THE RESCUE OF A DENTAL CRIPPLE AND A LIFE TRANSFORMED

When this gentleman who is generally healthy and a smoker to boot requested for help, it was quite a challenge. He could not eat properly because the upper denture tended to fall down and he had only a few lower front teeth left. Cost was not a big issue but he still preferred some savings if possible. 

The options were presented and the choices were between standard implants or minis or a mix of them with the accompanying pros and cons. We started in December 2009 and completed in December 2010. It could have been earlier except that the gentleman had the lowers done first and tried it out for several months before he made the judgement call that minis do work and requested for minis for the uppers as well. 

With all the pros and cons discussed and informed consent obtained, we proceeded to place in 12 minis or MOSTDIs as I like to call them. One was lost from the incisor area basically because the anterior ridge was extremely narrow. Nevertheless, 10 was enough. We cemented BUDs( Bridge/crown Underpinning Device) on them which allowed for direct impressions. 

From THE BUDDY SYSTEM described in this blog 

with

 MOSTDIS, MOSTDIBUDS, MOSTDIDADS AND MOSTDIMUMS. 

FIRST AND ORIGINAL PATENTED BY MOSTDI INNOVATIONS PTE LTD

The Lab loved us because they did not have to manipulate all sorts of analogs and whatnots etc.  They just built the bridge directly with some relief around the MOSTDIBUDs and incorporated cleaning grooves to enable removal of all excess cement and regular self maintenance.

THE DENTAL CRIPPLE WAS RESCUED AND HIS LIFE TRANSFORMED

HORRENDOUS!

REMAINING TEETH PRESERVED

ROOT CANALS DONE ON THE LEFT CANINE AND PREMOLAR

CONSERVATION OF SOUND TOOTH STRUCTURE

A HANDSOME UPPER FULL DENTURE MADE

MOSTDIS WITH MOSTDIBUDS PLACED

CEMENT AROUND THE BUDS CAN BE EYEBALLED AND THOROUGHLY REMOVED.

PIC TAKEN A WEEK OR SO LATER SHOWS VERY HEALTHY MUCOSA ALL AROUND THE MOSTDIBUDS/ABUTMENTS

SEE HOW HEALTHY THEY ARE!!

LINGUAL VIEW OF THE LOWER LEFT BRIDGE TO SHOW HOW HEALTHY THE SURROUNDING MUCOSA IS MAINTAINED

OOPS. THIS IS A PIC OF THE DENTURE THAT THE PATIENT WAS WEARING BEFORE THE MOSTDIS WERE PLACED

SEE THE CLEANING GROOVES BUILT BETWEEN ALL THE MOSTDIS

LINGUAL VIEW OF LOWER RIGHT BRIDGE

LOWER COMPLETED 

PATIENT WANTS TO SEE WHETHER MINIS WORK.... TSK

DIRECT IMPRESSION MODELS TAKEN WITH NO NECESSITY OF ANALOGS

SIMPLIFY! SIMPLIFY! A JOBSIAN TRAIT

HERE IT IS MINIS! MINIS! MINIS!

BRING ON THE BRICKBATS

BUT THE PATIENT IS ABSOLUTELY ASTOUNDED AND PLEASED 

AT LESS THAN HALF THE COST OF STANDARDS 

ALMOST NO TRAUMA AND NO BONE GRAFTS

ALL WITHIN TWO MONTHS OR LESS

CLOSE-UPS

THE GUY IS STILL SMOKING AND BITING VERY WELL THANK YOU!

CLOSE-UPS 

THE FIRST IMPLANT SYSTEM DESIGNED TO PROTECT THE EMERGENT MARGIN OF THE IMPLANT AKA THE ARCHILLES HEEL OF ALL DENTAL IMPLANTS

SEE AND LISTEN TO  "THE THREE CRITICAL MARGINS OF IMPLANT DENTISTRY" 

ON YOUTUBE

IT IS A SEMINAL DISCOURSE ON A SUBJECT THAT IMPLANT DENTISTS TEND TO AVOID LIKE THE PLAGUE

http://www.youtube.com/watch?v=N1GF_82dY1g

HEALTHY! HEALTHY!

USED THE UPPER FULL DENTURE FOR REMOVABLE TEMPORIZATION WITH SOFT LINER

CONCLUDED THAT IT WILL BE BETTER TO REMOVE THE FLANGE AND CEMENT IN THE DENTURE INSTEAD AND REMOVABLE BY THE DENTIST ONLY

OBSERVE THE CLEANING GROOVES

FINAL RESULT

CALLED MICRO-PILING IN ENGINEERING

YOU NEED TO JOIN THEM FOR STRENGTH AND DURABILITY

IF IMPLANT DENTISTRY IS THIS SIMPLE AND SAFE

THEN IT SHOULD BE TAUGHT AT UNDERGRAD LEVEL

AND ALL GENERAL DENTISTS SHOULD AVAIL THEMSELVES TO LEARN AND DELIVER.

IT SHOULD NOT BE CONFINED TO ONLY SOME SPECIALISTS AND A FEW ADVENTUROUS   GPS

CURRENTLY ONLY THE RICH AND THE BRAVE ARE BENEFITING

LET US DEMOCRATIZE IMPLANT DENTISTRY 

AND BENEFIT THE AVERAGE AND THE NOT SO BRAVE!!

THAT MEANS THE REST OF THE WORLD.

MINIMIZED DENTAL IMPLANT REPLACEMENT OF THE UPPER LEFT CANINE IMMEDIATELY AFTER EXTRACTION

This lady presented with a retained primary left canine due to a congenitally missing permanent canine. Since it was already mobile and inflamed, we extracted it and immediately placed in a mini dental implant. A composite BUD was moulded on with the MOSTDIMOLD and the resulting abutment was shaped. An impression was taken and sent for a PFM which was then cemented the following visit. In this particular case, there was some resorption of the adjacent premolar root due probably to the prolonged retention of the  chronically inflamed primary canine next to it. A flap was raised and all infamed tissue was curretted thoroughly before placement of the mini. Three years later, an xray revealed that the resorbed portion of the root has been filled with bone and the implant supported canine was still looking good and biting strong.

The bone had filled up the socket and climbed up the mini dental implant to the max, thus giving the mucosa good support, hence the wonderful aesthetics.

Put minis in the hands of the GPs and minimized dental implants will become the main workhorse of implant dentistry. The future of implant dentistry is mini dental implants in the trained and skilled hands of the GPs!

About two years later, the patient came back complaining of swelling and discharge for some time next to the implant. An xray revealed that the discharge was from the premolar whose root had been partly resorbed by the chronic infection before the implant was placed. The implant was not only healthy and firm, bone had climbed up....... I mean regenerated around it right up to the crown. The treatment was then merely to do an endo on the premolar..... nothing to do with the mini dental implant. Up! Up! The Mighty Mini!!!

The pic here you see is not one from the time of the cementation of the crown, but more than two years later. No loss of papillae and no black triangles.

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

NARROW DIAMETER DENTAL IMPLANTS: POSTED IN OSSEONEWS

K. F. Chow BDS., FDSRCS says:

October 23, 2009 at 11:26 am

THE CASE FOR NARROW DIAMETERS/MINIS/REDUCED DIAMETERS/ MINIMIZED DENTAL IMPLANTS/MOSTDIS

Narrow diameter dental implants are being increasingly used not only to stabilize dentures but also for long term applications like crowns and bridges. I agree with Carl in that there is no such thing as an absolute contraindication in medicine. Even botox which will kill you if injected into your bloodstream is used ingeniously and judiciously to extend the youthful looks of people. The key word is “judiciously”. Know your medicine well and know what you want to do with it and then you can apply it safely and usefully.

It is significant that one of the doyens of implant dentistry has recognized that narrow diameters have their uses especially in narrow ridges and in suitable bone. I started out with conventionals and with the advent of minis, incorporated them into my treatment planning and in many complex cases have successfully integrated them both into my treatment planning taking into consideration the patient’s expectations and budget,the materials available and their limitations and my own experience, knowledge and skill.

However, with the greatest of respect, having read the classic Contemporary Implant Dentistry, I wish to highlight some misconceptions and give my opinion.

As pointed out earlier, many narrow diameters or minis used for fixed applications are 2.4mm to 2.9mm in diameter and are made of solid titanium alloy grade 5. They are certainly stronger than say a 4mm diameter fixture that has a hole in the middle to receive an abutment. Say the abutment is 2mm in diameter. That leaves the surrounding rim with a thickness of only 1mm! That is weaker definitely than a solid 2.5mm diameter mini. Furthermore, many of the conventional fixtures are made of titanium grade 3 or 4 which is 99.9% pure titanium and is softer and therefore weaker than the alloy.

One piece minis heal very well if they are placed in with a torque of at least 35 to 50ncm.Reason being that the healing challenge is much less than conventionals and also the transmucosal wound is very small, so that chances of infection in a normal patient is minimal.

As for the misconception that the surface area is insufficient, Paresh Patel has given an eloquent correction to that. Minis are usually placed longer than conventionals and in multiples. So as Patel has pointed out, two 2.5 by 10mm minis give a total surface area of 157sq mm. This has a greater surface area than a conventional of 4 by 10mm which gives only 125sq mm. 2.5 by 13mm gives 100sq mm. 2.5 by 16mm gives 125sq mm. All these are commonly used such that the argument of insufficient surface area for osseointegration holds no water.

The initial or primary stability of minis, I find often surpasses that of conventionals. In fact, I surmise that because of the minimal trauma and small entrance, the surrounding bone and soft tissue has overwhelming healing advantage when compared to conventionals that invokes a much greater healing challenge to the surrounding tissues. The overwhelming healing advantage in the context of minis may mean that the classical necrotic margin phase of osseointegration may be bypassed and osseointegration in the case of minis may be taking place almost immediately. Anyone wants to do a PhD on this?

Narrow diameter users must concede however that the charges of inadequate prosthodontic solutions to solve the problems of non-parallellism, insufficient prosthetic components, and poor emergence profile may have some credence. These problems I believe are being sorted out. As it is, narrow diameters or minis are here to stay and will be increasingly integrated into treatment plans to cater to all sorts of situations that it can solve much better than conventionals. I look forward to minis making great strides to make the benefits of implant dentistry affordable to everyone who needs them, and not just to the well-off only. I forsee that they will play an increasingly greater part in the development of implant dentistry and am preparing a book…”Minimized Dental Implants” and hope to outline and deliver elegant prosthodontic solutions to minis that will address the current shortcomings as pointed out.

ECTODERMAL DYSPLASIA SEEN SINCE AGE 8 NOW 13. FINISH WITH MINIS?

Mother had been searching all over the country for a dentist willing to treat her son. With some trepedition took it on. First visit refused even to open the mouth. Spoke with the patient and asked this 8year old to come  again. Gave him a small gift. Got these models only on the third visit.

At 10 years old bracketed the two centrals and approximated the two teeth. By now patient has gotten used to visiting us and being comfortable in the dental chair. Parents and child becoming more positive and encouraged as they see the two centrals attaining a more natural position.

Retained the centrals together with a flat wire and composite. What next ?!?!

We raised the bite to a more normal vertical dimension with over crowns on the posterior molars. Observe the edentulous ridges. They have never ever hosted teeth before and cannot then be called alveolar bone.
How are we going to restore this 13 year old's dentition?

A pair of removable acrylic partial dentures with stabilizing stainless steel clasps is not too bad a temporization. In fact the boy was very pleased and grinned from molar to molar. And the parents were almost ecstatic. Are minis/narrow diameters/small diameters the best bet for this boy? Or are we going to place conventionals with the accompanying bone grafts etc. Methinks I will place minis cos I can remove them and reposition them at will as the youngun matures and I have to modify his teeth upwards to match his growth until maturity. Not only that, I will use minis for the final "permanents" or more accurately and realistically speaking even for all our unchallenged patients, for long term use in supporting the necessary crowns and bridges. Minis the best...... simpler..... faster...... cheaper........ stronger .....more versatile!!!!!!
Especially for ectodermal dysplasia may well be the treatment of choice!!