<\/p>\n
Dr. Domingue:<\/p>\n
That\u2019s what it is in literature.\u00a0 Literature says if you have anything 5 millimeters or more, consider doing an internal sinus lift.\u00a0 The reason why that is is because if it\u2019s anything more than 5 millimeters, you\u2019re going to be making a very large, very full thickness elevation flap.\u00a0\u00a0 If you\u2019re going to try to do a lateral technique sinus lift, it\u2019s going to be really huge, and there\u2019s going to be a lot of edema.<\/p>\n
So, the technique to do would be to do a crestal approach if it\u2019s more than 5 millimeters.\u00a0 If it\u2019s 5 millimeters or less, you\u2019re going to need a lot more room and also a lot more bone growth.\u00a0 So, a lateral technique would be the one recommended.\u00a0 Look, we do teach a technique on internal sinus lift that the founder of RMDI, Dr. Moody, invented. It\u2019s a great technique to get vertical ridge augmentation in patients that have 5 millimeters to 10 millimeters of bone, and you want to get an extra 3, 4 millimeters.<\/p>\n
<\/p>\n
Dr. Lavine:<\/p>\n
It\u2019s like the lift graft, the Moody Kit.<\/p>\n
<\/p>\n
Dr. Domingue:<\/p>\n
Yeah.\u00a0 You heard about it?\u00a0 It\u2019s actually a great kit.\u00a0 I\u2019ve had great success with it.\u00a0 It\u2019s pretty impressive, and when I started doing that in my practice, I just saw improvements in the success rates.\u00a0 I just started doing it in my practice.\u00a0 I\u2019m like, \u201cOh my gosh.\u00a0 This is just too easy.\u201d\u00a0 It makes lift grafts a whole lot easier, and he has a whole kit.<\/p>\n
<\/p>\n
Dr. Lavine:<\/p>\n
Yeah.\u00a0 So, you showed that case where there was a cyst that was removed.\u00a0 Can you place an implant in the future there?\u00a0 If so, what\u2019s the time frame to attempt to put an implant into an area like that?<\/p>\n
<\/p>\n
Dr. Domingue:<\/p>\n
I\u2019m guessing it was that patient that was had the [01:08:28] on.<\/p>\n
<\/p>\n
Dr. Lavine:<\/p>\n
You showed on where it looked like there was a huge cyst distal to number 18.<\/p>\n
<\/p>\n
Dr. Domingue:<\/p>\n
Oh, the patient with the pathology, right?<\/p>\n
<\/p>\n
Dr. Lavine:<\/p>\n
I think so.<\/p>\n
<\/p>\n
Dr. Domingue:<\/p>\n
Yeah, yeah.\u00a0 For her, she was seen by the local surgeon.\u00a0 He removed the whole cyst out, closed back the area.\u00a0 She is now going to be on her regular recall.\u00a0 The recall and the recommended recall for the odontogenic keratocyst is initially once a month for first six months and then follow up once a year for the next five years.\u00a0 Then, after five years, once every five years, and she\u2019ll continue coming to the office every six months for a routine hygiene.<\/p>\n
Now, for her, in particular, we haven\u2019t addressed it yet, but we\u2019re going to assume obviously a re-appointment.\u00a0 We\u2019re just letting her heal a little more, but whenever she comes back into our office, we will talk about if her tissues have healed well enough in that area, it\u2019s not contraindicated to place an implant local to an area that had odontogenic keratocyst.<\/p>\n
That tooth is still giving her issues.\u00a0 We\u2019re not sure if it\u2019s a fracture molar.\u00a0 We just know she\u2019s had continuous pain and has been treated several times.\u00a0 So, we\u2019re going to look at removing that tooth in the near future and putting in an implant.<\/p>\n
<\/p>\n
Dr. Lavine:<\/p>\n
Okay.\u00a0 A couple of questions here related to antibiotics.\u00a0 I\u2019m not sure if I totally understand this one:\u00a0 What\u2019s the gentamicin amount used?\u00a0 Do you place antibiotic in with the allograft material? Another question is if tetracycline is not available anymore, what do you use instead?<\/p>\n
<\/p>\n
Dr. Domingue:<\/p>\n
Okay.\u00a0 To address the tetracycline, doxycycline.\u00a0 Use doxycycline if you don\u2019t have tetracycline available to you.\u00a0 To address the gentamicin, I don\u2019t remember the doses off the top of my head.\u00a0 I\u2019ll have to look it up for whoever asked that question.\u00a0 Please send me an e-mail, and I\u2019ll e-mail you back the response after the phone call.<\/p>\n
<\/p>\n
Dr. Lavine:<\/p>\n
Okay.\u00a0 How do you know that you actually have a stable implant?\u00a0 Are you doing some resonance frequency? Are you just tapping it? How do you know that it\u2019s ready to be restored?<\/p>\n
<\/p>\n
Dr. Domingue:<\/p>\n
I don\u2019t have the Osstell unit that measures if it\u2019s integrated and to what degree. I don\u2019t have that.\u00a0 We never had that when Dr. Branemark was placing implants.\u00a0 So, usually what I do is at 3 months, 4 months, we\u2019ll take a periapical radiograph, make sure everything looks fine, the bone has collectibly gotten better, there\u2019s no radiofrequencies around there, everything looks perfectly fine.\u00a0 Intraorally, the soft tissue looks perfect.<\/p>\n
We\u2019ll first work out the healing abutment, place on a standard abutment, take our impression, and I\u2019ve never had an issue with losing an implant.\u00a0 When you go to reverse torque, the healing abutment, if the patient yells, \u201cOuch,\u201d when you do that, that\u2019s a clear indication that the implant is not osseointegrated.\u00a0 You\u2019re going to have some granulation tissue around the implant, and it\u2019s not healed yet.\u00a0 So, either advised to remove the implant if it\u2019s that bad or continue and let the patient heal for another four to eight weeks.<\/p>\n
<\/p>\n
Dr. Lavine:<\/p>\n
Okay.\u00a0 What about, let\u2019s say you\u2019re placing the implant, and the bone cracks as you\u2019re screwing it down.\u00a0 What would be the typical course of action?\u00a0 Would you take it out and regraft the membrane at that time?<\/p>\n
<\/p>\n
Dr. Domingue:<\/p>\n
Great question. I\u2019m really excited because we talk about this.\u00a0 So, this is one of those operative complications.\u00a0 You\u2019re creating this perfect osseotomy.\u00a0 The bone looks amazing.\u00a0 You\u2019ve got great healing, great flaps, and then you\u2019re going to put the implant in.\u00a0 You\u2019re not just paying attention, either you get cocky or you\u2019re focused on something else.\u00a0 All of a sudden, you\u2019re buckle bone just fractures.\u00a0 What do you do?<\/p>\n
You spent all this time making the perfect surgery.\u00a0 We\u2019ll show cases of where I\u2019ve had complete bone fracture. Then, we\u2019ve grafted it the day, and it healed perfectly.\u00a0 I\u2019ll also show cases where we\u2019ve grafted the same day we had buckle bone fracture, and there\u2019s an aesthetic risk associated with it.<\/p>\n
Then, we\u2019ll actually show cases where this is a clear indication to remove the implant, graft the site, suture the tissue, let the area heal, and then, come back again another time because this is going to be an aesthetic nightmare.\u00a0 It\u2019s also going to be a spinner implant, and it\u2019s just a poor area for wound healing.\u00a0 It\u2019s just a poor area for implant, and you need to abort it, graft, and come back at a later time.<\/p>\n
So, that happens often.\u00a0 It even happens when you\u2019re doing your osseotomy.\u00a0 You create the perfect osseotomy, and then, all of a sudden, you blow out the bubble because you weren\u2019t paying attention.\u00a0 We\u2019ll cover how to treat that with membranes, bone grafting, and ridge augmentation, site preservation to either get primary closure and place your implants the same day or just get primary closure with a bone graft.<\/p>\n
<\/p>\n
Dr. Lavine:<\/p>\n
What do you do with those spinners?\u00a0 You\u2019ve got that spinner.\u00a0 Do you bury it in weight, assuming that you can\u2019t put a larger diameter implant in there?<\/p>\n
<\/p>\n
Dr. Domingue:<\/p>\n
That\u2019s the first thing I would say.\u00a0 I didn\u2019t show a case today, but I\u2019ve had a case where I put a 4.6 millimeter implant, and it was a spinner.\u00a0 What a disappointment because I did a beautiful internal sinus lift.\u00a0 Then, I come out with a spinner.\u00a0 Well, I moved over to a larger diameter implant, and it was able to suffice.\u00a0 If you can\u2019t, what do you do?<\/p>\n
If you can go with a longer implant, that\u2019s advised.\u00a0 If you have a 10.5 millimeter implant, why not drill the osseotomy a little bit deeper then put a longer implant?\u00a0 If you still can\u2019t get away and you still have a spinner, do you take it out and graft it?\u00a0 If it\u2019s an anterior site, that\u2019s a good question.\u00a0 You\u2019re going to have to weigh the risk associated with the patient coming in.\u00a0 There\u2019s going to be an infection there.\u00a0 You\u2019re going to remove the implant and graft again.\u00a0 That\u2019s going to cost you tons of time and tons of money, and you\u2019re never going to make enough money off that case. That\u2019s something we\u2019ll talk about, too.<\/p>\n
Bone graft is expensive.\u00a0 Membranes are very expensive, and what are we charging to preserve a socket?\u00a0 What are we charging to implant and bone graft and soft tissue graft whenever we do these procedures?\u00a0 Commonly, dentists will work a patient up for a single unit implant and say, \u201cLook.\u00a0 We\u2019re going to charge for the implant abutment crown. \u00a0Let\u2019s do it,\u201d and they\u2019re not really focusing on the big picture.\u00a0 The big picture is when you get in there, it\u2019s like, \u201cOh my gosh.\u00a0 There\u2019s absolutely no bone.\u00a0 I\u2019m going to have to bone graft this area.\u00a0 There goes $150 of bone graft that I have to eat.\u00a0 I\u2019m going to put a membrane on that area. There goes another $100.\u201d<\/p>\n
So, instead of pre-operatively charging the patient and realizing that ahead of time, we just ate up $300 worth of material, which could have potentially posed a lot better off with the patient.\u00a0 Then, say you do put a spinner in, there you go losing the implant.\u00a0 Now, you have to re bone graft that area, wait for it to heal again, and put them in the provisional.\u00a0 That\u2019s tons of your time.\u00a0 Talk about losing money out the door.\u00a0 That\u2019s tons of your time and effort that just gets completely lost.<\/p>\n
So, the economics behind dental implants is something that we\u2019re definitely going to be addressing and how that\u2019s related to complications related to the implant industry.<\/p>\n
So, for the spinners, weight the risks. If you want to risk putting an implant in, that\u2019s your choice.\u00a0 I\u2019ve done it both ways.\u00a0 I\u2019ve placed a spinner in, and I\u2019ve had success.\u00a0 I\u2019ve placed spinners in and have not had success, and it\u2019s just something that if you\u2019re willing to risk the complications associated with spinners not working out.\u00a0 If you\u2019re not, take it out and graft the area.<\/p>\n
<\/p>\n
Dr. Lavine:<\/p>\n
Okay.\u00a0 We did have a question about whether this session\u2019s being recorded.\u00a0 The answer is yes.\u00a0 All of you are going to be a sent a link, probably by tomorrow, that you can download and watch the entire recorded webinar at your convenience.\u00a0 So, don\u2019t worry about that.<\/p>\n
A few more questions here, and then, we\u2019re probably going to wrap it up.\u00a0 Do you use internal or external implants?\u00a0\u00a0 I guess they\u2019re asking about the hex.<\/p>\n
<\/p>\n
Dr. Domingue:<\/p>\n
I used internal hexed implants.\u00a0 If I ever would use an external hexed implant, do you guys remember that case that we showed earlier where it was a full arch, six implants on the lower where I increased the band of attached tissue?\u00a0 On that case, the prosthetics was very difficult, and again, we\u2019ll talk about this in historic complications.\u00a0 It was very difficult with internal hex, and the way we did it was we had to use non-hex abutments to restore that case.\u00a0 In that case, it would have been really nice to have some external hexed implants to restore that case, which would have made my life so much easier.\u00a0 Typically, internal hexed implants as well.\u00a0 I used platform switched laser lock implants.<\/p>\n","protected":false},"excerpt":{"rendered":"
Dr. Domingue: That\u2019s what it is in literature.\u00a0 Literature says if you have anything 5 millimeters or more, consider doing an internal sinus lift.\u00a0 The reason why that is is because if it\u2019s anything more than 5 millimeters, you\u2019re going to be making a very large, very full thickness elevation flap.\u00a0\u00a0 If you\u2019re going […]<\/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-200","post","type-post","status-publish","format-standard","hentry","category-detox-foot-patches"],"_links":{"self":[{"href":"http:\/\/footpatches.com\/detox\/wp-json\/wp\/v2\/posts\/200","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=200"}],"version-history":[{"count":1,"href":"http:\/\/footpatches.com\/detox\/wp-json\/wp\/v2\/posts\/200\/revisions"}],"predecessor-version":[{"id":201,"href":"http:\/\/footpatches.com\/detox\/wp-json\/wp\/v2\/posts\/200\/revisions\/201"}],"wp:attachment":[{"href":"http:\/\/footpatches.com\/detox\/wp-json\/wp\/v2\/media?parent=200"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"http:\/\/footpatches.com\/detox\/wp-json\/wp\/v2\/categories?post=200"},{"taxonomy":"post_tag","embeddable":true,"href":"http:\/\/footpatches.com\/detox\/wp-json\/wp\/v2\/tags?post=200"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}