Avoid Dental Implant Complications with Cone Beam-CT Technology

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I believe Cone Beam-CT technology and treatment planning software have the greatest potential for helping doctors avoid or reduce the frequency of implant complications. Our in office I-Cat cone beam CT (Imaging Sciences International) scanner allows us to evaluate the patient’s anatomy in 3D 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 implant 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.

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Meet Me in South Africa July 2013

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The International Team for Implantology (ITI) is a unique network that unites professionals around the world from every field of implant dentistry and related tissue regeneration. As an independent academic association, it actively promotes networking and exchange among its membership. Established in 1980, the ITI has become one of the largest independent academic organizations in implant dentistry and the related field of tissue regeneration. For more than 30 years, Straumann has enjoyed a unique partnership with the ITI, supporting networking, education and research.

I have attended the International Team for Implantology (ITI) Congress multiple times and have been asked to present on numerous occasions. As an ITI Fellow, Education Committee member, Consensus Conference participant, and ITI Treatment Guide contributor, I have been immersed in this invaluable organization and feel that all ITI Congresses are well worth attending.

I have been ask to participate in the ITI congress that will meet in Johannesburg, South Africa. The dates are July 26-27, 2013. This is the South African winter season with cooler temperatures and a wonderful time of year for a safari style vacation. I’m planning now to take my family on such an adventure after the meeting.

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Avoiding & Managing Perforation of the Maxillary Sinus

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One complication dental implant surgeons need to avoid and manage is perforation of the maxillary sinus when performing sinus lift procedures or placing implants in the maxillary sinus area.

In the Case of Lateral Window Sinus Lift Procedures

A cone beam CT scan enables the surgeon to see where the sinus septae are located. Typically, the surgeon can avoid perforation of this membrane by using a diamond bur, specialized diamond instrumentation for window preparation or Piezo electric instrumentation (Piezotome, Salvin Dental Specialties).

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Dental Implant Complications: Paresthesia

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Avoiding & Managing Dental Implant Complications: Paresthesia

Etiology and Avoidance

Nerve injuries occurring during implant surgery can be from multiple causes. Mandibular block anesthesia and infiltration, especially in the area surrounding the mental foramen, can cause an altered sensation involving the lip, chin, and the tongue. Retraction injuries can also present with similar symptoms. In the majority of these cases the resultant paresthesia will eventually resolve.

Nerve injury may also inadvertently occur during osteotomy preparation, especially when the surgeon does not realize that the system drills are longer than the planned implant. As a general rule, a safe zone of 3mm should be respected, in terms of distance from the inferior alveolar nerve and the apical extent of the osteotomy preparation. Increased distances may be indicated when the cancellous marrow is sparse and poor bone density is encountered.

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One of My Chief Concerns: Dental Implant Complications

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The initial focus of my implant practice was esthetics. I applied the principles of plastic and reconstructive maxillofacial surgery toward developing a site preservation protocol and towards achieving predictability with hard and soft tissue site development. We assembled a team that allowed us to provide a comprehensive multidisciplinary approach to esthetic implant therapy, and I shared our cumulative experience in my textbook Soft Tissue and Esthetic Considerations in Implant Therapy (Quintessence 2003).

I also focused on learning how to avoid and manage implant complications. I made a point of analyzing our own experiences with complications, and I had opportunity to treat a large number of implant related complications referred to my practice. Over time, I gained considerable knowledge and experience concerning the factors that need to be recognized to avoid a wide variety of complications, as well as the treatment planning concepts and techniques required to manage patients who had experienced these complications.

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