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FDA on Mini Implants

Dennis, a dentist, asks:

In all of the discussions on mini dental implants, there have been several references to the FDA requirement of a dental implant diameter of at least 3mm (formerly 3.25mm) and length of 7mm to qualify for the description of a dental implant.

1. When were these guidelines established? Does anybody have any reference material for this?

2. How does this 'classification' affect the insurance payments (where allowable) of dental implants of either smaller diameter, such as mini dental implants or shorter length, such as when Endopore and Bicon dental implants are used?

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November 27, 2006 in Mini Dental Implants | Permalink

Broken Abutment

Dr. White asks:

I have had two patients 'break' the abutment about half way down the dental implant. 

I have tried to unscrew the segment but it's torqued in place. Tried to reset the upper part of the prep but not enough screw threads available. Please help.  How do I remove this? What should I do to correct the situation?  The dental implant is not the problem. It's in tight. Any advice would be appreciated.

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November 27, 2006 in Abutments, Treatment Planning & Complications | Permalink

Maxillary Dentures Supported by Mushroom-Shaped Mucosal Implants?

Dr. Flynn asks:

A local general dentist is advertising palateless maxillary dentures supported by mushroom-shaped mucosal dental implants.

Apparently the denture must be worn for two months while the soft tissue heals around the dental implants (which do not appear to extend into the bone).  I can not find any information concerning this procedure. Has anyone heard of this and/or had any experience with this?

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November 27, 2006 in Overdentures, Techniques and Procedures | Permalink

Implants Showing Thru Gingival Tissue

Dr. Mena asks:

I recently did a few immediate loading cases with root-formed dental implants and composite resin temporization on titanium or zirconia abutments.

All of the cases had some kind of chronic infection prior to the extraction, which was the reason for the extractions. All cases were treated with antibiotics after the extractions and dental  implant placement. The dental implant fixtures had primary stability and I torqued them to about 40 Ncm. No bone grafting was performed between the alveolar wall and the dental implant.

Until now, the dental implants have been working well, but some of the implants are showing thru thin gingival tissue. Is this going to become a problem? Any thoughts?

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November 27, 2006 in Treatment Planning & Complications | Permalink

Bone Augmenation and Ridge Preservation

Robert A. Horowitz is a Periodontist who maintains a private practice limited to Periodontics and implant dentistry in Scarsdale, NY and New York City. He is a Clinical Assistant Professor in the Department of Implant Dentistry at the New York University College of Dentistry. Dr. Horowitz is heavily involved in research, product development and teaching. Our readers are also encouraged to also read a prior interview with Dr. Horowitz in which he provided valuable information and clinical tips on intraoral photography.

OsseoNews: Dr. Horowitz, you are a leading expert on alveolar ridge preservation and ridge augmentation. How does this relate to implant dentistry?

Dr. Horowitz: The most important lesson to be learned from the literature, as well as from my own personal experience, is that when a tooth is extracted, a bone augmentation or preservation procedure must be instituted at the time of extraction.

OsseoNews: What happens if the tooth is extracted and no bone augmentation or ridge preservation is accomplished?

Dr. Horowitz: You can expect at least 30-60% bone loss within 6 months around the extraction socket. You can also expect at least 1mm loss of vertical bone height. These numbers are straight out of the peer-reviewed dental literature. That represents a tremendous loss of bone volume that could, if preserved, provide much needed support for implants.

To read more of this interview on Bone Augmentation, please  click here and visit our new website.

November 27, 2006 in Bone Grafting, Dental Implant Interviews, Ridge Augmentation | Permalink

Pregnancy and Dental Implants

Petra, a dental implant patient, asks:

I am a dental implant patient and I recently experienced an implant failure in a rather unexpected way. I had the dental implant (lower jaw in the back) for about 4 years without any complications whatsoever.

However, during my second pregnancy and while breastfeeding it started to become a bit loose. The dentist thought the abutment was loose and tried to tap off the crown to screw it tight again. However, the crown would not come off.

It seems that the wrong (permanent instead of temporary) cement was used originally. An x-ray showed that the dental implant was completely fine, no significant bone loss, no inflammation. A few weeks later the dental implant was loosened and came out with the crown still cemented to it.

My question is did my body reject the dental implant after 4 years because of my pregnancy? Or did the dentist pull too hard when he tried to remove the crown? What happened? Is there any data regarding pregnancy and dental implants?

To read more of this interview on Pregnancy and Dental Implants, please  click here and visit our new website.

November 20, 2006 in Patient Questions | Permalink

Dental Implants in the Interforamina Area

Dr. Fabrizio asks:

I have a case where the mandibular nerve exited the mental foramen, but seems to continue mesially and connects with the controlateral nerve in the incisor region.

The patient will be edentulous and I am planning to place dental implants in the interforamina area. I am wondering what are the consequences of invading the anterior portion of the nerve. Any thoughts?

To read more of this interview on Dental Implants in the Interforamina Area, please  click here and visit our new website.

November 20, 2006 in Treatment Planning & Complications | Permalink

Locator Attachments

David, a dentist, asks:

What is the current thinking about using Locator attachments for mandibular overdentures?

I would like to know which design works better in the mandible, two or four dental implants with Locator attachments? Are there any better attachments that are being widely used? What about using dental implants and overdentures in the maxilla?

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November 20, 2006 in Dental Implant Attachments, Overdentures | Permalink

Unscrewing Dental Implants

Sam, a dentist, asks:

I have placed 4 dental implants in the 28 ,29, 30 and 31 areas. The patient called me the day after surgery to complain that his lip and chin are still numb.

I had the patient come in and I unscrewed the dental implants in 31 and 30 areas by a thread or two. The patient immediately started having more sensation in his lip and chin. The sutures opened shortly after and the sites healed by secondary intention.

Six weeks post-op the cover screws began showing through the wound site and the dental implants do not feel as tightly fixated as they were before. The patient also has one area on his lips where he still does not have sensation. What should I do at this point? What do you think of the prognosis?

November 20, 2006 in Dental Implant Complications | Permalink | Comments (11)

Insurance Coverage for Dental Implants

Is this the start of a big trend?
Delta Dental of Michigan, Ohio and Indiana (Delta Dental) will begin covering dental implants as part of its standard benefits beginning January 1, 2007. That means enrollees will have the option of choosing an implant to replace a missing tooth instead of a conventional fixed bridge.

"Although implants have been available for many years, advances in dentistry have greatly increased their rate of success," said Thomas J. Fleszar, D.D.S., M.S., president and chief executive officer of Delta Dental. "Today, they are often the best method for replacing a single missing tooth in a healthy patient. Therefore, we feel it's the perfect time to incorporate implant coverage as part of our standard benefits."

Delta Dental was one of the first carriers to offer contract riders to employers wishing to cover this service and has closely monitored advances in implant materials, training, and technology.

Fleszar said the company will cover endosteal implants, the most commonly used type of implant, which is placed into the jawbone. The other type of implant in use today, subperiosteal, fits on top of the bone under the gums and will not be covered because they have a high failure rate. Endosteal implants now have a success rate of 98 percent over 10 years.

Delta Dental of Michigan, Ohio, and Indiana was a pioneer in using evidence-based research to evolve dental plan designs. It was the first dental benefits provider to change coverage for dental X-rays in the mid-1980s based on research that recommended reducing the frequency of X-rays for those not at high risk for tooth decay; as a result, many patients have been protected from unnecessary radiation exposure.

Source: www.deltadentalmi.com

November 20, 2006 in Dental Implant News | Permalink | Comments (7)