<\/p>\n
Dr. Lavine:<\/p>\n
Okay.\u00a0 Can you pull up the slides where you showed the website again?\u00a0 We have a couple of questions about the actual course.\u00a0 So, there it is.\u00a0 It\u2019s rockymountaindentalinstitute.com.\u00a0 You can see all the courses there, and we\u2019ve been very fortunate to have Dr. Lingo and Dr. Cummings and Dr. McCracken who are all speakers.\u00a0 They\u2019ve done webinars in the past, and I would encourage people to come your course.\u00a0 You said it\u2019s March 14th<\/sup>, correct?<\/p>\n <\/p>\n Dr. Domingue:<\/p>\n It\u2019s March 14th<\/sup>.\u00a0 Yes, yes.<\/p>\n <\/p>\n Dr. Lavine:<\/p>\n Okay.\u00a0 What about the restoration.\u00a0 Screw-retained, cement.\u00a0 Do you have a strong preference for one or the other?<\/p>\n <\/p>\n <\/p>\n Dr. Domingue:<\/p>\n Screw-retained, we do both in our practice.\u00a0 We screw retain implant crowns, and we also cement retain implant crowns.\u00a0 There\u2019s protocols to both.\u00a0 If you\u2019re going to have less than ideal vertical dimension, you\u2019re going to have to screw retain your implant crown.\u00a0 You\u2019re not going to have enough room to make an abutment and a crown.\u00a0 If you have anything less than 8 millimeters, it\u2019s going to have to be a screw-retained crown.\u00a0 If you\u2019re going to have anything more than 8 millimeters, it really doesn\u2019t matter.\u00a0 You can do either or.<\/p>\n I do often screw retain implant hybrids. We do single unit crowns.\u00a0 We do full arch screw retain.\u00a0 It just depends on the patient\u2019s needs.\u00a0 It depends on what I feel is necessary for the case, but there is a place in implant dentistry for both.<\/p>\n <\/p>\n Dr. Lavine:<\/p>\n Okay.\u00a0 Immediate implants, implants around sockets are not. Is there a general rule of thumb about when you\u2019re going to graft?\u00a0 Is there a certain amount of space that you\u2019re comfortable with or not comfortable with?\u00a0 Does it depend on how integrated the implant is?\u00a0 How do people deal with the fact that there\u2019s almost always going to be some space there?<\/p>\n <\/p>\n <\/p>\n Dr. Domingue:<\/p>\n Graft it.\u00a0 Graft it routinely.\u00a0 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, \u201cMy tooth is broken.\u201d\u00a0 Well, you need to take it out.\u00a0 We\u2019re going to do this.\u00a0 We\u2019re going to do it that day.\u00a0 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.<\/p>\n Like you said, we either have one root, two roots, or three roots sometimes, and implants are conical tapered.\u00a0 They\u2019re not definitely the same anatomy as a natural tooth, but they don\u2019t have to have the same anatomy as a natural tooth.\u00a0 Typically, maxillary anterior teeth are going to be much more buckle-oriented that your implant is going to be.\u00a0 So, you\u2019re going to have to create a different emergent profile for the implant and have plans for that.<\/p>\n Let\u2019s say, picking on a maxillary anterior region, if we\u2019re going to place an implant more towards the palate and gauge the palatable bone to get a semi-force torque, we\u2019re going to have a big defect where the roots of the maxillary anterior where. So, that\u2019s going to grafted.\u00a0 We\u2019ll 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.<\/p>\n Screw down a cover screw to prevent bone from getting to that area.\u00a0 Grasp the buckle defect with some bone. Unscrew the prosthesis, and I use thick abutments routine in our practice.\u00a0 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.<\/p>\n <\/p>\n Dr. Lavine:<\/p>\n Yeah.\u00a0 Do you recommend any resorbable membranes that stick around long term when left exposed?<\/p>\n <\/p>\n Dr. Domingue:<\/p>\n A lot o people like GORE-TEX\u00ae membranes.\u00a0 I don\u2019t remember the name of the company, but they make GORE-TEX\u00ae titanium-reinforced membrane.<\/p>\n <\/p>\n Dr. Lavine:<\/p>\n But I said resorbable so\u2026<\/p>\n <\/p>\n Dr. Domingue:<\/p>\n Oh, resorbable that lasts a long time when exposed?\u00a0 I don\u2019t know a lot of membranes that last for a long time.\u00a0 Once they get inside and saliva pours into the membrane, usually they degrade pretty quickly.\u00a0 So, I don\u2019t have any.\u00a0 Whenever you use resorbable membranes, it\u2019s advised to get, if not primary closure, get as close to primary closure as possible, but if you\u2019re going to have a big exposure of resorbable membrane, you have to expect that membrane to resorb pretty quickly.<\/p>\n <\/p>\n Dr. Lavine:<\/p>\n Okay.\u00a0 Any thoughts on foundation?<\/p>\n <\/p>\n Dr. Domingue:<\/p>\n Yeah.\u00a0 I believe I used to use foundation in residency, but it\u2019s a bovine collagen material.\u00a0 It\u2019s conical in form, and there\u2019s different sizes, small, medium large.\u00a0 They\u2019re very, very inexpensive, and they\u2019re used for socket preservations.\u00a0 It\u2019s porous.\u00a0 So, the idea would be when you remove a tooth degranulated area, instead of using bone graft material that\u2019s expensive, you can use these bovine collagen membranes.\u00a0 It\u2019s a membrane\/socket preservation seal.\u00a0 They work. They absolutely work, and there is a place for them in there.\u00a0 So, yeah, that is a good one.<\/p>\n <\/p>\n Dr. Lavine:<\/p>\n Okay.\u00a0 What\u2019s your e-mail address again?\u00a0 I know some people were interested in being able to follow up with you.<\/p>\n <\/p>\n Dr. Domingue:<\/p>\n 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.<\/p>\n <\/p>\n Dr. Lavine:<\/p>\n We did have a question about the graft kit that Dr. Moody uses.\u00a0 He\u2019s on the call. I don\u2019t know, Justin, if you want to talk about the graft kit, or do you know more about it, Danny?\u00a0 Are you there?<\/p>\n <\/p>\n Dr. Domingue:<\/p>\n The graft kit.\u00a0 I don\u2019t know if where you would get the graft kit from.\u00a0 I just got it from Dr. Moody just because he\u2019s a friend of mine.<\/p>\n <\/p>\n Dr. Lavine:<\/p>\n Okay.\u00a0 He\u2019s not mic\u2019d up.<\/p>\n <\/p>\n <\/p>\n Dr. Domingue:<\/p>\n They do have them at the Rocky Mountain Dental Institute for sale.\u00a0 You can purchase one.\u00a0 They\u2019re not very expensive.\u00a0 They\u2019re I don\u2019t know. I don\u2019t remember the cost or how much I paid for it, but they\u2019re fairly inexpensive.\u00a0 They\u2019re really, really accurate.<\/p>\n <\/p>\n Dr. Lavine:<\/p>\n People could call up if they want to get more information about the kit.<\/p>\n <\/p>\n Dr. Domingue:<\/p>\n Absolutely.\u00a0 You can call the 1-800 number and ask to speak to Genie, and she\u2019ll give you much more information on that.<\/p>\n <\/p>\n Dr. Lavine:<\/p>\n Okay.\u00a0 What about tumor bone?\u00a0 Have you ever used it or recommended it?<\/p>\n <\/p>\n Dr. Domingue:<\/p>\n I have not used that so I don\u2019t really, I can\u2019t really make a statement on that.\u00a0 Tumor bone?<\/p>\n <\/p>\n Dr. Lavine:<\/p>\n Okay.\u00a0 Another follow-up question on the foundation.\u00a0 Are you striving for a 100% primary closure when you\u2019re using foundation?<\/p>\n <\/p>\n Dr. Domingue:<\/p>\n I do.\u00a0 I try to get primary closure whenever I use foundation.\u00a0 It\u2019s great to use, and it\u2019s really easy.\u00a0 It\u2019s already pre-formed.\u00a0 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.\u00a0 Yes.<\/p>\n <\/p>\n Dr. Lavine:<\/p>\n Okay.\u00a0 For most of your cases, since they\u2019re relatively easy cases, are you always using a splint, a stent, or are you free handing it?\u00a0 How do you typically handle most of your cases?<\/p>\n <\/p>\n Dr. Domingue:<\/p>\n Like I said earlier, I don\u2019t have the statistics in front of me and I need to work on that, but I\u2019d probably say that about 60% to 70% of the implants that we place in our practice are immediate placement.\u00a0 Because of that, you\u2019re not going to use a surgical guided stent for that.\u00a0 What I\u2019m trying to get to, Lorne, is I\u2019m trying to get using surgical stents more in my practice because it\u2019s a quicker surgery time for me.\u00a0 It\u2019s a quicker surgery time for the patient.\u00a0 There\u2019s less morbidity associated with guided surgery.\u00a0 It\u2019s quicker.\u00a0 There\u2019s all types of advantages.<\/p>\n The disadvantage to using surgical guidance is there\u2019s a lot more work before the patient gets in the office.\u00a0 \u00a0There\u2019s a lot more work for me on my computer, dialing in in English, getting the implants in the proper orientation.\u00a0 Then, getting that outsourced for a surgical guide and there\u2019s a cost associated with that.\u00a0 Implants are expensive enough as they are, you\u2019d 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.<\/p>\n It\u2019s an area of implant dentistry that\u2019s a nuance for a lot of guys that haven\u2019t done a lot of implant surgery.\u00a0 Like I said, I\u2019ve only done a handful of guided surgeries, but it\u2019s something that I definitely want to incorporate more in my practice.<\/p>\n <\/p>\n Dr. Lavine:<\/p>\n Okay.\u00a0 We\u2019re running out of time.\u00a0 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.\u00a0 His e-mail is justin@rockymountaindentalinstiitute.com.<\/p>\n Danny, it\u2019s always a sign of a good webinar to see what the attendance is like, how many people dropped off towards the end.\u00a0 We actually have significantly more people on the call than we did when it started.\u00a0 So, that is always a good sign.\u00a0 So, I really want to thank you.\u00a0 This was a really great webinar.<\/p>\n As I\u2019ve mentioned, a number of our clients have been to some of the other courses that Dr. Lingle\u2019s done and Dr. Cummings and Dr. McCracken.\u00a0 We don\u2019t have any reports on yours yet, but, again, that\u2019s still six weeks away.\u00a0 I would highly encourage people to consider coming out to take the course.<\/p>\n Obviously, you\u2019re going to be covering a lot of information, live course.\u00a0 You can\u2019t beat it.\u00a0 I just want to thank you again for being on the call because this has been one of the best webinars we\u2019ve had.<\/p>\n <\/p>\n Dr. Domingue:<\/p>\n I appreciate it, Lorne.\u00a0 Thank you so much.\u00a0 Thanks, everybody, for sticking around, and, again, if you have any questions, let me know.\u00a0 I look forward to seeing all of you guys in March.<\/p>\n <\/p>\n Dr. Lavine:<\/p>\n Thank you, everyone, for being on the webinar.\u00a0 We know you have lots of things to keep your life busy, and taking the time was very much appreciated.\u00a0 Thanks, again, to Rocky Mountain Dental Institute, just a real class act.\u00a0 I highly encourage you to go to the website, check out their courses.<\/p>\n 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.\u00a0 So, I want to thank you both.\u00a0 I thought this was a great presentation.\u00a0 As most of you know, we do webinars on a regular basis.\u00a0 We\u2019ve got more coming up.\u00a0 I think our next one is on nitrous oxide next week.\u00a0 We\u2019ve got a couple of other ones, six months smiles.<\/p>\n We look forward to seeing everyone in future webinars.\u00a0 Good night, everyone.<\/p>\n <\/p>\n Dr. Domingue:<\/p>\n Good night.<\/p>\n","protected":false},"excerpt":{"rendered":" Dr. Lavine: Okay.\u00a0 Can you pull up the slides where you showed the website again?\u00a0 We have a couple of questions about the actual course.\u00a0 So, there it is.\u00a0 It\u2019s rockymountaindentalinstitute.com.\u00a0 You can see all the courses there, and we\u2019ve been very fortunate to have Dr. Lingo and Dr. Cummings and Dr. McCracken who 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