REPLACING MANDIBULAR FREE END SADDLE WITH THE BUDDY SYSTEM

The most distal mini seems to be hitting the IDN. However, because of the small diameter of the mini, little damage is done and most of the time, it is asymptomatic. If symptoms occur, it is a simple matter to remove the mini and the nerve recovers rapidly. Severance or neurometsis of a nerve by a mini is almost impossible, and this is a hugh advantage over conventional sized implants. In this particular case, the xray probably shows an overlap rather than an impingement onto the nerve. There was no sign or symptoms in this case. Thus, a long mini can usually be used even if it seems to enter the nerve canal because it is often only apparent and even if it does so, the nerve is not injured because the nerve occupies only part of the canal and you have to be pretty "lucky" to strike it right in the centre.

Using the Buddy System as described in this blog, we placed mini implants and cemented on the buds. Immediately, we took an impression and sent it to the lab.

And two weeks later........... we cemented the bridge in and the patient went off.

More than a month later, the patient came back. No problems.... he was able to eat quite well on the right side. Can you now look at my left side.... the upper bridge is failing.... please do what you did like on the right side !!

The following pictures is another case of a free end saddle restored with minis.

This is the condition of the composite abutments around the mini-implants and its surrounding soft tissue 3 years later. The PFM bridge came off and had to be recemented. The soft tissue looks healthy and relatively inflammation free. This patient also happens to be a norcturnal bruxer.

6. ECTODERMAL DYSPLASIA: UPRIGHTING THE PEG SHAPED CANINES AND MINIS TO FINISH THE CASE ?

Open coil springs to upright the two peg shaped microdontic canines. Minis in the empty spaces to complete the case. Conventionals will require bone grafts to increase the width of the ridge. Or bone splits can be attempted. If this is my son, I will just place minis together with the BUDDY SYSTEM  and complete the case cheaper, faster, safer stronger than conventionals. Minis with PFMs can be completed in 2 weeks or less, depending on lab support.

ANATOMICAL POSITIONING OF MINIS TO REPLACE UPPER RIGHT MOLAR

   

Notice the "CLEANING GROOVE" between the two abutment holes. This is to facilitate the threading of a bridge cleaner and floss in between and thus the undersurface of the crown can be flossed right to the surface of the implants. The ability to floss thus and the smallness of the emergence margin of the mini will arguably prevent any peri-implantitis in the long run.

In contrast, a conventional implant with an aesthetic emergence profile that includes a large emergence margin cannot be flossed all the way to the surface of the implant proper. The emergence profile emerges out of a volcanic-like crater in the gums. The surface of the crater is usually slightly inflamed and together with the large surface will arguably be more susceptible to peri-implantitis as compared to a mini dental implant. Examine the pics below.

Let's continue with the replacement of the upper molar by copying the anatomical/biologically ergonomical/natural/no-brainer/obviously correct positions of the roots.

The upper right first molar was deemed unsavable and extracted. After a short healing period, 2 minis were placed. One on the palatal wall of the sinus and the other on the buccal wall of the sinus. The divinely ordained and inarguably best anatomical positions of the palatal and disto-buccal roots were copied by the two mini dental implants. The undersurface of the crown was designed with a"CLEANING GROOVE" to enable threading of a dental floss and flossing.

JUST ENOUGH IS THE WAY TO GO

K. F. Chow BDS., FDSRCS November 16th, 2010

“Wolff’s law” states that bone models and remodels in response to the mechanical stresses it experiences so as to produce a minimal-weight structure that is ‘adapted’ to its applied stresses. The behaviour of bone according to Wolff’s law mirrors a fundamental trait of mother nature, i.e. optimal economic use of substance in the performance of a function.

Thus to use a wide diameter implant because there is a wide hole seems to contradict this fundamental. A living organism deserves to be treated according to living rules of life, not static non-living engineering presumptions.

Granted that we need to use a titanium screw, since the tooth germ implant is not yet available….. it does make more organic living sense to use the optimal titanium necessary to allow maximal living tissue around it and thus also minimize the perio pocket that inevitably forms around all dental implants.

Minimized and optimized diameter implants should be the trendand not large diameter dental implants. If we have to put something foreign into the living body, put in the smallest you can. That is what the “GREEN MOVEMENT” is all about…… to use just enough and leave the rest alone and we will save the world !

After all, are we not living in the narrow sweet zone between bleeding to death and clotting to death. And if our beloved earth is 10,000 Km nearer or further from the sun, we will either burn or freeze.Just enough is the way to go.

THE TRANSMUCOSAL PASSAGE OF THE DENTAL IMPLANT AND THE THREE CRITICAL MARGINS

Every dental implant ever placed has created an iatrogenic  periodontal pocket. Yap! Has created a pathology in the mouth that has a certain amount of inflammatory infiltrate around it that ranges from a low grade perimucositis to a full fledged peri-implantitis.

This fact does militate against  the use of large and extra-large diameter implants. The periodontal pocket that accompanies every dental implant we place is a reality that every implant dentist must accept and manage as an acceptable evil for the sake of the greater benefit of being able to replace a lost tooth almost as good as before.

 The issue at hand is what is the best approach to managing this compromise for the sake of the larger good. The best replacement for a lost tooth of course is another tooth, and that will likely come in the future in the form of a tooth germ implant or stimulation of germ cells already present but dormant. As that may take another generation or so before we can bypass all the barriers involved, we are stuck with titanium screws for the forseable future with its accompanying perio pocket and the management issues involved.

KAI FOO'S THREE CRITICAL MARGINS

The transmucosal passage of the dental implant is a poor imitation of that of the tooth. The tooth has a very sophisticated self-renewing living cuff around the neck of the tooth as it emerges into a bacteria filled environment.

There have been some claims of hemidesmosomes between the connective tissue and the surface of the implant but they are at best a far cry from the original ! Let us look at a study on the inflammation present around dental implants.

"PERSISTENT ACUTE INFLAMMATION AT THE IMPLANT-ABUTMENT INTERFACE"
is the title of this study. The conclusion suggests that,  "these findings may motivate a clinician to place an implant shoulder above the alveolar crest or to utilize a one-piece implant to minimize potential inflammation and/or possible hard or soft-tissue loss".


I would like to further add that narrow diameter dental implants will give a smaller transmucosal passage and therefore arguably lower the amount of inflammation and therefore the chances of peri-implantitis in the long run, provided that satisfactorily hygienic prostheses( read the BUDDY SYSTEM in this blog) are delivered at the same time. This is assuming that narrow diameters are strong enough...... and time is beginning to indicate that it is, when used in the right way and context.


http://smalldentalimplants.blogspot.com/2010_05_01_archive.html


http://smalldentalimplants.blogspot.com/2010/05/buddy-system.html

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.