Dental Implantology: BONE CLIMBING UP MINI DENTAL IMPLANT

The lower right first molar was extracted due to severe periodontitis resulting in loss of bone support. Two mini dental implants were immediately inserted into whatever bone was available. The patient was covered with antibiotics for several days. A porcelain bonded to metal crown was fixed about 2 months later over a composite core that was lightcured over the minis. Six years later, an xray was taken.... looks like the bone has "climbed up" the implant. The tooth was firm and functional.
A NEW WAY TO REGAIN ALVEOLAR BONE SANS GRAFTS?!!

A SIGNIFICANT PARADIGM SHIFT IN THE GROWING BACK OF ALVEOLAR BONE

Human Histologic Verification of

Osseointegration of an Immediate

Implant Placed into a Fresh Extraction

Socket With Excessive Gap Distance

Without Primary Flap Closure, Graft, or

Membrane: A Case Report

Dennis P. Tarnow, DDS*

Stephen J. Chu, DMD ,MSD, CDT**

* Clinical Professor and Director of Implant Education, Columbia University College of

Dental Medicine, New York, New York.

** Clinical Associate Professor and Director of Esthetic Education, Columbia University

College of Dental Medicine, New York, New York.

This case report provides

clinical and histologic proof that the immediate placement of implants into

extraction sockets with an intact buccal wall allows healing and osseointegration

despite a large gap distance and without primary flap closure, a bone graft, or

a barrier membrane. (Int J Periodontics Restorative Dent 2011;31:515–521.)

In the discussion, the following statement was made:-

It is possible then that an

implant placed in an extraction site

without soft tissue closure could

heal with bone-to-implant contact

before the soft tissues have an opportunity

to interfere.

However, I beg to differ.

Based on the case shared on "Bone Climbing Up Mini Dental Implant",

my postulation is as follows:-

In spite of the absence of a buccal and lingual plate, no well defined socket,

a mini dental screwed into the cortical plate at the bottom of the bony crater

left behind by a mobile, periodontally compromised tooth,

will stimulate the alveolar bone to reform and grow around the implant

to a more normal level

in spite of the presence of granulation and epithelial tissue.

BONE CLIMBING UP MINI DENTAL IMPLANT

I think I am seeing things.........but my patient is not complaining and is happily biting away.

The upper right did not have that much bone, so I did a sinus lift .....what.
Hoping to develop and innovate to the point that I can use all minis and still lift the sinus ......or avoid it like some 3 rooted upper molars do....2 buccal roots in the buccal sinus wall and 1 palatal root in the sinus palatal wall.......what?! You canna do that you....... well if He can, why not little me? Will keep ya allll posted.

Oh, this guy did not wanna his lower right bridge yanked and thrown away. So we salvaged it with a mini right through the pontic. Told 'im that its temporary......but now its almost 3 years and he thinks its permanent. Anyways.... I never promised him its permanent!

BONE CLIMBING UP MINI DENTAL IMPLANT

Immediate extraction and implantation. Bone level is definitely higher than when the implant was first placed.

Well what do you think? Nah........ can't be bone climbing up the implant. Its a camera trick!
Whatever it is, I am really glad and I guess I will continue to do this "miracle" as long as the miracles keep coming and not run out.

Not very scientific, but my patient is not complaining.

BONE CLIMBING UP MINI DENTAL IMPLANT

A case of immediate extraction and implantation, followed by PFM bridge within 3 weeks. Follow-up xrays showed healthy bone growing around the minis. Not only did the bone seem to have climbed up the second implant from the left, there is also a layer of healthy cortical bone around it and between the minis.

There was a study that claimed that bone remodels around the minis at much higher rates than around a conventional, indicating the possibility that the bone around the mini maybe mainly woven bone and therefore not as good and sound as that around a conventional. Looking at this series of xrays, I am not sure that is true and if so, is it a disadvantage or advantage?

There is also the possibility that the bone that seemed to have climbed up the mini may not be in close intimate contact with the surface of the implant, and therefore may not be osseointegrated. Alright then, I am going to CBVT this one as soon as I think it is necessary enough to buy one.

BONE CLIMBING UP MINI DENTAL IMPLANT

This young girl avulsed her tooth. It was reimplanted and splinted. Endodontics was done, but eventually the tooth had to be extracted due to external resorption of the root. A mini was subsequently placed with a composite crown in place. About 13 years old then, orthodontic treatment was commenced and completed. By then, she was about 16, so we placed in a PFM. If we compare the 2 Xrays closely, it can be seen that the bone level has climbed or risen up to match that of the adjacent teeth. Thus in young children, where bone maturity has not been reached, an adjustable composite tooth built on a mini may be an option in order to compensate for bone growth and obviate submergence that may result. Treatment of choice?