June 17, 2005
 LAX Radisson Hotel, 6225 Century Boulevard, Los Angeles, CA 90045, 310/670-9000

This meeting was sponsored by NobelBiocare

Surgical and Prosthetic Considerations
for Implant Dentistry

9:00-9:30 AM     Simplified Tooth Removal, and Socket Grafting for Ridge Preservation
                        and Accelerated Ossification in Preparation for Dental Implants
                         Robert Fontanesi, DDS Orange, CA

In areas where dental implants are planned or may be placed sometime in the future, it is imperative that the alveolar process be preserved as much as possible.Prior to the advent of osseointegrated implants many periodontists and restorative dentists routinely referred all except the simplest extractions, to oral surgeons, and oral surgeons, in general, removed teeth in the most expedient manner, which often involved elevation of a mucoperiosteal flap and the removal of facial bone. The judicious use of the periotome and a 4.0mm gouge osteotome facilitates tooth removal and ridge preservation. The periotome can be used more effectively if malleted and there is the misconception that periotomes should never be used on the facial aspect of the tooth to be removed, for fear that the facial plate of bone will fracture. Multi-rooted teeth, which are beyond repair and have little or no periodontal bone loss, can be extremely difficult to remove, particularly maxillary molars and first premolars.  These areas are usually not appropriate sites for immediate implantation; therefore, the most important consideration in their removal is the preservation of the surrounding bone. The proper use of a 4.0mm gouge osteotome, to release the facial plate leaving the periosteum attached to the “green stick” fractured segments of bone, converts a potentially difficult time consuming procedure, to a simple predictable one. Extraction socket grafting is a controversial topic.  Some studies indicate that placing graft material into an extraction socket makes no difference in final ridge volume and instead interferes with normal ossification of the defect.  There is a plethora of techniques and materials used to treat extraction sockets, all with some value and many are over-treatment.  Reflection of a full thickness flap to place a barrier membrane actually causes increased loss of the facial plate, due to loss of blood supply. The simple placement of Dynagraft (demineralized freeze-dried bone in a putty matrix) sealed with cyanoacrylate provides predictable and inexpensive results.

places where you can purchase osteotomes:

Osseous Technologies of America (OTA)

            -Periotome

 

7400 Center Ave. Suite 111

Huntington Beach, CA 92647

(866) 901-5050

(714) 901-5080 fax

OtofAmerica@aol.com

 

 

ISOTIS OrthoBiologics

            -Dynagraft II

 

2 Goodyear

Irvine, CA 92618

(800) 550-7155

(714) 389-3351 fax

www.isotis.com

 

 

E.A. Beck & Co.

-Narrow Groovy #200-592

 

657 W. 19th St

Costa Mesa, CA.  92627

(800) 854-0153

(949) 645-4085 fax

 

            or

 

H&H Company

 

4435 Airport Drive

Ontario, Ca.  91761

(800) 491-9989

 



9:35-10:05 AM    Management of Implant Failure
                         Nikitas Mordohai, DDS, USC Adv. Ed. in Prosthodontics



10:10-10:40 PM   Implant Restorations for the Edentulous Patient: Esthetic
                          Solutions
                          Christopher Marchack, DDS , Pasadena, CA

10:40-11:10 PM    Break

11:15-11:45 PM   Considerations of Superstructure for Successful Implant
                          Prosthesis
                          Kenji Tsuchiya, DDS, Tokyo, Japan

 There are two key factors required to achieve the successful dental implant-supported treatment as an esthetic and functional restoration:

 1. “Restoration driven implant placement”- Determine the optical position of an implant determined by the diagnostic wax up of the ideal prosthesis followed by a surgical guide based on the location and shape of final prostheses.

 2. “Peri-Implant soft tissue management”- begins with atraumatic surgery and  manipulation of the peri-implant tissue prior to implant placement and at the          delivery of the provisional and/or definitive prosthesis..

 In addition to the above factors, the selection of appropriate abutments and crowns is considered as an important factor since there are various kinds of abutments and crowns available now. In this presentation, the above main factors along with the actual cases will mainly be reviewed.

11:50-12:20 PM   The Internal Sinus Manipulation (ISM) Technique:
                          an Adjunctive and New Procedure
                         Jason Yamada, DDS, Torrance, CA

Placement of implants in the maxillary posterior region is often impeded or prevented due to a lack of vertical ridge height.  The maxillary sinus is often pneumatized or slopes very low around the apices of some of the maxillary posterior root tips. Boyne and James in 1980 first described a procedure to raise the floor of the sinus and membrane in order to graft bone and create more autogenous ridge height for implant placement. Summers in 1994 first described an internal sinus augmentation procedure using osteotomes to gently tap and raise the sinus membrane up and thereby creating space for bone graft and implant fixture placement.  Subsequent techniques have been devised using air and water pressure, an inflatable “mini-balloon” and others in order to more predictably and or easily raised the sinus membrane off the floor of the antrum.

Although very predictable cald-wel luc external sinus augmentation procedures necessitate a large flap, vertical incisions and result in a great deal of inflammation and discomfort for the patient and may time consuming dependant on the practitioners skills and the difficulty of the case.

Although an internal procedure may be quicker and less traumatic for patients, the amount of lift and bone grafting that can be achieved as well as other limitations may necessitate an external procedure.  Furthermore, the amount of “lift” that can be achieved is questionable.

Today I will present a new procedure that can be used internally through an osteotomy prior to implant placement to achieve the following:

1)      The ability to create adequate “lift” to accommodate most implant lengths

2)      A quicker procedure done by the surgeon

3)      A similarly predictable procedure as previous techniques

4)      Less patient morbidity and post-operative sequelae


12:20-2:00 PM     Lunch

2:00-2:30 PM     Non-Profitable implant treatments !
                         Bernard Gantes, DDS, Seal Beach, CA

A clinical case of a young female was presented. 2 missing teeth # 7 and 8 with 2 implants. Poor soft tissue contour was corrected through multiple surgeries making the overall treatment non-profitable. In conclusion, it is preferable to promises far less that what we think we can deliver.

2:35-3:05 PM     Using the Internet to Grow Your Practice.
                         Lance McCollough, President & CEO, Prosites, Inc.

The presentation displayed the benefits of having an office website. Requirements of an effective web site were covered and how to be listed on Google, Yahoo, DMOZ (non-profit). Prosites provides web designs for Nobel and dentists. 

3:10-4:15 PM     Branding Your Implant Practice
                        Baldwin Marchack, DDS, Pasadena, CA

The speaker (double degree DDS - MBA ) exposed the importance of branding using images, music and good experience for better customer satisfaction.

Winning combination for success: 1) good brand (halo effect) 2) never be arrogant 3) understand the consumer revolution 4) customer have a choice 5) the biggest guy does not always win.

Why patient choose you: focus on your brand; good customer service; being on time; have a reputation based on trust honesty and fairness (printed fee listing); be a good listener; associate with a brand (halo effect); finally avoid being arrogant and associate yourself with new technology.

Meeting adjourned at 3:15PM