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where they are. - www.rxroots.com photographs courtesy: Benedict Bachstein
From: Fred Barnett
To: ROOTS
Sent: Friday, September 12, 2008 11:25 PM
Subject: [roots] Case: Implant #18/19
Implant case from Einstein Endo....
Fred
This is the first case I planned for Implants here at Einstein. She
presented in December 2007 and was referred for apical surgery on teeth #18
& #19. After establishing non-restorability, #18 and #19 were extracted and
grafted with BioOss and a BioMend membrane. She has been followed up several
times since grafting to monitor progress.
The patient returned last week for implant placement. She previously
presented with her night guard which I asked her to keep and used it to
fabricate a surgical guide. I chose to raise a larger flap to have full
visibility of the surgical site and placed two B11 Ankylos Implants with a
diameter of 4.5mm and 11mm long. I decided to go the most conservative route
and submerged the implants. The next stage is to expose the implants and get
her on the way for restorative treatment.
Any comments? - Benedict
PS: The radiolucencies on the X-rays are all over the PAN of this African
American female. The patient has an established diagnosis of cemento osseous
dysplasia - Benedict Bachstein, D.M.D.
This case looks well done, handled very conservatively which is the proper way to do it when you are starting out.
Looks like you had a parallelism issue initially that you corrected well. Lingually placed incision keeps
incision line off of the implants.
Watch your emergence profile on restoration as a 4.5mm fixture is much narrower that a prepared molar,
as I’m sure you well know.
My only question from the rads is what’s going on with the two bi’s? is that superimposed mental foramen
or what? I think I see radioluscencies on both on the films.- gary
Fred, Nice to see endo getting involved in implants.
Why the bio oss? To preserve the buccal soft tissue contour? - Bill
Bill , better endo get involved because "implants" section here is perpetually deserted.
We have what about say 2 posts in a month max.- Dr Sanjay Jamdade
Dear Fred, Very nice case. Yes, when having enough bone up to the dental nerve canal, it is a better choise
to allow the bone to heal (even without bone and membrane) and afterwards, to put the implants.
When initial stability is good enough, the use of healing screws instead of cover ones, allow you to skip
the second surgery ( middle crestal incision should be necessary in this case). - Enrique M. Merino
Dear Fred,
Very nice case. Yes, when having enough bone up to the dental nerve canal, it is a better choise
to allow the bone to heal (even without bone and membrane) and afterwards, to put the implants.
When initial stability is good enough, the use of healing screws instead of cover ones, allow you
to skip the second surgery ( middle crestal incision should be necessary in this case).- Enrique M. Merino
Fred, that is great case! Textbook one :-))
Glad to see more Ankylos users!
Was it Ankylos C/X (judging from immediate post-insertion x-rays with implant mount)?
It is already launched in US? - Dmitri
Nice Case Fred! That was indeed a situation that needed implantology as an aid. If L. Steve Buchanan keeps
on talking the talk, a lot more of these will be done in our (or Oral Surgeons) hands. Well handled and my
best to the Resident who performed the surgeries.- Jay Jacobson
Benedict, The BioOss and Biomend are a waste of good money. See Becker's article for the membrane done in the 90's.....
I would have just extracted, allowed healing for 3-4 months and gone in and placed the implants.
Kevin Mullen or Keith Kanter have more experience then I, they might have placed the implants immediately.
- Joey D, "They look well placed"
Dr Dovgan do you mean there is no point in doing socket grafting? - Dr Sanjay Jamdade
Fred, Could have used only a fibrin clot here also. Call yu friendly neighborhood BTI rep. - Dan Shalkey
There is no need to push the envelope in the posterior mandible region.
Numerous studies have shown that once you reach 10mm, the survival rates are insignificantly
different beyond that threshold. Two of my teaching colleagues, both perio prosth guys at Penn,
don’t even order anything other than 10’s and 11.5. - Gary L Henkel
Hi, nice flap design. How did you decide to place 11mm's instead of 13mm's? - Tony Wu
Implant #18/19
This case looks well done, handled very conservatively which is the proper way to do it when you are starting out. Looks like you had a parallelism issue initially that you corrected well. Lingually placed incision keeps incision line off of the implants. Watch your emergence profile on restoration as a 4.5mm fixture is much narrower that a prepared molar, as I’m sure you well know. My only question from the rads is what’s going on with the two bi’s? is that superimposed mental foramen or what? I think I see radioluscencies on both on the films.- gary Fred, Nice to see endo getting involved in implants. Why the bio oss? To preserve the buccal soft tissue contour? - Bill Bill , better endo get involved because "implants" section here is perpetually deserted. We have what about say 2 posts in a month max.- Dr Sanjay Jamdade Dear Fred, Very nice case. Yes, when having enough bone up to the dental nerve canal, it is a better choise to allow the bone to heal (even without bone and membrane) and afterwards, to put the implants. When initial stability is good enough, the use of healing screws instead of cover ones, allow you to skip the second surgery ( middle crestal incision should be necessary in this case). - Enrique M. Merino Dear Fred, Very nice case. Yes, when having enough bone up to the dental nerve canal, it is a better choise to allow the bone to heal (even without bone and membrane) and afterwards, to put the implants. When initial stability is good enough, the use of healing screws instead of cover ones, allow you to skip the second surgery ( middle crestal incision should be necessary in this case).- Enrique M. Merino Fred, that is great case! Textbook one :-)) Glad to see more Ankylos users! Was it Ankylos C/X (judging from immediate post-insertion x-rays with implant mount)? It is already launched in US? - Dmitri Nice Case Fred! That was indeed a situation that needed implantology as an aid. If L. Steve Buchanan keeps on talking the talk, a lot more of these will be done in our (or Oral Surgeons) hands. Well handled and my best to the Resident who performed the surgeries.- Jay Jacobson Benedict, The BioOss and Biomend are a waste of good money. See Becker's article for the membrane done in the 90's..... I would have just extracted, allowed healing for 3-4 months and gone in and placed the implants. Kevin Mullen or Keith Kanter have more experience then I, they might have placed the implants immediately. - Joey D, "They look well placed" Dr Dovgan do you mean there is no point in doing socket grafting? - Dr Sanjay Jamdade Fred, Could have used only a fibrin clot here also. Call yu friendly neighborhood BTI rep. - Dan Shalkey There is no need to push the envelope in the posterior mandible region. Numerous studies have shown that once you reach 10mm, the survival rates are insignificantly different beyond that threshold. Two of my teaching colleagues, both perio prosth guys at Penn, don’t even order anything other than 10’s and 11.5. - Gary L Henkel Hi, nice flap design. How did you decide to place 11mm's instead of 13mm's? - Tony Wu
