November 2010 – Implants By Paresh

Can Mini Dental Implant Crowns & Bridges Look Good and be kept clean?

November 23, 2010/in Blog /by Paresh Patel

I get asked this question a lot from both dentists and patients. I think the answer is most likely yes. Lots of variables contribute to the successful outcome of any implant and the crown or bridge that goes over the top of it. Tissue type, bone level and sometimes how much time and funds the patient has to invest.

But for the most part I think patients, if given all the information, can be happy with the aesthetic outcome with mini dental implants and the crown or bridge they support.

My next patient was in for her normal 6 month cleaning appointment. She stopped me to tell me how happy she was with her fixed crowns on her mini dental implants in her upper jaw.

These crowns and mini dental implants have been in for 1 year now. This case used Intra Lock mini implants. But as I state in most of my posts any well constructed mini dental implant such as the OCO Biomedical mini or micro, IMTEC MDI, or HiOssen mini are appropriate. Even as a dentist I think I would have a hard time figuring out which ones are regular crowns on teeth and the mini dental implant crowns.

This patient is able to keep her mini dental implant Crowns by First Impressions Dental Lab clean with a normal toothbrush, floss, and/or a water pick. The two crowns are connected together and are supported by 3 mini dental implants. The hygienist and patient both can floss between all the mini implants.

Paresh B Patel DDS Dentist Mooresville NC

Mini Dental Implants

Extraction and Immediate Placement of OCO Mini Dental Implant

November 18, 2010/in Blog, Uncategorized /by Paresh Patel

What are mini dental implants good for? I would say lots of things; like immediate use, less cost than a regular dental implant,less trauma, less pain, less healing and more immediate satsifaction for both me as the dentist and the patient.

Before a one piece mini dental implant, like the OCO i-mini and OCO i-micro existed, I would have been tempted to do some heroic dentistry. In this case a post, crown lengthening and a porcelain crown. In a few years this patient would be back in my dental chair with my crown in her hand and we both would be frustrated.

Clinical view of the broken lower front tooth. In this case even if I wanted to do a bridge it would have been a bad idea. The adjacent tooth (the one on the left side of the broken tooth) was part of her bridge that extends back to the molar.

So off to the OCO Biomedical tool-chest of goodies that Chris Sanchez sent me. I found a 3.0 x 16mm mini dental implant. Ahh…..this would work well here.

With some Salvin Peritomes (sharp dental extraction instruments used to removed the broken tooth with minimal trauma) I proceeded to extract the root.

With the tooth root out and the bone on both sides still intact I decided to continue with the OCO mini dental implant placement.

To be certain I was keeping in line with the adjacent teeth and roots I took a dental x-ray with the pilot bit in place. Looks like we were in good shape to place the OCO mini dental implant.

OCO Biomedical i-mini 3.0 x 16mm one piece dental implant in place with the machined collar right below gum level.

OCO mini dental implant in line with the adjacent teeth. In keeping the dental implant in the correct angle it would be easy to make a temporary tooth while the gum tissue healed.

Temporary crown in place over the OCO Biomedical mini dental implant….about 20 minutes after placing the mini implant.

Final x-ray of the OCO mini dental implant. I will have the patient come back in 4 weeks to check gum healing around the mini implant. If all looks good an impression will be made and First Impressions Dental Lab will make a porcelain crown to fit over the mini dental implant.

I will post pictures of the crown once it is in place.

Paresh B Patel DDS General & Implant Dentist Mooresville NC

Mini Dental Implants

OCO Biomedical Mini Dental Implant for a Molar Crown ~ 1/2 the Cost & 1/2 the pain

November 11, 2010/in Blog /by Paresh Patel

1/2 the time, 1/2 the cost, 1/2 to no surgery needed and less pain? This is what my patient asked me. She said, 'Are you sure about this?'

She was reading from a poster in our office touting the benefits of mini dental implants. I told her in most cases YES. Well she told me….I don't really care about most cases I care about mine!

With that in mind we went to work. Yes I recognize the open margin on the molar behind the missing tooth. The patient is aware and will address that tooth as time and $$ allow.

X-ray of the missing lower tooth molar. I had extracted a failing root canal tooth about 4 months ago and packed the extraction socket with some Foundation bone preservation material. The area looked well healed and ready for some 'painless' mini dental implants.

I gave her 1/2 a carpule (shot) of dental anesthetic and placed 2 2.2 x 10mm OCO Biomedical Micro Implants. Less numbing than I give for a lower tooth filling.

OCO mini dental implant impression caps in place to take a traditional impression.

Final X-ray of OCO mini dental implants

Lab model from First Impressions Dental Lab showing the mini dental implants and the soft tissue silicone.

PFM Mini Dental Implant Crown to fit over the OCO mini implant

Although this case shows the use of a OCO Biomedical mini dental implant; it could have been done with any reputable mini (IMTEC MDI, Intra Lock MDL, HiOssen etc…)

OK…its been a few weeks and the patient is ready to get her crown. Here are the clinical photos of the mini dental implant crown over the OCO mini implants.

Paresh B Patel DDS General & Implant Dentist Mooresville NC

Mini Dental Implants

OCO Biomedical Mini Dental Implants ~ Improved Zest SaturnO-ring

November 11, 2010/in Blog, Uncategorized /by Paresh Patel

Is it difficult to get 6 mini dental implant o-ball attachments to line up for an upper full denture plate?

Several mini dental implants in the upper jaw with more than 5 degrees of divergence (off angles)

Is it sometimes hard for patients to line up that many snaps and figure out how to get the denture fully seated?

Well…..sometimes yes. As the dentist we have to put the mini dental implant where the bone is, or do another surgical procedure to make the bone ready to have all parallel mini dental implants. To make it clear, most of my patients decline to have this additional procedure done and we work with what bone is available.

As the patient the answer is sometimes yes as well.

Transistor sockets Transistor and the socket it fits in. You can imagine how difficult it becomes to line up the pins to fit into the socket if they are not all in line. Even with one off angle you have to figure out which one goes in first to make the pin and socket fit together. Very similar to the upper denture and 6 mini dental implants.

But hang on….now with the new Zest SaturnO-ring its a bit easier to handle off angle mini dental implants. These new o-rings allow for up to 30 degree of correction between mini implants. This is possible due to the housing having a Titanium Nitride race that allows the rubber o-ring to pivot inside.

OCO Biomedical should have the Zest SaturnO-rings available to ship. I have tried them and am sold on their ability to make snap in dentures easier for both the mini implant dentist and patient. These o-rings will fit on most mini dental implants, (IMTEC MDI, Intra Lock, Hiossen,OCO etc…)

Paresh B Patel DDS Dental Implants Charlotte NC

Mini Dental Implants

Zest SaturnO-rings for Mini Dental Implants ~ Upgrade your Snap in Dentures

November 10, 2010/in Blog, Uncategorized /by Paresh Patel

After the hundreds of mini dental implants I have placed to secure upper and lower dentures I would have thought there could be a better snap for the O-ball attachment.

But thanks to Paul Zuest there is one now, the SaturnO-ring. Released in late October it offers up to 30' of angle correction. The standard o-rings that come with most mini dental implants(Intra Lock, IMTEC MDI, OCO Biomedical) offer around 5' .

It has a TiN coated race that allows the rubber

o-ring to rotate freely inside the metal housing.

Wow…great engineering and a great idea… I wish I had though of that.

Picture on right shows the race pivoted up inside the housing.

Zest offers a standard size Saturno for a 2.25mm Ball and a Micro size Saturno for a 1.8mm Ball attachment.

Standard on left and

Micro on right

There is also a neat little o-ring tool so when you need to replace those worn out black rings you don't damage them with a sharp dental instrument getting them in the metal housing.

I had just the case to try out these new Zest SaturnO-rings. My patient had 6 mini dental implants (Intra Lock) placed in the upper jaw to secure in his full upper denture plate. As much as we tired to make it easy for him to remove it was just too tight. He struggled to get it in or out. Some of the issue I am certain was the divergent angles of the mini dental implants. I fitted him with one of his bag full of old dentures with a lab processed Molloplast soft liner over the 6 mini dental implants.

He was comfortable with that molloplast liner and it did provide some grab on the mini dental implants but of course I wanted to give the SaturnO-rings a try.

I reamed out his horseshoe upper denture, taking away the old standard housings.

In the mouth were fitted 6 micro housings, they were picked up inside the upper denture with some self cure pink acrylic. They worked great! I thought I was done. But darn it, he still could not get that thing in and out like he wanted to a few days into it. Poor guy was just getting older and I wanted to make him happy. I think most of it was he just wanted to feel like he could accomplish this task for himself.

So I reamed them out again and decided to try the idea of using the larger SaturnO-ring on the mini implants to give him some retention but not quite as much.

The SaturnO rings snapped over the 1.8mm ball like I expected and had less retention. There were 3 mini implants that touched each other with the housings so I placed 3 standard housings for those areas.

We picked them up just like normal. Less retention…yes. Enough retention? Charlie said two thumbs up. He was able for the first time now to put them in and out….without a Mirror! Even I was impressed. He was smiling ear to ear.

Thanks to some clever engineering at Zest Anchors we as have another choice to make patients lives better with mini dental implants.

Paresh B Patel Dentist Mooresville NC

Mini Dental Implants SaturnO rings for Intra Lock IMTEC OCO Biomedical

Missing Teeth Replaced with Mini Dental Implants & Porcelain Crowns ~ A technique from the Advanced CE Seminar

November 8, 2010/in Blog /by Paresh Patel

This is part II of the post Mini Dental Implants to replace a missing front upper tooth. See recent posts for the history of the case.

Its been 4 weeks or so and the all Porcelain crowns are back from First Impressions Dental Lab to fit over the ACE Secure Mini Dental Implants.

Lateral crown

Mini Dental Implant Crowns

A scan was taken of the mini dental implants with a iTERO digital optical scanner and Jon Younce at the lab was able to plan the case in a all digital format to make Zirconium all porcelain crowns.

All Porcelain Ridge Lap Mini Dental Implant Crowns.

These crowns could be made over any mini dental implant (Intra Lock, IMTEC, OCO Biomedical mini, Hiossen etc…)

I have often been told that it is not possible to make good looking anterior(front) tooth crowns on top of mini dental implants because of the ridge lap design. Or without creating a emergence profile below the gum its not possible.

I think the real issue is the patients gum thickness. If the gum is too thin you see the gray halo of the implant as it comes out of the gum. Even if you have a traditional implant with a two piece design and a custom fabricated ceramic abutment if the gum is too thin its hard to have room for the crown.

So I like to have patients know before we place the mini dental implants if they have thin tissue type and what can be done to make the gum thicker if aesthetics is a primary concern.

As with anything in dentistry….almost everything is possible…..its just how much time, money and effort the patient and doctor are willing to invest.

Paresh B Patel DDS Dentist Mooresville NC

OCO Mini Dental Implants

ACE Surgical Mini Dental Implant with a Zest Locator for the Upper Denture Plate

November 4, 2010/in Blog, Uncategorized /by Paresh Patel

Does your upper denture gag you? Does it feel like a big bulky piece of plastic? Do you not taste your food anymore? Do you talk funny or don't sound like yourself anymore?

These are all the things my patient told me yes to. That is a lot of yes answers to have on one patient. Usually I don't get that many issues with the upper denture. But when we do have someone that just simply can not wear the upper full denture plate its a huge problem; both for function and esthetics.

Upper denture prior to placing 4 Mini Dental Implants with a Zest Locator attachment (different than a o-ball and ring snap typically used on mini dental implants).

Zest Locator attachment. It has a flat surface to make inserting the snap easier on the patient than the o-ball and ring. It also has different nylon rings that can be swapped out by the dentist to offer the patient levels of retention…..so if the denture is not tight enough a more retentive ring can be placed. This feature is not available on the o-ball mini dental implant.

4 ACE Surgical Secure Mini Dental Implants with Locator attachments.

Upper denture marked for location of the ACE Secure Mini Dental Implant.

Space created for the Zest Locator 'snaps' that will be fitted inside the existing upper denture. In a few weeks I will make the upper denture into a horseshoe shape so he can: 'Talk better, taste his food better and gag much less'

Snaps picked up in the upper denture. These rings will be replaced with more retentive rings after the implants heal into the bone. But even today the denture is tight and my patient is impressed with how much hold he has now.

Final Pan X-ray of the ACE Surgical Mini Dental Implants with a Zest Locator Attachment.

In the end I am impressed with the Locator attachment. A bit more skill required to place these mini dental implants than a o-ball type. This is mostly due to the protocol of using a 2.3mm in the front and having to place a 3.25mm in the back. My preference would have been to just use 6 2.3mm minis and give the patient a few extra implants. But as with any product it is up to the dentist to determine what he/she feels is best for the patient. This case could have been done and been successful with any mini dental implant, IMTEC MDI, Intra-Lock, OCO Biomedical mini or micro.

Paresh B Patel DDS Dentist Mooresville NC

ACE Surgical Mini Dental Implant

Mini Dental Implants are not FDA approved to use for crowns…or are they?

November 3, 2010/in Blog, Uncategorized /by Paresh Patel

Where is this coming from? Why would we as dentists want to misinform the very patients that seek our help? If we don't know the answer its best to tell the patient I don't know. We should say, if you are considering getting this procedure with mini dental implants you ought to seek out a dentist that does a lot of them. I think it would be better to let our patients know the truth and let them make decisions for themselves on how they want their mouth taken care of. In the end its their health, time and money….not ours.

To answer the question do Mini Dental Implants have FDA approval to use long term for crowns or dentures… YES they are.

Image of the 510(k) approval from the FDA, straight from their website stating in plain English that mini dental implants (IMTEC MDI) are approved to use for however the dentist sees fit; long term or short term. IMTEC MDI is the substantial equivalent that most other, if not all other manufacturers have applied to get their FDA approvals.

Does being FDA approved mean anything? Well it means something, but as with any medical device you have certain risks and benefits. If we as dentists are going to try and take the position that traditional implants are FDA approved and minis are being used outside of their prescribed approval then that is just wrong and means nothing. They are both approved to use in the mouth. Do they both work…yes. Do they both have the potential to fail…yes.

They both have about the same success rate (anywhere from 96-97% success). You can make any study look good for the parameters you want it to….but in everyday wet fingered dental offices you will find this number to be correct. A skilled traditional implant dentist and a skilled mini implant dentist will have around the same success ratios. If anyone tells you they have a huge failure rate with minis then they just have not got the proper training….just like if someone tells you that traditional have a huge failure rate in their hands….you may wish to see the help of someone else.

FDA 510(k) approval for a Intra Lock Mini Dental Implant Prosthetic Abutments in plain English showing approval for use in either upper or lower jaws for a removable (denture) or fixed (crowns and/or bridge) prosthesis. You can see all the other major brands, OCO Biomedical mini and micro, ACE Surgical Secure Mini, etc… have FDA approval on the FDA website.

Paresh B Patel DDS Dentist Mooresville NC

Mini Dental Implants

Mini Dental Implants ~ 1/2 the Cost All the Benefits

November 2, 2010/in Blog, Uncategorized /by Paresh Patel

Dr. Paresh B Patel's interview on Charlotte Today. Click to watch patient comments on their experience with mini dental implants for an upper and lower full denture and mini dental implant for a fixed porcelain crown.

Paresh B Patel DDS Dentist Mooresville NC

Mini Dental Implants

No Bone for Dental Implants ~ Would Mini Dental Implants work?

November 1, 2010/in Blog, Uncategorized /by Paresh Patel

One of the main reasons patients don't move forward with dental implant treatment is lack of bone. This lack of adequate bone can be in the width or height dimensions.

Cone Beam CT scan showing a lower mandibular ridge with severe resorption in both the vertical and horizontal dimensions. The ridge of bone is only 1.2mm wide at the top and stays that way for 9mm until you get to the wider bone near the chin.

In this case we had no choice but to flatten the ridge to make room for the smallest mini dental implant we have (1.8mm wide). Once that was done there was only 11mm of height left to place the mini implant in the lower jaw.

The mouth has a very specialized kind of bone, its called alveolar bone. This alveolar bone is not found anywhere else in the body. Its purpose is to hold the roots of your tooth the the base of the jaws. Once teeth are lost this bone just melts away or is resorbed by the body. If you have a loose or ill fitting denture or partial the constant rubbing and moving will cause this bone loss to accelerate. Even in areas of one missing tooth the alveolar bone melts away. Without a tooth root over time the bone will be lost. The good news is that any dental implant, mini or traditional conventional will help to keep this bone from melting away any further.

This picture shows how substantial bone loss can be from missing lower jaw tooth molars. The ridge of bone is thin and is vertically deficient. Options could be to do a block onlay graft of bone or to consider using mini dental implants. One of the benefits of mini dental implants is that we can sometimes avoid this additional surgical procedure.

Area where a tremendous amount of bone has been lost in the lower jaw. A large defect that would require bone grafting to place traditional size dental implants.

So what should you do if there is no bone left for a dental implant? The most elegant solution is to repair the missing bone and gum to gain the height and width that was once there. This requires the experience and high degree of surgical skill of an experienced Oral Surgeon, Periodontist or a well trained General Dentist who does this kind of surgery on a daily basis. We refer this kind of treatment to a highly skilled dentist in our area.

But with every procedure there are some drawbacks. For this kind of bone grafting or repair the potential hazards are: prolonged healing time, additional surgery, additional temporary dentures to fit over the repaired bone while it heals, potential morbidity and expense. There could be additional pain and discomfort or injury to the nerve. Mini Dental Implants are an alternative to consider to bone grafting or bone augmentation. The patient not only saves on the cost of the bone grafting (anywhere from $3000 to $6000) but we can use the mini dental implant almost immediately.

This picture shows how thin a ridge can get. It would be very difficult to place a traditional implant here without doing a surgical bone grafting procedure.

Here we have placed a mini dental implant without any bone augmentation procedures.

Intra Lock Mini Dental Implants in thin bone. Here I used a 2.0mm Intra Lock mini; however just about any mini dental implant would work….other minis I use include OCO Biomedical mini or OCO Biomedical micro, IMTEC MDI, ACE Surgical Secure Mini Prep or Hiossen.

Porcelain Crowns on the top of the mini dental implants cemented in place.

This x-ray shows a 2.0mm wide mini dental implant. Notice how thin the bone is…it is at most 4mm wide. A traditional regular implant would not fit without bone augmentation(repair) surgery. The pink shows where the nerve bundle exits out of the jaw into the gum tissue.

Archive for month: November, 2010