October 2009 – Implants By Paresh

Expand the Bone or not to Expand the bone? That is the question

October 29, 2009/in Blog, Uncategorized /by Paresh Patel

Mini Dental Implants for Single Crown

Our patient today, as it seems like most these days…seem to know WAY more about implant placement than I would have ever thought.

Charlotte had braces years ago and was going to get an implant to replace her missing lower premolar tooth. As we all know, life has a way of throwing the unexpected at you and she never got the implant and crown. Over that period of time the molar tipped forward a bit into the space.

More importantly the width of the missing tooth area collapsed (cheek to tongue distance). Charlotte had already did her research on bone splitting and bone block grafting as an option to place a traditional implant. She decided to consider getting a mini implant as an alternative to those procedures and have a PFM crown placed as the final restoration.

We talked about her options and she elected to have the mini implant placed. Mini Dental Implant placed in thin ridge

With Charlotte's permission guiding planes were made on the two adjacent teeth. This also helped to upright the tipped molar for a better contact area for the PFM mini implant crown.

Intra Lock MDI 2.0 x 10mm in place and above the Inferior Alveolar Nerve Canal

I will continue the post with pictures of the Mini Implant Crown in place.

The impression of the mini dental implant was sent to First Impressions Dental Lab for the fixed crown. Mini Dental Implant Lab

Mini Implant Crowns for Missing Back Teeth

October 26, 2009/in Blog, Uncategorized /by Paresh Patel

I had a hard time figuring out how to start this case blog. Its an interesting story. A patient of mine, who was one of the first multiple crowns over the top of mini implants that I did, referred to me a friend of his. The patient of mine was a boxer and was missing teeth on each opposing side.

I knew I was in for a challenge, but to my surprise the case turned out well. Lots of help from Jon at First Impression Dental Lab and getting his bite as correct as possible made the difference in this case. I do not envy anyone who has to get someones bite established that has no frame of reference and has teeth on the opposite sides!

Although we did not do as many crowns and mini implants as planned, the case worked out well for the patient. Most important to him is that he no longer has to wear partial dentures.

The case has been in function over just over a year (9-25-09) and hopefully I can track the case for several years. One year post op pan is shown. I told him if he did not return for the follow up exams every year…I would find him and knock out the rest of his teeth! Somehow I don't think I would win that boxing match, but he seems like a nice enough guy and will return without threat of bodily harm.

The Main Event

Now to the real case. Our new patient, intrigued with implants to replace his missing back upper teeth, saw a prominent and well qualified dentist in his home town of Asheville NC.

A CT scan (3D – xray) was taken and a very impressive treatment plan was created for our patient. Bi lateral sinus lifts, bone grafting, PRP(Platelet Rich Plasma), implants, custom zirconium abutments, and zirconium crowns. The treatment plan could not have been any better. The one thing that stopped this case dead in its tracks was that it was not affordable to the patient. As I tell my patients there is only one treatment plan in the end that is right….its the one the patient understands the pros and cons of and can afford. Apparently he noticed my boxer buddy's new teeth and they got to talking about mini implants…one thing led to another and he ended up coming to my office for a alternative treatment plan.

Why minis? Both mini implants and conventional implants are constructed from medical grade titanium alloy. Mini implants have been researched and used widely now for over 10 years all over the world. Conventional dental implants now have more than 30 years of data, and many dentists will only use these larger implants. I believe that now is the time for a paradigm shift as I have been working with this alternative. I have no quarrel with others who are uncomfortable with mini implants, but I am ready for a change in thinking and treatment planning for patients that otherwise could not have implant supported teeth.

After studying his CT scan I told Tim that I though he had enough bone on the palatal slope of his upper jaw to place mini implants and skirt around the sinus pneumatization (dropping down of the sinus balloon to where the bone used to be). The mini implants could support a set of fixed crowns. Tim was not ready to get rid of the existing bridgework he had on his remaining upper teeth just yet. We did discuss that when that time comes we ccould extract the remaining upper teeth, place additional mini implants and fabricate a full arch bridge. This wwould also give us the benefit of cross arch stabilization. Another challenge to the case was the hyper eruption of the last molar on the lower right side. The space between the arches had gotten so small I cautioned Tim that we may not be able to get porcelain on the top of the last tooth.

The mini implants were placed, impression made and on this case I tried a modified ridge lap design where there will be a 1mm space from the lingual so Tim can use a electric toothbrush to keep the implants clean. I know that most dentists who place crowns over mini implants like having the ridge lap design tight to the tissue on both the cheek side as well as the roof of the mouth or tongue side. I think with having a 1mm space I know the implants can be kept clean. Minis in place 1mm gap being show from lingual Occlusion being established…the bridge will be sent back to the lab to final polish the metal.

Pan x-ray with crowns in place. I will have the patient come back in 1 month, 3 months and then 1 year to see how the soft tissue reacts to the 1mm space and how he is keeping thing clean. The post will get updated with new pictures at those times.

Paresh B Patel DDS Mini Dental Implant Dentist

General Dentist Mooresville NC

Mini Implants ~ Do They Hurt Dr Patel?

October 23, 2009/in Blog, Uncategorized /by Paresh Patel

I get asked this question quite often. Of course there is going to be some discomfort you would think having a titanium screw inserted into the jaw bone…..but believe it or not most if not all of my patients claim it was less painful than having an extraction.

Not ever having an implant placed or a tooth removed from my own mouth I always think when I see the condition of most of the mouths that need implants…how is this not hurting to begin with?

But as with most things in life the older I get the more I figure out I don't understand.

So without further adieu…our patient in her early 60's is now ready to introduce her broken down teeth to Dr. Good (as in good by to the broken and unrestorable roots she has left). They have been in this sort of condition for the last decade or so.

The teeth are atraumatically extracted (how an extraction is autraumatic I am not quite certain). But we try and preserve as much bone as possible I guess is the point.

The sockets are packed with our freezed dried mixture of mineralized and de-mineralized bone and closed up tight so we hopefully will have some bone to place our mini implants in a few months.

Tick tock…tick tock…tick tock…

Wow…its now been 4 months all in the space of a few lines.

The patient has mini implants placed in the healed areas and we will splint the minis together with some composite while the integrate into the bone.

On the patients left side the mini ended up having to be placed a bit closer to her natural tooth as there lack of good bone where I wanted to place the mini implant.

She is coming back to see us in 6 weeks and I will continue the post at that time. To keep costs down for her she has elected to have resin crowns made by First Impression Dental Lab to fit over the mini dental implants.

Paresh B Patel DDS Mini Dental Implants

General Dentist Mooresville NC

Mini Dental Implant Crown ~ Mini Implant Cost

October 22, 2009/in Blog, Uncategorized /by Paresh Patel

News flash of the week…we had our first 'drive by'. No not a drive by shooting but a patient that said, he saw our sign on his morning drive to work each day. Intrigued by what a mini implant was he did, 'a bit of searching on the inter-web.' Pleased with what he learned he decided to make a visit to our office.

So Danny's now in the chair and as he is talking to me he has a curious habit of flipping his one tooth partial round and round in his mouth. DM Partial He tells me its DM Missing tooth been years since he lost his front tooth, thought about getting a 'real implant' but he did not see the value in around $1500 for the implant, $500 for the screw that goes into the screw, and $1500 for the cap (all his words).

I assured him that I was not going to put a 'fake' implant in his mouth…it would be made of a similar titanium alloy and should integrate into his upper jaw just like those 'real' implants.

We decided to place a Intra-Lock MILO 3.0 x 15mm mini implant to support a single front tooth crown. No flap, no stitches, two small drill holes and then the implant was seated in the bone. The entire process to place the mini implant was a surprise to Danny in terms of time and lack of discomfort.

I was able to take one of my acrylic burs and make a hole in the back of his partial. He was able to use that to cover the mini implant until the lab fabricated crown come back to the office.

The post will be updated with his final crown photo in a few weeks.

DM Mini Implant xray He did ask if I could cut off the front tooth on his partial when he gets his crown. Why, I asked puzzled? He said, ' so I can flip that darn thing round and round.'

Mini Dental Implant Bridge (Ken Clifford DDS Fixed Hybrid Denture Bridge is Here!)

October 13, 2009/in Blog, Uncategorized /by Paresh Patel

Do you have a denture? Would you like to get rid of it for good? Well now thanks to mini dental implants and my good friend Ken Clifford you have that option.

A patient of mine came to me and said, 'Dr. Patel I am so glad that I had mini implants placed to keep my lower denture from coming out every time I tried to eat or talk….but can you give me some teeth that I don't have to take out?'

After pondering the thoughts of how to make a bridge that most people could afford I saw my friend Ken at the Annual Academy of Mini Implant Dentists in Orlando. He had a great idea; why not take high quality, 4 layer denture teeth (in my opinion they look better than some porcelain teeth I have seen) and make a fixed bridge for our patients who suffer with dentures? The more I thought about it the more it made sense.

Why should we tell patients that if I take some really accurate impressions and then make a tracing of how your chewing motions are that I will be able to create a set of dentures that will work? Its just not true…they might work…but I think most just make do with what they have. Dentures resting on gum tissue and chewing muscles will always create some sort of problem. Soreness in the gums, irritations when chewing foods that get under the denture, the list can go on and on and most denture wearers will attest to that.

So with mini implants in hand, and soon in our office, a Cone Beam 3D X-ray its 'time to get to work,' as Ken would say. After some careful planning we decided to upgrade Vicki's ability to chew by adding 7 additional mini implants on the lower arch. One Intra Lock 2.0 x 18mm was placed in between the four she had. 3 additional Intra Lock 2.0 x 11mm were placed on each side for a total of 11 mini dental implants. These will be used to hold a molar to molar (Roundhouse) Fixed Hybrid Denture Tooth Bridge; also know in my office as the Ken Clifford Bridge. This bridge will be cemented over the top of the mini implants and will not be removed by the patient.

The existing denture was modified to allow it to seat over the additional mini implants. She will comfortably wear her denture until the fixed set of teeth are made.

It will be designed in the same fashion as a traditional fixed hybrid bridge over regular diameter implants.

I will continue the post as I get the model work back from First Impression's Dental Lab.

Here is an example of a Fixed Hybrid Mini Implant Bridge. Photo courtesy of Ken Clifford DDS.

Visit my dental office on the web at www.dentalminiimplant.com or if you are in Lenoir NC

Visit Dr. Ken Clifford on the web at www.kenclifford.com or if you are in Chico, CA.

Mini Implants ~ Traditional Implants ~ Extractions ~ Crowns & Bridges

October 8, 2009/in Blog /by Paresh Patel

Mini Dental Implants Case presentation of the week – Here is a patient that was referred to our office by another patient that we placed mini dental implants and restored the minis with crowns.

He had ALOT of needs. But as with most things we see, I had some ideas and the patient had their own set of ideas. With ample discussion and informed consent he decided to have a few extractions and some mini implants to support fixed crowns and bridges.

Pre Operative Pan Xray

Root tips on lower left and Root tip Upper extracted today

Mini Implants in place

Doug Turner 007

X-ray of mini dental implants in extraction site and traditional implant immediate placement upper

Extractions ~ Immediate Placement of Mini Dental Implant ~ Socket Preservation

October 8, 2009/in Blog, Uncategorized /by Paresh Patel

Interesting Case – Today we saw a young chap that was sent to us by his mother. She had 4 mini implants placed in her lower jaw to secure her denture some months back at our practice.

He told me that he has not smiled in several years…sad story but when we took a look it was apparent why.

Wow! No wonder…well, we got him motivated with a patient education appointment, several periodontal deep cleaning appointments and then the big day for him….we would extract the 4 front teeth, root canal therapy on the 2 canine teeth and place 4 mini dental implants. DFDB (Demineralized Freeze Dried Bone) was placed around the minis to keep the proper height and width of his gum and bone tissue.

Our plan is to let the mini implants heal into the bone and make 6 crowns for the final restoration. While the minis are healing and the body is creating new bone from the bone grafting material, the patient will have a temporary bridge made from chair side acrylic.

I was not completely pleased with the final picture (a few drops of blood and a sagging lip from the anesthetic)…but he jumped out of the chair when he saw his smile in the mirror.

I will keep the case post going as the case progresses.

Mini Dental Implants – What are they?

October 6, 2009/in Blog, Uncategorized /by Paresh Patel

A mini dental implant is a titanium implant that acts like the root of your tooth. It can be used for securing a denture or partial denture. Mini implants can be used for fixed crowns or bridges. When used to replace a single rooted tooth many mini implant dentists place one mini implant. When used to replace a multi rooted tooth (like a molar) 2 or more mini implants are placed. A crown or bridge if fabricated by the dental lab and cemented over the mini implant.

If used to secure a denture the head of the implant is shaped like a ball and the retaining fixture acts like a socket that contains a rubber O-ring. The O-ring snaps over the ball when the denture is inserted into your mouth. The denture is tissue supported and implant retained, in other words the denture no longer has to be held in place with adhesives or held in by the patient's own mouth muscles.

Archive for month: October, 2009