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Short Implant 2    Better Endo    Endo abstracts    Endo discussions
Web discussions    MB 1,2,3    Bleeding    MB2    Endo abstracts

The opinions within this web page are not ours. Authors have been credited for the individual posts where they are. Photos courtesy Terry Pannkuk - ROOTS
  Short 6mm long implant

From: Terry Pannkuk
To: ROOTS
Sent: Friday, June 19, 2009 1:50 AM
Subject: RE: [roots] A Shorty Implant

I have 3 different systems, NBC, Astra, and Neoss.  I've placed NBC the most and it's been pretty bulletproof
and popular with my referrals.  Astra like Ankylos doesn't have a long polished collar.  I didn't want to use
NBC on this case because I want as much integration surface area as possible and a polished collar is useless
integratable surface.

The 6mm long implant was the only option here because of nerve proximity.  It seemed like a much better option
than strategically extracting the two adjacent teeth for an implant supported bridge which I'm sure would have
been an idea proposed by some implantologists.

The main reason many like long implants is to get through all the fake bone that is unnecessarily packed deep
into sockets.  The only predictable bone that integrates is native bone. If you've filled an entire socket up
with crap you have to go deep. :)

Here's an extraction I just finished moments ago.  It took a lot of time to precisely place graft only in the
defect perio defect area and keep the socket base free of foo foo.

Note the huge ball of granulation tissue attached to the root of the extracted tooth.  I pretty much only
grafted this lost bone and nothing else.  A Collacote plug was placed in the socket base, graft only in the
defect area, covered with Biomend and sutured.   I won't need a super long implant when I place it later.
Ever wonder why maxillary sites integrate with a lower success rate than mandibular sites?   Maybe because
implantologists don't maximize the amount of native bone that grows back into these sockets.   If I simply
packed the socket full of fake bone and placed the implant later I would have virtually no native bone from
the osseous crest to the sinus floor.  That would mean very questionable integration - Terry



Hi Terry, Short implants works also well, 

Regards - Michal Józwiak ( well known as dr MacGyver)

Michal, That's wild! :)

I don't think the standard paradigm of crown-root ratio concerns that apply to natural teeth apply to implants.
You do have to worry about fixtures breaking though.  That patient must not have heavy occlusal forces right? :)
- Terry

Terry, 
look at this case from my practice. Of course this is a failure but very impressive. The forces of osteointegration
are amazing -  Michal Józwiak

I forgot to explain my opinion of the pain episode after the first attempt at placement.  I don't believe the pain was
directly related to mental nerve damage but was likely related to inflammation/peri-implantitis affecting the nerve
indirectly.  Whatever the explanation truly is...it didn't really matter, the implant was immediately failing and
I've learned enough to know "when in doubt take it out".

The patient called back today delighted with the result saying she felt much better after this placement and is having
no discomfort or numbness today.....very good sign!

I'd like to think I have all the answers but I don't.  In retrospect I feel that I never should have attempted to place
an 8mm, it was too long and risky.  I couldn't screw it in deep enough to get adequte primary stability.  Second time
was the charm.

Just remember that today's heresy usually ends up being tommorrow's dogma.....don't worry too much about other people's
critiques if you have solid rationale and evidence to support your clinical behavior - Terry

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