Archive for the ‘Dental Implant Failures’ Category
When a single tooth requires a crown, the prosthetic crown will in most instances rest upon whatever tooth structure was originally supporting the crown of the natural tooth. However, when restoring an edentulous area with a bridge, the bridge is almost always restoring more teeth than there are root structures to support. For instance, in the photo at right, the 5-unit bridge will only be supported on three abutment teeth. In order to determine whether or not the abutment teeth will be able to support a bridge without a virtually guaranteed failure due to lack of proper support from the remaining root structures, the dentist should employ Ante’s rule, which states that the roots of the remaining abutment teeth must possess a combined total surface area in three dimensions more than that of the missing root structures that are to be restored with the bridge. When the situation yields a poor prognosis for proper support, double abutments may be required to properly conform to Ante’s rule.
Duration : 0:0:30
Patients talk about gum grafting with Tulsa periodontist, Dr. David Wong. Unlike traditional gum grafting procedures, we use techniques that do not always involve the patient’s palate, which makes periodontal surgery, faster, nearly painless, and predictable. Form more information, Dr. Wong’s website is www.Tulsagums.com
Duration : 0:3:2
Dr. Steven Kendrick, family and cosmetic dentist in Midwest City Oklahoma, presents a lecture on implant prosthetics and “Numbers every general dentist needs to know”. http://www.TulsaInstitute.com
Duration : 0:8:11
Introducing the Benex Root Extractor by Dr. David Wong. This instrument is used to remove tooth roots effortlessly and painlessly while preserving the bone for a future dental implant. www.tulsagums.com
Duration : 0:5:11
Tulsa periodontist, Dr. David Wong from the Tulsa Institute, demonstrates a basic frenectomy procedure. Dr. Wong is a periodontist in Tulsa, Oklahoma and trains dentists in basic surgical procedures. http://www.TulsaInstitute.com
Duration : 0:2:3
Sinus-lift Partial Failure. A preview from series WWW.IMPLANTDENTALVIDEO.COM of professionally-made videos showing in detail specific manoeuvres in surgical procedures in the fields of Implantology, Oral & Maxillofacial Surgery and Periodontal Surgery performed by internationally recognized Oral & Maxillofacial Surgeon, Professor Zoran Stajcic
Duration : 0:0:32
Considerations
For dental implant procedure to work, there must be enough bone in the jaw, and the bone has to be strong enough to hold and support the implant. If there is not enough bone, more may need to be added with a bone graft procedure discussed earlier. Sometimes, this procedure is called bone augmentation. In addition, natural teeth and supporting tissues near where the implant will be placed must be in good health.
In all cases, what must be addressed is the functional aspect of the final implant restoration, the final occlusion. How much force per area is being placed on the bone implant interface? Implant loads from chewing and parafunction can exceed the physio biomechanic tolerance of the implant bone interface and/or the titanium material itself, causing failure. This can be failure of the implant itself (fracture) or bone loss, a “melting” or resorption of the surrounding bone.
The dentist must first determine what type of prosthesis will be fabricated. Only then can the specific implant requirements including number, length, diameter, and thread pattern be determined. In other words, the case must be reverse engineered by the restoring dentist prior to the surgery. If bone volume or density is inadequate, a bone graft procedure must be considered first. The restoring dentist may consult with the periodontist, endodontist, oral surgeon, or another trained general dentist to co-treat the patient. Usually, physical models or impressions of the patient’s jawbones and teeth are made by the restorative dentist at the implant surgeons request, and are used as physical aids to treatment planning. If not supplied, the implant surgeon makes his own or relies upon advanced computer-assisted tomography or a cone beam CT scan to achieve the proper treatment plan.
Computer simulation software based on CT scan data allows virtual implant surgical placement based on a barium impregnated prototype of the final prosthesis. This predicts vital anatomy, bone quality, implant characteristics, the need for bone grafting, and maximizing the implant bone surface area for the treatment case creating a high level of predictability. Computer CAD/CAM milled or stereo lithography based drill guides can be developed for the implant surgeon to facilitate proper implant placement based on the final prosthesis occlusion and aesthetics.
Treatment planning software can also be used to demonstrate “try-ins” to the patient on a computer screen. When options have been fully discussed between patient and surgeon, the same software can be used to produce precision drill guides. A popular software package called Simplant (simulated implant) uses the digital data from a patient’s CBCT to build a treatment plan, then produces a data set which is sent to a lab for production of a precision in-mouth drilling guide.[1]
Duration : 0:1:48
At edentulous (without teeth) jaw sites, a pilot hole is bored into the recipient bone, taking care to avoid the vital structures (in particular the inferior alveolar nerve or IAN and the mental foramen within the mandible). Drilling into jawbone usually occurs in several separate steps. The pilot hole is expanded by using progressively wider drills (typically between three and seven successive drilling steps, depending on implant width and length). Care is taken not to damage the osteoblast or bone cells by overheating. A cooling saline spray keeps the temperature of the bone to below 47 degrees Celsius (approximately 117 degrees Fahrenheit). The implant screw can be self-tapping, and is screwed into place at a precise torque so as not to overload the surrounding bone (overloaded bone can die, a condition called osteonecrosis, which may lead to failure of the implant to fully integrate or bond with the jawbone). Typically in most implant systems, the osteotomy or drilled hole is about 1mm deeper than the implant being placed, due to the shape of the drill tip. Surgeons must take the added length into consideration when drilling in the vicinity of vital structures.
Duration : 0:0:22
This is Part I of 2 of a dental implant surgery demonstration given in Tulsa by Dr. David H. Wong, board-certified periodontist in Tulsa, OK. http://www.TulsaInstitute.com
Duration : 0:8:41
In this video, Tulsa periodontist, David H. Wong presents part 2 of an implant surgery demonstration performed at the Tulsa Institute. Further videos and instruction can be found at www.TulsaInstitute.com or downloaded on iTunes by searching “Tulsa Institute”. http://www.EverydaySurgery.com
Duration : 0:8:31