Dr. Ara Nazarian discusses implant treatment with fewer appointments
When a patient presents to your dental practice with questionable and/or non-restorable teeth requiring full-mouth extractions, the biggest concern is whether or not implants can be placed at the same surgical visit and, if so, will the patient be able to walk out with fixed teeth. Having an implant within your practice that allows you to load or progressively load so that these patients’ demands are met allows you to position your practice to a whole new level.
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Of course, certain parameters must be met in order to facilitate this type of treatment. This includes, but is not limited to, the quality and quantity of bone, the presence of infection, the patient’s health, and the skills of the dental provider. Additionally, the selection of the most appropriate materials for the most ideal situation must be met.
Planning
A CBCT scan using the CS 8100 3D (Carestream Dental) (Figure 5) was taken to accurately capture the information needed to properly treatment plan this case and ensuring the most ideal outcome, especially since the patient discussed his frustration with previous treatment that did not last very long or address his primary needs and requests.
The implants utilized in this case were OCO Biomedical’s Engage™ dental implants. These implants are known for their unchallenged high implant stability at placement, which is a critical success factor in these immediate load cases. With the combination of their patented Bull Nose Auger™ Tip and Mini Cortic-O Thread™, the Engage™ implant system offers practitioners a bone level implant with high initial stability for selective loading options.
The prefabricated immediate provisional restorations were tried in to ensure a passive fit over the temporary abutments. Once confirmed, rubber dam material was placed to avoid the restoration from locking on during the relining procedure with Visalys® Temp (Kettenbach) temporary material. After the material polymerized, the immediate provisional restoration was removed, and any access material was removed with the Torque Plus (Aseptico) lab handpiece and acrylic bur (Komet). Once trimmed and polished, the provisional restorations were seated with Temp-Bond™ Clear (Kerr Dental) (Figure 11).
Seven days postoperatively, the patient returned with very little discomfort, swelling, or bruising. He was very pleased with his new upper- and lower-fixed provisional restorations (Figure 12). Now that the patient was no longer anesthetized, the occlusion was checked again to confirm there were no interferences in lateral and protrusive movements. The next step in his treatment would consist of full arch impressions for the definitive restorations approximately 4-5 months postoperatively.
Conclusion
Having the ability to take a patient from start to finish in a fewer amount of appointments within your practice allows you to position yourself as a provider that can fulfill your patient’s surgical and restorative needs. With the proper training and appropriate materials, a dental provider may provide extraction, grafting, and implant placement within one appointment at one location. Not only does this allow you to reduce the amount of visits for the patient, but this type of service also helps maintain the cost to the patients since they are not seeing multiple dental providers. Most importantly, this enables the dental provider full control of the surgical and prosthetic outcome. Depending on the patient’s desires, the clinical conditions of the oral environment present, and the skills of the provider, a dentist may choose to extract teeth, level bone, and graft with guided dental implant placement within his/her dental practice.
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