Dentaltown New Grad 2013 - (Page 49)

implants feature by Ara Nazarian, DDS, DICOI One population that has been overlooked or avoided by many in the dental profession is denture wearers. For one reason or another, the denture patient has caused many frustrations for the providing dentist, especially in regard to the mandibular denture. Conventional mandibular dentures for patients with severely atrophic mandibles oftentimes present problems of retention, phonetics, function and pain due to instability. Endosseous implants have been successfully used to restore edentulous mandibles with implant-supported fixed bridges, hybrid prosthetic dentures and removable overdenture prostheses. However, atrophy of edentulous ridges might limit implant placement in the mandible. Anatomic limitations and resorbed alveolar ridges might compromise implant number, length and inclination. The use of traditional implants sometimes requires extensive surgery, ridge augmentation or bone grafting. Small-diameter implants placed with flapless surgery to support pre-existing conventional dentures present an alternative method of restoring patients with atrophic mandibles. Smalldiameter implants are an excellent example of this trend. They dramatically broaden the spectrum of mandibular overdenture patients who can be successfully treated. These small-diameter implants (1.8-2.9mm in width) differ from their full-sized counterparts in a number of significant ways. The configuration of the implant permits a more conservative placement protocol. No tissue flaps or tapping procedures are required, which results in fewer traumas to both gingival tissue and bone. Their smaller size also permits placement in ridges that might not otherwise be suitable for full-sized implants. The small-diameter implants are firmly seated in place in intimate contact with bone. Once they have been fixed in place, they can be immediately loaded. There is no need for a long waiting period or second stage surgery. The simplified protocols, conservative procedures and elimination of gingival surgery make this implant ideal for medically, anatomically and financially compromised patients. Case History A woman in her early 60s presented to our office frustrated with her lower complete denture. She complained that it was non-retentive and non-functional always falling out during speech or during eating. The patient suffered from hypertension, which was controlled with medication. She had been a denture wearer for the last 25 years resulting in resorption of the mandible. Palpation and radiographic examination revealed a moderately narrowed mandibular ridge. Crestal bone width and ridge height were sufficient to receive a length of 2.2x13mm Sterngold ERA (Zimmer) small-diameter implants. The mental foramina were located on either side, and it was determined that four implants could be safely placed within the cuspid-tocuspid area. All risks, benefits and alternatives were reviewed with the patient before initiating treatment. The patient was draped and a clean operating environment established. Local infiltration of anesthetic was administered (Fig. 1). Markings were placed to designate landmarks and areas of insertion. Keeping correct alignment, the implant drill was advanced through the gingival tissue and the cortical plate. During this stage it was very important to accompany each step of drilling with generous amounts of sterile water to prevent over-heating of the bone. Once penecontinued on page 50 dentaltown.com « NEW GRADS 49 http://www.dentaltown.com

Table of Contents for the Digital Edition of Dentaltown New Grad 2013

Howard Speaks: Informed Decisions
Professional Courtesy: So You Want to Be Successful? Be Professional
Continuing Education Update: Never Stop Learning
After Going Through Dental School, What Advice Would You Give Students?
Checklist for Reviewing an Associate’s Work
You Should Know: Townie Meeting
Office Visit: Resident On Call
Office Visit: In His Element
Are You Prepared to Begin Practicing Dentistry?
Three Stages of a Dental Career
What You Need to Know About Student Debt Relief
Gain an Early Financial Edge
Pregnancy and Employment in the Dental Practice
Personal Protective Equipment
Win Patient Loyalty
Denture Stabilization with Small-diameter Implants
Partnerships: A Match Made in Heaven or a Pathway to Financial Hell
Taking Oral Health Care Education from the Classroom to the Clinic
Continuing Education: Nine Lessons from the Real World

Dentaltown New Grad 2013