Dentist Q&A

Questions and Answers about Dental Implants and Advanced Clinical Dentistry

Anterior Esthetic Zone Implant Placement: What are the guidelines you use when placing the implant to get best outcome?

jrhodesdmd

Placing implants in the anterior zone can be tough. There aren't many textbooks out there that explain where to place the implant and why to get the best esthetic outcome
When placing an implant in lets say the #8 position for example what are the consideration? How much bone do you need? How deep do you place the implant for proper emergence profile? What is the proper mesial/distal/Buccal/lingual positioning of the implant during placement. Size selection etc??
thanks in advance

Comments: (2)

inveptirrinia

There are some many allografts on the market: Amnion (Biocover), Alloderm, ACdermis, Puros Dermis etc.
What are you using and why? What are you getting the best results with? What technique helps enhance results using allografts for root coverage and ridge augmentation?
Thank you for your input

Comments: (10)

jdchan

There appears to be various systems to fill extraction sockets after routine extractions to perserve the ridge height for possible implant placement in the future. What are the recommended system or materials that are simple, succesful and practical for most patients?
In Short what material or technique give you the best bone for implant placement?

Comments: (6)

PANDENTAL

I have many questions on this. There are so many implant systems out there its hard to choose:
1.Are the implant systems ranked??
2.Which is the best implant systems in the world and which are the next five if any???
3. Does the surface of the implant make 1 implant better then another? Is there any research comparing implant surfaces?
4. Has the implant success rate changes over time?
5. What is the easiest system in placement and restoratively.
Thank you for your time in answering my questions.

Comments: (23)

Rathika

Could you enlighten me on the flapless technique and its indications?
Whats the best system to do this with?
Whats the best indication and when do you avoid? What success rate is reported over flapping and placing?

Comments: (11)

Tom House DDS MD

I have a patient that has been on oral Bisphosphonates for 8+ years and needs several implants and a couple areas will need sinus lifts. The literature is very unclear on how to approach. Marx CTX is not proven? Not sure a drug holiday will make a difference?

I am looking for opinions on how people handle these situation in their offices? What is your protocol?

Comments: (3)

inveptirrinia

I did a recent open sinus lift on a patient and placed a xenograft with the sinus with PRP. Patient came back one week later with puss coming from the flap and pressure pain in the sinus and temperature. I managed it with amox 500mg 4 times a day and it is now two weeks later and the infection still has not cleared up.
What is the best way to clean out the graft? How would you manage the situation? Is it even possible to get all the graft out without damaging the membrane?

Comments: (28)

Dr. Cohen

I have a 57 year old patient who has a past history of head and neck cancer treated with radiation and chemotherapy 6 years ago. The patient hasrampant caries and poor salivary flow. Several teethn are going to be extracted and replaced by implants in the teeth 30, 29 and 8 position.

What are your concerns?

Does the patient need hyperbaric oxygen and whats the protocol.

Comments: (3)

Dr. Cohen

I have a patient missing teeth #8 and #9. I am always vexed on whether to place two implants or one implant and cantilever.

I know the tarnow study says to place one and cantilever. What is your opinion. What parameters to you look at in determining when to place two or 1 implant?

Comments: (9)

inveptirrinia

Horizontal and vertical ridge defects are encountered every day in the implant practice. With so many materials to choose its hard to know what you can get the best or consistent results with.
My question is what material or protocol are you getting consistent results for in building out a ridge/bone regeneration for future implant placement?

Comments: (9)

leopold

I have patient 15 years old patient,who complain in gum pain (Fistula is in the furaction and is nonrestorable).
Tooth #19 had a RCT done couple years ago, and now its failed and needs and extraction. On PA x-ray there is a 5-6 mm cyst on mesial root, distal 3-4 mm, and furcation is involvment, and tooth hopeless, and needs to be extracted.
When do you think best time to place implants in children? How do you know when a childs growth is complete and safe to place implants.
thank you.

Comments: (5)

Dr. Barbie

I had a patient sent to me recently who saw her local oral surgeon where he did bilateral sinus lifts using hip grafts. I thought that was kind of invasive especially when the literature supports the use of Bio-oss. With all the advances in bone grafting is it really needed???

Comments: (8)

hawkeye

There are a whole host of articles on how to repair a sinus membrane perforated during open sinus lift: Loma Linda Pouch, Pikos Membrane, Suturing, etc, etc, etc.

However, I have not seen any literature on how to handle a sinus tear during a close sinus approach? Can it be repaired? How do you repair it? How do you even know if it is perforated?

Comments: (8)

Dr90210

I used to do many immediates implant placements in my office but now I tend to graft. I see various lectures where people are still pushing for immmediates placement and immediate load. What do you do an Why? Do you tend to graft and delay placement of the implant of do you do an immediate implant placement?

Comments: (5)

DrChevy

Piezosurgery seemed to have changed the way we are practicing. However, I think my counterparts have passed me by. I am strictly using it for Sinus lifts where it makes a huge difference in reducing Sinus Complications.
My counterparts use it in every aspect of surgery. I am not that confident in it? What and where are people using piezo in daily practice? Do you see a difference to your surgery or practice?
Thank you for reading
Chevy

Comments: (8)

Logan MD DMD

Many of my oral surgery counterparts are using infuse. I have used it with good results in both the sinus and gbr. Only problem I see is with swelling and inflammation.

What kind of results are you getting with infuse and where are you using it?

Comments: (14)

drallen

Sinus lifts are relatively a young procedure and I dont know if we truly know the risks or longterm success of sinus lifting.
Do you know a meta-analysis or other literatur about of success, indications or contraindications for sinus lifting and grafting?

Comments: (6)

Logan MD DMD

Being an oral surgeon I tend to do more block grafts from the ramus, chin, skull or hip. Lately, I see many people at lectures getting really decent results with bone allografts and xenografts. I am curious what people are using and why for reconstructing ridge defects for implant placement? Is there any special techniques you do? What membrane do you use?

Comments: (7)

sinuslifter

Very nice case you have there. Great documentation. What type of implants did you use in that case? Were they Klockner implants? I just saw that they were based out of Spain as you are.

Thanks

Comments: (1)

GV Black

What are you doing when performing biopsies in the esthetic zone such as the gingiva for maxillary incisors? For example, say you have an exophytic lesion of 8mm diameter on the attached gingiva of the maxillary central incisor. Would you:

A) Excisional biopsy, allow to heal, CTG graft later
B) Excisional biopsy, CTG graft now

Interested to see what my colleagues are doing.

Comments: (3)