration of Dental Implants | Permalink | Comments (12)

HA Coated Dental Implants

Dr. Nimchuk asks:

HA coatings on dental implants have been shown to accelerate surface bone apposition, thereby shortening the waiting period for dental implant restoration.

We also know the HA surface degrades and in some instances separates, so the trend has been to substitute coatings with roughened surface dental implants, which incidentally also show better and more rapid integration times. In addition, we know that titanium alloy dental implants are more fracture resistant than grade one, two or three and that in the case of narrow diameter implants, it makes sense to choose alloy implants.

Based on the above, a dilemma arises with the Replace Implant and the TiUnite surface which out of neccessity require the dental implant to be manufactured in grade 1 titanium. If you wish to use alloy with Nobel implants you can do so only if you use a smoother surface or HA.

My question is: Now that we have 15 years of experience with HA coated implants, how do HA coatings perform over the long term? What is the resorptive factor of HA and the clinical implications of the osseointegrated interface? Can we still say this is a good and viable surface to use and should we therefore possibly choose an HA-coated dental implant in narrow diameters over TiUnite because of the strength of material issue (for those who choose to use a Nobel Biocare Replace product)?

August 22, 2006 in Nobel Biocare, Surface Treatments | Permalink | Comments (3)

Locator Attachments or a Bar?

Charles, a dentist asks us:

I have a patient who had four 4x10mm dental implants placed in her mandibular anterior.  I was planning on doing Locators and making an overdenture. 

The gingival connective tissue over the dental implants is very dense and thick.  From the implant platform to the highest point on the surrounding gingival is 4mm for each dental implant.  This means the Locator abutments are going to have to be taller than I planned and this will create longer lever arms that will apply more force to the dental implants. Should I still go ahead with the Locators or should I change the treatment plan to a bar? Thanks.

August 21, 2006 in Restoration of Dental Implants | Permalink | Comments (14)

Dental Implant Maintenance

Dan, a dentist, asks:

I am having a hard time getting my dental implant patients to return for regularly scheduled routine maintenance of their implants. 

Most of my dental implant patients are wearing a complete maxillary denture and a mandibular implant retained overdenture.  I charge them the same fee that I charge for a routine prophy.  I schedule a recall every 4 months.  What are you doing?  Are you bringing them back in every 4 months for routine implant maintenance? How are you getting them back in for maintenance? Thanks for your suggestions.

August 21, 2006 in Implant Practice Management, Maintenance of Dental Implants | Permalink | Comments (2)

Ideal Number of Dental Implants

Philip, a dental implant patient, asks us:                     

I am a 49-year-old male from the UK and suffering from advanced gum disease. I have a few teeth left but they are extremely mobile and they will have to be extracted.

As far as I am concerned, I want a full set of dental implants for both jaws, as dentures fill me with absolute dread. I cannot afford UK prices so I have researched abroad and settled on Hungary as the best balance between quality and price. I have sent panoramic X-rays to various dentists in that country and have had differing opinions on treatment options available to me.

What is clear is that due to extensive bone loss I will definitely need two sinus lifts before dental implants can be placed. What I can't understand is the different number of implants advocated by different dentists.

Is there an ideal number of dental implants for a complete functioning set of teeth on both jaws? The number of dental implants suggested range from four or five on each jaw, to eight and ten being the most suggested. So, I would be very appreciative of your thoughts as to what constitutes a minimum, or or better yet an ideal number of dental implants? Thanks for your help.

August 21, 2006 in Patient Questions | Permalink | Comments (4)