...the absolutely, positively remodeling of
the tissue, meaning the bone
form will change.
Question: Do you really need to go to a specialist?
Dr. Singer: You know, I'm glad you asked that
question, and implants have
really only been out for twenty years they
have been popular.
And most
specialists out there don't have any more
training or knowledge or they
didn't have it in their program when they
went to school, so everybody has
really learned about this outside of their
training.
It all depends who can
do it is on what their training level is,
so you ask questions, what's
their success rate.
I'm a regular dentist, but I have hundreds
of hours in
implant-specific surgery education.
So I do mostly implant surgeries.
I'm
not a specialist, but just because you're
a specialist doesn't mean that
you had any training in it.
If you were a periodontist and you graduated
from periodontal school twenty years ago you
had no implant-specific
training, ditto for oral surgery, ditto for
prosthodontics.
These programs
now for younger people this implant is more
integrated, but it's into the
programs before these people graduate.
A specialist doesn't necessarily
know as much or more, than a general dentist.
Question: What about maintenance?
Dr. Singer: Maintenance, you must rinse out
if you have an implant, with
prescription mouthwash, chlorohexadine, every
day.
That's what I do for my
patients.
You must keep it clean.
Fortunately, they tend to be bullet proof
in most people, but my patients are supposed
to be on 3-month checkups ,
just to make sure everything is good.
And if you ever feel anything
slightly off go right in.
That's it.
Because it means a piece of food is
caught or something is there, it's a little
sore.
Get it taken care of
before it gets more involved.
[Video 00:02:13] Here we see a broken tooth.
The remaining tooth root is
removed with an elevator and there is no replacement
with an implant at
this time.
Whenever there are missing teeth there will
be bone shrinkage
called bone atrophy.
We must now graph the area if we want to place
an
implant in this location.
We start with a flap retraction.
This is followed
by decortication of the bone.
These little holes will allow blood to reach
the area more easily and help with graft maturation.
Two bone screws are
placed.
These screws hold the soft tissue away from
the graft, and act as a
scaffold for the bone to form.
The area is filled with the patient's own
bone or a bone substitute.
Blood will soak the graft and begin the healing
process.
If deemed necessary, we can then cover the
area with a resorbable
membrane to further help with the healing.
The flap is re-positioned and
sutured into place.
The patient may wear a partial removable denture
during
the healing phase as a temporary tooth replacement
option.
The sutures will
be removed or dissolved if self-dissolving
sutures are placed.
Underneath, the membrane will dissolve while
maintaining the area, and
preventing in-growth from the soft tissue
or gums.
The bone underneath will
mature and become part of the ridge.
At about 5-7 month the area is again
exposed with a flap, and the bone screws are
removed.
The access holes can
be left or filled with bone particles.
Now the bone can be prepared for
implant fixed replacement.
In this situation a single-stage type of implant
placement is demonstrated, where the healing
cap is placed at the same time
as the implant.
During this healing phase the patient can
still wear the
removable partial denture.
The area heals and the sutures will dissolve
or
be removed.
With adequate time of approximately 4-6 months,
we can then restore the
implant.
The healing cap is removed.
An abutment is attached to the implant
to give it structure, followed by a crown
that will replace the top of the
tooth.
The gums around this crown may not fit perfectly
at first, but will
mold to fit in time.
We can place implants in an atrophied posterior
maxilla, with the addition of grafting.
The lateral window technique
involves raising a flap on the buccal side
of the ridge and then creating
an access window.
The bone is very thin in this area and can
be prepared
without damaging the inner membrane with a
slow speed round drill.
Once the window is created the bone can be
pushed into the sinus and the
membrane lifted with special sinus lift instruments,
to create a new sinus
floor.
The membrane will fold over itself as it is
being lifted, creating a
barrier as well as covering small perforations.
In this situation we still
have enough bone left in the ridge to stabilize
an implant, and so we can
place the implants at the same time as the
grafting procedure.
The space
created is then filled in with different bone
substitute selected by the
dentist.
This can be the patient's own bone or an allograft.
The window
access can be covered with a membrane to aid
in healing and the flap
repositioned.
With time, the grafted bone will turn into
mature patient
bone close to the original.
