KAI FOOS RED DRAGONFLY

One of the most beautiful image of a dragonfly that I ever captured in my garden.
Everytime I look at it, I am reminded how crude our imitations of mother nature is.
And also what a pathetic imitation our dental implants are compared to the real thing.

GRANMA'S NEW FANGIIS!

AAAAAARGH!!  Looookit me new fangiis! Ah ken eeven kleann dem with dem dental flossii what!

GRANMA'S GOT NEW FANGIIIS!

Hiyaaa Folks! Lost alllmuz all me sky tiith. Me ground tiith there but cannaa grind! Kuz me tiith done rotted under me bridges. Nein soorry fer me. Kleverrr dentiist done plazed new uns! Dem olde iinplants dey call dem. Sum big .....sum smallllll......miniiiis...what!  AAAAARGH......dem miniisss wurrkks ai teilll ya. Ya gimme yer fingerrr and triiee......likes what me munching now! C dem baack beig an frunt ar miniis what!

Returning Clinical Judgement From the Lab Back to the Dentist

Yes. They are mini dental implants. The anterior implant has a composite bud light-cured on. The posterior 2 implants have metal buds cemented on. A direct impression was taken and sent to the lab where the bridge is made the usual way in which conventional crowns and bridges are made but designed to provide a friendly interface with the gums and easy maintenance. With the increasing use of dental implants, the dentist has become more and more lab-dependent to the extent that he/she often seem just like a technician. All the dentist have to do is to send the models and X-ray images to the laboratory and back comes a precision-stent together with the prefabricated crown or bridge. The dentist places the stent, drills the hole and screws in the implant to a preset depth and then cements the crown or bridge. Simple and straightforward but highly lab-dependent and turns the dentist from a clinician into a technician. The bud and direct impression approach gives back the dentist the responsibility of clinical judgement and the satisfaction of doing things intelligently without having to rely on a lab to instruct him exactly where and how deep to place a dental implant. If the current trend of lab-dependency goes on, the dentist does not have to think much any more and can just follow the exact instructions from the lab technician. And you can be sure that there will be many clinical problems that will arise as a result of the increasing surrender of clinical judgement  to the dental laboratory. The laboratory cannot eyeball what the dentist can in the immediate clinical situation.

Maintenance of Hygiene for a Minidentalimplant Bridge

Maintenance of hygiene for a bridge is important. This minidentalimplant bridge can be flossed anteriorly and posteriorly and also in between the implant abutments. The bridge is designed so that the interproximal clefts are generally between the mini dental implants. Thus it is important not only to place the minis parallel but also precisely in the middle of where a normal tooth is expected to be. This will lend itself to ease of bridge design for the technician as well as ease of flossing in between the implants with the help of a bridge cleaner. The narrow diameter of the minis results in a corresponding narrow transmucosal passage of the dental implant as it traverses the gum and emerges into the mouth. Logically then, it will have a lower chance of infection and peri-implantitis as compared to conventional larger diameter implants especially accompanied by an aesthetic emergence profile that demands a broader transmucosal passage especially at the point where it emerges into the mouth. So, not only can this design be flossed right up to the implant circumference but it also has a smaller passage for possible pathogens to invade. This is an advantage over conventionals provided the smaller diameter is just as strong as a larger diameter conventional.Since the small diameter implant is a one piece solid implant as compared to the larger diameter implant which is usually 2 piece and therefore has a hole in the fixture to receive the abutment, leaving a narrow circumferential margin of metal of 1mm or less, it follows that the 2.5mm diameter one piece solid implant may arguably be stronger than a 4mm diameter hollow dental implant.

This the final result after the rubberdam has been removed. Later, I will show a photo showing how this bridge can be maintained by cleaning the underside or mucosa interface of the porcelain fused to metal bridge.
This is important for the prevention of infection and for the longterm health of the soft tissue around the dental implant. Thus we can replace missing teeth that not only look good, but bite well and last long.

Dental Implantology: Mini Implant Abutments

Dental Implantology: Mini Implant Abutments

One of the ongoing problems in Mini Implant Dentistry is the need for an elegant prosthodontic solution. The BUDs are my contribution to this need. Here the 3 unit bridge is being cemented over the BUDs as seen in the previous picture. The BUDs are cemented or bonded over the mini implant heads, and the excess cement cleared off immediately. The advantage here is that we can actually eyeball it to make sure that no excess cement is left and this will prevent any inflammation or beachhead for pathogens to gain a foothold on and eventually cause peri-implantitis.

A rubber dam is used during cementation so as to prevent cement from seeping into the transmucosal passage of the dental implants.Hope my readers found them interesting.

Mini Implant Abutments

Three implant abutments. These are called BUDs which stand for Bridge Underpinning Device. Two of them are stainless steel buds and one is a composite bud.

Dr Chow on connection problems between the implant and the crown

April 15th, 2009

All things being equal, i.e. no major systemic problem and local conditions are healthy…a morse taper connection ensures that there is no microgap between the fixture and the abutment and therefore no toxic pump as a result of colonisation of the gap together with function. Fact is the 2 pieces behave like one piece….basic engineering principle. Thus in makes like Astra, Bicon, Ankylos and others like some Korean Implants, the Morse taper connections cum platform shifting(if its Morse taper, it automatically translates into a platform shift), there is little or no bone resorption in the majority of cases. In fact often it can be seen that the bone grows right onto the “gap”!

There are 2 critical margins:- one is the abutment-fixture margin and the other is the abutment-crown margin which is also a major problem in that excess cement from this margin often remains in the gum-implant interface and can cause resorption of the bone as well as inflammation of the gums.

The abutment-fixture connection problem,I feel has been largely addressed successfully by the Morse taper solution. The crown-abutment margin with its excess cement or microgap if screw-retained is still quite an enigmatic problem that is yet to be addressed as successfully. I call it the “critical margin” in oral implantology.

Cheers!

Dr Chow on Allergy to grafts in oral implantology

Dr K. F. Chow May 14th, 2009

Theoretically, an individual can be allergic to anything because anything can be an allergen i.e. a substance that is considered by the immune system as a foreign body. Once the immune system identifies a foreign body, it responds basically 4 different possible ways…..4 types of hypersensitivity mediated either by B cells of T cells.

Your patient’s sounds like the 4th type….T cell mediated delayed hypersensitivity……allergic contact dermatitis likely due to your gloves..powder….ointment or something that touched your patient’s face.

Treatment is usually steroids systemic or topical or both. If things are getting better, that means things are getting better and no drastic treatment like removing the grafts etc. is necessary. Just make a note on your patient’s record and avoid the possible causes in the future.

Cheers!