You can think about doing a vestibuloplasty.\u00a0 Those aren\u2019t very predictable, and they\u2019re hard to do and very hard on patients.\u00a0 So, pre-operative planning.\u00a0 If we had don\u2019t pre-operative planning on this before, we would have gotten tissue around this implant on the buckle aspects.<\/p>\n
Collapse after extraction.\u00a0 You will lose a lot of soft tissue and bone tissue.\u00a0 This guy was in two days ago, and we have a lot of buckle bone and lingual bone lost.\u00a0 We\u2019re going to expect a ton of soft tissue collapse.\u00a0 You\u2019ve got an oral complication, some infection.\u00a0 We can pull this tooth, and we can graft.\u00a0 We\u2019re going to have to extract and notify the patient that we\u2019re going to pull this tooth, we\u2019re going to bone graft, we\u2019re going to lose a lot of soft tissue and bony structure.\u00a0 So, next time we go, we\u2019re going to have to either do a vertical ridge augmentation, maybe even an internal sinus slip soft tissue to augment this area, to grow this area back.\u00a0 This is a very compromised site.<\/p>\n
Hard tissue deficiencies in the maxillary interior, height and width ratios. This patient had these teeth pulled when she was 16.\u00a0 She\u2019s 35 years old now.\u00a0 She has severe, as you can see, horizontal ridge loss.\u00a0 She has [27:48] lower anterior teeth.\u00a0 I would not recommend just getting her in and starting to put implants on the anterior maxillary area.\u00a0 The treatment planning for this patient would be to intrude the incisors, bulk out the maxillary interior ridge areas for height and width.\u00a0 You might even need to come up on the high tool of it, remove some bones, but this is a very difficult patient to restore.\u00a0 As you can see, the crest of her soft tissue is roughly 3 millimeters to 4 millimeters away from the edge of the mandibular anteriors.<\/p>\n
Maxillary posterior region sinus involvement in this lady right here.\u00a0 She wanted two implants replacing these two teeth.\u00a0 We thought about placing an implant here in site 15, however, she doesn\u2019t have an opposing tooth because she wanted two implants.\u00a0 So, the ability to pre-operatively plan internal or lateral augmentation graft, when to do an internal sinus and when to do a lateral internal sinus slip depending on the bone quality and quantity in this area.<\/p>\n
Mandibular anterior hard tissue deficiency.\u00a0 You\u2019re not going to be able to put an implant on this tissue on the same day.\u00a0 You\u2019re going to augment this site with either a chin graft, a ramus graft, or a particular allograft.\u00a0 Suture the site really nicely.\u00a0 Let it heal and go back in here in a future date and place an implant.<\/p>\n
Mandibular posterior area hard tissue deficiency.\u00a0 We didn\u2019t have a CT scan for this patient, and that\u2019s something really nice to have nowadays is the ability to have the technology.\u00a0 So, when we did this case in the residency program, we just flapped back, and we saw this super fine ridge, not a lot of bone, poor area to put an implant in.\u00a0 What we just had to do was to graft the site with a particular graft material and come back in.\u00a0 This is after 12 weeks.\u00a0 We\u2019ve got tons of bone from the lateral ridge augmentation of the near graft.<\/p>\n
Occlusion is something that we had talked about, and Dr. Mike McCracken who teaches that and goes in depth with this and how to restore somebody\u2019s vertical dimension of occlusion, whether it\u2019s implant-supported bar over dentures, implant retained dentures, implant screw down hybrids, or fixed dentition.\u00a0 If somebody has a closed vertical dimension of occlusion, we get them in.\u00a0 We just take a Panorex and realize she\u2019s edentulous on the lower right mandibular, and we just want to put in implants.\u00a0 Well, that\u2019s going to be a restorative nightmare to put in two implants up here. This is in the restorative phase.\u00a0 When are we going to make this a screw down prosthesis and when we\u2019re going to make this a [30:49] prosthesis.\u00a0 Altered passive eruption.\u00a0 This is the same lady before.\u00a0 There\u2019s no way we\u2019re going to be able to sneak in some implants around here without intruding these lower anterior teeth to the ortho.<\/p>\n
People that have parafunctional habits.\u00a0 This is a classic case of a guy in his mid-forties, and he just grinds through his teeth all day, every day.\u00a0 Occlusion is a big concern.\u00a0 You\u2019re not going to be able to place an implant in site number 8 and get a nice tooth form and function.\u00a0 You\u2019re going to have to do a full mouth rehab, open up this bite, crown the upper and lower anterior teeth, place an implant there, and try to scalp the tissues, and hopefully come out with a nice aesthetic outcome.<\/p>\n
Joint instability.\u00a0 Patients that cannot keep their mouth open for a very long period of time, patients that have a very limited mouth opening, patients that suffer from TMJ, these are also concerns and complications that can arise during the implant surgery.\u00a0 So, you should also pre-operative plan for these cases.<\/p>\n
Aesthetics.\u00a0 People\u2019s smile line.\u00a0 This guys is not highly aesthetically demanding when I asked him to smile as big as he could.\u00a0 He has hyper lip ability, and this is not really aesthetically pleasing for me, but for him, it really didn\u2019t matter.\u00a0 Pre-op planning, if we\u2019re going to place implants on somebody, do they have a high smile line, do they have a normal smile, or do they have a low smile line?\u00a0 Treatment plan accordingly.<\/p>\n
Long white teeth versus pink porcelain.\u00a0 If you\u2019re going to do a full upper, full lower on somebody, are you going to shorten their teeth with pink porcelain, or are you going to create some long teeth and not use pink porcelain?<\/p>\n
Flange, of course, are needed to support the lips of a person if somebody doesn\u2019t have lip support.\u00a0 If you take that from them, you bring them from a complete denture to a full fixed, those people are going to have some issues.\u00a0 They\u2019re either going to stick with implant-supported denture and just let them know their ability for aesthetic concerns with those patients, and we\u2019ll talk how to treatment plan those patients and what to do beforehand.<\/p>\n
Now, with the advents of cone beam CT technology, it has been tremendous, helping me out in my practice.\u00a0 I feel like it helps me, and the cases seem to go a lot quicker.\u00a0 I know the bone morphology.\u00a0 Without cone beam technology, if we want to place and implant here in this area and we look on the CT scan and it didn\u2019t have a mandibular posterior lingual area, they have a severe curvature, which would inhibit this area to get an implant.\u00a0 So, we need to talk about other options for this area or even not placing an implant.<\/p>\n
Pathology in an area.\u00a0 Get a nice radiograph.\u00a0 Patient came in with lots of pain on this tooth.\u00a0 She was referred to our practice for extraction and implant placement.\u00a0 I noticed something back here.\u00a0 So, we had to take a CT scan to figure out what\u2019s going on, and we got a nice Panorex to show you guys from that.<\/p>\n
There\u2019s this huge pathology, and she had this develop in the past two years.\u00a0 We looked at a previous Panorex, and she never had this.\u00a0 You could also see it extending into the inferior alveolar nerve canal.\u00a0 This referred out to a local oral surgeon, and he removed the cyst. It came back as benign or odontogenic keratocyst, but knowing this ahead of time, if we just take a PA and we don\u2019t know what\u2019s going on back here, we can get in a lot of trouble.<\/p>\n
Being close to a nerve in an area.\u00a0 This is a primary example of somebody who wants mandibular posterior implants, and these are two 10.5 millimeter implants.\u00a0 We\u2019re not going to be able to place these implants in without either shortening the implants or moving to a vertical ridge augmentation, but it\u2019s too close to the nerve.\u00a0 Cone beam technology gives us that.<\/p>\n
Vascularity is also an issue.\u00a0 You don\u2019t want to sever and artery and have some bleeding issues.\u00a0 So, this is a CT scan of a mandibular anterior lingual artery and also an incisal artery coming in the incisal canal.\u00a0 You definitely don\u2019t want to hit those during surgery. Guided surgery has been a nice for dentists.<\/p>\n
Lab fabricated.\u00a0 Some of this is what I used to do in my own practice.\u00a0 I used to make my own stents, developed the crown-to-implant ratio, marked my middle, use a pilot drill, and flap back the tissue and get a nice outcome.\u00a0 However, this surgery is only done on models.\u00a0 So, we don\u2019t really always know the morphology of the bone underneath so it\u2019s not really recommended.<\/p>\n
Originally, Cerec by Sirona, the scanning software where you can scan the adjacent teeth and mill out an acrylic surgical guide.\u00a0 It\u2019s really nice, and the technology has improved from whenever I did this.\u00a0 This was done a while back, and we can get a nice implant immediately.\u00a0 Again, it doesn\u2019t account for the bones and the roots of the adjacent teeth.\u00a0 Now, they\u2019ve come out with a nicer system.\u00a0 They\u2019ve teamed up with GALILGEOS, and they\u2019re outcomes are a lot nicer than this one.<\/p>\n
CBCT aided guided surgeries.\u00a0 This is a case that we did.\u00a0 This is a laser-centered surgical guide done for the maxillary anterior region.\u00a0 The surgery was done flapless.\u00a0 It was a quick surgery.\u00a0 She was in and out, just a great tool to use for a hard and difficult case.<\/p>\n
Medication protocol.\u00a0 A lot of people talk about pre-op antibiotics, and just recently, last week, the Journal of Clinical Oral Implant Research came out with a study with a multicenter randomized controlled clinical trial.\u00a0 Dr. Chen Pan stated in his conclusions, \u201cFor a single implant placement prophylaxis, systemic antibiotics before or after single implant surgery does not necessarily improve the outcome or prevalence of post-operative complications.\u201d\u00a0 So, we need to dive in more to literature and talk about the antibiotic therapy in conjunction with implants.<\/p>\n
Post-operative pain medications.\u00a0\u00a0 What do we recommend and not recommend, understanding that Motrin\u00ae, ibuprofen, does inhibit a prostaglandin.\u00a0 So, you can get post-operative swelling after therapy.\u00a0 People always come into our office and say, \u201cI want an implant done.\u201d\u00a0 The day of the procedure, they come into our office, and we\u2019re going to sedate them.\u00a0 That morning, they didn\u2019t take their blood pressure medication.\u00a0 They didn\u2019t take their routine medications.\u00a0 We need to tell patients all the time to continue all prescribed regular medications, and after we do the procedure to continue taking their medications as prescribed.<\/p>\n
This is just a brief summary, like I said, of what we\u2019re going to talk about at Rocky Mountain Dental Institute.\u00a0 If you go on the website, rockymountaindentalinsitute.com, and if you go under Courses, you\u2019ll see a list of courses of what\u2019s being offered.\u00a0 There\u2019s eight different courses anywhere from prosthetic reconstruction to bone grafting to complications, and marketing.\u00a0 So, for the course, you can click on Implant Complications on the drop down tab.<\/p>\n
You can read a little bit about the course overview, the course outline, a little bit about myself.\u00a0 On the Start Here tab, you can see the different dates.\u00a0 I want to make a note so that everybody who\u2019s on this, the date that\u2019s actually listed right here is incorrect.\u00a0 It\u2019s actually the week before, March 14th<\/sup>.\u00a0 Then, you just go ahead and click on Register Now to register for a course.\u00a0 If you haven\u2019t been to a course yet, you can create your own account, fill out the user registration information and hopefully we get to see you guys in March for the next course.<\/p>\n I\u2019d like to open it up for other questions if you guys have anything.<\/p>\n <\/p>\n Dr. Lavine:<\/p>\n Oh, yeah.\u00a0 They\u2019ve got lots of questions.\u00a0 So, your course is March 14th<\/sup>, and it\u2019 basically all on implant complications, correct?\u00a0 Is it a live course, or is it more of a didactic course?<\/p>\n","protected":false},"excerpt":{"rendered":" You can think about doing a vestibuloplasty.\u00a0 Those aren\u2019t very predictable, and they\u2019re hard to do and very hard on patients.\u00a0 So, pre-operative planning.\u00a0 If we had don\u2019t pre-operative planning on this before, we would have gotten tissue around this implant on the buckle aspects. Collapse after extraction.\u00a0 You will lose a lot of soft […]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1],"tags":[],"class_list":["post-194","post","type-post","status-publish","format-standard","hentry","category-detox-foot-patches"],"_links":{"self":[{"href":"http:\/\/footpatches.com\/detox\/wp-json\/wp\/v2\/posts\/194","targetHints":{"allow":["GET"]}}],"collection":[{"href":"http:\/\/footpatches.com\/detox\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"http:\/\/footpatches.com\/detox\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"http:\/\/footpatches.com\/detox\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"http:\/\/footpatches.com\/detox\/wp-json\/wp\/v2\/comments?post=194"}],"version-history":[{"count":1,"href":"http:\/\/footpatches.com\/detox\/wp-json\/wp\/v2\/posts\/194\/revisions"}],"predecessor-version":[{"id":195,"href":"http:\/\/footpatches.com\/detox\/wp-json\/wp\/v2\/posts\/194\/revisions\/195"}],"wp:attachment":[{"href":"http:\/\/footpatches.com\/detox\/wp-json\/wp\/v2\/media?parent=194"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"http:\/\/footpatches.com\/detox\/wp-json\/wp\/v2\/categories?post=194"},{"taxonomy":"post_tag","embeddable":true,"href":"http:\/\/footpatches.com\/detox\/wp-json\/wp\/v2\/tags?post=194"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}