Dr. Lavine:
Okay. Can you pull up the slides where you showed the website again? We have a couple of questions about the actual course. So, there it is. It’s rockymountaindentalinstitute.com. You can see all the courses there, and we’ve been very fortunate to have Dr. Lingo and Dr. Cummings and Dr. McCracken who are all speakers. They’ve done webinars in the past, and I would encourage people to come your course. You said it’s March 14th, correct?
Dr. Domingue:
It’s March 14th. Yes, yes.
Dr. Lavine:
Okay. What about the restoration. Screw-retained, cement. Do you have a strong preference for one or the other?
Dr. Domingue:
Screw-retained, we do both in our practice. We screw retain implant crowns, and we also cement retain implant crowns. There’s protocols to both. If you’re going to have less than ideal vertical dimension, you’re going to have to screw retain your implant crown. You’re not going to have enough room to make an abutment and a crown. If you have anything less than 8 millimeters, it’s going to have to be a screw-retained crown. If you’re going to have anything more than 8 millimeters, it really doesn’t matter. You can do either or.
I do often screw retain implant hybrids. We do single unit crowns. We do full arch screw retain. It just depends on the patient’s needs. It depends on what I feel is necessary for the case, but there is a place in implant dentistry for both.
Dr. Lavine:
Okay. Immediate implants, implants around sockets are not. Is there a general rule of thumb about when you’re going to graft? Is there a certain amount of space that you’re comfortable with or not comfortable with? Does it depend on how integrated the implant is? How do people deal with the fact that there’s almost always going to be some space there?
Dr. Domingue:
Graft it. Graft it routinely. A lot of the patients that I see and I really feel that most dentists see now are the ones that come in and say, “My tooth is broken.” Well, you need to take it out. We’re going to do this. We’re going to do it that day. The best service in the world is to remove the implant, place the implant that day, and if it is an aesthetic area, to immediately provisionalize out of occlusion.
Like you said, we either have one root, two roots, or three roots sometimes, and implants are conical tapered. They’re not definitely the same anatomy as a natural tooth, but they don’t have to have the same anatomy as a natural tooth. Typically, maxillary anterior teeth are going to be much more buckle-oriented that your implant is going to be. So, you’re going to have to create a different emergent profile for the implant and have plans for that.
Let’s say, picking on a maxillary anterior region, if we’re going to place an implant more towards the palate and gauge the palatable bone to get a semi-force torque, we’re going to have a big defect where the roots of the maxillary anterior where. So, that’s going to grafted. We’ll show techniques on how to deal, but the technique I use is engage the implant properly into more a lingual aspect than the root of the maxillary anterior tooth.
Screw down a cover screw to prevent bone from getting to that area. Grasp the buckle defect with some bone. Unscrew the prosthesis, and I use thick abutments routine in our practice. Use thick abutment, which is a plastic temporary abutment, and use these dental teeth formers to make a provisional crown, and always, when you need to provisionalize, you need to worry about sculpting the thick abutment to create a nice soft tissue profile.
Dr. Lavine:
Yeah. Do you recommend any resorbable membranes that stick around long term when left exposed?
Dr. Domingue:
A lot o people like GORE-TEX® membranes. I don’t remember the name of the company, but they make GORE-TEX® titanium-reinforced membrane.
Dr. Lavine:
But I said resorbable so…
Dr. Domingue:
Oh, resorbable that lasts a long time when exposed? I don’t know a lot of membranes that last for a long time. Once they get inside and saliva pours into the membrane, usually they degrade pretty quickly. So, I don’t have any. Whenever you use resorbable membranes, it’s advised to get, if not primary closure, get as close to primary closure as possible, but if you’re going to have a big exposure of resorbable membrane, you have to expect that membrane to resorb pretty quickly.
Dr. Lavine:
Okay. Any thoughts on foundation?
Dr. Domingue:
Yeah. I believe I used to use foundation in residency, but it’s a bovine collagen material. It’s conical in form, and there’s different sizes, small, medium large. They’re very, very inexpensive, and they’re used for socket preservations. It’s porous. So, the idea would be when you remove a tooth degranulated area, instead of using bone graft material that’s expensive, you can use these bovine collagen membranes. It’s a membrane/socket preservation seal. They work. They absolutely work, and there is a place for them in there. So, yeah, that is a good one.
Dr. Lavine:
Okay. What’s your e-mail address again? I know some people were interested in being able to follow up with you.
Dr. Domingue:
My e-mail address is on the website for Rocky Mountain Dental Institute, but if you have any questions, my personal e-mail address is my last name, domingue.danny@gmail.com. Feel free to e-mail me all questions, any questions you guys might have.
Dr. Lavine:
We did have a question about the graft kit that Dr. Moody uses. He’s on the call. I don’t know, Justin, if you want to talk about the graft kit, or do you know more about it, Danny? Are you there?
Dr. Domingue:
The graft kit. I don’t know if where you would get the graft kit from. I just got it from Dr. Moody just because he’s a friend of mine.
Dr. Lavine:
Okay. He’s not mic’d up.
Dr. Domingue:
They do have them at the Rocky Mountain Dental Institute for sale. You can purchase one. They’re not very expensive. They’re I don’t know. I don’t remember the cost or how much I paid for it, but they’re fairly inexpensive. They’re really, really accurate.
Dr. Lavine:
People could call up if they want to get more information about the kit.
Dr. Domingue:
Absolutely. You can call the 1-800 number and ask to speak to Genie, and she’ll give you much more information on that.
Dr. Lavine:
Okay. What about tumor bone? Have you ever used it or recommended it?
Dr. Domingue:
I have not used that so I don’t really, I can’t really make a statement on that. Tumor bone?
Dr. Lavine:
Okay. Another follow-up question on the foundation. Are you striving for a 100% primary closure when you’re using foundation?
Dr. Domingue:
I do. I try to get primary closure whenever I use foundation. It’s great to use, and it’s really easy. It’s already pre-formed. Bring it into the socket, and what I do is a non-surgical envelope flap so without making any real instrument incisions, release the periosteum full thickness, bring it over to the lingual, and try to get as best a primary closure as I can. Yes.
Dr. Lavine:
Okay. For most of your cases, since they’re relatively easy cases, are you always using a splint, a stent, or are you free handing it? How do you typically handle most of your cases?
Dr. Domingue:
Like I said earlier, I don’t have the statistics in front of me and I need to work on that, but I’d probably say that about 60% to 70% of the implants that we place in our practice are immediate placement. Because of that, you’re not going to use a surgical guided stent for that. What I’m trying to get to, Lorne, is I’m trying to get using surgical stents more in my practice because it’s a quicker surgery time for me. It’s a quicker surgery time for the patient. There’s less morbidity associated with guided surgery. It’s quicker. There’s all types of advantages.
The disadvantage to using surgical guidance is there’s a lot more work before the patient gets in the office. There’s a lot more work for me on my computer, dialing in in English, getting the implants in the proper orientation. Then, getting that outsourced for a surgical guide and there’s a cost associated with that. Implants are expensive enough as they are, you’d hate to add that cost to the patient, but I am looking for a less expensive route to be able to give guided surgery for my patients.
It’s an area of implant dentistry that’s a nuance for a lot of guys that haven’t done a lot of implant surgery. Like I said, I’ve only done a handful of guided surgeries, but it’s something that I definitely want to incorporate more in my practice.
Dr. Lavine:
Okay. We’re running out of time. If there are people that want to know more about that Moody kit, Dr. Moody is on the call, and he said you can certainly call Rocky Mountain Dental Institute or you can e-mail him directly. His e-mail is justin@rockymountaindentalinstiitute.com.
Danny, it’s always a sign of a good webinar to see what the attendance is like, how many people dropped off towards the end. We actually have significantly more people on the call than we did when it started. So, that is always a good sign. So, I really want to thank you. This was a really great webinar.
As I’ve mentioned, a number of our clients have been to some of the other courses that Dr. Lingle’s done and Dr. Cummings and Dr. McCracken. We don’t have any reports on yours yet, but, again, that’s still six weeks away. I would highly encourage people to consider coming out to take the course.
Obviously, you’re going to be covering a lot of information, live course. You can’t beat it. I just want to thank you again for being on the call because this has been one of the best webinars we’ve had.
Dr. Domingue:
I appreciate it, Lorne. Thank you so much. Thanks, everybody, for sticking around, and, again, if you have any questions, let me know. I look forward to seeing all of you guys in March.
Dr. Lavine:
Thank you, everyone, for being on the webinar. We know you have lots of things to keep your life busy, and taking the time was very much appreciated. Thanks, again, to Rocky Mountain Dental Institute, just a real class act. I highly encourage you to go to the website, check out their courses.
Obviously, a lot of you on this course are really interested in becoming at placing implants, but this importantly dealing with all the issues and all the complications that can come up. So, I want to thank you both. I thought this was a great presentation. As most of you know, we do webinars on a regular basis. We’ve got more coming up. I think our next one is on nitrous oxide next week. We’ve got a couple of other ones, six months smiles.
We look forward to seeing everyone in future webinars. Good night, everyone.
Dr. Domingue:
Good night.