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Coagulum forming over the implant

From: Terry Pannkuk
To: ankylos@rxdentistry.com
Sent: Thursday, May 06, 2010 2:21 AM
Subject: Immediate Placement

>Terry: No disrespect, but I was one of the first users of Nobel Biocare SR in St. Louis MO,
>and I would never ever use this implant in the esthetic zone.  I probably placed 900 SR nobels
>and I could not stand sometimes getting crestal bone loss.  I feel I placed them as well as
>most and I could never achieve ideal cosmetics with this system.  Massive Micro-Gap and
>Micro-movement.  Educate your referring GPs and I bet they  then change their mines.
>My referring base knows I am doing what is best for the patient always.  Technology changes
>and we have to learn and keep up - Bill, Perio

I agree with you.  I don’t place these in the esthetic zone either.   I don’t find the
micromovement/microgap problem to be as severe a clinical problem as you claim with NBC.
Here’s this guy’s smile when we asked him to smile.  If this had been an esthetic case and
the referring dentist had insisted on NBC Replace Select, I wouldn’t have performed the case.
I prefer the Astra implants for the esthetic zone.

I checked the site a few moments ago (two days later), a nice coagulum is forming over
the implant.   I’ll leave it for 4 months no rush,  then uncover and send to the restorative
dentist for restoration.   Not pushing the envelope when you don’t have to seems like a good
credo to me.   The NBC Replace Selects have been very trouble free, extremely rare complications,
and a favorite of the majority of dentists in Santa Barbara.   When in Rome I do what Romans do,
otherwise I’d be exiled and have to go to another province. J  Quite frankly, I don’t get a chance
to place many max anterior implants because its problematic reconciling the fact that so many
dentists want me to place NBC’s in these areas.  I won’t do it.  I pick and choose my cases that
I think are appropriate and refer out the ones I find would be a conflict with the restoring
dentist’s desires.   Basically, if the dentist won’t accept an Astra in the esthetic zone,
I refer out to someone who will do what they want.  I’m not worried about an NBC in this second
bi spot for this particular patient. -  Terry