Dental Implantology

MINIMIZED DENTAL IMPLANT REPLACEMENT OF THE UPPER LEFT CANINE IMMEDIATELY AFTER EXTRACTION

2011-12-21T00:05:00.000-08:00

This lady presented with a retained primary left canine due to a congenitally missing permanent canine. Since it was already mobile and inflamed, we extracted it and immediately placed in a mini dental implant. A composite BUD was moulded on with the MOSTDIMOLD and the resulting abutment was shaped. An impression was taken and sent for a PFM which was then cemented the following visit. In this particular case, there was some resorption of the adjacent premolar root due probably to the prolonged retention of the chronically inflamed primary canine next to it. A flap was raised and all infamed tissue was curretted thoroughly before placement of the mini. Three years later, an xray revealed that the resorbed portion of the root has been filled with bone and the implant supported canine was still looking good and biting strong.

The bone had filled up the socket and climbed up the mini dental implant to the max, thus giving the mucosa good support, hence the wonderful aesthetics.

Put minis in the hands of the GPs and minimized dental implants will become the main workhorse of implant dentistry. The future of implant dentistry lies mini dental implants in the trained and skilled hands of the GPs!

NARROW DIAMETER DENTAL IMPLANTS: POSTED IN OSSEONEWS

2011-11-23T02:18:00.000-08:00

K. F. Chow BDS., FDSRCS says:

October 23, 2009 at 11:26 am

THE CASE FOR NARROW DIAMETERS/MINIS/REDUCED DIAMETERS/ MINIMIZED DENTAL IMPLANTS/MOSTDIS

Narrow diameter dental implants are being increasingly used not only to stabilize dentures but also for long term applications like crowns and bridges. I agree with Carl in that there is no such thing as an absolute contraindication in medicine. Even botox which will kill you if injected into your bloodstream is used ingeniously and judiciously to extend the youthful looks of people. The key word is “judiciously”. Know your medicine well and know what you want to do with it and then you can apply it safely and usefully.

It is significant that one of the doyens of implant dentistry has recognized that narrow diameters have their uses especially in narrow ridges and in suitable bone. I started out with conventionals and with the advent of minis, incorporated them into my treatment planning and in many complex cases have successfully integrated them both into my treatment planning taking into consideration the patient’s expectations and budget,the materials available and their limitations and my own experience, knowledge and skill.

However, with the greatest of respect, having read the classic Contemporary Implant Dentistry, I wish to highlight some misconceptions and give my opinion.

As pointed out earlier, many narrow diameters or minis used for fixed applications are 2.4mm to 2.9mm in diameter and are made of solid titanium alloy grade 5. They are certainly stronger than say a 4mm diameter fixture that has a hole in the middle to receive an abutment. Say the abutment is 2mm in diameter. That leaves the surrounding rim with a thickness of only 1mm! That is weaker definitely than a solid 2.5mm diameter mini. Furthermore, many of the conventional fixtures are made of titanium grade 3 or 4 which is 99.9% pure titanium and is softer and therefore weaker than the alloy.

One piece minis heal very well if they are placed in with a torque of at least 35 to 50ncm.Reason being that the healing challenge is much less than conventionals and also the transmucosal wound is very small, so that chances of infection in a normal patient is minimal.

As for the misconception that the surface area is insufficient, Paresh Patel has given an eloquent correction to that. Minis are usually placed longer than conventionals and in multiples. So as Patel has pointed out, two 2.5 by 10mm minis give a total surface area of 157sq mm. This has a greater surface area than a conventional of 4 by 10mm which gives only 125sq mm. 2.5 by 13mm gives 100sq mm. 2.5 by 16mm gives 125sq mm. All these are commonly used such that the argument of insufficient surface area for osseointegration holds no water.

The initial or primary stability of minis, I find often surpasses that of conventionals. In fact, I surmise that because of the minimal trauma and small entrance, the surrounding bone and soft tissue has overwhelming healing advantage when compared to conventionals that invokes a much greater healing challenge to the surrounding tissues. The overwhelming healing advantage in the context of minis may mean that the classical necrotic margin phase of osseointegration may be bypassed and osseointegration in the case of minis may be taking place almost immediately. Anyone wants to do a PhD on this?

Narrow diameter users must concede however that the charges of inadequate prosthodontic solutions to solve the problems of non-parallellism, insufficient prosthetic components, and poor emergence profile may have some credence. These problems I believe are being sorted out. As it is, narrow diameters or minis are here to stay and will be increasingly integrated into treatment plans to cater to all sorts of situations that it can solve much better than conventionals. I look forward to minis making great strides to make the benefits of implant dentistry affordable to everyone who needs them, and not just to the well-off only. I forsee that they will play an increasingly greater part in the development of implant dentistry and am preparing a book…”Minimized Dental Implants” and hope to outline and deliver elegant prosthodontic solutions to minis that will address the current shortcomings as pointed out.

ECTODERMAL DYSPLASIA SEEN SINCE AGE 8 NOW 13. FINISH WITH MINIS?

2011-03-24T02:03:00.000-07:00

Mother had been searching all over the country for a dentist willing to treat her son. With some trepedition took it on. First visit refused even to open the mouth. Spoke with the patient and asked this 8year old to come again. Gave him a small gift. Got these models only on the third visit.

At 10 years old bracketed the two centrals and approximated the two teeth. By now patient has gotten used to visiting us and being comfortable in the dental chair. Parents and child becoming more positive and encouraged as they see the two centrals attaining a more natural position.

Retained the centrals together with a flat wire and composite. What next ?!?!

We raised the bite to a more normal vertical dimension with over crowns on the posterior molars. Observe the edentulous ridges. They have never ever hosted teeth before and cannot then be called alveolar bone.
How are we going to restore this 13 year old's dentition?

A pair of removable acrylic partial dentures with stabilizing stainless steel clasps is not too bad a temporization. In fact the boy was very pleased and grinned from molar to molar. And the parents were almost ecstatic. Are minis/narrow diameters/small diameters the best bet for this boy? Or are we going to place conventionals with the accompanying bone grafts etc. Methinks I will place minis cos I can remove them and reposition them at will as the youngun matures and I have to modify his teeth upwards to match his growth until maturity. Not only that, I will use minis for the final "permanents" or more accurately and realistically speaking even for all our unchallenged patients, for long term use in supporting the necessary crowns and bridges. Minis the best...... simpler..... faster...... cheaper........ stronger .....more versatile!!!!!!
Especially for ectodermal dysplasia may well be the treatment of choice!!

REPLACING MANDIBULAR FREE END SADDLE WITH THE BUDDY SYSTEM

2011-01-11T07:22:00.000-08:00

The most distal mini seems to be hitting the IDN. However, because of the small diameter of the mini, little damage is done and most of the time, it is asymptomatic. If symptoms occur, it is a simple matter to remove the mini and the nerve recovers rapidly. Severance or neurometsis of a nerve by a mini is almost impossible, and this is a hugh advantage over conventional sized implants. In this particular case, the xray probably shows an overlap rather than an impingement onto the nerve. There was no sign or symptoms in this case. Thus, a long mini can usually be used even if it seems to enter the nerve canal because it is often only apparent and even if it does so, the nerve is not injured because the nerve occupies only part of the canal and you have to be pretty "lucky" to strike it right in the centre.

Using the Buddy System as described in this blog, we placed mini implants and cemented on the buds. Immediately, we took an impression and sent it to the lab.

And two weeks later........... we cemented the bridge in and the patient went off.

More than a month later, the patient came back. No problems.... he was able to eat quite well on the right side. Can you now look at my left side.... the upper bridge is failing.... please do what you did like on the right side !!

The following pictures is another case of a free end saddle restored with minis.

This is the condition of the composite abutments around the mini-implants and its surrounding soft tissue 3 years later. The PFM bridge came off and had to be recemented. The soft tissue looks healthy and relatively inflammation free. This patient also happens to be a norcturnal bruxer.

6. ECTODERMAL DYSPLASIA: UPRIGHTING THE PEG SHAPED CANINES AND MINIS TO FINISH THE CASE ?

2010-12-05T21:37:00.000-08:00

Then, we use the MOSTDIMUM to make the composite BUD, around which we construct two composite laterals, giving this young man his first ever decent smile line which we hope will continue the process of transforming his life for the better. Wait till you see the final transformation!!!!!!

After grafting the lateral labial surfaces, we place in the minis.

Now, what do we do? We put in two implants for the laterals of course! What sort of dental implants? Ahhhhhhh......... Conventionals are out of the question. Minimized dental implants of course! Even then, we still had to graft the labial surfaces of the laterals to increase the thickness because there was only a wafer thin layer of bone there...... having had no teeth there before at all.... congenitally missing. Here then is a classic case of minis being the treatment of choice!

Open coil springs to upright the two peg shaped microdontic canines. Minis in the empty spaces to complete the case. Conventionals will require bone grafts to increase the width of the ridge. Or bone splits can be attempted. If this is my son, I will just place minis together with the BUDDY SYSTEM and complete the case cheaper, faster, safer stronger than conventionals. Minis with PFMs can be completed in 2 weeks or less, depending on lab support.

ANATOMICAL POSITIONING OF MINIS TO REPLACE UPPER RIGHT MOLAR

2010-12-01T02:12:00.000-08:00

Notice the "CLEANING GROOVE" between the two abutment holes. This is to facilitate the threading of a bridge cleaner and floss in between and thus the undersurface of the crown can be flossed right to the surface of the implants. The ability to floss thus and the smallness of the emergence margin of the mini will arguably prevent any peri-implantitis in the long run.

In contrast, a conventional implant with an aesthetic emergence profile that includes a large emergence margin cannot be flossed all the way to the surface of the implant proper. The emergence profile emerges out of a volcanic-like crater in the gums. The surface of the crater is usually slightly inflamed and together with the large surface will arguably be more susceptible to peri-implantitis as compared to a mini dental implant. Examine the pics below.

Let's continue with the replacement of the upper molar by copying the anatomical/biologically ergonomical/natural/no-brainer/obviously correct positions of the roots.

The upper right first molar was deemed unsavable and extracted. After a short healing period, 2 minis were placed. One on the palatal wall of the sinus and the other on the buccal wall of the sinus. The divinely ordained and inarguably best anatomical positions of the palatal and disto-buccal roots were copied by the two mini dental implants. The undersurface of the crown was designed with a"CLEANING GROOVE" to enable threading of a dental floss and flossing.

JUST ENOUGH IS THE WAY TO GO

2010-11-27T08:08:00.000-08:00

K. F. Chow BDS., FDSRCS November 16th, 2010

“Wolff’s law” states that bone models and remodels in response to the mechanical stresses it experiences so as to produce a minimal-weight structure that is ‘adapted’ to its applied stresses. The behaviour of bone according to Wolff’s law mirrors a fundamental trait of mother nature, i.e. optimal economic use of substance in the performance of a function.

Thus to use a wide diameter implant because there is a wide hole seems to contradict this fundamental. A living organism deserves to be treated according to living rules of life, not static non-living engineering presumptions.

Granted that we need to use a titanium screw, since the tooth germ implant is not yet available….. it does make more organic living sense to use the optimal titanium necessary to allow maximal living tissue around it and thus also minimize the perio pocket that inevitably forms around all dental implants.

Minimized and optimized diameter implants should be the trend and not large diameter dental implants. If we have to put something foreign into the living body, put in the smallest you can. That is what the “GREEN MOVEMENT” is all about…… to use just enough and leave the rest alone and we will save the world !

After all, are we not living in the narrow sweet zone between bleeding to death and clotting to death. And if our beloved earth is 10,000 Km nearer or further from the sun, we will either burn or freeze. Just enough is the way to go.

THE TRANSMUCOSAL PASSAGE OF THE DENTAL IMPLANT AND THE THREE CRITICAL MARGINS

2010-11-16T01:10:00.000-08:00

You can see and hear the lecture on the three critical margins of implant dentistry..... boring though !!
http://www.youtube.com/watch?v=N1GF_82dY1g

Every dental implant ever placed has created an iatrogenic periodontal pocket. Yap! Has created a pathology in the mouth that has a certain amount of inflammatory infiltrate around it that ranges from a low grade perimucositis to a full fledged peri-implantitis.

This fact does militate against the use of large and extra-large diameter implants. The periodontal pocket that accompanies every dental implant we place is a reality that every implant dentist must accept and manage as an acceptable evil for the sake of the greater benefit of being able to replace a lost tooth almost as good as before.

The issue at hand is what is the best approach to managing this compromise for the sake of the larger good. The best replacement for a lost tooth of course is another tooth, and that will likely come in the future in the form of a tooth germ implant or stimulation of germ cells already present but dormant. As that may take another generation or so before we can bypass all the barriers involved, we are stuck with titanium screws for the forseable future with its accompanying perio pocket and the management issues involved.

KAI FOO'S THREE CRITICAL MARGINS

The transmucosal passage of the dental implant is a poor imitation of that of the tooth. The tooth has a very sophisticated self-renewing living cuff around the neck of the tooth as it emerges into a bacteria filled environment.

There have been some claims of hemidesmosomes between the connective tissue and the surface of the implant but they are at best a far cry from the original ! Let us look at a study on the inflammation present around dental implants.

"PERSISTENT ACUTE INFLAMMATION AT THE IMPLANT-ABUTMENT INTERFACE"
is the title of this study. The conclusion suggests that, "these findings may motivate a clinician to place an implant shoulder above the alveolar crest or to utilize a one-piece implant to minimize potential inflammation and/or possible hard or soft-tissue loss".

I would like to further add that narrow diameter dental implants will give a smaller transmucosal passage and therefore arguably lower the amount of inflammation and therefore the chances of peri-implantitis in the long run, provided that satisfactorily hygienic prostheses( read the BUDDY SYSTEM in this blog) are delivered at the same time. This is assuming that narrow diameters are strong enough...... and time is beginning to indicate that it is, when used in the right way and context.

http://smalldentalimplants.blogspot.com/2010_05_01_archive.html

http://smalldentalimplants.blogspot.com/2010/05/buddy-system.html

BONE CLIMBING UP MINI DENTAL IMPLANT

2010-11-09T07:28:00.000-08:00

I think I am seeing things.........but my patient is not complaining and is happily biting away.

The upper right did not have that much bone, so I did a sinus lift .....what.
Hoping to develop and innovate to the point that I can use all minis and still lift the sinus ......or avoid it like some 3 rooted upper molars do....2 buccal roots in the buccal sinus wall and 1 palatal root in the sinus palatal wall.......what?! You canna do that you....... well if He can, why not little me? Will keep ya allll posted.

Oh, this guy did not wanna his lower right bridge yanked and thrown away. So we salvaged it with a mini right through the pontic. Told 'im that its temporary......but now its almost 3 years and he thinks its permanent. Anyways.... I never promised him its permanent!

BONE CLIMBING UP MINI DENTAL IMPLANT

2010-11-09T07:08:00.000-08:00

Immediate extraction and implantation. Bone level is definitely higher than when the implant was first placed.

Well what do you think? Nah........ can't be bone climbing up the implant. Its a camera trick!
Whatever it is, I am really glad and I guess I will continue to do this "miracle" as long as the miracles keep coming and not run out.

Not very scientific, but my patient is not complaining.

BONE CLIMBING UP MINI DENTAL IMPLANT

2010-11-09T06:53:00.000-08:00

A case of immediate extraction and implantation, followed by PFM bridge within 3 weeks. Follow-up xrays showed healthy bone growing around the minis. Not only did the bone seem to have climbed up the second implant from the left, there is also a layer of healthy cortical bone around it and between the minis.

There was a study that claimed that bone remodels around the minis at much higher rates than around a conventional, indicating the possibility that the bone around the mini maybe mainly woven bone and therefore not as good and sound as that around a conventional. Looking at this series of xrays, I am not sure that is true and if so, is it a disadvantage or advantage?

There is also the possibility that the bone that seemed to have climbed up the mini may not be in close intimate contact with the surface of the implant, and therefore may not be osseointegrated. Alright then, I am going to CBVT this one as soon as I think it is necessary enough to buy one.

BONE CLIMBING UP MINI DENTAL IMPLANT

2010-11-09T06:38:00.000-08:00

5. ECTODERMAL DYSPLASIA: BEST TREATMENT PLAN SHOULD INCLUDE MINIS ?

2010-10-15T12:08:00.000-07:00

Now things are beginning to take shape and the first of many spontaneous smiles !! Those are real narrow ridges, considering that they never carried teeth before....... can they even be called alveolar bone?
Narrow ridges with limited budget and desire to smile asap and certainly no inclination for bone grafts and the like ......... MINIS THE BEST BET ?

4. ECTODERMAL DYSPLASIA: ARE MINIS THE BEST BET TO FINISH THIS CASE ?

2010-10-15T12:03:00.000-07:00

Having made it my stated purpose as.... "to make him smile easily and spontaneously", I proceeded to cosmetically bond and reshape his two "draculas" into more innocently looking incisors. With growing inspiration, I orthodontically began approximating them.

3. ECTODERMAL DYSPLASIA: TREATMENT WITH MINIS THE BEST BET ?

2010-10-15T11:54:00.000-07:00

First thing I decided was to raise the bite with over crowns on whatever posterior grinders he had been alloted due to his condition. Ah......that would moderate down his pouting lips and make him less like wanting to kiss you.

2. ECTODERMAL DYSPLASIA: ARE MINIS THE BEST BET IN THE TREATMENT OF THIS CONDITION ?

2010-10-15T11:46:00.000-07:00

Took the appropriate xrays and even did a cephalometric study of his face. What are his expectations and budget ? What is his oral and general condition ? What is my experience and knowledge that I can apply here ? What is the precise diagnosis of his dental condition and what then is an appropriate treatment plan......taking all these into consideration ?

1. ECTODERMAL DYSPLASIA: ARE MINIS THE BEST BET FOR COMPLETING THIS CASE ?

2010-10-15T11:34:00.000-07:00

This 20 year old young man seldom smiles for obvious reasons. I wrote him a referral letter to a dental school...... however he came back. So.......I decided to treat him........ maybe I can help him to smile again..... I said to myself...... not really believing it.

CASE OF REPLACING CONGENITALLY MISSING UPPER LATERAL INCISORS WITH MINIS

2010-09-15T09:08:00.000-07:00

RESORBED MANDIBLE CASE: BEST TREATMENT PLAN? Reply to Dr John Carroll in Osseonews

2010-08-21T03:21:00.000-07:00

Resorbed Mandible Case: Best Treatment Plan?.....A Reply to Dr John Carroll in Osseonews

Dear John Carroll,

Thank you for posting one reference to support your claim on having the numbers and facts on your side. Let me quote the full conclusion that was given in the study that you quoted......

“The results therefore support caution when considering the applicability of implants <= 3mm diameter for single tooth and FPD restorations. Standardized fatigue testing reports for commercially available implants is recommended.”

The keyword is “caution”. The study does not proscribe or condemn outright the use of minis. Instead, it advocates caution because it realizes that its conclusion is deficient and inconclusive because of the following:-

Insufficient data. Only 9 samples from Straumann 3.3mm NN, NobelDirect 3.0 and Hi-Tec TRI-N-13 were tested as prescribed.
It is a simple overload test and not a cyclic loading test. A simple overload test is one in which you just keep pressing on to the test object until it breaks or bend. A cyclic loading test presses onto the test object intermittently at forces equivalent to those common in the average mouth until it breaks or bend.
The introduction to the study itself confesses to its deficiency, “ Cyclic loading tests mimicking years of functional use should ideally be used to test implant designs [Bragger 1999]......ISO 14801; 2003.” Thus a simple overload test is deficient and not conclusive.

Before taking a position, we need much more evidence than from one study that has clear shortcomings. The literature to support the increasing use of minis is quite a lot. I will quote just a few:-

The effect of maximum bite force on marginal bone loss of mini-implants supporting a mandibular overdenture: a randomized control trial. Clinical Oral Implants Res. 2010 Feb.
Immediate obturator stabilization using a mini dental implants. J Prosthodont. 2008 Aug.
Mini-implants to reconstruct missing teeth in severe ridge deficiency and small interdental space: a 5-year series. Implant Dent. 2004 Dec.
Clinical evaluation of single-tooth mini-implant restorations: a five-year retrospective study. J Prosthet Dent. 2000 Jul.
Mini dental implants: An adjunct for retention, stability, and comfort for the edentulous patient. Oral Surg/Med/Pathol/Radiol/Endod 2005
Immediate loading of narrow-diameter implants with overdentures in severely atrophic mandibles. Sang-Choon Cho, Stuart Froum, Chih-Han Tai, Young Sung Cho, Nicholas Elian, Dennis P. Tarnow.

The gold standard is a double blind randomized control trial. Until that comes, we have to depend on case studies and reviews on minis which is currently quite substantial. We should use both regulars and minis judiciously as both has their pros and cons.

Sincerely,

K.F. CHOW BDS., FDSRCS

SOMETHING TO GAIN BESIDES THE PATIENT'S BEST INTEREST.

2010-08-04T11:17:00.000-07:00

THREE YEARS LATER

This gentleman was 78 when he saw me. He was one of those dream patients who never quibbled about payment. He could not eat steak anymore and he wanted to eat steak. "Can you help me doc?"

So we started our rescue of this dental cripple who could not eat, talk or smile properly without having his chrome denture falling down each time. He was rich though and paid me whatever I billed him.....no questions asked.

First we placed conventional sized implants in all the posterior areas where it was necessary. When it came to the front, I had a difficult tussle with my conscience. If I placed conventionals, I would have to do bone grafts and wait from 3 to 6 months before completion. And I would be able to charge him top dollar for the conventionals and the bone grafts. What did I do?

I placed in 4 minis.......yeah...just 4 minis and placed in a PFM bridge, all within a month in 2 visits. And I charged him a third what I would have charged him if I placed him conventionals.

I decided that if he is my father, thats what I would have done ! The best option at his age and lack of bone in the area were minis ! But I will make less dough ! Hang the profits........yea .....tough.......besides gaining the patient's best interest....I gained a sense of satisfaction and a good conscience.

The last picture was taken recently at age 82. Yeah, I did gain more than the patient's best interest.

Here are some more cases. For the atrophic maxillary anterior ridge, minimized dental implants should be the treatment of choice !!

Bone Climbing Up The Mini Dental Implant

2010-08-02T11:24:00.000-07:00

Bone Climbing Up The Mini Dental Implant

2010-08-02T11:09:00.000-07:00

The OPG shows the bridge failing with a fracture on the upper right canine. The bridge was removed and 2 minis were placed together with a new 4 unit bridge 5 years ago. 2 natural teeth were joined with 2 mini implants in a bridge.

The patient did not come back for recall until recently, 5 years later. The bridge was still present and an xray showed healthy cortical bone and not only preservation of bone height but also some bone gain up the distal mini implant. In addition, the 2 natural teeth were preserved. The patient was already in the seventies five years ago.

Bone Climbing Up The Mini Dental Implant

2010-08-02T10:37:00.000-07:00

The lower right first molar was extracted and after a short healing period, 2 minis were placed.
A PFM was placed and the patient happily used it for 2 years but came back then to complain of a toothache which he assumed must be due to the implant we placed for him.

An xray showed that the toothache was due to the second molar distal caries. The incidental finding was a very healthy and strong looking cortical bone around the minis. Amazingly also, bone has climbed at least 2 thread widths up the mini dental implant ! Is this, should this be the new standard of care in implant dentistry ?

Should we then consider using minis more often ? Are minis advantageous over conventionals in some areas ? These are questions that need to be asked objectively and scientifically without prior assumptions.

CASE OF FULL UPPER FULL DENTURE STABILIZATION WITH MINIS

2010-07-26T10:54:00.001-07:00

And there you have it......a stabilized full upper denture that can be snapped on and off at will for whatever reason. Now she can smile and talk and eat and drink without being afraid that it will fall off at the most embarassing moments. You can do it for the uppers and you can do it for the lowers.

We also gave her some O-rings and an instrument called kaifoo to take out and replace the O-rings once they are worn out.

CASE OF FULL UPPER FULL DENTURE STABILIZATION WITH MINIS

2010-07-26T10:50:00.000-07:00

The upper full denture was then snapped on to the implants on the upper jaw. They could also be snapped off at will by the patient whenever she wants for cleaning purposes mainly and sometimes just for fun. Oh, by the way, those tall looking teeth on the lower right are porcelain teeth built onto mini dental implants. They would have looked better with some pink gumwork.

CASE OF FULL UPPER FULL DENTURE STABILIZATION WITH MINIS

2010-07-26T10:46:00.000-07:00

We then cold cured the O-rings and housings into the denture to correspond exactly to the mini O-ball head implants.

CASE OF FULL UPPER FULL DENTURE STABILIZATION WITH MINIS

2010-07-26T10:44:00.000-07:00

So we placed 6 mini O-ball heads into the upper jaws. Minimally invasive, almost bloodless, and immediately load them.

CASE OF FULL UPPER FULL DENTURE STABILIZATION WITH MINIS

2010-07-26T10:41:00.000-07:00

This patient's main complaint was that the upper full denture was too big and keeps falling down when she opens her mouth......a real nuisance and causes her untold misery because she loves to socialise. Please can you help?
This is what we did.

CASE OF FULL LOWER FALSE TEETH STABILISED BY MINI-IMPLANTS

2010-07-22T06:23:00.000-07:00

The old gentleman lived another 6 years and died only recently.......but not until he had umpteen good well chewed meals.......and great enjoyment with the family at all sorts of cafes and restaurants! Minis can change your life for the better faster, cheaper.......and yes....I would dare say better than other alternatives because it is also very much less traumatic!

WATCH OUT FOR THE NEXT POSTING WHERE YOU WILL SEE AN UPPER FULL SET OF FALSE TEETH STABILIZED BY MINIS.

CASE OF FULL LOWER FALSE TEETH STABILISED BY MINI-IMPLANTS

2010-07-22T06:19:00.000-07:00

The lower false teeth could now be snapped-on and snapped-off by the patient himself after some practice and a little guidance. Just about 2 hour job and voila!........That very night, our 76 year old began to eat again and......to enjoy his food again! He was no more shy of going out with the family to eat anymore. His life was changed!........for the better!

CASE OF FULL LOWER FALSE TEETH STABILISED BY MINI-IMPLANTS

2010-07-22T06:15:00.000-07:00

Then, we made 4 holes where the minis were and using O-rings and housings, we cold-cured them to the false set of teeth ........to create a minor miracle!

CASE OF FULL LOWER FALSE TEETH STABILISED BY MINI-IMPLANTS

2010-07-22T06:13:00.000-07:00

First, we placed in 4 O-ball head mini-implants inter foraminally.

CASE OF FULL LOWER FALSE TEETH STABILISED BY MINI-IMPLANTS

2010-07-22T06:10:00.000-07:00

Hello. This is a case of a 76 year old man who has lost interest in living because he cannot eat properly anymore.
His son said that he wanted to die because his lower false teeth moved everytime he tried to chew and he felt very miserable. This is what we did.

REMOVABLE FALSE TEETH FOR THE UPPER JAW

2010-07-19T11:12:00.000-07:00

K. F. Chow BDS., FDSRCS July 19th, 2010

If you are placing 5 conventional implants, you might as well place one more to make it 6 and have a fixed prosthesis. A fixed prosthesis will be more reliable than a removable one because there will be less pulling and pushing of the implant during removal and placement if a removable is used.

And some will also convince you that 4 is enough….all on four.

But if you are placing minis for a removable prosthesis, then place 6 for balance, three on each side between the centrals to the premolars. Place the longest you can and bicortical if possible, because the maxillary bone is softer….and therefore more piling is needed….yeah…like building a house….see.

Bone augmentation is unnecessary and very difficult, as is suggested by Dr Richard Hughes. To raise the height of the maxillary ridge, you will have to use a titanium mesh with bone graft mixed with bone marrow…..and it will take a much longer time, incur more pain to the mouth as well as the pocket.

Go with minis and forget about the bone graft as there will be adequate aesthetics with an acrylic prosthesis with plenty of pink acrylic to fill up the deficiencies.

One Implant Supports 2 Lower Incisors

2010-07-16T09:36:00.001-07:00

K. F. Chow BDS., FDSRCS July 14th, 2010

Even if the patient is willing to pay, Black’s principle of “Conservation of sound tooth structure” should not be forgotten.

The two incisors looks alive and sound to me. The conservative option should always be considered first before other options in the name of aesthetics and “patient willing to pay”.

One Implant Supports 2 Lower Incisors

2010-07-14T08:16:00.001-07:00

K. F. Chow BDS., FDSRCS July 14th, 2010
Yes. Definitely yes, because one 3.5mm diameter implant of length 12mm will have as much if not more surface area than the existing 2 periodontally involved incisors. And we all know that an ankylosed tooth/implant is much more difficult to remove than a periodontal ligamentalised tooth, area for area. Probably half the surface area will do.
And it will prevent loss of the adjacent periodontally involved incisors provided they are root-planed at the same time. Even better if they are splinted to the implant.
Two 1.8mm diameter minis will also suffice. A removable prosthesis is a no no because it will speed up the loss of the incisors, seeing that they are already periodontally compromised and probably mobile.
Please…..no extractions as far as possible. You might as well do a conventional 4unit bridge on the 2 incisors…than to extract them.
K. F. Chow BDS., FDSRCS July 14th, 2010
We must not subcumb to the hubris of thinking that our dental implants are better than real living teeth with real living periodontal ligaments. They are a very good imitation…….only an imitation..though a damn good one.

MY TAKE ON BIOLOGIC WIDTH IN DENTAL IMPLANTS

2010-07-04T07:41:00.001-07:00

K. F. Chow BDS., FDSRCS July 4th, 2010
“Biologic width” as I understand it( please correct me if I am wrong), was a term borrowed from prosthodontics. It denotes the observed resultant distance that develops between the crown-abutment margin of a natural tooth and the crestal bone level when the margin is placed less than 2mm to the crestal bone level. The observed distance or “biological width” is about 2mm.
It means that if we place the crown-abutment margin less than 2mm distance to the crestal bone level, the bone level will resorb or die-back until there is at least a 2mm gap distance to the crown-abutment margin. It was labelled biologic or biological because it was observed as a “natural”(sic) biological response of the bone tissue to the crown-abutment margin. This response was attributed to the irritation that the margin inflicts on the bone for some reason.
And this is the reason that we extrude a class 3 fractured tooth so that when we build a post crown, the distance between the crown margin and the bone level can be increased to at least 2mm to prevent further resorption of the bone and subsequent exposure of the crown margin.
This term was borrowed into implant dentistry to explain why bone always seem to resorb back at least 2mm away from the abutment-fixture margin. The resorption was attributed often to microorganisms finding a snug home in the microgap.
With the advent of “platform switching” and morse tapering the microgaps became non-existent or too small for the microorganisms to squeeze in any more and thus the dieback stopped! Or is it because the margin was designed away from the bone? In many morse taper designed implants, it was observed that bone grew over the abutment-fixture margins! So the former reason may be correct.
Recently, after a marathon lecture by Carl M. I am almost convinced that inadequate attention to the biomechanics of the bite may also be part of the cause of the dieback of bone. Still learning, guys.
Maybe we should try one pieces more often because then we do not have to bother with the abutment-fixture margins and therefore no diebacks but liveons!

THE BUDDY SYSTEM 9

2010-05-27T08:24:00.000-07:00

CONCLUSION

Mini dental implants are here to stay. The short learning curve and simple protocol to place them means that dentists will be trained faster and such treatment is affordable to the vast majority of people especially in the developing world. However, it must be pointed out that basic medical and surgical principles apply and a sound knowledge of oral anatomy, bone physiology and proper treatment planning is essential for long term success. www.smalldentalimplants.blogspot.com/

For the patient, is it better to make a big hole or a small hole in the gums?

For the dentist, is it better to do a simple less problematic procedure, or a complex more problematic procedure which may in the end achieve similar results.

THE BUDDY SYSTEM 8

2010-05-27T08:14:00.001-07:00

THE BUDDY SYSTEM 7

2010-05-27T08:12:00.001-07:00

THE BUDDY SYSTEM 6

2010-05-27T08:11:00.000-07:00

Larger or Smaller Diameter Dental Implant

2010-05-27T08:03:00.000-07:00

K. F. Chow BDS., FDSRCS May 27th, 2010

The primary cause of the failure could be systemic or local. The patient is middle aged, with high BP and high cholesterol, hopefully controlled. Check the patient for diabetes and treat if necessary.

Dues should be paid to Dr Vaziri for highlighting the possible local causes like residual infection left behind by the endodontically treated tooth and the possibly low blood supply to the periodontium of such teeth that may prevent proper osseointegration.

Having said that, Carlos Boudet gave a very reasonable and workable local treatment response to the problem. But the possible systemic causes should be looked at first.

Lastly, a larger diameter implant is an absolute no no.
Besides all the eloquent reasons given earlier by the learned dentists not to do so, I would like to add one more.

Every dental implant we place also comes with a periodontal pocket….yes a pathology…. an iatrogenic condition. Bone will forms a biologic bond with titanium but the gums do not. What we have is a far cry from the sophisticated gingival cuff around a real tooth with the epithelial attachment and a well planned organisation of different types of fibres all designed to prevent infection from penetrating the emergent margin of the tooth.

If we have to make a perio pocket everytime we place and implant, it makes good sense to make a small diameter pocket rather than a larger diameter pocket that comes with a larger diameter implant. If we have to make a hole in the gums, make a small one as far as possible…. a smaller diameter ….not a larger diameter.

Cheers.

Platform Switching and the Three Critical Margins of Dental Implants

2010-05-20T04:14:00.000-07:00

K. F. Chow BDS., FDSRCS May 20th, 2010
The term “platform switching” may be a misnomer. Misnomer means using the wrong word to describe something. The platform that we are referring to is the round surface area on top of the fixture in which the screw hole for the abutment is located. Branemark set the trend by making sure that the abutment fits exactly over the top-surface of fixture, with the periphery flush with each other……which is a logical decision at the time….and everyone copied him…….which always resulted in a “normal” resorption of the bone away from the junction.
The advantage of “platform switching” was discovered when a dentist did not have the right sized abutment to fit flush with the fixture and inserted an abutment whose circumference/undersurface area was smaller than the platform/topsurface area of the fixture. This happily and unintentionally took the junction/microgap/microorganisms away from the bone and thus to the pleasant astonishment of the dentist after reviewing the xray, showed that the so-called acceptable normal resorption of the bone away from the implant ceased!!
Thus “platform switching/shifting” was born. The platform however remained the same and was never switched or shifted. That is why i think that it is a misnomer, i.e. wrong word. What changed was the circumferential size of the abutment. An abutment with a smaller circumference than that of the fixture was then resting on the top-surface of the fixture.
Maybe the right term should be “abutment downsizing” or “footprint reduction” or just simply “platform mismatch” or “margin shifting” or “green technology” or …”gum friendly”…or “shy margins”…….. oh hack…just call it “platform switching” to comply with the aura of mystery and awe that implant dentistry should continue to have for old times sake!!!!!!
If you understand the concept, then you can easily see which implant system is platform switching and which is not.
There are 3 critical margins in implant dentistry. The abutment-fixture margin, the crown-abutment margin and the emergence margin…altogether is found within the transmucosal passage of the implant.
Platform switching has solved the problem of the abutment-fixture margin. Most savvy manufacturers are all moving towards this design. The crown-abutment margin is still unresolved whether you screw or cement, it still poses an inflammatory problem.
As for the emergence margin…..one solution may be to reduce the circumference by reducing the diameter of the emerging dental implant. But with our emphasis on the “emergence profile” for the sake of aesthetics, it is unlikely to be practiced widely. As the Chinese have a saying..”Oi lang…Ng moi mang”…which translates as wanting beauty even at the expense of life and health.
‘Nuff said.
THE THREE CRITICAL MARGINS IN IMPLANT DENTISTRY

THE BUDDY SYSTEM

2010-05-12T11:09:00.000-07:00

Dear Visitors,

Will be in Seoul to attend a Scientific Symposium on Implant Dentistry.
Also will deliver a talk on Narrow Diameter Dental Implants: Its History and Clinical Uses.
Will load the pictures on the Buddy System when I return in a week or so.

Regards.
Dr. Chow

THE BUDDY SYSTEM 5

2010-05-12T10:20:00.001-07:00

A direct impression was then made with a high quality precision type of alginate or silicone/rubber base material. The resulting models were then sent to the dental laboratory to construct the necessary three unit bridge 654/. Alginate is more than adequate because we are not dealing with real teeth but implants and the accuracy obtained is adequate. A temporary bridge may or may not be placed since aesthetics is not a concern here. In this case, no temporary bridge was placed. The BUDs acted as comfort caps over the implants since they were designed to be rounded and smooth.
Once the bridge was constructed, the patient was recalled and after testing in the mouth and adjusting the bite where necessary, the bridge was cemented over the BUDs with a suitable cement. In this case, glass ionomer was used. A temporary cement may be used for the sake of retrievability. Once the excess is removed, the crown and bridge is then functional. The underside of the bridge is accessible to cleaning with a floss and a bridge cleaner with the help of interdental brushes.
This is a patent pending product.

THE BUDDY SYSTEM 4

2010-05-11T09:50:00.000-07:00

A PROSTHODONTIC SOLUTION

FOR THE MINI DENTAL IMPLANT

As a result of the current less than satisfactory prosthodontic solutions for the mini dental implants, a new solution has been developed. This method is called the “BUDDY METHOD” and is described as follows for replacing the right upper premolars and first molar. It can also be used in all parts of the mouth. The method is described as follows:-

Mini dental implants were inserted parallel to each other with 4mm sticking above the gums. This will include the O-ball head and neck with about 0.5 to 1.0mm of the collar sticking above the gum. Minis from Imtec or Intralock or others of similar design can be used.
The BUDs{Bridge Underpinning Devices} were snapped onto the 56/ mini dental implants. The snap-on and snap-off function is simple, repeatable, precise and lends itself to impression taking without easily coming loose or shifting. They are checked to make sure the base of the BUDs are flush with the mucosal surface or are pressing down upon the mucosa from between 0.5 to 1.0mm deep into the mucosa surface. The base of the BUDs are designed such that they will not cut the mucosa but merely compress the mucosa a little, much like that of the pontic of a conventional bridge. After checking that there is good contact between the base of the BUDs and the mucosa surface, the BUDs are then snapped off the heads of the mini dental implants. A permanent cement like polycarboxylate, glass ionomer or zinc phosphate can be placed into the BUDs and they are then snapped back onto the mini dental implants. Once the cement is set, the excess can be removed with a sharp probe or a scaler.
The remaining dental implant for some reason could not be placed parallel to the rest. In order to correct it, a moulding device was loaded with a light cure composite and inserted over the implant head with a rubber dam between the composite and the mucosa and then light-cured. The rubber dam is to give the composite a smooth surface against the gums. The moulding device was removed, leaving a composite BUD over the mini implant. The composite bud was then shaped with a tapered diamond bur in order to gain parallelism with the other 2 implants.

To continue........watch out for some pictures. Check out minimized-dentalimplants.blogspot.com where I am progressively writing a comprehensive book on mini dental implants......cheers!

THE BUDDY SYSTEM 3

2010-05-10T10:41:00.000-07:00

2. IMPRESSION AND ANALOGUE METHOD

A more elegant technique developed with the use of an impression coping on the mini implant head. The coping came off with the impression and then analogues were fitted into the impression copings before pouring the cast models. The crowns and bridges were then built overt these analogues or over the copings which were then incorporated into the prosthesis. A recurring problem with this technique is the tendency of the impression copings to shift or come loose during the impression taking, resulting in inaccuracies.

3. COMPOSITE/GLASS IONOMER/CEMENT BUILDUP METHOD

A sticky material like composite, glass ionomer or a dental cement can be applied on to the mini implant head. The implant head should be etched beforehand with an acid similar to the one used to etch porcelain. Once set, the build-up can be trimmed into the shape of an abutment. A direct impression can be taken for crown and bridge construction in the laboratory. The downside in this approach is the unknown long term effect of the substance contact with the mucosa around the implant. This may cause a chronic low grade inflammation of the mucosa which may one day deteriorate into peri-implantitis and result in failure of the implant.

To be continued.............check out minimized-dentalimplants.blogspot.com where I am progressively writing a comprehensive book on mini dental implants......cheers!

THE BUDDY SYSTEM 2

2010-05-10T07:29:00.000-07:00

THE CURRENT CHALLENGE IN MINI DENTAL IMPLANT TREATMENT

When minis were first used to carry crowns and bridges, the main problems were that the heads of the minis were too small to lend themselves for impression taking and difficult prosthodontic construction of crowns and bridges in the laboratory. When cast, the heads would fracture off easily. Several methods have been devised to overcome this problem:-

FILL UP WITH CEMENT METHOD

The lab technicians simply built up the fractured heads of the minis and then constructed the crown or bridge on top of them. Because of the small diameter of the mini dental implant, the resulting crown always have a base that rests on the mucosa immediately surrounding the emerging implant. This overlapping of the crowns and bridges on the mucosa is universal when restoring mini dental implants. The crowns and bridges were cemented into the patient’s mouth. Whatever gaps present between the crowns and the mini heads were filled up generously with cement. The excess were then removed from around the periphery of the crowns and bridges. These always resulted in a circular margin of cement in direct contact with the mucosa. This direct long term contact of cement to mucosa were assumed to be acceptable and unlikely to cause long term complications. Todd Shatkin’s “FIRST Technique” is basically of this nature and thankfully so far has given little or no problems since it was first used about ten years ago.

FIRST stands for Fabricated Implant Restoration Surgical Technique. This is a highly lab-dependent technique outlined as follows :-

X-rays and models are sent to a FIRST Laboratory.
A precision made surgical stent is made that will determine precisely the number and position of each mini dental implant to be placed. Even the depth to which each implant is placed is determined by the titanium sleeve that is incorporated into the surgical stent.
The final crown and bridge is prefabricated in the FIRST Lab and sent to the dentist together with the surgical stent.
All the dentist has to do is to place in the surgical stent and drill the prescribed holes to the exact depth required, all guided precisely by the surgical stent.
The mini dental implants are then screwed in to the exact depth as indicated by the titanium sleeves built into the stent.
The crown or bridge is tested in the mouth and then filled with a resin cement and cemented into place. All excess cement is removed and the treatment is complete.

To be continued.....................also check out minimized-dentalimplants.blogspot.com where I am working on my book on mini dental implants.

THE BUDDY SYSTEM

2010-05-08T09:54:00.001-07:00

THE BUDDY SYSTEM:

A PROSTHODONTIC SOLUTION

FOR THE MINI DENTAL IMPLANT

Dr. Chow Kai Foo

BDS Singapore, FDSRCS England, Cert. of Implantology Germany, FICD

THE STORY OF MINI DENTAL IMPLANTS

Mini dental implants were initially used as transitionals. One of the first makers were Dentatus of the

U.S.A.

They were placed in between conventional implants so that while the conventionals were osseointegrating, the transitionals were used to support the temporary bridges. However, when the time came to bring the conventionals into function and to remove the transitionals, some of them could not be unscrewed and were found to be osseointegrated. These osseointegrated transitionals were then cut off at the bone level and left in situ. The conventional 2 piece implants were then connected and the prosthodontics completed.

It did not take long for some innovative dentists to decide to use the transitionals to support permanent crowns and bridges. One of them was Dr. Sendax who went on to help form the IMTEC Corporation which produces most of the mini dental implants today.

With the increasing success of mini dental implants, other players began to emerge. Intralock produced the MDL(Mini Drive Lock) mini dental implants. Currently, many companies from countries stretching from Canada, Europe, and all the way to South Korea are rapidly jumping onto the bandwagon to produce mini dental implants which is defined generally as any dental implant whose diameter is anything less than 3mm. The market for minis is currently growing at a rapid clip of 20 to 30% annually, with the IMTEC Corporation leading the pack. It is significant that in 2008, 3M which is a 28 billion USD company bought over the IMTEC Corporation.

WHY DID THIS HAPPEN?

The mini dental implant market is growing rapidly because of the following reasons:-

USFDA approval of IMTEC mini dental implants for long term use. This gave an added boost to many dentists worldwide the confidence to use minis.
The simple surgical procedure involved resulted in rapid healing, shorter treatment time, and a much lower cost than conventional 2 piece dental implants.
Simplicity of instrumentation and placement procedure allows for rapid training of dentists and a much shorter learning curve.
Patients were pleased with the quickness of delivery of the implants and prosthodontics together with the minimal trauma involved. In many cases, patients were pleasantly surprised by the lack of bleeding and pain due to the flapless procedure employed. Many patients have benefited since then, especially in cases of lower full dentures where the loose denture can be stabilized removably in a predictable manner in one visit of one or two hours.

To be continued.........

NARROW DIAMETER DENTAL IMPLANTS

2010-05-08T09:28:00.003-07:00

K. F. Chow BDS., FDSRCS April 6th, 2010
Many of my complex cases are treatment planned with both narrow diameter and regular diameter dental implants. My experience in cases when I use only narrow diameter is that I complete my cases much faster than when it involves regular diameters. As such, it behoves serious practitioners to keep both types in mind when treatment planning because I forsee that we are beginning to shift towards a more balanced and sensible approach rather than a prejudiced and narrow approach.
Cheers!
Richard Hughes, DDS, FAAID, FAAIP, DABOI April 7th, 2010
Dr. Chow: I agree.
sergio April 7th, 2010
Couldn’t agree with you more, Dr.Chow.

NARROW DIAMETER DENTAL IMPLANTS

2010-05-08T09:28:00.001-07:00

K. F. Chow BDS., FDSRCS November 13th, 2009

Thanks for the kind words guys. While I am yet feeling elated and therefore a little brash, let me push the debate a little further.

We all know that the transmucosal passage of the dental implant when compared to the transmucosal passage of an actual, real, original living tooth is actually a pathetic imitation of the real thing. The real thing has a nice epithelial attachment with a nice drain around the tooth constantly flushed with antibacterial substances and prohealth nutrients for the gingivae. Not only that the gingival cuff has circular fibres, connective tissue to tooth fibres, bone to tooth fibres , connective tissue to bone fibres etc. that gives each tooth a nice firm resilient yet elastic cuff around the it. Go review your periodontology texts and see for yourself.

The dental implant has only a pseudo epithelial attachment and a few if any specialised soft tissue fibres and at best is actually an iatrogenic and pathetic imitation of the original! The Archilles heel of dental implants is this transmucosal passage. Peri-implantitis is a problem we all have to tackle like periodontitis. And with dental implant placement growing in the double digits around the world, it is going to be an increasing problem.

The best solution is probably a tooth germ implant which may be a generation away. We may be stuck with dental implants for some time yet.
One way to tackle it and hopefully to decrease the incidence of peri-implantitis may be to decrease the diameter of the implants as it emerges through the mucosa. One shortcoming of conventionals is its large diameter especially done in the name of an aesthetic emergent profile. Narrow diameters may be one of the answers to decreasing and managing the incidence of peri-implantitis.

Nuff said.

NARROW DIAMETER DENTAL IMPLANTS

2010-05-08T09:27:00.000-07:00

Ken Clifford, DDS October 24th, 2009
Dr Chow - Amen to all your comments. There is absolutely no reason not to use mini implants. I have been cementing full arch mini implant hybrid bridges as a denture alternative for the past two years. My opinion is that a CEMENTED bridge on mini implants is an affordable alternative for patients unwilling or unable to pay for the all on four bridges, or the conventional implant porcelain/metal solutions. Cementation to minis eliminates the micromovement responsible for most implant failure in a full arch situation. By using quality denture teeth and a quality denture acrylic with high flexural strength, I can quickly construct a highly aesthetic denture alternative which can be loaded immediately. Patients go home happy, and so do I!
Paresh B Patel October 27th, 2009
Dr. Chow, thank you for your well organized and eloquently articulated thoughts on the current state of mini implants. I look forward to reviewing your text “Minimized Dental Implants”

NARROW DIAMETER DENTAL IMPLANTS

2010-05-08T09:23:00.000-07:00

K. F. Chow BDS., FDSRCS October 23rd, 2009

However, with the greatest of respect, having read the classic Contemporary Implant Dentistry, I wish to highlight some misconceptions and give my opinion.

HOW TO AVOID DOING A SINUS LIFT.

2010-05-07T08:50:00.001-07:00

K. F. Chow BDS., FDSRCS May 7th, 2010

Dear Dr A,

I guess you are another fictitious Doc with an alphabet. Nevertheless, it is an interesting question.

If you do not want to do a sinus lift, any reason will do though it might not be a good one. I myself once did not want to do it because I hated having to make a large opening into the sinus! And if I can avoid it, I did. So I tried crestal lifts invented by Summers. Works, but often found myself having to spend more time than if I just did a lateral window which is more sure and definitive. There are various ingenious ways nowadays, the latest seem to be the “hatch” technique with a special off centre drill.

However, if you want to avoid all these, there are several ways to avoid a sinus lift altogether:-
* Do a conventional bridge on adjacent teeth. Use the tooth in front and the tooth behind the edentulous space. Or a cantilever might work.
* Place an implant in the tuberosity where there is usually more than enough bone and join it to the natural tooth just anterior to the edentulous space.
* Or use MINIs! Do a tripod. 3 minis with the tips cut off at 5mm length, and build a crown on it.
* 2 or 3 Minis carefully threaded into the walls of the sinus on the buccal and the palatal where there is usually 3-5mm thickness of bone. These technique requires a lot of skill and experience though.
* Use short large diameter fixtures from Bicon, Endopore or some of these Korean makers that come in diameters up to 8mm!
* Or like Dr Richard Hughes suggest…. place in a subperiosteal.

Now all of the above require quite a lot of skill and experience…..maybe you might just want to learn to do a lateral window sinus lift which actually, once you get the hang of it may be actually simpler and surer in results!

Cheers.

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

2010-01-03T09:23:00.000-08:00

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

2010-01-03T09:16:00.000-08:00

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.

Regards.
Dr K.F.Chow
*

KAI FOOS RED DRAGONFLY

2009-11-30T07:38:00.000-08:00

One of the most beautiful image of a dragonfly that I ever captured in my garden.
Everytime I look at it, I am reminded how crude our imitations of mother nature is.
And also what a pathetic imitation our dental implants are compared to the real thing.

GRANMA'S NEW FANGIIS!

2009-11-26T09:36:00.000-08:00

AAAAAARGH!! Looookit me new fangiis! Ah ken eeven kleann dem with dem dental flossii what!

GRANMA'S GOT NEW FANGIIIS!

2009-11-25T09:13:00.000-08:00

Hiyaaa Folks! Lost alllmuz all me sky tiith. Me ground tiith there but cannaa grind! Kuz me tiith done rotted under me bridges. Nein soorry fer me. Kleverrr dentiist done plazed new uns! Dem olde iinplants dey call dem. Sum big .....sum smallllll......miniiiis...what! AAAAARGH......dem miniisss wurrkks ai teilll ya. Ya gimme yer fingerrr and triiee......likes what me munching now! C dem baack beig an frunt ar miniis what!

Returning Clinical Judgement From the Lab Back to the Dentist

2009-11-21T08:36:00.000-08:00

Yes. They are mini dental implants. The anterior implant has a composite bud light-cured on. The posterior 2 implants have metal buds cemented on. A direct impression was taken and sent to the lab where the bridge is made the usual way in which conventional crowns and bridges are made but designed to provide a friendly interface with the gums and easy maintenance. With the increasing use of dental implants, the dentist has become more and more lab-dependent to the extent that he/she often seem just like a technician. All the dentist have to do is to send the models and X-ray images to the laboratory and back comes a precision-stent together with the prefabricated crown or bridge. The dentist places the stent, drills the hole and screws in the implant to a preset depth and then cements the crown or bridge. Simple and straightforward but highly lab-dependent and turns the dentist from a clinician into a technician. The bud and direct impression approach gives back the dentist the responsibility of clinical judgement and the satisfaction of doing things intelligently without having to rely on a lab to instruct him exactly where and how deep to place a dental implant. If the current trend of lab-dependency goes on, the dentist does not have to think much any more and can just follow the exact instructions from the lab technician. And you can be sure that there will be many clinical problems that will arise as a result of the increasing surrender of clinical judgement to the dental laboratory. The laboratory cannot eyeball what the dentist can in the immediate clinical situation.

Maintenance of Hygiene for a Minidentalimplant Bridge

2009-11-20T07:43:00.000-08:00

Maintenance of hygiene for a bridge is important. This minidentalimplant bridge can be flossed anteriorly and posteriorly and also in between the implant abutments. The bridge is designed so that the interproximal clefts are generally between the mini dental implants. Thus it is important not only to place the minis parallel but also precisely in the middle of where a normal tooth is expected to be. This will lend itself to ease of bridge design for the technician as well as ease of flossing in between the implants with the help of a bridge cleaner. The narrow diameter of the minis results in a corresponding narrow transmucosal passage of the dental implant as it traverses the gum and emerges into the mouth. Logically then, it will have a lower chance of infection and peri-implantitis as compared to conventional larger diameter implants especially accompanied by an aesthetic emergence profile that demands a broader transmucosal passage especially at the point where it emerges into the mouth. So, not only can this design be flossed right up to the implant circumference but it also has a smaller passage for possible pathogens to invade. This is an advantage over conventionals provided the smaller diameter is just as strong as a larger diameter conventional.Since the small diameter implant is a one piece solid implant as compared to the larger diameter implant which is usually 2 piece and therefore has a hole in the fixture to receive the abutment, leaving a narrow circumferential margin of metal of 1mm or less, it follows that the 2.5mm diameter one piece solid implant may arguably be stronger than a 4mm diameter hollow dental implant.

2009-11-19T08:56:00.000-08:00

This the final result after the rubberdam has been removed. Later, I will show a photo showing how this bridge can be maintained by cleaning the underside or mucosa interface of the porcelain fused to metal bridge.
This is important for the prevention of infection and for the longterm health of the soft tissue around the dental implant. Thus we can replace missing teeth that not only look good, but bite well and last long.

Dental Implantology: Mini Implant Abutments

2009-11-14T05:46:00.000-08:00

Dental Implantology: Mini Implant Abutments

One of the ongoing problems in Mini Implant Dentistry is the need for an elegant prosthodontic solution. The BUDs are my contribution to this need. Here the 3 unit bridge is being cemented over the BUDs as seen in the previous picture. The BUDs are cemented or bonded over the mini implant heads, and the excess cement cleared off immediately. The advantage here is that we can actually eyeball it to make sure that no excess cement is left and this will prevent any inflammation or beachhead for pathogens to gain a foothold on and eventually cause peri-implantitis.

A rubber dam is used during cementation so as to prevent cement from seeping into the transmucosal passage of the dental implants.Hope my readers found them interesting.

Mini Implant Abutments

2009-11-11T07:42:00.000-08:00

Three implant abutments. These are called BUDs which stand for Bridge Underpinning Device. Two of them are stainless steel buds and one is a composite bud.

Dr Chow on connection problems between the implant and the crown

2009-05-30T08:11:00.000-07:00

April 15th, 2009

All things being equal, i.e. no major systemic problem and local conditions are healthy…a morse taper connection ensures that there is no microgap between the fixture and the abutment and therefore no toxic pump as a result of colonisation of the gap together with function. Fact is the 2 pieces behave like one piece….basic engineering principle. Thus in makes like Astra, Bicon, Ankylos and others like some Korean Implants, the Morse taper connections cum platform shifting(if its Morse taper, it automatically translates into a platform shift), there is little or no bone resorption in the majority of cases. In fact often it can be seen that the bone grows right onto the “gap”!

There are 2 critical margins:- one is the abutment-fixture margin and the other is the abutment-crown margin which is also a major problem in that excess cement from this margin often remains in the gum-implant interface and can cause resorption of the bone as well as inflammation of the gums.

The abutment-fixture connection problem,I feel has been largely addressed successfully by the Morse taper solution. The crown-abutment margin with its excess cement or microgap if screw-retained is still quite an enigmatic problem that is yet to be addressed as successfully. I call it the “critical margin” in oral implantology.

Cheers!

Dr Chow on Allergy to grafts in oral implantology

2009-05-30T08:03:00.000-07:00

Dr K. F. Chow May 14th, 2009

Theoretically, an individual can be allergic to anything because anything can be an allergen i.e. a substance that is considered by the immune system as a foreign body. Once the immune system identifies a foreign body, it responds basically 4 different possible ways…..4 types of hypersensitivity mediated either by B cells of T cells.

Your patient’s sounds like the 4th type….T cell mediated delayed hypersensitivity……allergic contact dermatitis likely due to your gloves..powder….ointment or something that touched your patient’s face.

Treatment is usually steroids systemic or topical or both. If things are getting better, that means things are getting better and no drastic treatment like removing the grafts etc. is necessary. Just make a note on your patient’s record and avoid the possible causes in the future.

Cheers!

Flapless Implant Surgery | OsseoNews Discussions on Dental Implants

2008-11-20T01:59:00.000-08:00

Flapless Implant Surgery | OsseoNews Discussions on Dental Implants: "A volumetric scan is ideal but need not be essential provided you know your anatomy and make full use of whatever low tech but economical techniques that are available like what had been described. In many parts of the world, we may not have the scan and use of it may put it out of reach of almost everyone except the very affluent; not to mention a computer fabricated surgical stent.
As it is many who need implants cannot afford them. Optimal technology suitable for the context especially the economy of the local people should be used together with a large dose of common sense.
Dental implants are the best replacement of lost teeth. As such we should strive to bring its extraordinary life-changing benefits to as many people as possible. Having said that, we should continue to develop more and more accurate means, hightech or otherwise in order to place implants better and faster and more affordably."

Flapless Implant Surgery | OsseoNews Discussions on Dental Implants

2008-11-20T01:58:00.000-08:00

Flapless Implant Surgery | OsseoNews Discussions on Dental Implants: "The whole surgical world is moving towards minimal invasive procedures. I believe flapless surgery or transmucosal placement or just making an incision big enough to do the osteotomy is the natural and sensible progression in implant surgery provided no extensive bone grafting is required. Popular rhetoric that it is blind is untrue. It is partially-blind because we have the benefit of models, bone-mapping, Xrays and imaging techniques that give us a pretty good idea of the bone morphology especially when you can eyeball it in vivo albeit covered with a layer of mucosa. Added on to the tactile palpating remote sensing of our supersensitive finger tips, we actually can “see” quite well without flapping and compromising the integrity of surrounding tissues. Flapless unless choiceless is the way to go."

Mini Implants for Long-Term Use? | OsseoNews Discussions on Dental Implants

2008-11-20T01:52:00.000-08:00

Mini Implants for Long-Term Use? | OsseoNews Discussions on Dental Implants: "Mini-implants have the advantages of low cost, simple surgical placement and high versatility, have moderate success rates and are easy to insert when anatomic measurements are carefully considered. When failures are noted, retrieving the loosened one and/then inserting another mini-implant has little discomfort and is usually well accepted by patients. A vast majority of clinicians believe that implants not requiring surgical preparation have higher failure rates, while implants with better stability require flap surgeries for insertion and removal. Whereas conventional or modified oral implants have been shown to successfully serve as anchorage for orthodontic appliances, mini-implants failed to reach these high success rates. When the high failure rates of mini-implants are under evaluation two main factors have to be considered. The biomechanical loading of peri-implant bone as well as the time schedule of loading have been shown to have a major impact on the peri-implant bone healing and can be assumed to determine the clinical fate of mini-implants. Therefore, mini-implants can serve as anchorage for orthodontic force systems when loads do not exceed a tolerable strain level. It is important to note that the amount of stresses and strains are dependent on the geometry of the screw as well as on the mechanical properties of the implant and bone. The"

FDA on Mini Implants | OsseoNews Discussions on Dental Implants

2008-11-20T01:48:00.000-08:00

FDA on Mini Implants | OsseoNews Discussions on Dental Implants: "A well known one piece small dental dental implant or mini dental implant as some wants to call it is called “self-tapping threaded screws indicated for long-term intra-bony applications. Additionally, they ….. may also be used for inter-radicular transitional applications. These devices will permit immediate splinting stability and long-term fixation of new or existing crown and bridge installations, for full partial edentulism, and employing minimally invasive surgical intervention.”

The quotation is taken clean from the FDA K031106 certification. Note that the term used is “self-tapping titanium threaded screws” and not “implants”. It seems that the FDA has to date decided that any threaded titanium screw that is of diameter 3mm and more is called an implant but anything below that is called a titanium threaded screw. However, its uses appear to be close to, if not equivalent to the uses of conventional implants……….i.e.long-term fixation of new and existing crown and bridge installations. Additional uses are inter-radicular transitional applications, immediate splinting stability, full and partial edentulism…..and using minimally invasive surgical intervention to boot! So the one piece small dental implants, though not labelled as implants seem to be approved to function as implants and is more versatile in"

Mini Implant Systems | OsseoNews Discussions on Dental Implants

2008-11-20T01:46:00.001-08:00

Mini Implant Systems | OsseoNews Discussions on Dental Implants: "What is a transitional and what is a provisional and what is an implant and what are their differences? I guess a transitional and a provisional is synonymous and by definition means something temporary until something permanent can be placed. Its probably something like a temporary resin-acrylic bridge until a permanent ceramic bridge is placed.Though nowadays we are seeing more and more composite bridges which last a long time. What do we call them then…..long term use composite bridges? In the mentioned case the transitionals as they grow stronger and more lasting are gradually morphing into permanents! Or should we call them pretenders to the throne? If what Todd says is true, he has at least 2000 fixed crowns and bridges masquerading as permanents for the last 3 to 6 years.Are they now still transitional, longterm, temporary or permanent? Who is the authorised guardian of these terms? Maybe as professionals, we should be wary of being tied down to terms without understanding the rationale behind them. What is important seems to be will it work clinically without compromising basic science and material characteristics. Hope these does not confuse too much but bring about returning regularly to first principles to make sure we are not propagating some standard that was set some time ago and has remained static although the dynamics has changed"

Mini Implant Systems | OsseoNews Discussions on Dental Implants

2008-11-20T01:46:00.000-08:00

Mini Implant Systems | OsseoNews Discussions on Dental Implants: "I find the FDA specifications for an implant if true very strange if not arbitrary. Is 3mm a magic figure or what? Why not 2.5mm or 3.5mm or 2.88mm? If that is really their criteria, then on what rationale have they came out with the magic number of at least 3mm diameter before a dental implant is called a dental implant? Would have thought that adequate osseointegration should be the primary criteria and the rest should be merely complementary. Can somebody from the FDA or privy to their line of logic please enlighten. Thank you."

Mini Implant Systems | OsseoNews Discussions on Dental Implants

2008-11-20T01:44:00.000-08:00

Mini Implant Systems | OsseoNews Discussions on Dental Implants: "Mini implants are at the same stage of developement that conventional implants were in the 80’s. I have been doing mini’s for 6 years the reason being I realized that conventional implants can only help about 20% of my patient population. Like conventional implants I started slow and went to Victor Sendex’s course where I saw the true potential for these implants. Like with all implants you need to work back from the prosthetics. I have used 3 systems and have found that Intra-Locks MDL(2.0 and 2.5) and Milo(3.0) provide me with the versality to do single units, partial denture retention and the old stand by full denture retention. They are also most useful in the bail out case. Mini implants are the DUCT TAPE of implant dentistry. They have helped me salvage cases that I could have not done any other way and not have the patient declair bankrupcy. Intra-Lock is the only system that has looked beyond denture retention. The prosthetic elements will allow you to do cases that you may have not gotten to due because of the limitations of conventional implant size. Check out my website to see what I mean. Get over it! Mini implants are not just transitional and are here to stay! The secret is knowing the anatomy of where you are using them which I fortunately learned with my conventional implant experience. Like with conventional"

Mini Implant Systems | OsseoNews Discussions on Dental Implants

2008-11-20T01:43:00.000-08:00

Mini Implant Systems | OsseoNews Discussions on Dental Implants: "Yap. A hollow tube is stronger than a solid tube provided you do not screw something into it intimately so much so that it is not just resisting forces from without but it is also fighting a third column of forces within that is persistently trying to force it to explode, and that is why one of the main drawbacks of 2 piece implants is connecting screw failure! A 1 piece solid implant of 2.5mm diameter is on measure still more advantageous to a 3mm diameter hollow implant with a screw tight inside trying to push it apart. So, maybe the FDA may begin to see the light and pontify down the magic number below 3mm as long as it is not hollow. By the way, whether Pluto is a planet or not depends on whether you are a faithful nolstalgic traditionalist or a sort of a curious gungho advancing experimentalist determined to improve and simplify things.Elegance should not be complicated but simple yet functional."

Mini Implant Systems | OsseoNews Discussions on Dental Implants

2008-11-20T01:42:00.000-08:00

Mini Implant Systems | OsseoNews Discussions on Dental Implants: "I was first introduced to dental implantology in 1968 by Dr. Leonard Linkow, while doing a post graduate program working in the department of Prosthodontics at the Hebrew University in Jerusalem Israel. Dr. Linkow demonstrated his concepts of placing different shaped titanium fixtures into the existing residual jaw bone
( an assortment of “blades”, screws,endosteal stabilizers, intramucosal inserts, subperiosteal frames,and even a coined titanium “Star of David” into the jawbone of a rabbi, ; and he called them all dental implants.

An artificial device that can be embedded into the jawbone and protrude into the oral cavity such to support a tooth or teeth is, in my humble estimation, a dental implant. I can understand the point of view of the FDA to place a value on the engineering specifications of the strength of a fixture, and decide that anything less than 3mm in diameter is not strong enough to be considered a permanent fixture, and is therefore not considered a dental implant, in order to place guidelines to protect the public.

However, if dentists like Dr. Victor Sendax did not have the moxy and ingenuity to go beyond the “established guidelines” of definition, and help out a famous opera star when his permanent bridge was falling out of his mouth before a performance ( and steril"

Mini Dental Implants: Extensive Debate | OsseoNews Discussions on Dental Implants

2008-11-20T01:37:00.000-08:00

Mini Dental Implants: Extensive Debate | OsseoNews Discussions on Dental Implants: "Dear NikkiB,
Your mum sounds like one of my patients. 4 mini implants were place on his lower ridge and his loose lower denture was fastened reversibly to the implants. Reversibly means that the denture can be fastened and removed at will for cleaning purposes. Generally, the existing dentures is used so that the patient need not have to get used to a new set of dentures. Once the patient is used to the implants, a new denture can be made if necessary. This particular patient was 82 years old. He was able to eat much better that very night. Hope your mum’s problem is solved soon. Mini implants are very forgiving in the sense that its easier to place than the conventional sized implants and if one fails, it can be removed easily and a new one placed immediately if necessary. warmest regards. Dr. kfchow"

Mini Dental Implants: Extensive Debate | OsseoNews Discussions on Dental Implants

2008-11-20T01:36:00.000-08:00

Mini Dental Implants: Extensive Debate | OsseoNews Discussions on Dental Implants: "Branemark generally copied the size and the shape of the tooth in designing his first implant which is logical and made sense at the time. Everyone copied him after that without too much thought about the validity of his assumptions because it works. The question today is how much osseointegration is required to support a tooth say, the premolar in the mouth. The answer to this question will determine how big an implant should be and therefore will determine whether we should continue to make root sized implant fixtures or reduce and minimise its size optimally. How much osseointegration in terms of surface area and quality of bone attachment is required to support a premolar satisfactorily in a functioning dentition needs to be examined closely anew. Lets assume the quality of osseointegration is uniform for most interfaces between the bone and titanium surface. Therefore looking at just the surface area required per se, it follows that if osseointegration aka ankylosis is say, twice as tough as the normal periodontal ligament, then my friends, it seems that the minimised diameter implant is going to triumph over the conventional sized implant as the main workhorse in dental implantology! To say it simply, if it is true as we all know that ankylosis is tougher than the periodontal ligament sq mm for sq mm, then the minimised diame"

Late Facial Swelling After Implant Placement? | OsseoNews Discussions on Dental Implants

2008-11-20T01:29:00.000-08:00

Late Facial Swelling After Implant Placement? | OsseoNews Discussions on Dental Implants: "Insufficient information to clinch a diagnosis. A thorough systemic and localised history and localised examination is necessary. Site of implants, pain, swelling etc. is essential. Anything is possible from sarcoma to just a simple delayed hematoma…. and even a blocked salivary gland. Having said that, it is usually just something common and local like infection or denture trauma or part of the healing process since it is an immediate post extraction placement of implants. Maybe a loose screw on the fixture? We need to approach with a comprehensive overview, considering all the details before zeroing on the diagnosis. Thoroughness is essential

Cheers"

Possibility Implant Has Moved? | OsseoNews Discussions on Dental Implants

2008-11-20T01:28:00.000-08:00

Possibility Implant Has Moved? | OsseoNews Discussions on Dental Implants: "Dear Anon,
What happened is obviously an alien abduction. While doing an extreme MRI on it, it moved. Please double check with your patient.
OK OK, I am just joking!

It could be that after you placed the healing abutment, the patient accidentally bit on a hard piece of nut or some such thing that is hard and large which we sometimes insist on placing into our stoma in order to masticate and consume it. The hefty crunch was so hefty that it actually caused the bone to give way, but not the periosteum though…… and the whole implant moved 2mm. After that horrid experience, the patient decided to give it a prolonged and careful rest and ate on the other side most of the time and lo and behold, the implant reosseointegrated again in its new location. Over the extended time that you mentioned, the patient selectively forgot about it or chose not to mention it in case you blame him/she for any residual problem. I could have sworn that that is what happened to one implant I placed several years ago.

Cheers!"

Drilled Too Deep when Preparing Hole for Implant Insertion: Should I Be Concerned? | OsseoNews Discussions on Dental Implants

2008-11-20T01:24:00.000-08:00

Drilled Too Deep when Preparing Hole for Implant Insertion: Should I Be Concerned? | OsseoNews Discussions on Dental Implants: "Having 1 or 2 mm extra depth to your implant is okay provided it did not traumatised any vital structures like the sinuses or the idn or the linqual or labial plates. Even so, if the implant does not impinge excessively into these structures, the body’s unrivalled healing abilities will cover up our misdemeanour. Of course we should rely primarily on our skill and foresight via thorough treatment planning to avoid these misdemeanours and only rely on the bodiy’s built in smart healing powers as a failsafe device. If in doubt about sterility, it does no harm to cover the patient with antibiotics. Might be helpful to also advice the patient to take some yogurt for those few days and some days after to replace any good bacteria in the gut that may have been destroyed.

Cheers."

Numbness After Implants | OsseoNews Discussions on Dental Implants

2008-10-06T07:15:00.000-07:00

Numbness After Implants | OsseoNews Discussions on Dental Implants: "Dr Amayev September 11th, 2006

No matter what kind of surgeons you are anything could happen .Of course we must try to ovoid any possible complication to our patient and treat them with respect but sometimes complication may happen. In order to avoid any possible complication we should just stop what we are doing as been previously mention by Dr Kfchow. I don’t believe that there is a dentist or another type of medical professional or any other profession who never had a complication. We all humans and if we did something we have to try to resolve and help that patient in any possible way if we can. From what Lerry or Ben told us, I don’t know you are a doctors or not but if you are it seems like you both the best and never had any complications in your practice. If you didn’t I am very happy for both of you. Never say this may not happen to you ,look in a future you still practicing. Think about that. May be you don’t have enough experience that why you so positive about your self . I’ve been practicing for 15 years and my practice is limited to implants dentistry only and I still can get complications, but I know how to manage them if I don’t i always ask. There’s no human been in this wold who will know everything. Take your time both of you, and slow down. Good Luck....

Numbness After Implants | OsseoNews Discussions on Dental Implants

2008-10-06T07:13:00.000-07:00

Numbness After Implants | OsseoNews Discussions on Dental Implants: "Rhonda September 11th, 2006

Dear Dr.KFChow-Thank you for your perspective on repairing of damaged nerves..it is greatly appreciated. For 3 months gums, chin and lips completely numb. Every night I would massage my face, do facial exercises smiles, frown, puff out my cheeks and teach myself to chew on that side without biting my lip. Bascially, physical therapy to get circulation, feeling and life back to my face. I will never give up and I refuse to take medications because it is uncomfortable. After 3 months, the prickling, tingling and itchy feelings started to occur, Now that I have read your information that these are goods signs as my regular dentist has also stated, It is much more tolerable!!! Ben & Larry thank you also -There is much truth in what you write the Dr. that did my implant has been in my family for many years - he has removed my childrens impacted teeth with success and no problems…He is really a good person, he had no intention of causing me this problem, it was successful for my right sided implant.. just not for my left side. I did choose him and choose this surgery and knew of complications,I am trying to deal with this the best way for me. I hope in someway this helps someone who maybe going through the same situation."

Numbness After Implants | OsseoNews Discussions on Dental Implants

2008-10-06T07:11:00.000-07:00

Numbness After Implants | OsseoNews Discussions on Dental Implants: "kfchow-mostdi-msia August 29th, 2006

I had a patient who experienced numbness of the lower right lip after placement of dental implants on the right molar area. Xrays showed one of the implants impinging on the inferior dental canal. That implant was removed 2 days later and the patient recovered full sensation after about 3 weeks. I think the patient suffered from neuropraxia i.e. compression of the nerve. I guess speed of recovery if at all will depend on the extent of the damage…. is it just compression injury or incision injury….partial incision or full incision. However, since the nerve is running within a well defined channel in the bone, chances of some recovery and even full recovery may be high even in cases of neurometsis. I hope Dr. Joglekar has a full recovery eventually.
Regards. Dr. kfchow Malaysia"

Numbness After Implants | OsseoNews Discussions on Dental Implants

2008-10-06T07:09:00.000-07:00

Numbness After Implants | OsseoNews Discussions on Dental Implants: "Dear Rhonda,
I am sorry to hear of your problem. However, nerve damage is one of the possible complications to placing dental implants on the lower jaw molar area. No matter how experienced the dentist or oral surgeon is, sometimes it happens. This is the same in every field of surgical intervention. Such incidences happily are rare when reasonable care is taken, but like I said, it happens even to the best of doctors. But to the patient it happens to, such knowledge brings only a little consolation. From your account, I would agree generally with what your regular dentist has told you. The damage has already been done at the time of surgery and the backing out of the implant was the right step. But nerves have a notoriously unpredictable pace of recovery. It depends on exactly how much damage was inflicted. The accurate assessment of such damage however is very difficult even with the most advanced imaging systems. Also, the healing of nerves is still not completely understood. Lots of research has been done on the healing of nerves and the factors involved together with stem cell research. Christopher Reeves(Superman)’s saga highlighted to the whole world how hard we are trying to understand nerve healing and conversely how little we actually know and how helpless we are when it comes to repairing damaged nerves. The overall lesson is to try your best not to damage them and when the damage is done, remove the causative factors as quickly as possible within reason. I agree with your regular dentist in that totally removing the implant at this stage will not improve the situation significantly. Also, the tingling and itchy sensation is a sign of healing. How complete the healing is, only time will tell. But it is encouraging to observe that it is improving with time. All the best and my best hopes for a complete recovery.

Dr.KFChow Malaysia

Flapless Implant Surgery | OsseoNews Discussions on Dental Implants

2008-10-06T06:43:00.000-07:00

Flapless Implant Surgery | OsseoNews Discussions on Dental Implants: "Dr. KFC January 25th, 2007

The whole surgical world is moving towards minimal invasive procedures. I believe flapless surgery or transmucosal placement or just making an incision big enough to do the osteotomy is the natural and sensible progression in implant surgery provided no extensive bone grafting is required. Popular rhetoric that it is blind is untrue. It is partially-blind because we have the benefit of models, bone-mapping, Xrays and imaging techniques that give us a pretty good idea of the bone morphology especially when you can eyeball it in vivo albeit covered with a layer of mucosa. Added on to the tactile palpating remote sensing of our supersensitive finger tips, we actually can “see” quite well without flapping and compromising the integrity of surrounding tissues. Flapless unless choiceless is the way to go."

Mini Implant Systems | OsseoNews Discussions on Dental Implants

2008-10-06T06:33:00.000-07:00

Mini Implant Systems | OsseoNews Discussions on Dental Implants: "true believer November 13th, 2006

Who brings progress to man? The playitsafers or the reachupfortheskyers? The very fact that we are practising the blessed art of dental implantology is because of people like Linkow and Branemark who in their time were vilified and branded as a bit of their heads. Linkow was labeled a “mad dentist”. But today we are thankful for them and their ability to accept critism with magnanimity."

Mini Dental Implants: Extensive Debate | OsseoNews Discussions on Dental Implants

2008-10-06T06:14:00.000-07:00

Mini Dental Implants: Extensive Debate | OsseoNews Discussions on Dental Implants: "kfchow-mostdi-msia June 28th, 2006

Branemark generally copied the size and the shape of the tooth in designing his first implant which is logical and made sense at the time. Everyone copied him after that without too much thought about the validity of his assumptions because it works. The question today is how much osseointegration is required to support a tooth say, the premolar in the mouth. The answer to this question will determine how big an implant should be and therefore will determine whether we should continue to make root sized implant fixtures or reduce and minimise its size optimally. How much osseointegration in terms of surface area and quality of bone attachment is required to support a premolar satisfactorily in a functioning dentition needs to be examined closely anew. Lets assume the quality of osseointegration is uniform for most interfaces between the bone and titanium surface. Therefore looking at just the surface area required per se, it follows that if osseointegration aka ankylosis is say, twice as tough as the normal periodontal ligament, then my friends, it seems that the minimised diameter implant is going to triumph over the conventional sized implant as the main workhorse in dental implantology! To say it simply, if it is true as we all know that ankylosis is tougher than the periodontal ligament sq mm to sq mm, then the minimised diameter implant is sufficient to hold a normal tooth! Has anyone done a comparative study between a normal periodontally held tooth and an ankylosed titanium implant? Its beginning to make more and more sense to me that a small diameter implatnt is actually sufficient to hold a tooth and if true, its good news for everyone because implantology is going to be cheaper, easier and more versatile than it is now.

Search on for Way to Grow New Teeth | OsseoNews Discussions on Dental Implants

2008-10-06T05:44:00.000-07:00

Search on for Way to Grow New Teeth | OsseoNews Discussions on Dental Implants: "Kai Foo Chow FDSRCS October 6th, 2008

Meanwhile, lets be thankful for dental implants. Yes, the current holy grail in dental implantology is the tooth germ implant or MOTGI: Made to Order Tooth Germ Implant. However, Motgis will probably take at least another 10 years, maybe more. The hurdles involved are growing the toothgerm in the lab, twitching the genetic switches to develop the toothgerm into a canine, molar, premolar or incisor. Also, it has to be specific in left or right and in terms of size. Next, dentists have to be trained to place them and special surgical protocols have to be developed.

Not easy, but nevertheless we must be reachfortheskyers and not playitsafers. Imitating the original is one hack of a job!

Meanwhile, dental implants are already a vast leap forward to the moon. Motgis will be a quantum leap to Mars.

Cheers."

Dental Implantology: The next Challenge

2008-09-28T23:37:00.000-07:00

Dental Implants are recognised widely both professionally and by people at large as the best replacement for lost teeth. Though it cannot be as good as the original, it is close to it in terms of function, appearance and durability. Previously the challenge was to replace lost teeth that bite well, look good and last long. These challenges have largely been overcome in the last ten years or so. The new challenge is to make dental implants universally available at an easily affordable price. To achieve these, the training of dentists have to be made simple and speedy and adequate. This is important because currently worldwide, hardly 5 to 10% of dentists routinely practise dental implantology. A universally simple and affordable dental implant system needs to be invented.