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From: Mark Pasternack
Date: Sun, 13 Apr 2008 22:35:42 -0400
Subject: [implants] The ideal osteotomy
I would like to hear what others are doing in relation to occlusion.
Ok, here is a post let me know if there is a better way of getting the info out there I used word to do this thought that
something on the prosthetic side might be of interest since most of what I am seeing is related to the surgical side, and
I think many of us do both so I just fished through my photo library and found this interesting occlusal splint scheme to
reduce forces on implant teeth would love to hear what others are doing in regards to occlusion maybe this will get that
Donít let the mirror shots fool you, the top two are the right side, the bottom two are the left side.
The left side has a natural tooth bridge from 23 to 25. 34 is a natural tooth crown. The rest are implants.
Patient must wear an occlusal splint at night (I do this for all fixed implant cases). There should be no contact at all
on the implant teeth. Of course, when the opposing teeth are implant teeth as well, the splint must contact something.
In cases like these the internal aspect of the splint which contacts the lower teeth is fabricated in a softer acrylic
like molloplast B. Since the canines are all natural teeth, the occlusal scheme is cuspid guided.
Maybe the implant is not the important part of the integration equation. Perhaps the osteotomy is far more important. So
I ask, what are the characteristics of the ideal osteotomy that are most likely to result in the integration of any
implant? Some of you will say "quantity and quality of bone". But it must matter how and where we place our osteotomy.
What are the important things to achieve? - Dan Shalkey
Dan, The failures that I've had have almost always been due to infected bone in the vicinity of the implant placement. I
had a case where I placed a lower first molar implant. Everything was great for the first 2 months. The second bicuspid
abscessed and required endo. Within a month the implant loosened up and I removed it. Another case involved a congenitally
missing max. lateral incisor. Placed implant, poor bone so I kept my fingers crossed. When the central blew and needed
endo the implant loosened up within weeks. I swore that before I placed another implant next to a tooth that was iffy I'd
do a preventive endo and eliminate the potential problem. The first was a pressed fit implant and the second a BioHorizon,
so it wasn't the implant type, but the osteotomy should not have been done in potentially problematic bone. This is why I
love placing implants, you really do learn something from every case. - Bernie
I have learned the hard way.......
Rules in my office and just in my hands.
Implants will NOT be placed in the following situations:
1. Failed root canal tooth sockets even if the implant totally outsized the socket
2 Next to endo teeth that show any type of lesion (BONE SCARE) or failing restoration.
3 Next to endo that is done recently and has a lesion
4 Nest to a tooth that requires removal for any reason
5 Bone graft must be 3 months old and bleed at time of placement.
6 No blood in implant site, no implant placement
7 Occlusion issues that have not been resolved before placement.
8 2 failures of implants in a site and not an obvious reason
9 4 mm's of bone in the sinus floor and 35 NCM of primary stablization.
I am sure I have some others but that is my start.
Now as a general dentist who places implants and teaches implant placement.......THIS BY NO MEANS MEANS I KNOW WHAT I AM
DOING......because I teach. BUT
I can pick and choose my cases and can always refer. BUT I do no refer the above situations so that someone else can
Just some Monday morning thought before going out to FIGHT THE BATTLE OF DENTAL DISEASE - Jeffrey C Hoos DMD FAGD
Although several of these make good sense and if you decide to handle things this way it is certainly your right to do so,
but again I think it is important to point out that many of these are RELATIVE and not absolute CONTRAINDICATIONS. They
may result in a statistical drop in overall success in a population of a few percentage points, but implants can be and
have been and will continue to be placed in a number of these circumstances around the world. It is important to engage
the patient in these dialogues and include them in the decision making process. - Gary