Case Study of the Month

Here is a case study for you to evaluate. I welcome your responses. I will give my evaluation at the end of the month.

A dentist recently placed 6 size 15mm max MDI implants for a patient CUD retention with Standard IMTEC Housings (MH-1). The procedure went well, however, when the dentist saw the patient the following week the gum tissue was swollen and had covered a good portion of the implants. As well, there appeared to be a "circle of pus" around each implant head. However, when the dentist touched the area there was no exudate-it was the tissue itself that had become a pale whitish yellow. The patient claimed he had taken all his antibiotics but he was disappointed with the denture and said that he thought it would be tighter. All 6 implants were rock solid at his second visit.

Questions:
1. What is the diagnosis?
2. What actions should be taken?

More Kudos

Ben, just a short note to thank you for all your help so far getting up to speed, especially in the area of single units mini-implants. You are generous with your time when we talk and a good " coach ". The designs and the stints have been very helpful. Keep up the good work! And pass my praises to Noah and his team as well.

With appreciation, Harris Rittenberg

Dentist Comment

Just wanted to thank you for your presentation on mini implants. You did a fantastic job! I understand that it is not rocket science to place these in most cases, however, your lecture and format made me more comfortable in my apporach. It's great seeing younger docs like you lecturing and encouraging others to venture in this exciting field.

I will email you once I place my first minis and again thanks for getting me excited about implants.

Dr. Mehul Patel

What Should I Tell My Patients about the MDI?

I am sometimes asked by dentists how to present the MDI to patients.  Here is some information I have provided on osseonews:

By introducing the MDI you have a great opportunity to dramatically affect your patients lives.  Here are my recommendations:

1. You should tell your patients the truth. 
1. The MDI has been used with great success since the 1970’s.
2. The IMTEC MDI is FDA approved for long-term use.
3. There is no cutting of the gums and little po pain
4. The MDIs can be immediately put into function
5. They can be used for fixed and removable applications
2. Get the best training available. I am a consultant for F.I.R.S.T. Laboratories and recommend their 2-day training program.  It is comprehensive for both fixed and removable applications for the IMTEC MDI.  It is mostly scientific (i.e. not a sales pitch) lots of case examples and real world management issues addressed.

The Mini Dental Implant may be one of the most important procedures available to patients today.  The applications have been realized by thousands of dentists and touted by Dr. Christensen as an important addition to a dentist’s armamentarium.   Whether stabilizing upper or lower dentures, replacing single or multiple teeth, or used to salvage failing bridges you should feel comfortable offering the MDI to your patients as a long term solution.

A Surgical Guide Template is not a substitute for a Brain!

Surgical Guide Templates like those provided by F.I.R.S.T. Laboratories can change the way you practice dentistry.  They are after all the key component in one-visit implant surgery and crown placement procedures.  But, the MDI surgical guides do have their limitations.  No matter how perfect these templates are designed the self-tapping nature of the system requires that the pilot hole be minimal.  As the Mini Dental Implant advances in the bone past the pilot hole terminus which course does the MDI take?  The answer we would all like is that it continues in the same path until final placement; alas this is often not the case.  The MDI also is not completely restricted by the surgical guide template.  This means that the MDI may deflect and course a different path than intended if it comes in contact with dense trabecular bone or other bony variations.  The good news is that it is often quite easy to keep the implants on the right path.  The trick is to realize that a surgical guide template is not a substitute for a brain…in other words, as you place the MDI be cognizant of the implants progress with respect to angulation and direction.  Here are some tips.

Before you use a surgical template ask yourself the following:

1. Does the template look right?
   
2. If I follow it will I likely perforate the buccal or lingual cortices?
   
3. Will I be angled too closely to a tooth? 

During Placement do the following:

1. Use firm apical pressure while deliberately placing the MDI.
   
2. Stay in the middle of the template.
   
3. If you start to veer off course you can correct the placement by putting pressure on the tool in the direction opposite that you want the MDI to go (to change course toward a distal direction of the implant tip put mesial pressure on the wrench while pressing in an apical direction.
   
4. Remove the template to check progress periodically.

The bottom line is if it doesn’t look right you should stop, reverse the implant, redirect or re-drill if necessary.  If the template is not working don’t use it.  Not every case is a great choice for a guided surgery option and sometimes you unfortunately can’t tell until you are in the middle of it.  When performed properly MDI placement can be very easy but your continuous concentration is important to the technique sensitive protocol.  Call or email me if you need any more advice and Good Luck!

Surgical Motor or High Speed?

Can you use a high-speed handpiece to drill an MDI pilot hole?  Absolutely!  The main goal for the proper placement of an IMTEC Mini Dental Implant is primary stability.  When Bone quality or quantity is likely to be an issue, like in the maxilla or type 3-4 bone, an extremely shallow pilot hole is ideal to preserve as much bone as possible.  This is best accomplished by perforating the cortical bone only slightly (just 1-2mm.) with a high-speed dental handpiece and a sharp sterile diamond bur.  High-speed bony contouring is used quite often in periodontal procedures today.  Remember to use copious amounts of irrigation so that you do not char the bone.  If you'd like more information or a free case evaluation contact me at F.I.R.S.T. Laboratories 877-4MDI-LAB.

Comment about Dr. Oppenheimer

Today I just placed my first 3 mini-implants in a maxillary partial denture case. I was amazed as to how easy it really was! I was told that "if you can extract a tooth, you can place an implant". And 'they' are right! I was reluctant to get into implants because I thought they were not for the general dentist but I decided to try the mini implant system by Imtec. I also contacted FIRST Dental Lab and spoke to Dr. Ben Oppenheimer who walked me through the case. He helped me select the proper implants, he designed the surgical guide, and made the immediate temporary partial. The patient needed a failing abutment tooth extracted which, would have left her entire upper right quadrant edentulous. Everything went right into place and because of the mini implant system, she left with a secure temporary partial in place.


Steven Esposito DMD, MAGD

Ballston Spa, NY