LOWER FULL DENTURE STABILIZATION IN A RESORBED REPAIRED MANDIBLE

This is an elderly lady in the seventies. Not only is her mandible resorbed, it is also repaired due to a fracture in the right body of the mandible. Conventional sized implants will be risky and unnecessary because minimized aka mini implants can be used. It is a 1-2 hour job and is the treatment of choice in this case. In fact, it should be the treatment of choice in most if not all lower denture stabilization cases.

DONE IN 2007

NOTE THE DIFFERENT MAKE OF MINIS

ANY BRAND WILL DO

THESE PHOTOS WERE TAKEN FIVE YEARS LATER IN OCTOBER 2012.

THE PATIENT WANTED A NEW PAIR OF DENTURES

NOTE THE PLAQUE !!

ARE THE SURROUNDING GUMS HEALTHY ??

YOU BET !!

AS SEEN AFTER CLEANING OFF THE PLAQUE.

NOTE HOW HEALTHILY KERATINISED THE MUCOSA IS AROUND THE EMERGENCE MARGINS OF THE MINIS

AFTER FIVE YEARS,  THE O-RINGS AND HOUSING ARE STILL THERE BUT VERY LOOSE.

THE TWO CENTRAL ATTACHMENT DEVICES ADAPTED FROM SNAP-ON FASTENERS MADE OF STAINLESS STEEL WIRES HAS CORRODED AWAY.

WATCH THIS SPOT FOR THE NEW DENTURES

AND FOR THE LATEST STATE OF THE ART

DADS IN ACTION.

DAD STANDS FOR DENTURE ANCHORAGE DEVICE.


MOSTDI INNOVATIONS



AFTER 5 YEARS, THE PATIENT CAME BACK FOR A NEW SET OF CHOMPERS.
THE MOSTDIS WERE STILL STRONG AND HEALTHY.
THE NEW CHOMPERS WERE EQUIPPED WITH STATE OF THE ART DADS.
DAD STAND FOR DENTURE ANCHORAGE DEVICE AND CAN BE OBTAINED FROM MOSTDI.NET http://mostdi.net/

Dear Friends. If you can use mini dental implants to stabilize 

a lower full denture for this patient !!

Whose lower jaw is so narrow that one section fractured

and been repaired before with a bone plate......

And on top of all is an elderly lady who is likely suffering from osteoporosis,

then mini dental implants can be used successfully to stabilize almost 

all lower full dentures.

In fact, for most cases, it should be the treatment of choice !!

http://mostdi.net/

MOSTDI INNOVATIONS

A KNIFE EDGED RIDGE CASE

This gentleman wanted to be able to chew again on his right jaw. A very narrow ridge. We placed in the implants and usually in such cases, the bridge is cemented permanently within a month. The bridge was cemented. As a result, the patient was able to chew his food again. It encouraged him so much  that within six months,after a successful removal of bladder stones, he began to exercise regularly and cut down in his smoking. The last time we saw him, he was hale and hearty and telling his friends about how dental implants changed his life for the better.

ANOTHER CASE OF KNIFE EDGED RIDGE

This is a patient who already had a conventional in place from another dentist and came back from another country. We placed in a Mostdi and a mostdibud and cemented a two unit bridge over it.

Yes. We practise lipping over the mucosa liberally. It is a practice which every dentist have used successfully over the years with conventional bridges built on natural teeth. The main problem then were and are cervical caries in the abutment teeth immediately adjacent to the pontics. When used with implants, it does not happen because implants do not decay. In addition, a large sulcus in the name of a nice emergent profile is avoided with its concomitant uncleansable excess cement is avoided. In this case, all the excess cement can be removed definitively with the use of a dental floss. A cleaning groove in between the two abutments will allow a bridge cleaner to effectively remove all excess cement conclusively. Gives you great peace of mind.

WHAT IS A SAFE DISTANCE BETWEEN MINIS?

A rule of thumb would be 2mm. We can do it closer than conventionals because of its smaller diameter. The basic principle is to ensure optimal living tissue around the implant to maximize healing potential.

I think you should have a very rational way of doing things and that should keep a dentist within the limitations of any form of treatment modality. We should stop looking at minis emotionally but scientifically. I say emotionally because many criticisms are based on the suspicion that the dentist cannot do conventionals... therefore resort to enter into the game via minis. While true sometimes, what is wrong with that?..... and what do you say to a dentist who is adept at using both and yet still use minis successfully and rationally in situations where conventionals just will not do?? We should move on and just accept that dental implants come in all forms of shapes and sizes and materials etc. etc. and as professionals and scientists, use them based on principles and common sense and not just condemn blindly. This will rob the profession of a very useful treatment modality and shortchange the patient. We should see minis like we see fillings. We have different materials for fillings to be used in different situations within their known limitations.

MOSTDIS: A SOLUTION FOR BLACK TRIANGLES.... TREATMENT OF CHOICE ! ? !

In upper anterior cases where the use of conventionals usually result in black triangles due to its large size, I am increasingly convinced that minis should be the treatment of choice because their narrow diameters allow plenty of nutrients for the inter-implant tissues so much so that initial black triangles rapidly get filled up with living tissue, and aesthetically to boot.

BLACK TRIANGLES !

A month or so later, they have disappeared.

This particular patient was a total dento-phobic ++++. He had never seen a dentist for years. He called me on the phone and outlined his fears. His first visit, all I did was talk to him, took an impression and an OPG. If I were to offer to do conventionals only, I gravely doubt that I would ever see him again. With minis, I had great confidence to treat this patient with the minimal of trauma and pain and delivered his teeth fast and in a very satisfactory way. He completed a questionnaire in which he said that he was very happy with the results except for the price and I was charging him less than half what I would have charged him with conventionals with the accompanying steep prices, surgery, time  and possible complications with such a complex case.

Even though they look awfully close, they are not that close because they are minis and have plenty of living tissue surrounding them. The lower left second molar area have two minis that look as if they are touching each other. They look like that because they were placed diagonally to each other and a 2D xray gives that impression. This last 2 failed not because they were too close but because the upper molar had overerupted and bit heavily on them. 

GOAL !!!

There are many cases where minis are the treatment of choice. 

Congenitally missing upper laterals. 

Lower anteriors. 

Ectodermal Dysplasia. 

Post cancer rehab. 

Post facial trauma rehab. 

Patients who do not want bonegrafts and narrow ridges.

Recently, I gave a talk on "Minimized Implants and Their Uses". 

Later, I gave another talk entitled "A Happy Balance".

Minis are an important adjunct in implant dentistry and I really think that it is the way forward. In this talk, I outlined what "Evidenced Based Medicine" is and gave documented evidence to support minis. Thinking dentists should not be prejudiced. The first implant dentists were general practitioners and were considered quacks. Since then, the specialists have claimed implant dentistry for themselves. We should proceed with openness and humility instead. I have done on both Asians and Caucasians and minis work on both indiscriminately, always with informed consent after offering them options for conventionals and minis or both.

I will be speaking on the topic, 

"Treatment of Complex Cases: Striking a Happy Balance". 

I will show how conventionals and minis can be used in tandem to resolve cases simpler, faster, safer...... that otherwise will be very difficult. This will be in the MDA/FDI Scientific Convention and Exhibition in January Kuala Lumpur Malaysia.

Check it out here: http://www.mda.org.my/90-20130112-01.html

My blog that I am refering to is not the blog showing different clinical cases. 

It is another blog where I am writing a book entitled, 

"Minimized Dental Implants: 

The Coming Workhorse of Implant Dentistry".

http://minimized-dentalimplants.blogspot.com/2010/05/minimized-dental-implants-coming.html 

Cheers.

Dr Chow

IMPLANTATION AND EXPLANTATION ON PATIENT'S INSISTENCE

We placed in the upper anterior implants carefully and everything healed uneventfully. 

However, when the patient returned, he insisted that we remove them, the reason being that,

"He just could not accept them as part of his mouth and body!"

This was a realization that he had only after he had the implants placed.

After numerous attempts to persuade him otherwise, we finally accepted the fact that the patient for some reason beyond us, cannot accept the dental implants as part of his mouth and body. By then, the implants were fully osseointegrated and ready for harvesting and prosthodontics. 

So near, yet so far!!!!

Rest assured, we tried our level utmost to convince the patient how simple the prosthodontics were and how much he already paid and what a boon a set of fixed teeth as compared to his dentures were.

With all the preliminary exercises in persuasion and explainations done conscientiously, we got the patient to sign a carefully worded consent form indemnifying us from all the consequences of his thoroughly informed consent. With that in safely in the drawer, we proceeded to grant the patient his wishes.

We exposed the implants and tried to unscrew them first. 

One came out just by unscrewing them at about 50 ncm, my guesstimate.

One had to be trephined almost the whole length before it could be removed.

One was trephined to about 2-3mm depth and then it was elevated gently out.

We stitched it up and the wound healed uneventfully.

The patient wore back his old set of dentures, happily relieved..... I think.

We never saw the patient again because we wrote into the informed consent a clause stating that the patient will not seek any further treatment from us again.

A CASE OF OBSESSIVE-COMPULSIVE BEHAVIOUR?


MY BLOGBOOK:
http://minimized-dentalimplants.blogspot.com/2010/05/minimized-dental-implants-coming.html

IMPLANT TOGETHER WITH BONE GRAFT

This patient's lower right molar had to be removed due to severe chronic periodontitis and loss of supporting bone. After one month, after the mucosa had overgrown the socket a bit, we inserted the implant the following way:-

1. We drilled right through the mucosa in a flapless procedure until we hit paydirt.... I mean bone. Unfortunately the first drill went right into the inferior dental canal and there was a gush of blood. The bleeding was stopped with a piece of spongostan and biting on a piece of gauze.
2. After another 2 months, we went in again flapless again, this time more carefully in avoiding penetration of the inferior dental canal. After tapping the osteotomy and trying in the implant to its full depth, we removed it and made a straight incision along the direction of the alveolar crest.
3. After lifting the flap bucally and lingually, we curetted the socket thoroughly to gain a raw fresh bony surface. 
4. We then removed any loose granulation tissue attached to the flaps, screwed in the implant 4.5 by 11mm Ankylos. Bio-Oss was used to fill up the gaps 360 degrees around the implant. No membrane was used. Primary closure was achieved.

Because of some general health issues, we could not complete the case sooner. After almost one year, we screwed on the abutment, cemented on the crown and took an Xray and we had the pleasant surprise of seeing the bone graft substantially replaced by well calcified bone to the maximum level available!!!!!

MY BLOG BOOK: HTTP://MINIMIZED-DENTALIMPLANTS.BLOGSPOT.COM/