Implant Planning & Sequencing: Part Two

 Oral Surgery, Treatment Planning  Comments Off
Feb 042013
 

Last week I began sharing a treatment planning approach to implant placement and sequencing. It looked at clinical situations that would be best served by immediate placement or hard tissue preservation or augmentation.  This second part will look at case scenarios that should be evaluated for soft tissue preservation/augmentation, a combination of soft and hard tissue procedures or can be dealt with effectively by allowing natural healing after extraction.

Soft Tissue Preservation/Augmentation:

  • Sites planned for implants with thin or highly scalloped tissue
  • Sites planned for implant placement with a deficit of tissue or discolored tissue Continue reading »

Implant Planning & Sequencing: Part One

 Esthetic Dentistry, Oral Surgery  Comments Off
Jan 292013
 

One of the challenges we face today is treatment planning and sequencing implant placement. One decision is whether to use immediate placement or delayed placement of the fixture. We also have to decide how to manage the implant site and extraction. Hard tissue augmentation or preservation may be indicated, along with soft tissue augmentation.Of course once we decide which procedures are recommended and the timing, we then have to make specific decisions on how those procedures will be accomplished. Dr. Ronald Jung presented a systematic way to look at these options and sort through them based on the clinical parameters of the case. These two posts will share that system with you. Continue reading »

The Recipe for Growing Bone & Soft Tissue

 Oral Surgery, Restorative Dentistry  1 Response »
Jan 242013
 

I had the privilege of being a learner yesterday as an attendee of the Seattle Study Club Annual Symposium.  This morning Dr. Michael Pikos presented on bone and soft tissue augmentation, and gave us the recipe. Although I do almost no surgery in my practice it is part of a large majority of my comprehensive treatment plans, and Dr Pikos’s explanation this morning was so powerful that I feel like I can now evaluate surgical sites in a whole new way. Whether through a process of natural healing or an intentional process of regeneration the recipe for growing bone and soft tissue is always the same: cells, signal and matrix. Continue reading »

Control of Facial Aesthetics

 Oral Surgery, Orthodontics  1 Response »
Sep 102012
 

I spent the day watching a DVD of Dr. G. William Arnett’s presentation from the 2012 Seattle Study Club Symposium on “Control of Facial Aesthetics”. I came away having learned quite a bit, but also clear I need to go take a course with Dr. Arnett and get the rest of the story, especially for my complex ortho referrals. One of the things I learned is I am most likely under-diagnosing the possibilities orthognathic surgery has to offer as I spend most of my time looking at the occlusion and dental esthetics. Dentistry controls the facial aesthetics through a variety of factors that include the character of the enamel, shape of the teeth, position of the teeth and jaws and completion of aesthetic procedures. In ideal dentistry the occlusion will indicate when orthognathic treatment is necessary, but analysis of the facial aesthetics will dictate the type of treatment required. Continue reading »

Dental Implant Failure Rate

 Oral Surgery, Restorative Dentistry, Treatment Planning  3 Responses »
Mar 162012
 

I had a great patient come in today disappointed because one of his two implant fixtures failed during the healing phase prior to uncovering. I have come to think of dental implants as invincible, the one procedure that never fails. Unfortunately, despite very low failure rates, we do have patients that encounter a problem. As I explained today knowing that the failure rate is less than X percent means nothing when you are in that group. In that case your experience of failure is 100 percent. I did what I know to do, and listened, acknowledged the frustration and disappointment without dismissing it or explaining it away. Continue reading »

Bisphosphonate Therapy & Dental Care

 Oral Surgery, Practice of Dentistry  Comments Off
Jan 032012
 

One of the hot topics over the last few years has been managing our patients who are taking bisphosphonates in order to minimize the risk of osteonecrosis of the jaw. When I think about my practice it seems a higher and higher number of my female patients are on medication for osteoporosis or osteopenia. I decided to look this up and sure enough it is estimated that over 80 million Americans are on bisphosphonates. With that large a number and most of those folks being routine dental patients, what do we need to know? Just today I came across a blog post from my friend Dr. Marty Jablow on a recent ADA report for dentists on this topic. The ADA has complied the data and research between 2008 and 2011 on this topic and produced a report designed to help those of us in practice make some sense of this topic. I spent the morning reading the executive summary of the report and I finally feel like I understand what I need to about this issue. Continue reading »

No More Packing Dry Sockets

 Dental Materials, Oral Surgery  2 Responses »
Nov 292011
 

Just before we closed the office for the holiday last week I had a patient come in suffering from a dry socket. In the name of full disclosure I must confess I haven’t done an extraction in over a decade. My patients however, do have them done and some experience the sequelae of a dry socket. The tooth had been extracted a few days earlier, and the specialist had packed the dry socket twice before leaving to see family for Thanksgiving. The patient reported the packing had relieved the discomfort, but the relief only lasted about twenty-four hours before the pain returned. Continue reading »