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Predictability of GBR?

Dr. H asks:

I am periodontist with two years experience with dental implants. Recently I placed implants in a 36 year old female,healthy, with no parafunctional habits, who had lost tooth numbers 19 and 30 several years ago. She has buccal-lingual bone resorption, so I decided to place the dental implant and do guided bone regeneration (GBR) at the same time.

I used a bioactive glass (fillerbone) and a membrane (Membracel). During the healing process, the flap opened exposing the membrane and the graft which eventually was lost, leaving an exposed dental implant.  I waited for the healing process to close the wound completely before taking a course of action. 

Two months now since the surgery and there is a complete closure of the wound, leaving only the head and the cover screw exposed.  The patient has shown excellent oral hygiene and has followed all the indications given (eg, brush gently, with a gentle toothbrush with a .20% chlorhexidine gel).

My questions are:  Should I try to regenerate again or can I load the dental implant knowing that I have at least a 30% vestibular dehiscence on the implant? Lingually, there is no implant bone defect.  Will I have tissue problems, especially plaque control, and how predictable is GBR after the implant has osseointegrated?  How can I be sure that I have a "tension free" flap, which is, I think, is my biggest problem?

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December 25, 2006 in Guided Tissue/Bone Regeneration | Permalink

Penetrating the Maxillary Sinus

Dr. Chin asks:

I recently placed 4 dental implants in the maxillary jaw. The panoramic radiographs I took before the procedure showed a 13mm vertical bone height in the left premolar area. I was planning to place 11.5mm length implants there.

The panoramic radiographs I took after the procedure show that 1 dental implant I placed penetrated the maxillary sinus by about 3mm. Primary stability is very good for all 4 dental implants.  Will I have to trephine out the dental implant and replace it with a shorter implant? Or can I leave them all as is and have a delayed loading? I am planning to restore the case with an overdenture. How long should I wait to load the dental implants?

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December 25, 2006 in Overdentures, Shorter Dental Implants, Surgical Placement of Dental Implants | Permalink

Bacterial Colonization Around the Micro-Gap?

Dr. H. asks:

Recently I have been hearing a great deal about the problem of bacteria colonizing around the micro-gap between the dental implant fixture and the abutment. I have heard that this micro-gap and bacterial colonization can produce bone loss.

Is this a real problem to be concerned with? If so, what are the best ways to prevent this? Is it simply an an issue related to a specific dental implant design? Thanks.

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December 25, 2006 in Abutments, Treatment Planning & Complications | Permalink

Immediate vs. Delayed Loading?

Dr. Cal. asks:

I have just read: Immediate versus delayed functional loading of implants in the posterior mandible - A 2-year prospective clinical study of 12 consecutive cases (Romanos G., Nentwig G-H. Int. J. of Periodontics and Restorative Dentistry; 2006:26:459-469).

The bottom line here is that after 2-years in the posterior mandible, there was basically no difference between the dental implants which had a 3-month osseointegration followed by restoration versus immediate loading of the dental implants! In this study,  3 dental implants were placed in the posterior mandible and splinted together. Have any of you out there done this sort of immediate load and what were your results? Do you see a difference? Any thoughts on immediate vs delayed would be appreciated.

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December 18, 2006 in Immediate Loading | Permalink

Implants for Orthodontics?

Dr. Mit. asks:

I am an orthodontist in Indiana. I would like to place mini-implants for anchorage in the anterior region for effective intrusion of anterior teeth.

Do any of you have experience in determining site, angulation, etc? What are the positive and/or negatives for this technique? Any studies? Thanks

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December 18, 2006 in Mini Dental Implants, Orthodontics | Permalink

Dental Implants in a Cleft Palate

Mark, a dental implant patient in Pennsylvania, asks:                   

I was born with a bilateral cleft palate. My two front teeth have been diagnosed with extensive external root resorption. I've gotten several opinions, and the consensus is extraction/graft with dental implants.

One surgeon wants to do the extractions and allograft in separate procedures, while another surgeon would do the graft at the same time of the extractions.  I've had 2 autographs (iliac bone) 10 and 12 years ago to repair the cleft, both of which were successful.

Are there any special considerations for grafting/ dental implants given the previous work that was done around the cleft? Are there any factors to be considered when placing dental implants for a cleft palate? Would an allograft, as opposed to native bone, be advisable given the greater amount of bone that will be needed?

One surgeon also said that removing the teeth may create a passageway into my nose, necessitating an autograft 3-4 weeks after extraction. He said he wouldn't be completely sure about the amount of bone surrounding the teeth until the extraction. Any advice is greatly appreciated.

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December 18, 2006 in Dental Implant Contraindications, Patient Questions | Permalink

High Quality CT Images for Dental Implant Patients

Dr. Douglas Goldsmith and Dr. Gary Orentlicher are both board certified oral and maxillofacial surgeons in private practice in Scarsdale, New York. They co-founded Facial Imaging, LLC, a company that makes it easy for doctors located both within and outside the United States to obtain and utilize CT images for their dental implant patients. The process produces high quality 3-D images quickly and economically for use in developing patient treatment plans for implant placement and restoration.

Facial Imaging can process CT or cone beam scan data for any 3-D software program. The doctor can view a scan on his or her computer just hours after a patient has had their CT scan performed. Facial Imaging has partnered with over 30 imaging centers in New York, Connecticut, and Massachusetts and is in the process of expanding their geographic outreach. Facial Imaging also offers 3-D treatment planning services. Read on to learn more about Facial Imaging. You can also visit their website at: www.facialimagingllc.com

To read the rest of this interview on Cone Beam CT, please click here.

December 18, 2006 in CT Scanning, Dental Implant Interviews, Implant Practice Management | Permalink

Nobel Smile ?

Can Nobel Biocare finally smile again?  Last week Sweden's Medical Products Agency (MPA) gave Nobel the green light to continue selling its NobelDirect and NobelPerfect implants.  The condition is simply that Nobel Biocare must rewrite instructions for the NobelDirect and NobelPerfect dental implants to inform customers and dentists of a possible bone loss problem and how to prevent it, the Swedish Medical Products Agency said. The company must explain by Jan. 8, 2007 how it plans to rewrite the instructions and cannot market the product until the new information is available.

Reaction to the MPA rulling was unquestionably positive.  "Without a product withdrawal, we believe many of the potential material risks have been avoided,'' Michael Jungling, an analyst at Merrill Lynch, said in a report. As a result, it's unlikely that Nobel Biocare "will face U.S. litigation or that its customer reputation will be tarnished."

However, it is important to note that a ban of the product is still possible. "We just don't have enough data to pull the product off the market at the moment,'' Lennart Philipson, the agency's director for medical devices, said at a press conference in Uppsala, Sweden. The shortcomings in the instructions could explain the increased risk of a breakdown of the jawbone, the agency said.         

What are your thoughts on this latest twist in Nobel saga? Has fortune once again smiled upon Nobel?

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December 12, 2006 in Dental Implant News, Nobel Biocare | Permalink

Shorter Dental Implants ?

Ted, a dentist, asks:
A doc friend of mine recently recommended that I try shorter dental implants. So I've been trying to get some opinions on these implants. Dentists on OsseoNews.com: What has been your experience with these shorter dental implants?

Are these shorter dental implants just as stable and tight fitting as the  longer ones? Supposedely, the shorter implants help do away with bone grafting in the sinus area. But do they really work in the upper jaw area in the molar regions?  In what other settings would these shorter dental implants be appropriate? Are there any studies supporting the use of these implants and the benefits thereof? Thanks.

To discuss Shorter Dental Implants, please click here to comment on our new website.

December 11, 2006 in Dental Implant Systems, Shorter Dental Implants | Permalink

Temporary Crowns and Bridges on Dental Implants?

Charles, a dentist, asks:

I have a devil of a time making temporary crowns and bridges on dental implants. Does anybody have any good techniques that they would care to share with the rest of us?

I have had problems locking on the temporary bridge to the dental implant platform where I had to cut off the temporary bridge very slowly and very carefully so I would not damage the abutment or dental implant platform. This is a real drag. I have tried some of the techniques I have seen demonstrated at courses but they have not worked for me.

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December 11, 2006 in Crowns and Bridges, Restoration of Dental Implants | Permalink