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Pain After Dental Implant Surgery

Michael, a dentist, asks:

I have placed 6 mandibular dental implants last week in a middle aged woman who has adequate bone height and width. The left side of is asymptomatic and healing well. The right side is extremely painful. 

After the anesthesia wore off she immediately began to have pain on her right side. After 3 days the pain was still severe and I opened the flap and cleaned the site and irrigated with 3% hydrogen peroxide  to kill the anaerobic bacteria that I presumed were causing the infection and inflammation.

One day later, her pain decreased and she told me that it was the first night that she could sleep without pain. But she said me that she began to feel a little tingling and throbbing on the left side of her chin. The throbbing and aching is still going on after 8 days. I have prescribed systemic antibiotics and analgesics and she reports that the situation has been improving but has not been completely resolved.

When I look at the panoramic radiography I can clearly see that I am not into the inferior alveolar nerve or mental nerve. What do you think has caused this problem? Have I done something wrong? What can I do now to help this patient?

October 30, 2006 in Dental Implant Complications | Permalink | Comments (16)

All On 4 Technique

Peter, a dentist from the Netharlands, asks:

I trying to form my opinion on the 'All On Four'  concept by Nobel Biocare. However, it is very difficult to find good data on the subject.

Everything looks fantastic, but my gut feeling tells me otherwise. I know gut feeling isn't very scientific, so I'd appreciate some feedback from other dentists worldwide.

Some dentists have told me that the All-on-Four on the mandible avoids bone grafting of the posterior mandible in many cases. Is this accurate?

In addition, can anyone please walk me thru exactly tell me how this works? Are impressions taken for dentures (to address the out of line bite and sagging facial muscles), with these then being incorporated into a bridge ready for fitting? I'm finding it difficult to accept that aesthetics may well be lost for stability. Can both be achieved? Thanks for any comments.

October 30, 2006 in Nobel Biocare, Techniques and Procedures | Permalink | Comments (21)

Understanding Surface Topography

Dr. Andy asks:

There are many different surface coatings for dental implant fixtures: hydroxyapatite (HA), acid etch, sand blast, TiUnite, Osseotite, and so on.

Each manufacturer makes claims that the particular surface coating on his dental implant fixtures produces the best osseointegration and the greatest chance for success. Are there any studies that compare these surface coatings?   Is one coating better than the other?  What is the driving rationale behind these different coatings? Where is this headed? Comments would be appreciated. Thanks.

October 30, 2006 in Surface Treatments | Permalink | Comments (8)

Educating Patients About Dental Implants

Dr. Marc Nevins is a Diplomate of the American Board of Periodontics and is an Assistant Clinical Professor at the Harvard School of Dental Medicine.  He maintains a private practice limited to Periodontics and Implants in Boston.  Dr. Nevins has taken time out of his busy practice to discuss his protocol for educating patients about dental implant treatment.

OsseoNews:  Dr. Nevins, what do you consider to be the most vexing problems of dental implant treatment?

Dr. Nevins:  Patient education is an important area often overlooked for its complexity.  When we present a treatment plan to the patient that involves implants, we are faced with the problem of communicating information effectively to the patient.  They must be able to make an informed decision about their treatment and ideally recruited as a co-therapist in the process.

OsseoNews:  Many dentists used some of the tried and true techniques such as showing the patient their radiographs and drawing on the radiographs or drawing pictures on the bracket table.

Dr. Nevins:  That kind of presentation can be successful but compared to what we have available today, it really is simplistic and not very effective.  We have so many resources now, that I cannot imagine going back to some of the techniques that I used to use.

OsseoNews: What have you found to be the most effective technique for presenting the treatment plan and gaining patient acceptance?

Dr. Nevins:  We have been using the XCPT ™  (Treatment Planning and Communication Software) now for the last year (See www.xcpt.com).  I personally have found this to be an invaluable tool.  In its simplest form we use it to demonstrate the diagnosis of patient’s radiographs on the computer screen. We can then use the mouse to draw on the screen to demonstrate various points about the patient’s radiographs.

OsseoNews:  You find that this works better than using conventional radiographs?

Dr. Nevins: No question.  Conventional radiographs are more difficult for the patient to interpret and they can be intimidating.  With the XCPT software, I can display the radiographs on the screen and we find that patients are far more comfortable with this arrangement.

OsseoNews:  How can you use the XCPT software to make the treatment plan and the actual dental implant protocol more intelligible to the patient?

Dr. Nevins: The beauty of this system is that we can display the actual radiographs of the patient.  So we are not talking about a generic presentation.  The patient can see exactly what we are going to do to them.  We can use realistic pictures from the image library to modify the patient’s radiographs.  We can demonstrate exactly where we are going to place the dental implants.  Then we can overlay the abutments into the implant fixtures.  Then we overlay the crown restorations, adjusting the opacity so the patients can visualize the abutment supporting the crown.

The graphics in this program are great.  We can demonstrate any step in the treatment plan, including the placement of provisional or transitional restorations and the treatment sequence.    

We can even use this software program on CT scans.  There are just so many applications.

One great advantage here is that we are not tasking the patient to conceptualize or imagine what the treatment is going to be like.  We just demonstrate it on the screen for them.

OsseoNews:  The treatment plan presentation is customized to the patient and how they present and exactly what treatment they are going to receive?

Dr. Nevins:  The great strength of this software program is that we can adapt it to the needs of each patient.  There is a very big difference between using a stock treatment plan presentation and actually developing a unique and customized treatment plan presentation for the patient.  It makes a big difference when the patient realizes that those radiographs up on the screen are his.

The presentation includes labeling the tooth numbers so when the patient leaves the office with a treatment plan, the XCPT image is printed for them and they can identify where the treatment will be performed.

OsseoeNews:  If the patient needs more complex treatment like a sinus lift, you can incorporate that into your presentation?

Dr. Nevins:  The XCPT software program is great for situations like that where we have to do more than just place an implant.  Bone grafting procedures can easily be demonstrated for the patient with graphics from the image library.  Even with the most complex treatment plan, we display overlays or diagrams and lead the patient through every step.

When we finish our presentation, we print out the radiographs and the each screen the patient viewed. They leave the office with all of this information.  I routinely send all of this information to the referring dentist either by mail or e-mail.  If the patient has any questions they can ask me or their referring dentist. 

Implant dentistry is a team approach.  This way we all know exactly what treatment is intended and how we are going to proceed.  Communication is they key.  The XCPT software makes this very easy.  I can e-mail the XCPT file or a JPEG of the plan to the restorative dentist to communicate the treatment plan.

OsseoNews:  How expensive is this XCPT software?

Dr. Nevins:   The software costs about $3500.  There is no other fee the first year but starting in the second year we began paying about $1K per year for their support package.

OsseoNews:  Is the software user friendly?

Dr. Nevins:  Very user friendly.  The on-site training lasts about a day, or less, depending on your background in computers.  The learning curve is very short.  I have to say that this is really easy to learn how to use.  If I have any problems, their support package entitles us to 24/7 access to their help desk.   The support package also includes upgrades to the system.

OsseoNews: How much time does it take usually to present the treatment plan using this software?

Dr. Nevins: I find that it takes about 5-10 minutes to use the XCPT to demonstrate the treatment plan and to continue the consultation with the patient.  Then my Implant Coordinator continues the discussion and spends as much time as the patient needs to review the treatment process and fees.  She answers questions and uses the XCPT program if the patient wants something demonstrated to them on the computer screen.

OsseoNews: Do you have a terminal in each of your operatories?

Dr. Nevins:  We have a terminal in each operatory and in consultation areas.  Being able to work in the operatory with the patient makes the process seamless and easy to integrate into practice. 

OsseoNews: Thank you Dr. Nevins for your time.

Interview conducted by:
Gary J. Kaplowitz, DDS, MA, M Ed, ABGD
Editor, OsseoNews.com

October 30, 2006 in Implant Practice Management | Permalink | Comments (2)

WorldWide Dental Bone Graft Market

According to Research and Markets, the global market for dental bone graft substitutes (including allograft, xenograft, and synthetic bone graft substitutes) and tissue regeneration is valued at over $40 million with Asia Pacific Markets expected to generate over $18 million over the next five years.

Comprising Australia, Japan, and South Korea, the Asia Pacific market for dental bone graft substitutes (BGS) and tissue regeneration has experienced significant growth.

Research and Markets states,"The rapid growth of cosmetic dental solutions has fuelled a significant increase in the number of global dental implants. This increase is driving the need for dental bone grafting and tissue regeneration. Growth in the dental market will be driven by a variety of factors, including the increased use of bone graft material both in dental implant and periodontal procedures, product improvements, the increased exposure of bone graft products, and an aging global population."

Source: ResearchandMarkets.com

October 28, 2006 in Bone Grafting, Dental Implant News | Permalink | Comments (0)

Mini Implant Systems

Dr. Lendran, from Malaysia, asks:

Can someone please tell me what the diffrence is between all the mini implant systems, i.e. Sendax MDI, Intermezzo and NobleBiocare IPI and others?

I am currently using sendax MDI. It works well for lower over dentures but is it good for single tooth replacement? I recently discovered Intermezzo and used it for upper lateral incisors.
I am looking for some comments on mini dental implant practitioners from around the world, as I'd like to understand which system to use in each particular case.  Would appreciate a summary of the benefits /features of each system. Thanks.

October 23, 2006 in Mini Dental Implants | Permalink | Comments (47)

Piezo Surgery Clones

Jeffrey, a dentist, asks:
Do any of you have information about new products (clones) in the piezo surgery field?

I've heard that some clinician in Paris has had some good results with his piezo unit.  Beautiful nerve repositions and amazingly clean chin and ramus grafts.  Do these units perform as well as the original? What other comments can I get about piezo surgery? Where can I get more information? Thanks.

October 23, 2006 in Piezosurgery | Permalink | Comments (7)

Oral Cancer and Dental Implants

Dr. Lee asks:

I have a patient who is an oral cancer survivor.  Five years after radiation treatment he has zero saliva and severe and extensive root caries. All teeth are hopeless and he will need full mouth extraction.

The patient wants dental implants. He will be starting hyperbaric oxygen treatment.  What are his risks if we attempt dental implant placement at this time? I could not find literature that presented controlled studies with or without hyperbaric oxygen and success rates following implant placement.

My question is should we wait until hyperbaric oxygen treatments are complete to place dental implants? Can we place implants during treatment? How do I treatment plan this case?

October 23, 2006 in Dental Implant Contraindications | Permalink | Comments (13)

Surgical Stents for Implant Placement

Harold, a dentist, asks:

I have begun to make surgical stents for my surgeon to guide the placement of dental implants in the maxillary aesthetic zone. There is some controversy over where to place a dental implant for a maxillary central incisor and what inclination to use.

I am making the stent to place the long axis of the dental implant so that it passes through the cingulum. I am locating the dental implant to the lingual of where the natural tooth was located to preserve the buccal cortical plate.

Some authorities, though, recommend orienting the implant so that it passes through the incisal edge of the natural tooth. What are you all doing? I'd appreciate some thoughts on the proper technique here. Thanks.

October 23, 2006 in Techniques and Procedures | Permalink | Comments (17)

Internal Vs. External Hex?

Dr. Kimbrow asks:

I know quite a few dentists who continue to use dental implants with an external hex.

However, now that the internal connection dental implants have been out for awhile, is there any great advantage to using external hex? What are the issues here, on both sides? Why would you choose external over internal or vice versa?

October 17, 2006 in Dental Implant Systems, Treatment Planning & Complications | Permalink | Comments (9)