I got a phone call last night from a Dentist friend of mine in Buffalo NY (one of the worlds best respected Mini Dental Implant clinicians). He had a patient of his from years ago that had a Resin Bonded Bridge that had now failed.
Knowing full well that this patient would end up back in the office of the guy who has restored the most mini implants in the US I felt a bit of pressure to get it as correct as possible.
The patient agreed to let me put a mini dental implant in to hold her resin bonded bridge in place until she could get back home and then have the permanent crown made over the mini implant.
So I put in a 2.0 x 15mm Intra Lock mini implant to hold the bridge. It was fairly easy to grind out a hole in the pontic and fit it over the mini…whew!
I filled in the one wing that was not broken and the hole I created in the pontic with resin cement. She left so happy and excited. She had a tooth until a new one could be made for her.
The assistant put my mentors patient in the iCAT CT chair and a few nail biting moments later I could see if I had threaded the bone and kept the mini in between the bone and not in air or soft tissue.
Now for the CT slices…
The next story is about a patient of mine named Storie….how bizarre. Well actually the patient is the wife of a patient of mine who had placed mini dental implants on to replace his existing partial denture.
X ray of broken premolar #13
I gave her the option of a root canal, post and a crown. I thought it was a good option but she had it in her mind to take the tooth out and have implants. We talked about traditional implants but she wanted what her husband had been offered – mini dental implants and crowns.
I took the tooth out with some peritomes to preserve the facial bone as much as possible .
As you can see the procedure was very atraumatic to the tissue as no flap was made. Notice hardly any blood in the sites where the mini implants were placed.
I standard impression was taken and the case was sent to Valdi and Shatkin FIRST Lab for 2 PFM Crowns. The thing I like about FIRST Labs is that you don't get charged for the lab analogs for the master model or the 2nd pour for contacts.
Not to mention that the crowns look good and more importantly fit well on the mini implants.
I dry fitted the mini dental implant crowns in the patients mouth…let her approve the color and aesthetics. She approved them and we cemented them. Overall it was a slam dunk case.
As promised here are the photos for the mini implant crown to replace a missing molar tooth. In this example of using mini implants for a crown 3 minis were used to replace the three roots on the missing upper molar.
3 Intra Lock Mini Dental Implants in tooth #3 position
We have been using the iTERO dental scanner for 20 months now and decided to see how it would scan muliple mini dental implants. I did take a traditional impression as a backup and also to verify the fit of the mini implant crown.
I discussed the case with Valdi at Shatkin FIRST Lab's and he felt like there should be no issue with the case using the iTERO scan. He built the case just like any other one he does on a daily basis.
iTero model of 3 mini dental implants
FIRST Lab Mini Dental Implant PFM Molar #3
Mini Implant Crown next to a standard crown
Mini Dental Implant Molar Crown Chewing Surface View
Mini Dental Implant Crown Side View
X-ray of Molar Crown on 3 Mini Dental Implants
Ok…so more than 6 weeks have passed since the blog about the mini dental implants and do they hurt. But the patient has finally come back and we took the impression for her crowns. If you need to scroll down to the original post you can see the teeth that were extracted and the mini dental implants that were placed.
I really wanted to do some Porcelain crowns over the mini implants but $$$ were scarce in this case so a decision was made to use lab fabricated resin crowns. I took a standard Poly Vinyl impression and sent the case to Shatkin FIRST Lab.
Nothing new required for me as the dentist. From there FIRST Labs places the mini dental implant analog into the impression and makes a replica of what is in the mouth.
Most of the patients I have seen either have some sort of removable appliance or a orthodontic retainer with the two missing teeth on it. The issue is that these teens don't really care to wear their retainer.
Another solution, the bonded bridge, seems to fail. While the bonded bridge works well on missing lowers, the clinical data shows that bonded bridges to replace missing upper laterals fail quite often because the central and canine tooth both move to different degrees under chewing function.
One solution that works well in my hands is a technique that Dr. Todd Shatkin taught me….use mini dental implants. The Intra Lock or IMTEC Mini Dental Implant can be threaded in between the canine and central. This mini implant can then hold a crown in place that the patient does not remove.
This photograph shows a Intra Lock 2.5 x 18mm mini dental implant to replace missing laterals.
At the last Annual meeting for Mini Implant Dentists a friend of mine, Dr. Steve Brown, showed several of his cases where he used one mini dental implant for each root on a missing tooth. Of course I thought, huh? Not a bad idea, but is there really space?
To confirm I spoke with Valdi at Sam Shatkin's FIRST Labs. Valdi is the master lab tech at the Lab and he said, 'No problem, Dr. Brown has been doing that for years.' So with that information in hand I had to give it a try.
So, having the sink or swim kind of attitude, I enlisted the help of a friend and long time patient of mine. He had a missing upper molar that he desperately wanted back, not to mention he had been bugging me to death about it.
So with the big day here and multiple sizes of Intra Lock mini dental implants in stock, we got John numb with 1/2 a carpule of Lidocaine…not a lot really. Just enough to get the gum tissue numb.
We made one pilot hole and placed a 2.0 x 11mm mini….and then another pilot hole was made carefully. One more mini was tightened into place…..was there space for one more? I looked over at the assistant, she nodded her head in approval. The patient was just sitting there just like the guy in the cartoon….'A bit wider Mr. Sprinkle, I need to see if this tennis ball, I mean this last mini implant can be fit in' I said.
So there it was, 3 mini dental implants all snug in place ready to support a molar crown!
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.
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…
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
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. He tells me its 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.
The post will be updated with his final crown photo in a few weeks.