about Dental implant complications & technological advancements-2

Dr.Mohammad Saeed replied to the questions about Dental implant complications & technological advancements

Greetings Dear Dentist,

A complication like :1: Damaging important anatomical structures such as the sinus or inferior Aleveolar canal could be easily avoided by MRI,which determines the thickness of the canal and the exact position and thickness of the neuro vascular bundle inside.CT also can define it but it fails in 2% of the cases according to C.E Misch.(also determines the thickness of the cortical plate of bone lining the sinus membrane to avoid penetrating it) as well as rare complications such as perforating buccal or lingial plates of bones can be avoided as well .

2: Over heating of bone due to drilling or cooling out side the 'bur-bone contact' or trauma from uncontrolled torque motors ( or controlled but too low RMP) could be avoided by the use of bone expanders ( which i use for more than years now with extreme success even experimentally on dogs)

3:complications of doubting an infected implant can be easily avoided and turned to Absolute sterilization thanks to the Gamma radiation.

4:complications like infection from surrounding roots can be avoided by panoramic and all the more advanced radiological methods.

5:Complication like over bleeding can be avoided thanks to blood sugar tests (which are easly made and fast to help the patient control the sugar level in the blood for about 2 weeks before implant surgeries)

6:complication like overloading can be detected by routine panoramic x rays to observe any resorption may occur in the bone with the direction ( angle ) of overloading.
...wish to continue but i am sorry i have to go.. :) we will continue later inshallah... :)
to know more about my researches please join my group which is facebook dentists...you will find some dogs photos on the main page( researches on implants)..if you have any questions pls let me know..nice to meet you dear Dentist.
bye

about Dental implant complications & technological advancements.

Dr. Anthony G. Sclar repied to the questions about Dental implant complications & technological advancements.

Improvements in implant surface technologies, surgical instrumentation, and prosthetic connections and restorative materials have greatly reduced hardware associated complications. In addition, implant designs which incorporate a “superior shift” of the implant abutment junction such as the Straumann ITI implant or more recently a “central shift” of the implant abutment junction such as the Prevail ™implant from BioMet 3i, the Ankylose® implant from Dentsply Tulsa Dental, and the OsseoSpeed™ implant from Astra Tech Dental, provide the opportunity for improved management of biologic width thus enhancing “soft tissue integration” and stability of underlying crestal bone levels. The potential benefits include improved esthetics and reduced incidence of peri-implant mucositis or peri-implantitis.

Nevertheless, I believe that Cone Beam CT technology and treatment planning software have the greatest potential for helping doctors avoid or reducing the numbers of implant complications. Our in office I-Cat cone beam CT (Imaging Sciences International) scanner allows us to evaluate the patient’s anatomy in 3 D and accurately identify the location and course of vital structures such as the inferior alveolar nerve. In addition, dental pathology not seen on plain films occasionally becomes readily apparent with this technology. When combined with a scan guide derived from a diagnostic wax up that duplicates the proposed final restoration, we are able to perform 3D treatment planning as we evaluate all of the restorative and surgical information on the screen. We can then convert the scan guide into a conventional surgical guide to prepare our sites for implant placement or to guide our 3D hard tissue site development procedures. The 3D diagnostics provides greater information allowing us to make better treatment planning and intra-operative decisions. Taking it a step further, we can order a computer generated surgical guide that incorporates a master cylinder and drill sleeves to allow precise 3D osteotomy preparation or even guided implant placement.

As with any technology, there is a learning curve and nuances which must be understood in order to avoid complications related to the technology itself. Some examples include misinterpretation of CT data or misfit or movement of a guide during surgery which can lead to irreversible complications. The bottom line for doctors is to make a commitment to learn all that they can about the technology and apply it at an entry level before proceeding into advanced applications such as guided surgery.

Nobel Direct Dental Implants In Question

Three years after patients were given Nobel Direct dental implants, the risk of the implant loosening has increased even more. A follow-up by researchers at the Sahlgrenska Academy in Sweden shows that eight per cent of the implants are lost.
Nobel Direct was launched in 2004 by Nobel Biocare AB. The implants were considered a great innovation, as they could be screwed directly into the jawbone without having to first lift up the mucous membrane.
"We have followed up 48 patients who were among the first to get the implant. For each passing year, we have been able to see how the problems related to these implants have grown more and more," observes Pär-Olov Ostman, a dentist who presented the study at the defence of his dissertation.
After one year, about five per cent of the implants had been lost, and 20 per cent of the remaining implants showed bone loss of more than three millimetres. The new report indicates that after three years, eight per cent of the implants had been lost, and 25 per cent of the remaining implants showed bone loss of more than three millimetres.
"We believe that the problems related to Nobel Direct result both from the design of the implant and an uneven surface against the soft tissue in combination with the method of treatment recommended by the company," according to Professor Lars Sennerby.
For some time, Nobel Direct was marketed as an implant that was easy to use, and therefore suitable for less experienced dentists. According to the company's marketing, the implant would also counteract marginal bone loss.
"If the implant is inserted in a more conservative manner, avoiding direct load, the results appear to be better. We believe that there are additional implants with similar design that can also cause problems if they are inserted in the same way as Nobel Direct. However, we are unable to draw any certain conclusions regarding these," says Professor Tomas Albrektsson, the head of the Department for Biomaterials Science at the Sahlgrenska Academy.
At the request of the Medical Products Agency, Nobel Biocare AB is now working to clarify certain information in the product information material. The company also markets several other titanium implants that have been scientifically proved to be very safe, including a Brånemark implant with the same patented surface as the Nobel Direct implant in dispute.

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Article adapted by Medical News Today from original press release.
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Facts about dental implants
The implant is a type of artificial dental root made of titanium. The titanium screw is surgically inserted in the jawbone, and must often become well-secured there so that after several months, it can be used as a foundation for crowns, bridges and dentures. The method was invented by Professor Per-Ingvar Brånemark at the Sahlgrenska Academy in the 1960s. There are several types of titanium appliances, but all are based on titanium being a metal with the unique property of being able to be osseointegrated.
The Sahlgrenska Academy is the health science faculty of Göteborg University. Teaching and research is carried out in medicine, odontology and nursing sciences. We have about 4,000 undergraduate and 1,000 postgraduate students. Of our 1,500 employees, 850 are teachers and/or researchers.
For additional information, please contact:
Elin Lindström Claessen
Information Officer, Sahlgrenska Academy at Göteborg University
Source: Ulrika Lundin
Swedish Research Council

Main Category: Dentistry News
Article Date: 02 Jan 2008 - 0:00 PST