Immediate implant placement and reestablishing vertical dimension

Dr. David Salmassy used the MPI™ Molecular Precision Implant by Ditron Dental USA to provide a life-changing implant procedure on this patient who hadn’t visited a dentist in more than 10 years.

Dr. David Salmassy illustrates a complicated implant placement with the MPI™ Molecular Precision Implant by Ditron Dental USA

Patients don’t come to dentists just for implants. They come to us for teeth and smiles. Some want to use those smiles to improve their life. This female patient, MC, is 30 years old and had a history of traumatic dental experiences that resulted in an extreme dental phobia. She had not seen a dentist in almost a decade, and her teeth deteriorated to a state of disrepair, broken off at the gum line. Her grandmother, already a patient of the practice, brought her to the office, asking me to “fix my grandbaby.”

Figure 1A: Imaging — the panoramic image produced from the CBCT

MC rarely spoke and never smiled. We took digital photographs and sent them to ROE Dental Laboratory in Cleveland, Ohio, for a PreVu™ Smile Simulation. This simulation allows us to show the patient his/her projected new smile at the outcome of treatment (Figure 2). Seeing the enhanced new smile before the implant procedure is like test-driving your new set of teeth. After viewing her Smile Simulation, MC and her grandmother accepted treatment, and we continued the process — taking traditional impressions, making models, and making the required measurements. We captured the proper and necessary intraoral photographs and CBCT imaging.

Figure 1B: Intraoral photo — pre-op of MC’s upper jaw

When the initial process was completed, we had a long-distance case-planning conference with ROE Dental Laboratory to design the placement of the implants. From the chart records and the CBCT, we elected to use the CHROME GuidedSMILE process to fabricate a virtual prosthesis for the patient. The surgical and prosthetic guides were fabricated so that we could position the actual teeth with a high degree of accuracy. All information was input into the computer based on the bite registration and the models that we sent. MC’s dentition had some complicated aspects. Because her upper teeth were broken off so badly, her bite had become over closed. As a result, she had lost much of her vertical dimension, which needed to be reestablished. We needed to open up her bite 8 mm.

Figure 2: Shows Smile Simulation before and after

MC also needed a bone reduction. Since she needed proper vertical dimension and height for the actual prosthesis, the apical end of the appliance had to be between 13 mm to 15 mm. Hence, we needed to reduce the bone to accommodate for these measurements.

Figures 3 and 4: 3. Surgical guide mount has been affixed to the upper jaw after removal of bone. Also shows the bite plane
used to secure the teeth in place. We have to ensure that is fixed first before going to the implant placement. 4. Implant
surgical guide with a guide sleeve and the guide holes in preparation for implant placement

We chose the MPI™ Molecular Precision Implant System by Ditron Dental USA. The precision fit of the components and tight tolerances are very important to the long-term success of treatment. The implants’ MolecuLock™ technology uses a biomechanical dental implant-abutment seal designed to reduce microgaps. Microgaps are reduced to less than 0.05 microns, which eliminate microleakage and bacterial penetration. This is critical for a patient who does not have direct access to hygiene under a prosthesis. Also, the better the tolerance, the better the fit. This facilitates a lack of movement of the components and the teeth, maintaining bone — an integral part of a successful implant.

Figure 5 (left): Using the surgical guide sleeves in the placement of the upper left posterior implant; and Figure 6 (right): Surgical guide in place showing the placement of the implants through the guide

The design features on the MPI include the unique Spherical Helix Chamber, which captures blood and bone fragments for assisted osseointegration, and the beveled collar, which shifts the dental implant-abutment junction inward away from the coronal bone, allowing you to achieve a platform-switching configuration that prevents coronal bone resorption.

Figures 7 and 8: 7. Guide platform for placement of the prosthesis showing the multi-unit abutments in place. 8. The prosthesis on the guide platform and the alignment of the multi-unit abutments with the computer preplanned and pre-positioned access holes in the prosthesis

Additionally, the MPI offers an expanding tapered dental-implant body with a self-tapping progressive double-thread design, which gradually condenses the bone-enhancing initial stability. The double threads result in an efficient insertion rate of 2.2 mm per revolution of the dental implant.

Figures 9 and 10: 9. Temporary cylinders attached to the multi-unit abutment. 10. Prosthesis
in place and guide tubes in preparation for the placement of the bonding

The MPI implant also has a single platform — one 2.45 mm dental implant-abutment internal hexagon connection for all diameters. This is huge for my office. It simplifies the restorative platform and provides a consistency and interchangeability of parts. That means there are fewer parts and pieces to keep track of and less inventory to maintain. It is easier to swap pieces out because it is one-size-fits-all, whether I use straight or angled abutments.

Figures 11 and 12: 11. Bonding agent applied to the outside of the temporary cylinders to pick up the actual position of the teeth in the arch. 12. Closure sutures around healing sleeves

The surgery went according to plan. First, we extracted 11 of MC’s teeth — Nos. 3, 5, 6, 7, 8, 9, 10, 11, 13, 14, and 15.

Figure 13: Immediately after returning the prosthetics to the mouth, attaching them to the multi-unit abutments

This implant procedure was “life changing” for MC. When she returned for her post-op photos, she described a conversation that she had with her 15-year-old son after surgery. She said, “He kept staring at me. He didn’t realize that I didn’t have any teeth before. I didn’t smile, and I didn’t show him that I didn’t have any teeth. Now that he sees me talk like a normal person, and he sees teeth, he says it’s amazing.” She continued, “They are so beautiful. This is my biggest milestone in life other than having my children.”

Figures 14 and 15: 14. Facial photograph showing the net increase in the vertical dimension and occlusion. There is a cotton tip applicator with a mark on the nose and a mark on the chin. The upper mark is the pre-op vertical dimension, and the lower mark is the postop vertical dimension. The VDO increased from 62 to 70. 15. MC 4 days after placement

For me, implants are not just about speech, phonetics, appearance, and function, although those are all very important.  We give a person back hope, self-esteem, and self-worth. The main reason that MC wanted her implants was her desire to return to the workforce. Before her surgery, she wouldn’t smile. In her post-op photo, she is beaming. It is very rewarding to see my patients get the smile of their dreams.

Ditron Dental USA also offers ULT — The Ultimate™ Implant with greater initial stability for immediate load. Read more about it here.

David Salmassy, DMD, completed his under-graduate studies with honors at Carroll College in Helena, Montana, receiving a Bachelor of Arts degree with minors in mathematics and chemistry. He attended the University of California at Davis Medical School where he completed research in molecular genetics for his honors thesis. He received his DMD degree at Oregon Health Sciences University. Dr. Salmassy completed his surgical residency in Oral and Maxillofacial Surgery at the University of California at San Francisco. During his training, he also completed 1-year medical training in general surgery and training in anesthesiology. He practices exclusively in Auburn, California, and is part of the medical staff of Sutter Auburn Faith Hospital.


Disclosure: Dr. Salmassy is not compensated by Ditron Dental USA and is not an officer, director, employee, or consultant for the company.

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