OsseoNews: Comments on Dental Implants http://www.osseonews.com OsseoNews.com is a leading resource for information on dental implants. Sat, 04 Jul 2009 09:44:36 +0000 http://wordpress.org/?v=2.0.5 http://www.osseonews.comhttp://www.osseonews.com/wp-content/themes/osseonews/images/logo.jpgOsseoNews.comCommentsForDentalImplantInformationAndDiscussionhttp://feedburner.google.comSubscribe with My Yahoo!Subscribe with NewsGatorSubscribe with My AOLSubscribe with BloglinesSubscribe with NetvibesSubscribe with GoogleSubscribe with PageflakesHere you will find the latest comments on dental implants from readers of OsseoNews.com Comment on Possible to Cause Compression Necrosis by Tightening Too Much? by Robert J. Miller, MA, DDS http://www.osseonews.com/possible-to-cause-compression-necrosis-by-tightening-too-much/#comment-73488 Sat, 04 Jul 2009 01:07:40 +0000 http://www.osseonews.com/possible-to-cause-compression-necrosis-by-tightening-too-much/#comment-73488 A nice collection of theories, but most are off the mark. The operative word here is NECROSIS. In a failed site where the implant and surrounding bone have been explanted, do we see a zone of necrotic bone? What we see is a fibrous encapsulation of the implant body. Now let's deconstruct the path leading to this event. An interrupted angiogenic response leads to fibrous tissue rather than bone contact with the implant surface. There are several reasons why this occurs. First is an inflammatory response. Bone that has even a slight pH drop (from neutral 7.4 to even 7.1) will completely inhibit osteoblast metabolism. Second is the catabolic phase of bone. Increasing the zone of microfracture as the implant is placed (as torque values increase) increases this catabolic phase. Osteoclastic activity is potentiated and bone is being resorbed in the early phases. Third is seating the implant well above it's designed torque value. As the implant bottoms out in the osteotomy, further torque on the implant results in the implant threads moving coronally while the implant remains stationary. This microfractures the intra-thread bone, compromising the microvasculature and accentuating the catabolic response. Last is the choice of implant surfaces. Some of them will actually increase the catabolic phase as well, leading to higher failure rates of some implant lines of the biggest implant manufacturers. Therefore, I believe that the term compression necrosis is a poor choice for explaining this phenomenon. Rather, we should be referring to compression microfracture. Our new paper comparing three of the leading implant surfaces (Calicum phosphate blasted, HF etched, and Calcium phosphate impregnated) leads us very clearly to the concept of LOWER insertion torque values, and a chemistry that eliminates the catabolic phase of bone, speeding up bone bonding by 500% within the first week (Ossean Surface - Intra-Lock International). RJM A nice collection of theories, but most are off the mark. The operative word here is NECROSIS. In a failed site where the implant and surrounding bone have been explanted, do we see a zone of necrotic bone? What we see is a fibrous encapsulation of the implant body. Now let’s deconstruct the path leading to this event. An interrupted angiogenic response leads to fibrous tissue rather than bone contact with the implant surface. There are several reasons why this occurs. First is an inflammatory response. Bone that has even a slight pH drop (from neutral 7.4 to even 7.1) will completely inhibit osteoblast metabolism. Second is the catabolic phase of bone. Increasing the zone of microfracture as the implant is placed (as torque values increase) increases this catabolic phase. Osteoclastic activity is potentiated and bone is being resorbed in the early phases. Third is seating the implant well above it’s designed torque value. As the implant bottoms out in the osteotomy, further torque on the implant results in the implant threads moving coronally while the implant remains stationary. This microfractures the intra-thread bone, compromising the microvasculature and accentuating the catabolic response. Last is the choice of implant surfaces. Some of them will actually increase the catabolic phase as well, leading to higher failure rates of some implant lines of the biggest implant manufacturers. Therefore, I believe that the term compression necrosis is a poor choice for explaining this phenomenon. Rather, we should be referring to compression microfracture. Our new paper comparing three of the leading implant surfaces (Calicum phosphate blasted, HF etched, and Calcium phosphate impregnated) leads us very clearly to the concept of LOWER insertion torque values, and a chemistry that eliminates the catabolic phase of bone, speeding up bone bonding by 500% within the first week (Ossean Surface - Intra-Lock International).
RJM

]]> Comment on Possible to Cause Compression Necrosis by Tightening Too Much? by Steve http://www.osseonews.com/possible-to-cause-compression-necrosis-by-tightening-too-much/#comment-73484 Sat, 04 Jul 2009 00:11:11 +0000 http://www.osseonews.com/possible-to-cause-compression-necrosis-by-tightening-too-much/#comment-73484 With the implant system that I use (BioMet-3i), I have always been able to place my tapering implants with very high insertional torque and I have not experienced "compression necrosis". It helps if you become experienced with a particular system and implant design, and then you will better understand the limitations/indications and tolerances which will vary. I personally know many experienced surgeons who use the system that I use with expertise, and whom have not witnessed any evidence of compression necrosis. I have over 15 years experience with all of the implant designs that BioMet-3i has developed over the years. With the implant system that I use (BioMet-3i), I have always been able to place my tapering implants with very high insertional torque and I have not experienced “compression necrosis”. It helps if you become experienced with a particular system and implant design, and then you will better understand the limitations/indications and tolerances which will vary.
I personally know many experienced surgeons who use the system that I use with expertise, and whom have not witnessed any evidence of compression necrosis. I have over 15 years experience with all of the implant designs that BioMet-3i has developed over the years.

]]> Comment on Dental Implant Spinning in Socket: How to Manage? by cory c. http://www.osseonews.com/dental-implant-spinning-in-socket-how-to-manage/#comment-73464 Fri, 03 Jul 2009 14:58:24 +0000 http://www.osseonews.com/dental-implant-spinning-in-socket-how-to-manage/#comment-73464 because i hate remakes i've tried to salvage the spinners i've had in various ways with overall about 50% success rate. i've done the careful removal of healing cap and litely placing abutment w/out torq and place crown out of occ. this works if you can stabilize implant crown with tight interprox. contacts,if you're using it for a denture attachment, forget it.i've tried the "screw it deeper" aproach and it worked like 1 out of 3 times.one time i had one that looked great like yours [radiographically and clinically] but was actually strip perforated on the buccal[i had used a tissue punch during placement]i flapped it and grafted the defect and it worked great.point is,it's already there so give it a shot,you might develop a tecnq we could all use. because i hate remakes i’ve tried to salvage the spinners i’ve had in various ways with overall about 50% success rate. i’ve done the careful removal of healing cap and litely placing abutment w/out torq and place crown out of occ. this works if you can stabilize implant crown with tight interprox. contacts,if you’re using it for a denture attachment, forget it.i’ve tried the “screw it deeper” aproach and it worked like 1 out of 3 times.one time i had one that looked great like yours [radiographically and clinically] but was actually strip perforated on the buccal[i had used a tissue punch during placement]i flapped it and grafted the defect and it worked great.point is,it’s already there so give it a shot,you might develop a tecnq we could all use.

]]> Comment on Maxillary Dentures Supported by Mushroom-Shaped Mucosal Implants? by Richard Hughes DDS, FAAID, FAAIP, Dipl.ABOI/ID http://www.osseonews.com/maxillary-dentures-supported-by-mushroom-shaped-mucosal-implants/#comment-73460 Fri, 03 Jul 2009 12:40:39 +0000 http://www.osseonews.com/maxillary-dentures-supported-by-mushroom-shaped-mucosal-implants/#comment-73460 Mucosal Inserts are a great treatment option for the max denture. You can obtain the inserts from Park Dental Research, New York, NY. I use these in my practice. I have also used these to treat cases that need obteraturs etc. You have to get the occlusion under control. Here again, they are great for the flat maxilla. Mucosal Inserts are a great treatment option for the max denture. You can obtain the inserts from Park Dental Research, New York, NY. I use these in my practice. I have also used these to treat cases that need obteraturs etc. You have to get the occlusion under control. Here again, they are great for the flat maxilla.

]]> Comment on Maxillary Dentures Supported by Mushroom-Shaped Mucosal Implants? by kel http://www.osseonews.com/maxillary-dentures-supported-by-mushroom-shaped-mucosal-implants/#comment-73423 Thu, 02 Jul 2009 14:40:30 +0000 http://www.osseonews.com/maxillary-dentures-supported-by-mushroom-shaped-mucosal-implants/#comment-73423 Sounds like you may be refering to the Biomet technique with the Concial Abutment technique. There is also a german technique called Konus crowns. If you need further info on this call me or call Biomet 3i. Kelly 1800-333-2667 x121 Sounds like you may be refering to the Biomet technique with the Concial Abutment technique. There is also a german technique called Konus crowns. If you need further info on this call me or call Biomet 3i.
Kelly 1800-333-2667 x121

]]> Comment on Anklyos Implants: Looking for Guidance Before Switching to this System by Joan http://www.osseonews.com/anklyos-implants-looking-for-guidance-before-switching-to-this-system/#comment-73403 Thu, 02 Jul 2009 07:11:17 +0000 http://www.osseonews.com/anklyos-implants-looking-for-guidance-before-switching-to-this-system/#comment-73403 What are the viws on Adin Implant system from Isreal What are the viws on Adin Implant system from Isreal

]]> Comment on Search on for Way to Grow New Teeth by someone http://www.osseonews.com/search-on-for-way-to-grow-new-teeth/#comment-73389 Thu, 02 Jul 2009 01:08:36 +0000 http://www.osseonews.com/search-on-for-way-to-grow-new-teeth/#comment-73389 Can we have an update on this situation? It looks like this article was posted nearly 5 years ago. I really need this to be soon. Can we have an update on this situation? It looks like this article was posted nearly 5 years ago. I really need this to be soon.

]]> Comment on How Do I Determine if the Implants are Osseointegrated? by Dr. P.P. http://www.osseonews.com/how-do-i-determine-if-the-implants-are-osseointegrated/#comment-73376 Wed, 01 Jul 2009 17:53:36 +0000 http://www.osseonews.com/how-do-i-determine-if-the-implants-are-osseointegrated/#comment-73376 In an uneventfull healing all implants will osseointegrate. Take an Xray : no black lines or images. Unscrew the cover or the healing screw: no pain or movement. Torque down the abutment up to 30 or 35 N/cm: no pain or movement. Then, the implant is osseointegrated. In an uneventfull healing all implants will osseointegrate.
Take an Xray : no black lines or images.
Unscrew the cover or the healing screw: no pain or movement.
Torque down the abutment up to 30 or 35 N/cm: no pain or movement.
Then, the implant is osseointegrated.

]]> Comment on Possible to Cause Compression Necrosis by Tightening Too Much? by Dr. P.P. http://www.osseonews.com/possible-to-cause-compression-necrosis-by-tightening-too-much/#comment-73374 Wed, 01 Jul 2009 17:33:00 +0000 http://www.osseonews.com/possible-to-cause-compression-necrosis-by-tightening-too-much/#comment-73374 The comments about Replace are right, but the mistake was to indicate an implant that was developed originally for immediate postextraction placement and latter indicated by Nobel for all purposes in the whole mouth. Necrosis synthoms are pain, no swelling but a never totally healed gingiva. After 7-10 days pain will disappear and in two to three weeks radiolucency will be watchable in a periapical X Ray. My advice: never torque your implants over 35N/cm (yes, you can do it but there is no need to do such a thing). Use a parallel wall implant in dense bone (never tapered). If you are a Replace user and you still want to use tapered implants in hard bone, then use Replant (implant Direct LLC) instead of Replace as it is better self cutting and has a vertical groove in the tip. What to do: retrieve the implant. Wait for bone healing/remodeling /ie 3 months). Place another implant with new drills, good cooling, taping and dense bone drilled and never go over 35n/cm. If the bucal wall is still present there is no need for bone fillers. Hope this will give you some light. Best regards. P.P. The comments about Replace are right, but the mistake was to indicate an implant that was developed originally for immediate postextraction placement and latter indicated by Nobel for all purposes in the whole mouth.
Necrosis synthoms are pain, no swelling but a never totally healed gingiva. After 7-10 days pain will disappear and in two to three weeks radiolucency will be watchable in a periapical X Ray.
My advice: never torque your implants over 35N/cm (yes, you can do it but there is no need to do such a thing).
Use a parallel wall implant in dense bone (never tapered).
If you are a Replace user and you still want to use tapered implants in hard bone, then use Replant (implant Direct LLC) instead of Replace as it is better self cutting and has a vertical groove in the tip.
What to do: retrieve the implant. Wait for bone healing/remodeling /ie 3 months). Place another implant with new drills, good cooling, taping and dense bone drilled and never go over 35n/cm.
If the bucal wall is still present there is no need for bone fillers.
Hope this will give you some light.
Best regards.
P.P.

]]> Comment on Alternative to Bone Grafts for Implants? by Dr. Akers http://www.osseonews.com/alternative-to-bone-grafts/#comment-73369 Wed, 01 Jul 2009 14:56:57 +0000 http://www.osseonews.com/alternative-to-bone-grafts/#comment-73369 I have been placing bone grafts of different types for over thirty years. I totally agree with Dr.Craig Misch. A small simple autogenous bone graft from symphysis/ramus would be the best for this patient. Anything else would be sketchy. Why take a chance with artificial grafts in a previous failed area that appears to be large Large size defects heal faster with natural bone.There would be more reliabilty and retain the future implant much better than alloplasts I have been placing bone grafts of different types for over thirty years. I totally agree with Dr.Craig Misch. A small simple autogenous bone graft from symphysis/ramus would be the best for this patient. Anything else would be sketchy. Why take a chance with artificial grafts in a previous failed area that appears to be large

Large size defects heal faster with natural bone.There would be more reliabilty and retain the future implant much better than alloplasts

]]> Comment on Possible to Cause Compression Necrosis by Tightening Too Much? by Dr. P. http://www.osseonews.com/possible-to-cause-compression-necrosis-by-tightening-too-much/#comment-73368 Wed, 01 Jul 2009 14:12:15 +0000 http://www.osseonews.com/possible-to-cause-compression-necrosis-by-tightening-too-much/#comment-73368 May sound unorthodox but we keep our implants in the freezer until placement. In woodworking or tightening a screw into sheet metal, you can feel the heat created. Just kinda makes sense. May sound unorthodox but we keep our implants in the freezer until placement. In woodworking or tightening a screw into sheet metal, you can feel the heat created. Just kinda makes sense.

]]> Comment on Using Osteotomes to Place Implants: Avoid Membrane Perforation? by Richard Hughes DDS, FAAID, FAAIP, Dipl.ABOI/ID http://www.osseonews.com/using-osteotomes-to-place-implants-avoid-membrane-perforation/#comment-73366 Wed, 01 Jul 2009 12:56:15 +0000 http://www.osseonews.com/using-osteotomes-to-place-implants-avoid-membrane-perforation/#comment-73366 The discussion about the length of the root form implant in the posterior mand or mx is a good one. I use Bicons, AB Dental, MIS and LaminOss. If you are in doubt about the depth of osteotomy in the mx or md a Bicon 5x8 or 5x11 is just fine and will work im most situations, just give it more time to integrate. The plateau design enhances the lock of the implant into the bone and you can use a shorter implant and yet have a sufficient bone to implant interface. The discussion about the length of the root form implant in the posterior mand or mx is a good one. I use Bicons, AB Dental, MIS and LaminOss. If you are in doubt about the depth of osteotomy in the mx or md a Bicon 5×8 or 5×11 is just fine and will work im most situations, just give it more time to integrate. The plateau design enhances the lock of the implant into the bone and you can use a shorter implant and yet have a sufficient bone to implant interface.

]]> Comment on Using Osteotomes to Place Implants: Avoid Membrane Perforation? by tony collins http://www.osseonews.com/using-osteotomes-to-place-implants-avoid-membrane-perforation/#comment-73361 Wed, 01 Jul 2009 11:09:54 +0000 http://www.osseonews.com/using-osteotomes-to-place-implants-avoid-membrane-perforation/#comment-73361 To test for perforation of the membrane, simply pinch the patient's nostrils and have them puff gently through their nose. If perforated,you will get blood bubbling from the osteotomy, and then an audible air hiss. If so still place the implant as it is the best plug. Whether you get only 4 mm of integration in the crestal bone or 4mm of extra bone growing on the implant is anyone's guess. To test for perforation of the membrane, simply pinch the patient’s nostrils and have them puff gently through their nose. If perforated,you will get blood bubbling from the osteotomy, and then an audible air hiss. If so still place the implant as it is the best plug. Whether you get only 4 mm of integration in the crestal bone or 4mm of extra bone growing on the implant is anyone’s guess.

]]> Comment on Too Much Insertion Pressure When Placing Implants Leading to Pain? by Bruce Laurie http://www.osseonews.com/too-much-insertion-pressure-when-placing-implants-leading-to-pain/#comment-73346 Wed, 01 Jul 2009 05:40:34 +0000 http://www.osseonews.com/too-much-insertion-pressure-when-placing-implants-leading-to-pain/#comment-73346 If one considers that lack of motion is the goal in having a smaller osteotomy than implant a spade 0.2mm smaller than the implant will do the job nicely. Bicon has spades with slightly more taper in the apical portion than along the body. This works well with Implant Direct's Screwplant, the best system in my humble opinion. One ends up with very little compression in the less vascular cortex and a little more in the more able to heal marrow space. The spades are used at 50 RPM (no heat) and the bone can be collected for grafting. Dexamethasone injected into the anesthtized vestible nearly always eliminates the need for analgesics stronger than Advil. 6 to 10 mg is all that is needed. This is the strongest antinflamitory in humans and a single large dose is almost without risk. If one considers that lack of motion is the goal in having a smaller osteotomy than implant a spade 0.2mm smaller than the implant will do the job nicely. Bicon
has spades with slightly more taper in the apical portion than along the body. This works well with Implant Direct’s Screwplant, the best system in my humble opinion. One ends up with very little compression in the less vascular cortex and a little more in the more able to heal marrow space. The spades are used at 50 RPM (no heat) and the bone can be collected for grafting. Dexamethasone injected into the anesthtized vestible nearly always eliminates the need for analgesics stronger than Advil. 6 to 10 mg is all that is needed. This is the strongest antinflamitory in humans and a single large dose is almost without risk.

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