In this video we present the technique used for immediate loading of a Legacy 3 dental implant that was placed at the time of extraction.
Since the patient is my mother, I did myself the restorative part of the case.
Both, temporary and final restorations, were screwed retained utilizing the pre-fabricated abutment that is provided with the implant.
Following this technique, the risk of cement trapped under the gingival tissue and subsequent cement sepsis development, is prevented. The presence of sub-gingival cement could progress to clinical signs of inflammation even so, after 2-3 years post restoration.
The use of prefabricated abutments has been shown to be more accurate than the use of UCLA abutments.
Keys for success in cases similar to the one shown are:
1. Case selection (ASA I patient)
2. Socket anatomy
3. Gap between the implant platform and alveolar facial wall
4. Soft tissue biotype
5. Implant primary stability
6. Crown's contour
7. Restoration's torque
8. Occlusal scheme
9. Oral hygiene of the patient
This is a video made by my wife Dr. Badell, who is also a periodontist. It shows you the advantages of utilizing iMovie software to create high quality videos that can be used for promotion of your work. The simplicity of this software does not require special training, it requires only imagination!. :)
I would like to emphasize the advantages of utilizing iMovie and Keynote for your presentations over other softwares. It is just easier and faster!
Special thanks to my wife for her wonderful job.
Best,
Ioannis
Patient presented with altered active eruption and gingival hypertrophy of the mandibular teeth. She refused osseous surgery. Treatment was therefore focused on elimination of the gingival hypertrophy and establishment of best possible clinical crown dimensions based on available distance from osseous crest. Any attempt to expose more tooth structure would fail due to soft tissue relapse. The patient was happy with the result. We recommended crown lengthening of the maxillary teeth for esthetic improvement but an osseous surgery would be absolutely necessary in order to obtain a more aesthetic result.
At the time of maxillary incisors' extraction, it is expected an average bone resorption of about 1.5-2mm in width and about 1-2mm in height using any type of bone preservation technique and materials. Thus, it is important to understand that some cases require GBR procedures in order to establish the proper amount of bone dimensions necessary to accommodate future implants.
This is a case where we utilized the sandwich technique in order to achieve our goal of placing implants in the future.
Good communication among the different members of the team is necessary from the beginning until the end (treatment planning phase until the treatment execution phase)
Description of a Free gingival graft technique. Goals: - Recession coverage
- Establishment of thick keratinized and attached gingival zone
- Elimination of muscle fibers that might be "pulling away" the free gingival margin.
Creating an ideal implant site is not always achievable. Sometimes the patient himself will not wish to undergo full treatment in order to achieve a result that will be nice for our pictures. However, it is important for the clinician to understand the biologics behind the decisions he will have to make for the best interest of his patient.
Creating adequate hard and soft tissue anatomy around an implant is proven to be critical for long term stable results.
In this case the presence of interproximal bone loss on the distal of tooth 2.1 is the detrimental factor that would not allow the establishment of gingival symmetry between R and L side. The tooth had already been extruded with no additional benefit. Any further attempt to improve its bone levels, would put in risk its longevity since C:R is already compromised.
Upon evaluating the patient's smile and discussing with him his options, it was concluded that symmetry will not longer be one of our primary goals in this case.
However, good hard and soft tissue quality is important to prevent future breakdown. This is particularly important in post-ortho cases where the anatomy of the alveolus and the position of the teeth has been changed compared to the genetic information of the patient.
Another interesting point is the interproximal bone stability (this is all you can evaluate from regular PA or BW xrays) around the implant. This was a Legacy implant, an implant with no platform shift design for the implant diameter used (3.75mm) and short conical connection (internal hex, 45') and it still shows very stable bone levels.
Possible reasons for the observed crestal bone stability:
1. Bone width around the implant (>2mm)
2. Soft tissue quality and thickness
3. Subgingival material
(no porcelain, only titanium abutment with a 3mm collar. Titanium is a biocompatible material, porcelain is not!)
4. Microgap position (crown-abutment interface) slightly subgingivally and away from the crest of bone
5. Biologic width component - if there is such a thing around implants- (different tissue structure around teeth and implants. There is no real attachment on implant or abutment surface up to this time point).
This is a post-orthodontic treatment case that required esthetic crown lengthening due to inappropriate gingival position and contours. The appropriate steps prior to this procedure in cases where the teeth will not be restored, are the following: 1. evaluate radiographically and clinically the interproximal bone position 2. evaluate, with bone sounding, the position of the bone in relation to the CEJ of the teeth 3. evaluate the presence and extension of frenums in the area 4. evaluate the crown and root position in relation to the bony envelope 5. evaluate the root shape and color All of the above are factors that can influence your results. Always tell the patient in advance that a second small procedure (touch up) such as gingivectomy with either blade or laser, might be necessary in order to achieve an optimal result. Best, Ioannis
This patient presented with a failed anterior bridge and huge aesthetic concern. We proceeded with extractions of the remaining teeth and immediate implant placement. A temporary titanium re-inforced acrylic prosthesis was placed within 24 hours. Utilizing the described protocol in the video, this type of treatment option can be very easy and predictable for the doctor and very satisfactory for the patient.
In this case we describe the indications of doing a Free Gingival Graft in order to cover a recession, increase the thickness of the tissue and create a zone of attached gingival in the lower central incisors.
It is very important to identify the cause of the problem:
1. Thin tissue biotype
2. Absence of attached gingiva
3. High Frenum insertion
4. Root position post orthodontic treatment
The free gingival graft in combination with plasty of the root during the procedure will eliminate the above causes and will offer a good and stable long term result.
Disadvantage of the technique:
1. Morbidity of the donor site ( use a stent and/or mouthwash NSAID)
2. No good color match of the graft with the adjacent tissue (even though is not really an aesthetic area but you have to inform the patient in advance)
Bottom-line:
Very predictable technique for this area of the mouth to treat muccogigival defects.
In this case we showed how important is to evaluate the edentulous space and to perform bone reconstruction of the whole area and not only of the extraction sockets. At the end, the quality of regenerated bone was very good, the initial stability of the implants was very high, therefore we decided to place only 2 and not 3 dental implants as original planned, to be restored with a 3-unit bridge.
It is my belief that bone manipulation techniques like ERE can give more long-term stable results than regular GBR techniques. No evidence is available in the literature, however we could start a debate on this matter.
