When Your Sinus Gets in the Way of Successful Implant Placement

When Your Sinus Gets in the Way of Successful Dental Implant Placement

Successful placement of implants in the posterior maxilla could potentially be compromised by the lack of vertical dimension between the alveolar crest and the floor of the maxillary sinus. Typically, 10mm of vertical bone is required for predictable implant success (Misch 1987) although success can be achieved with less than 20 mm (Fugazzoto 2007). Moreover, bone density in the posterior maxilla is often poor, which could lead to complications during implant fixation. To address these problems, maxillary sinus elevation surgery was developed to increase the amount of bone available for implant placement.

Lateral Window Sinus Lift: A Sinus Augmentation Technique

Implant placement can be performed simultaneously with the sinus elevation procedure or following a healing period that can last

6-9 months. Immediate placement during sinus elevation reduces overall healing time and eliminates another surgical procedure, which can be desirable to patients. The decision to place an implant during sinus augmentation is dependent on the presence of adequate bone volume and quality to provide for initial stability of the implant. Rosen and colleagues (1999) recommended at least 5mm of native bone for immediate implant placement during sinus augmentation. However, more recent studies have found that implant stability can be achieved with less than 5mm (Peleg 2006).

Lateral Window Sinus Augmentation: The lateral approach involves a modified Caldwell-Luc operation to gain access to the sinus cavity. A bony window is created in the lateral maxillary wall, the Schneiderian membrane is elevated, and bone grafting material is a combination of autogenous bone and allograft. An absorbable collagen membrane is placed between the bone graft and the membrane as well as over the bony window.

This technique is usually the preferred method of sinus elevation in situations of poor bone quality and minimal residual bone height because it allows for direct visualization and accurate bone placement and volume at the position of the implant. Also, tearing of the membrane can be easily treated, minimizing contamination of the graft during healing.

For more information about Sinus Augmentation (Lift) procedures or Dental Implant Procedures, contact Joseph R. Nemeth, DDS and Associates at 248.357.3100 or via email at jodi@drnemeth.com. You may also want to visit the practice website at http://www.drnemeth.com.

Dental Implant Composition

Dental Implant Composition

A dental implant is a man-made tooth root constructed from titanium. Titanium is a lightweight, soft, noncorroding metal. The surface of the titanium forms a natural ceramic coating when exposed to oxygen which enables bones cells to attach to it (a process called osseointegration). Since bone cells react better to titanium surfaces that are rough, most implants are put through a roughening process by the manufacturer.

To enhance bone healing, implants are sometimes coated with a calcium derivative found naturally occurring in human teeth and bones to jump start the osseointegration process called hydroxyapetite.

Implants are often threaded. In order to enhance implant placement and stability, thread shape and pitch are carefully calculated to help transfer biting force to the surrounding bone.

To learn more about Michigan Dental Implants, call Drs. Nemeth and Katranji at 248.357.3100 or email jrn@drnemeth.com or visit us on the web at http://www.drnemeth.com.

Ridge Modification Prior to Dental Implant Placement

The American Academy of Periodontology (AAP)
http://www.perio.org/

The AAP Reports:

Deformities in the upper or lower jaw can leave you with inadequate bone in which to place dental implants. This defect may have been caused by periodontal disease, wearing dentures, developmental defects, injury or trauma. Not only does this deformity cause problems in placing the implant, it can also cause an unattractive indentation in the jaw line near the missing teeth that may be difficult to clean and maintain.

To correct the problem, the gum is lifted away from the ridge to expose the bony defect. The defect is then filled with bone or bone substitute to build up the ridge. Your periodontist can tell you about your options for graft materials, which can help to regenerate lost bone and tissue.

Finally, the incision is closed and healing is allowed to take place. Depending on your individual needs, the bone usually will be allowed to develop for about four to 12 months before implants can be placed. In some cases, the implant can be placed at the same time the ridge is modified.
Ridge modification has been shown to greatly improve appearance and increase your chances for successful implants that can last for years to come. Ridge modification can enhance your restorative success both esthetically and functionally.

To learn more about Michigan dental implants, call Joseph R. Nemeth, DDS and Associates at 248.357.3100 or visit us on the web at http://www.drnemeth.com/. You can also visit the AAP website at http://www.perio.org/.

Michigan Dental Implant Impression Comparisons

Taking an impression is the first step in producing a model to indicate the positioning of Michigan dental implants and/or abutments in a patient's mouth. A device which facilitates the replication of implant positions on the study models is called and impression coping and is often required during the impression stage of placing dental implants.

Impressions may be taken in one of two ways: at the implant level or at the abutment level. Placement of an implant analog, a device which mimics the implant on the study model, must occur during an implant-level impression, while abutment level impressions require placement of an abutment analog or a device which mimics the abutment.

Which impression technique is used depends on the preference of the restorative dentist and also varies by implant system. With nonfriction implant systems, impressions can be taken at either the implant or abutment level. With internal friction abutments, delivery of the abutment to its final position is necessary before the final impression is taken.

Comparison of Implant-Level and Abutment-Level

	Implant-Level Impressions	Abutment-Level Impression
Ease of localization	Requires subgingival placement of copings	Easier, because margins are often supragingival
Impression copings	Necessary	Conventional impression without copings is available in some cases
Abutment selection and preparation	On a model in the laboratory	Can be done in the mouth, chairside
Abutment modification	Not needed once delivered	May be needed in the mouth
Custom abutment	Available	Not available (unless an implant-level impression was taken first).
Interim and final crown fabrication	Can be performed in the laboratory, together with the abutment selection and preparation	Chairside relines of provisional restorations and final impressions often necessary

*Source: http://online.lexi.com

Implant-level Impressions

Implant-level impressions are similar for any type of prosthesis. There are two main types of impression copings – closed tray and open tray. Closed tray or transfer impression copings remain on the implant complex after the impression is removed and need to be placed into the impression manually. Open tray or pickup impression copings are automatically retained in the impression after removal. This usually requires the manipulation of a long screw that is not present in transfer copings.

For more information on implant impression comparison, call (248) 357-3100 and talk to an implant specialist. If you're a general dentist who would like to see a demonstration of taking implant impressions in the Oakland, Wayne, or Macomb County Michigan area, feel free to contact Joseph Nemeth, DDS & Associates by phone or email jrn@drnemeth.com. Also look for us on the web at www.drnemeth.com.

A 3-Unit Bridge or Dental Implant

A 3-Unit Bridge or Dental Implant - Which is Right For You?

Each and every patient deserves a magnificent smile. Due to the incredible advances in aesthetic dentistry, there's no need for anyone to settle for less. With dental implants, missing teeth can now be easily, comfortably and most importantly, permanently replaced.

3-unit Bridge - The Traditional Option
Traditionally, a bridge has been the standard of care for replacing a missing tooth. Constructed of metal sub-frames and tooth-colored porcelain, bridges are fabricated to approximately match the natural shade of your existing teeth.

A bridge uses the teeth on either side of the missing tooth as support for the artificial tooth that replaces the missing natural tooth. The goal of a bridge is to restore chewing function while achieving an acceptable aesthetic outcome.

Unfortunately, since the jawbone under the replacement tooth is no longer being stimulated by being involved in the chewing function, bone is often resorbed into the body. This process creates a slowly-growing gap between the replacement tooth and the gums.

Key Features

• Slightly less expensive than a dental implant
• Achieve acceptable cosmetic outcome
• Restores chewing function

Drawbacks

• Requires healthy adjacent teeth to be ground down
• Potentially increases risk to the teeth that have been ground down
• Bone resorption results in compromises cosmetics over time
• Life span of only 5 to 7 years traditionally
• May contain metal

Single Tooth Implant - The State of The Art Solution

Dental implants can provide a more advanced replacement option for replacing a missing tooth than a traditional bridge, while preserving adjacent teeth.

Dental implants are small titanium screws designed specifically to replace a natural tooth root. Dental implants provide a highly biocompatible surface that encourages bone to attach to the implant during healing through a process called osseointegration. This process of bone attachment ensures long-term results.

Dental implants do not require adjacent teeth to be ground down or modified in any way. The implant also provides the added benefit of creating stimulation to the underlying bone.

Restoration with all-ceramic components can produce a beautiful, natural looking, translucent replacement tooth that looks almost identical to the tooth that is being replaced!

Key Features:

• Adjacent teeth remain untouched - no grinding down required
• Underlying bone integrity is preserved because stimulation is restored
• Helps to maintain long-lasting, cosmetically pleasing results
• Titanium is strong and is naturally accepted by the body resulting in a high level of osseointegration

Drawbacks

• Slightly higher cost than a bridge

When deciding between a dental implant and a three unit bridge, it is important to be educated about all of the benefits associated with choosing a dental implant. When you lose a tooth, your jawbone can shrink, aging your appearance prematurely. Implants help to prevent this premature aging.

Like natural teeth, your newly restored dental implant will be strong, stable and secure so you can comfortably eat all your favorite foods. Dental implants are a long-lasting solution - often lasting an entire lifetime.

And perhaps most importantly, your beautiful new teeth can give you back the confidence you may have lost when you lost a tooth. They can transform your daily life and can lead to a happier you!

If you'd like to know more about deciding between a dental implant and a three-unit bridge, visit implant manufacturer, Nobel Biocare on the web at www.nobelsmile.com. For an implant dentist in the Oakland County, Wayne County, or Macomb County, Michigan area, visit Dr. Nemeth and Associates on the web at www.drnemeth.com or call (248) 357-3100 to schedule a consultation visit.

Implant Supported Overdentures - Another Tooth Replacement Option

Guidelines for Recommending Implant Supported Overdentures

• Does the patient have complaints of soreness, instability or decreased function with his/her current denture?
• Is the patient's dissatisfaction or desire for additional function a result of the original appliance design or inadequate retention?
• Has the patient been infomred of the benefits of implant-supported overdentures: increased prosthesis retention, increased chewing ability, improved nutritional status, and reduction of future bone loss?
• Is there adequate interocclusal space in the anterior segment to accommodate the prosthetic attachments on the implants? Posts extend about 3-4 mm coronal to the tissue level. Attachments add an aditional 1-2 mm of height. The retentive device occupies 3-5 mm of buccolingual space.
• Is there adequate mandibular height for implant placement? In patients who have recently lst their teeth, the alveolar ridge may actually need to be reduced to provide adequate interocclusal space for the implants and the prosthesis. Often ridge height reduction is necessary to have enough buccolingual bone width. Optimally, a 13 mm implant is employed in the antierior mandible. The mandibular residual ridge can be assessed for height with a panoramic film.
• Is the current denture adequate in height and width to retain implant overdenture attachments? The height and width of the appliance must be adequate, the borders properly extended, and the occlusion balanced.

Two Main Categories of Michigan Dental Implants

Dental implants can be divided into two main categories: 1.) root-form implants and 2.) periosteal and blade implants.

Root-Form Dental Implants
The most widely used implants today are root-form implants. While they may resemble a cylinder or a screw, the screw type root form implant is the most common. These implants are manufactured in varying lengths and diameters so that most clinical situations can be accommodated. Most root-form implants have an attachment that is utilized in the final restoration process, i.e., a place for the crown to attach to the dental implant. These replacement crowns can attach to the dental implants in one of two ways: with an internal connection or an external connection.

External Connnection
The attachment rises approximately 1 mm above the implant when there is an external connection. The shape of the attachment may be a hexagon or a castle-like design depending on the type of root-form dental implant used and will have a screw hole in the center of the attachment for the abutment or crown. In cases where the abutment contains the screw in one piece, the implant attachment is non-engaging. For example, the head of the dental implant may be a hexagon but the abutment is round allowing rotation into place.

Internal Connection
If there is an internal connection, the attachment lies inside the implant and the shape of that internal space varies. Abutments might be threaded and screw-retained into the dental implant Michigan or, in systems known as "internal friction systems", abutments may be retained only by friction against the inner walls of the dental implant. Abutments might be shaped like a tooth prepared for a crown (for cemented restorations), or they may have a built-in hole for a screw (screw retained restorations). The implant platform may be flat or have beveled edges, although the beveled-edge type is becoming the most popular type of dental implant.

One-Stage vs Two-Stage Implants
Another major division of root-form dental implants is between one-stage implants and two-stage implants. On the day of surgery, a one-stage implant is exposed to the oral cavity immediately following placement while two-stage implants are covered by gingiva after surgical placement. With two-stage implants, a second surgery is necessary to expose them to the oral cavity. When surgical stability is good, two-stage implants can be purposely exposed at initial implant placement, thus eliminating the need for later re-entry. This is done by placing a healing abutment.

Periosteal and Blade Implants
A much less common type of root-form dental implant is the periosteal/blade implant. Periosteal implants are flat, mesh-like framewords that lie on the bone surface and cover a large portion of the bone, wrapping around buccally and lingually. Blade implants are small, flat plates that are inserted into a thin cut in the bone. With both of these types of root-form dental implant, the abutment is generally inseparable from the implant, but instead forms an inseparable part of the implant itself.

To learn more about root-form implants or any type of Michigan dental implants, call Joseph R. Nemeth, DDS, MaCCS & Associates at 248.357.3100 or visit us on the web at http://www.drnemeth.com/.