Dental Implant Failure Treament

I have a patient whose dental implants are completely stable but there is Peri-Implantitis. There has to be an eay way to treat this and prevent this type of situation in the future with other patients. The occlusion is fine and their home care is ok. Any thoughts?

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Food, if it sits out too long will spoil. That action is due to anaerobic bacteria breaking down proteins in that particular food. In milk, the odor of sour milk is caused by relatives of the bugs that create bad breath, when they break down proteins in milk (and all dairy foods). A reaction takes place where 'the bad breath bugs' extract sulfur compounds from the amino acids in these proteins. Specifically, the amino acid Cysteine is converted to Hydrogen Sulfide (the rotten egg smell) and Methionine becomes Methyl Mercaptan (which smells like a cross between old socks and garlic.) More....

How to control the bleeding before your application of Emdogain?

Dr. Sculean's suggestions from his Taiwan's lecture!

1. Completely remove all infammations (hard/soft tiss);
2. Rinse with normal Saline frequently;
3. Apply Emdogain from apex to crown;
4. Presuture (Mod. Mattress suture);
5. Premixture with bone graft before applied into defects.

Dr. Balshi's "The Immediate Loading Protocols" Part three

Osseonews: Dr. Balshi, from your description of your technique it appears that it is critical for you to determine if the implant fixture has achieved adequate primary stability before you deliver the prosthesis.
Dr. Balshi: Achieving primary stability is critical. We need to know that the implant fixture is securely locked into the surrounding bone in the initial stage. Secondary stability will be achieved later over time. If we determine that an implant fixture has not achieved primary stability, we have to treat it differently.
Osseonews: Could you describe your protocol for determining primary stability?
Dr. Balshi: In the majority of current treatment applications insertion torque generally provides the stability quantification. However in research cases we use Resonance Frequency Analysis (RFA). This provides an accurate, quantitative assessment of the quality of the implant fixture to bone interface. In essence we transmit mechanical vibrations to the implant to bone interface. We then monitor changes in resonance frequency. This provides a very accurate assessment of the stability of the implant in the bone.
Osseonews: How do you deploy this system?
Dr. Balshi: We connect a transducer directly to the implant fixture.
Osseonews: In essence you are measuring the stiffness or rigidity of the implant to bone interface.
Dr. Balshi: That is correct.
Osseonews: So with these accurate measurements you can make decisions about primary stability with confidence.
Dr. Balshi: It especially enables us to make decisions about cases where the bone density is less than desirable and where we have to determine whether we should connect the implant fixture to the prosthesis or if we should just allow it more time to integrate more.
Osseonews: This kind of evaluation would be more important for cases with less dense bone.
Dr. Balshi: We would like to all have the perfect bone morphology and density for implant placement. When that is not the case – as it often is – we need to be in a position to derive the most accurate information we can get about the implant to bone interface. This is where the true value of RFA is apparent. This enables us to make the best possible decisions about treatment.
Osseonews: By comparison, tapping on the implant and evaluating the kind of thud it makes to determine primary stability really pales.
Dr. Balshi: Listening for a thud or testing the implant with a torque wrench provides some information. But the RFA approach is non-invasive and provides highly accurate information, which you can quantitatively measure the changes over time, and is an excellent research tool.
Osseonews: For those wanting more information on RFA, where should they look?
Dr. Balshi: The best reference is: A resonance frequency analysis assessment of maxillary and mandibular immediately loaded implants. Balshi SF, et al. International Journal of Maxillofacial Implants 2005;20:584-594. Glenn Wolfinger and I are coa-authors. This provides a description of the technique as well as the science behind it.
Osseonews: It is very clear that computerized technology plays an important role in your protocols.
Dr. Balshi: Yes and it is important for your readers to understand that we do not simply advocate or trying a technique without the proper training. It is essential to understand the techniques in their entirety so you can apply them. We give courses at the Institute in understanding and using the computer technology and software applications. If you do not truly understands how the whole system works, you might want to consider spending more time learning about it before using it.

Dr. Balshi's "The Immediate Loading Protocols" Part two

Interview conducted by Gary J. Kaplowitz, DDS, MA, MEd, ABGD
Comment on this interview by visiting the OsseoNews Blog

OsseoNews (ON): In your protocol you connect the provisional fixed partial complete denture to the abutments that have been permanently torqued down into the implant fixtures. What is your technique for accomplishing this?
Dr. Balshi: After the abutments are torque down, we insert a prosthetic cylinder over the abutment. We then screw down the cylinder with guide pins which project well above the height of the cylinders. We relieve the prosthesis in the area of the abutment and cylinder and cover the abutments with rubber dam fragments to block out any undercuts. We then deliver acrylic around the cylinders and insert the prosthesis. The acrylic locks the cylinder into the acrylic veneer. We unscrew the guide pins and then adjust and polish the surface of the prosthesis. The prosthesis is then ready for delivery.
ON: How do you manage a situation where you place an implant and fail to achieve primary mechanical stability? For example, suppose you have a ‘spinner’ (i.e., an implant that rotates in the osteotomy site).
Dr. Balshi: We have experienced this problem on numerous occasions. We have developed two treatment protocols for spinners. One approach is to place a healing cap and to leave the implant undisturbed until osseointegration is complete. Another approach is to unite the spinners with stable implants that have achieved primary mechanical stability by means of a rigid prosthesis, an all acrylic fixed prosthesis or definitive metal reinforced prosthesis both work well. We have found that after uniting the spinner to the secure and stable framework eventually results in the osseointegration of the spinner. Spinners can be encorporated into an immediate load protocol. We are in the process of publishing an article on the clinical management of spinners.
ON: What about situations where you have grafted the implant site and fail to achieve primary mechanical stability?
Dr. Balshi: Again the critical requirement is to provide a stable and secure prosthesis that locks in the implant. Even with a graft, if the implant is locked into a stable and secure prosthesis, it will undergo osseointegration and can be used in an immediate load protocol.
ON: What are you using for graft material?
Dr. Balshi: We use autogenous bone for our grafts. We harvest bone from the extraction sites or osteotomy sites. We have found that this is the most successful graft material. It is readily available at the time of surgery and easy to harvest and place.
ON: Your orientation appears to favor fixed partial or complete dentures and fixed-detachable partial and complete dentures as opposed to overdentures.
Dr. Balshi: We have found over time, and again after decades of collecting data on our completed cases, that the fixed alternative is to be preferred over the removable. In the long term we have found that overdentures require far more maintenance and are prone to many problems. A screw-retained fixed-detachable partial or complete prosthesis is far more stable.
ON: What about the problem of providing support for the lips and cheek?
Dr. Balshi: Placing the teeth in the proper position is the most critical aspect of achieving proper lip and cheek support. We then fill in area between the teeth and the residual ridge using pink acrylic or porcelain. These prostheses can be designed for great esthetics and hygiene access. This should not represent a contraindication to using a fixed prosthesis