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Sunday, January 3, 2010

Extra Wide Implants for Immediate Placement: Any Experience with These? | OsseoNews Discussions on Dental Implants

Extra Wide Implants for Immediate Placement: Any Experience with These? | OsseoNews Discussions on Dental Implants: "K. F. Chow BDS., FDSRCS November 28th, 2009

I agree with Professor Tarek from that ancient city of knowledge, Alexandria. Its got the largest library in the ancient world. His approach is very sensible because it allows the bone and mucosa to heal and any infection to disappear. A 3.5mm diameter implant is reasonable as it allows plenty of marginal bone around it. I believe that the learned Professor will place implants that are at least 10mm long or more, based on the quality and quantity of the bone available.

The assumption that the fixtures used should at least match the size of the roots of the teeth that it is replacing is fallacious or to say it simply, incorrect.

The natural tooth is attached to the bone via a highly sophisticated biological structure called the periodontal apparatus. The dental implant is attached via osseointegration, a form of ankylosis. This normally pathologic occurence is now being used to attach all our much vaunted titanium screw implants. The surface area for effective ankylosis for the implant is much less than is required by the natural tooth for the periodontal apparatus[as we all know]. Briefly, it means the titanium fixture can be smaller in surface area than the tooth that it is replacing….probably only half is enough!

Folks, it means that we need not copy Branemark’s original assumption, which is reasonable at the time. But now with hindsight and understanding of osseointegation, we can use smaller-than-the-root implants and therefore Professor Tarek is right.

As for the wide diameter implants, I use them too for immediate extraction of molar cases. It gives good primary stability, cuts down on bone graft and gives good emergence profile….and of course faster turnaround for the patient and faster cashflow..sic.
But I am a bit worried about the extra large iatrogenic pocket that will result. The pocket will not only be vertical but horizontal since the surface of the larrrrge diameter implant will not be covered with bone but connective tissue which…err…does not integrate to titanium..what.?.

Got to shut up now before I decide to stop messing around with implants.**@@!"

Extra Wide Implants for Immediate Placement: Any Experience with These? | OsseoNews Discussions on Dental Implants

Extra Wide Implants for Immediate Placement: Any Experience with These? | OsseoNews Discussions on Dental Implants: "*
December 15th, 2009

Dear osurg,

“Iatrogenic”, according to Webster’s is defined as, “induced inadvertently by a physician”.

When we insert a dental implant into the bone and gums, we create a pocket around the neck of the implant as it traverses through the gum and into the oral cavity. This pocket is different from the normal gingival sulcus that is found around a normal tooth. When the gingival sulcus become diseased due to infection, trauma or abnormal immune response……it becomes inflamed and deeper and the diseased state is then called a pocket. I call the corresponding sulcus around the dental implant as it emerges into the mouth a pocket because it is not normal but a pathology. In this case the pathology is physician-induced and therefore iatrogenic!

If we examine the pocket around the implant histologically, it is a vast difference from that of a normal gingival sulcus. There are no true fibrous attachment like on a real tooth, only a pseudo-attachment and connective tissue that contains a higher number of defense cells than normal.

Yea, everytime we place a dental implant, we create a pocket….. a pathology…yep…..a diseased state. It is a fact that we must recognise so that we will use dental implants judiciously….only when we are convinced that the new pathology is better than the pathology it is replacing….to put it bluntly. Remember the first maxim of the Hippocratic Oath….first do not make it worse…err to paraphrase “do no harm”.

All well integrated dental implants possess pockets… thus what you say is true, “If you have pockets when your implant is healed you have a problem.” Every dentist who places implants should recognise that they have created problematic pockets that they must check regularly and maintain at status quo as far as possible. It is not nonsense, it is a histologic fact that we self enthroned “implantologists” should accept and therefore treat responsibly. The alternative would be neglect with the accompanying consequences.

Dr K.F.Chow