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Sage advice for doctors new to implants 1 Enroll in an introductory course. Get a feel for whether implant dentistry is right for you. 2 3 Educate yourself by enrolling in multiple courses. If implant dentistry is something you want to pursue, take an adequate number of courses — and wait until you feel confident in doing implant procedures. Learn basic surgical techniques. Aside from identifying important anatomical structures, diagnosis, treatment planning, radiographic interpretation and basic implant prosthetic principles — it’s critical that you understand basic surgical techniques. Start with an ideal case. Look for cases that have a good level of height and width of bone. Also, you want anatomical safe regions, such as the anterior mandible and single tooth replacements in both arches, eliminating three-unit bridges. Implant dentistry changed my life, as well as the lives of thousands of my patients. I started the procedure at 1:30 p.m. and had the provisional cemented by 3:30 p.m. Everything went absolutely perfectly. I was so excited that I said to my partner, “I don’t want to do anything else.” Replacing what nature had taken away was, from that instant on, exactly what I wanted to do for the rest of my professional life. Four weeks later, I placed her final bridge and placed the other implant on the opposite side. I told her that I’d have to charge her for that one because now I was an expert. We both laughed. She hugged me and said that I changed her life. Irma passed away in October 2000, 30 years later, with her implants and bridge still functioning until the day she died. After that first time, I went on to place many implant restorations, all types and various systems, over the next 42 years. I estimate that I have placed and restored more than 30,000 implants. IM 14 – www.inclusivemagazine.com –
Hygienist’s Corner A Probing Question with Susan S. Wingrove, RDH When assessing for peri-implant disease, “bleeding on probing” (BOP) is invaluable in the diagnostic process for peri-implant mucositis, and probing depths are valuable in assessing loss of bone support around osseointegrated implants. 1,2 An important yet controversial component of the assessment is probing the dental implant. Some implant surgeons recommend not probing the implant, or waiting three to six months following abutment attachment to avoid disrupting the perimucosal seal. 3 The perimucosal seal is fragile, and penetration during probing can introduce pathogens and jeopardize the success of the implant. Recent studies show that 0.15 Ncm may represent the threshold pressure to be applied in order to avoid false positive BOP readings around oral implants. 4 Currently, clinicians are using 0.15 Ncm–0.20 Ncm of pressure, but most agree that probing around dental implants is more sensitive than probing natural teeth; thus, caution should be used. 4 Emerging research holds that probing is not harmful, however, and is actually essential to the overall health of the implant. Complete regeneration of junctional epithelium and establishment of new epithelial attachment has been studied, revealing that probing around osseointegrated implants does not appear to have detrimental effects on the perimucosal seal. 5 Peri-implantitis infections occur in 28 to 56 percent of implants after five years. 6 An increase in reported cases of peri-implant diseases (collective term for inflammatory lesions, mucositis, and peri-implantitis) is a significant reason for monitoring and probing dental implants. The hygienist needs to know baseline measurements to be able to distinguish health from disease, or loss of osseointegration. This can give the hygienist a way of determining at recall visits whether detrimental changes have occurred. Also, if more than one hygienist is employed in the office, measurement with compatible probes in millimeters for all inflammation, exposed threads, or bone loss on films allow for more accurate monitoring and consistency. Courtesy of PDT Inc. Figure 1: Note difference in flexibility between metal probe (left) and plastic probe (right) There is a recommended protocol for probing dental implants. First, the complexity of implants makes the flexibility of the probe essential. Now with more platformswitching implants, narrow implants, and fixed prostheses, the tip needs to be flexible to follow the anatomy of the implant and get an accurate reading. Using a flexible plastic probe reduces the potential for trauma to the perimucosal seal and the risk of scratching the implant’s surface (Fig. 1). – Hygienist’s Corner: A Probing Question – 15
Page 1 and 2: Inclusive Restorative Driven Implan
Page 3 and 4: Contents 19 Restoring Mandibular Si
Page 6 and 7: Publisher Jim Glidewell, CDT Editor
Page 8 and 9: Contributors ■ Bradley C. Bockhor
Page 10 and 11: Trends in Implant Dentistry Average
Page 13 and 14: my first implant with Jack A. Hahn,
Page 15: The House that Jack Built Inspired
Page 19 and 20: Probe using only 0.15 Ncm of pressu
Page 21 and 22: Restoring Mandibular Single Teeth w
Page 23 and 24: Figure 4: Cross-sectional view of p
Page 25 and 26: Figure 13: Seated provisional resto
Page 27 and 28: Figures 26a, 26b: Acrylic abutment
Page 29 and 30: IMPLANT POSITION IN THE ESTHETIC ZO
Page 31 and 32: type of connection between implant,
Page 33 and 34: SMALL DIAMETER implants Planning fr
Page 35: Mandibular Spacing Maxillary Spacin
Page 38: used before the patient even presen
Page 42 and 43: BB: Sounds like it’s a truly inte
Page 44 and 45: Figure 6: Double-cord tissue retrac
Page 46: It’s a great time to be in dentis
Page 51 and 52: CLINICAL TIP Go online for in-depth
Page 53 and 54: 5a Figures 5a, 5b: A new bite regis
Page 55 and 56: Photo Essay: Immediate and Post-Pla
Page 57 and 58: 4a On the day of surgery, the risks
Page 59 and 60: With the implant securely hand-thre
Page 61: Case #2: Post-Placement Utilization
Page 65 and 66: 7a Once an appropriate osseointegra
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CLINICAL TIP When a Flapless Approa
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LAB SENSE Go online for in-depth co
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Digitally (CAD) Designed vs. Waxed
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mitigate the painful and disruptive
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Go online for in-depth content Trea
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BB: For the sake of our audience, c
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A lot of times, having the prosthes
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the time, and then I will prescribe
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Go online for in-depth content Crea
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Figure 3: In2Guide surgical guide c
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Figure 13: Implants torqued to full
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Figure 22: Teflon plumber’s tape
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“Rules of 10” Guidelines for Su
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Some added concern is focused on th
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The all-on-four concept generally r
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