Dentaltown October 2015 - (Page 76)
prosthodontics
feature
by Ara Nazarian, DDS, DICOI
O
ne 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 often present
problems of retention, phonetics, function and pain due to instability.
Endosseous implants have been
successfully used to restore edentulous
mandibles with implant-supported fi xed
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 fl apless surgery to support pre-existing conventional dentures present an
alternative method of restoring patients
with atrophic mandibles. Small-diameter implants are an excellent example of
76
OCTOBER 2015 // dentaltown.com
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 confi guration of
the implant permits a more conservative
placement protocol. No tissue fl aps 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 fullsized implants.
The small-diameter implants are
firmly seated in place in intimate contact
with bone. Once they have been fi xed 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-to-cuspid 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 penetration had been achieved through the
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Table of Contents for the Digital Edition of Dentaltown October 2015
On Dentaltown.com
Howard Speaks: Don’t Go it Alone
Professional Courtesy: Great Patient Relationships? F.U.!
Continuing Education Update
Industry News
All on Four’d Out
A Direct Hit to the Jaw: Bisphosphonates and Osteonecrosis of the Jaw in Osteoporosis and Cancer Patients
Five Components to Team Synergy
Practice Solutions: Clear-Aligner Therapy
In Focus: Microphotography using the Dental Operative Microscope
Anesthesia Safety
The Practice that Perseverance Built
What Kind of Payment Plans to Offer?
Are You Providing Five-Star Service?
Am I Being Too Conservative?
You Should Know: Healthy Grid
The Benefi ts of Mini Dental Implants
Denture Stabilization with Small- Diameter Implants
Independence Day
Post-Treatment Management of Orthodontic Patients
How to Track True Treatment Acceptance
CAD/CAM as a Marketing Tool
New Products
Practice Solutions: Voco
Poll
Surgical Crown Lengthening
Product Profi le: Umbie
And Sealants for All
Ad Index
Human Herpesvirus Infections and What They Mean for Dentists
Quick, Conservative and Highly Esthetic Treatment Planning for Severe Anterior Tooth Wear
Dentally Incorrect
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