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Dr. Domingue:<\/p>\n
Okay.\u00a0 That\u2019s a great question.\u00a0 At the course, it\u2019s going to be lots of lecturing on what we just talked about but absolutely in more details.\u00a0 We\u2019re also going to talk about complications during the surgery.\u00a0 We\u2019re going to talk about complications after the surgery and restorative complications like we talked about earlier, but we\u2019re also going to do live surgeries.\u00a0 It\u2019s a Thursday, Friday, Saturday course, and we\u2019re going to give a live surgery each day.\u00a0 So, it\u2019s going to be over the surgery, participation-involved surgeries.<\/p>\n
We are also going to have a live hands-on course in the post-operative complications and restorative complications.\u00a0 We\u2019re going to talk about implants whenever they fracture, how to remove the implants from the bone.\u00a0 We\u2019re going to have some stuff on drills.\u00a0 We\u2019re going to use ex-plants, the ability to remove an osseointegrated implant if it\u2019s at a bad angle.\u00a0 We\u2019re going to have some live hands-on participation as well.<\/p>\n
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Dr. Lavine:<\/p>\n
Okay.\u00a0 Are you ready for the questions?<\/p>\n
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Dr. Domingue:<\/p>\n
Let them roll.<\/p>\n
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Dr. Lavine:<\/p>\n
Okay.\u00a0 We\u2019ve got some great questions here. So, here\u2019s the first question:\u00a0 I have a patient who has a draining fistula from the neck of a healing implant.\u00a0 At the covering, there was granulation at the neck of the implant, and approximately 1 to 2 millimeters of the implant exposed on the buckle.\u00a0 How should I deal with this?<\/p>\n
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Dr. Domingue:<\/p>\n
So, it was draining from the neck after an implant placement?\u00a0 First of all, take a CT scan to figure out what\u2019s going on.\u00a0 If the implant is that infected, you might need to take the implant out to avoid any other complications.\u00a0 Get the patient numb, remove the implant, degranulate the site, try to put some gentamicin or some type of antibiotic in the area, maybe some calcium sulfate or betadine hydrate. \u00a0Suture the tissues.\u00a0 Get them on some strong systemic antibiotics like clindamycin 300 milligrams.\u00a0 Get them back in seven days.\u00a0 Check the wound healing.\u00a0 That seems to be like a very, very bad infection.\u00a0 I wouldn\u2019t mess around with that, but you need to get the patient on the obvious recall to make sure the infection\u2019s going away.\u00a0 If drain is coming out, you don\u2019t want that to get to any of the submandibular or sublingual spaces and spread.<\/p>\n
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Dr. Lavine:<\/p>\n
Okay. Next question.\u00a0 If a patient has two implants side by side in the mandibular molar areas, what\u2019s the current thought on whether the implants should be splinted or restored separately?<\/p>\n
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Dr. Domingue:<\/p>\n
That\u2019s funny.\u00a0 This is a very common question that a lot of people are asking nowadays, splint versus not splinting implants in posterior crowns.\u00a0 This is a multifactorial answer.\u00a0 It\u2019s not a \u201calways splint\u201d \u201cdon\u2019t always splint\u201d.\u00a0 There\u2019s a lot that has to do with it.\u00a0 If you\u2019re going to be putting two 6 millimeter implants on the posterior mandible, and you\u2019re going to be restoring with implant crowns that are 10 millimeters in width and 8 millimeters in height, it\u2019s probably advised to splint those teeth, especially if they\u2019re opposing the actual dentition.<\/p>\n
If the patient is an 80 year old female and she\u2019s getting two implants side by side and they\u2019re 10 millimters in length and she\u2019s opposing a natural denture, she doesn\u2019t have problems, it\u2019s not necessary to splint in that instant.\u00a0 She\u2019s not going to have impaired functionality.\u00a0 She\u2019s probably not a bruxor.\u00a0 She probably doesn\u2019t chew steak every single night.<\/p>\n
The reason why we splint implants or increase the strength of the implants is if one implant is split into the next implant, if the value of each implant is 2, it\u2019s not going to be 4.\u00a0 It\u2019s going to be a multiplication of that implant.\u00a0 Do you follow me?\u00a0 So, it does increase the strength of an implant if you do splint, but it\u2019s not always indicated to splint.\u00a0 However, I do splint many times when I see patients, and some patients don\u2019t want their implant crowns to be splinted because they want to floss through them<\/p>\n
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Dr. Lavine:<\/p>\n
Okay, what about splinting through natural teeth?\u00a0 Let\u2019s say, for example, someone\u2019s got implants on 8 and 9, and you\u2019ve got to restore 7 and 10.\u00a0 Are you thinking of maybe making them bridges or something like that.\u00a0 Is that contraindicated?<\/p>\n
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Dr. Domingue:<\/p>\n
The patient\u2019s missing teeth 8 and 9?<\/p>\n
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Dr. Lavine:<\/p>\n
Let\u2019s say there\u2019s implants already on 8 and 9, and maybe the dentist wants to splint or do a bridge.\u00a0 What\u2019s the current thinking as far as splinting an implant restoration to a natural tooth?<\/p>\n
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Dr. Domingue:<\/p>\n
That\u2019s a great question, and for a long time, we\u2019ve talked about not splinting.\u00a0 We used to, back in the day 20 years ago, always splint implants to natural teeth.\u00a0 Then, we saw a lot of failures, but with this failures what we saw was there was a 16% failure rate with whenever you splinted a natural tooth to an implant.\u00a0 The thought was that were was a periodontal ligament around the natural tooth, and in the implant, there\u2019s no periodontal ligament.\u00a0 So, it has to be that the failure rate is associated with the periodontal ligament not being in the implant.<\/p>\n
Well, that\u2019s not necessarily true, and the research shows that there\u2019s a low incidence of failure rate associated with splinting implants and natural teeth.\u00a0 The only failure rate is whenever you splint implants to natural teeth with a non-permanent cement or if you use interlocks, locking mechanisms.<\/p>\n