This slideshow is an extended  version of  Zirconia implant placement in Compromised Bone released on 03/01/2012. More often than not and especially in emergency cases, patients are undecided about the method of tooth replacement they desire a the time of tooth removal. As a result extractions are done in a conventional manner and even with the greatest care bone defects can be  created during the process of extraction. The natural process of bone resorption during healing after extraction can also make things even more complicated.

Warning: This is a surgical slideshow with graphic depictions and images of a bone grafting procedure and ceramic dental implant placement.

Zirconia Implant in Defective Bone_Surgical Version from Sammy Noumbissi DDS MS on Vimeo.

 On Thursday and Friday August 02 and 03, 2012 we will host our second session of  Real TimeVisual Dental Education™ for 2012.  This will be a two-day zirconia implantology training and certification course. A total of twelve (12) C.E. credits will be awarded for both days. This course will feature the Z-Systems one-piece ceramic dental implants and will cover the areas of case selection, advanced clinical and radiographic diagnostics, site specific implant selection, guided surgery and one-piece zirconia implant temporization modalities.

This Real Time Visual Dental Education™ program will consist of over-the-shoulder hands-on surgical and prosthetic exercises and live surgical and prosthetic demonstrations on zirconia implants.  Participants to this course will be introduced to the InVivo implant planning software from Anatomage during the 3D implant placement planning session.  Each participant will practice implant placement on a stereolithographic model of a real patient along with a surgical guide generated specifically for that case.  Early registrants (before July 01, 2012) will be able to submit CT scan data of their own patient and therefore will be able to practice on a stereolithographic model of their own patient. All participants will keep the stereolithographic models and the surgical guides for future reference.

On Friday August 03, the second day of the course two real-time live surgical procedures  and a live implant restoration session of zirconia implants will be performed by Dr. Noumbissi on live  patients. Attendance for this course is limited to six dentists and will be held in our Silver Spring implant practice.

COURSE OBJECTIVES

This course is designed to provide the clinician with the ability to confidently integrate one-piece zirconia dental implants in their practice.

This course will enable participants to:

• Understand the rationale behind the use of  Yttrium-Stabilized Zirconia as a dental implant material.
• Recognize indications for successful placement of zirconia dental implants.
• Identify the prosthetic need for implant site preparation and/or preservation.
• Proper and predictable selection of temporization techniques for one-piece zirconia implants.
• Utilize CBCT (cone Beam CT scan) and virtual implant planning software to increase case success.
• Appropriate selection of permanent restorative materials.

REGISTRATION

LODGING/LOCATION

CANCELLATION AND CHANGES

Pre-Surgery 3D Implant Planning

More often than not and especially in emergency cases, patients are undecided about the method of tooth replacement they desire a the time of tooth removal. As a result extractions are done in a conventional manner and even with the utmost care bone defects can be  created during the process of extraction. The natural process of bone resorption during healing after extraction can also make things even more complicated.

The case presented in the slideshow below is one where after the emergency extraction, the patient was given a removable partial denture also commonly called “flipper”. After a few weeks of wearing the flipper, the patient could no longer bear with discomfort of the flipper. After review of available options, the patient opted for a conservative, natural , metal free and non-removable method of tooth replacement. A  zirconia crown supported by a ceramic dental implant which is  also made of zirconia was selected to be the method of tooth replacement.

As part of our diagnosis and treatment planning protocol, a low radiation dental CT (CBCT) scan study of the area with the missing tooth  was completed and it was discovered that as a result of the extraction and the loss of bone volume the site of implant placement was compromised. We were also able to determine the remaining bone density/quality, predetermine the exact volume of bone to reconstruct, select the accurate implant size and predetermine the crown shape. The exact location of the maxillary sinus floor was identified and assessed because maxillary sinus perforation can some times occur when implants are placed in the posterior upper jaw. With so much information gleaned from the dental CT scan we were able to safely and predictably place a zirconia dental implant and immediately seat a fixed temporary crown on the implant the same day it was inserted in the jaw.

After a bone integration period and soft tissue maturation of four months, the temporary acrylic crown was removed, impressions were taken and a permanent zirconia crown was fabricated and cemented to the implant.

Today there is an increasing amount of people who choose to have their teeth replaced with dental implants. In some cases the replacement is immediate meaning that once teeth are removed, during the same surgery implants are placed to replace those previous teeth. The advantage of replacing a tooth with an implant at the time of extraction is that the amount of bone loss at the site of extraction is greatly minimized.  However for most people the decision or option to have their teeth replaced comes long after their teeth were lost, and after years of wearing removable partials, dentures or having fixed bridges anchored to adjacent teeth. The problem often encountered in  such cases is that the bone in the area where the teeth have been missing shrinks and there is significant loss of volume and height making it challenging to place implants . A bone augmentation or reconstruction procedure is then necessary and occasionally must be done prior to and in preparation for implant placement, this is what is commonly called a bone graft.

When situations of bone loss or long term absence of teeth present themselves the first step is to obtain the proper information for accurate diagnosis. A clinical and ultra low radiation 3D X-ray is taken of the jaw to be treated, the x-ray unit we use in our practice is called a Cone Beam CT Scan (CBCT) and it provides an accurate view and analysis of the problem. The slide show below shows how by means of clinical pictures and  dental CT scan we are able not only to plan the volume of bone that needs to be augmented but also with a second scan assess the success of the bone graft.

The placement of dental implants in the posterior maxilla can sometimes be complicated due to the loss of bone below the maxillary sinuses. This is very common after maxillary molars have been lost or extracted and no bone preservation procedures provided at the time of extraction. Sinus graft/lift procedures are then necessary in order to create a proper foundation for implant placement. This article, published in June 2010 pp 47-60 in the Journal of Implant and Advanced Clinical Dentistry (www.JIACD.com)compares the amount of new bone formation and residual graft material when mineralized human dried bone (allografts) are used versus bovine bone (xenografts) are utilized to increase bone volume in maxillary sinus.  Sammy Noumbissi DDS MS

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