Avoid Perimplantitis: Dental Implants and their Maintenance

ICOI World Congress XXXVI

The International Congress of Oral Implantologists ( I.O.C.I. ) is an association of general dentists, oral and maxillofacial surgeons, periodontists, prosthodontists, endodontists, orthodontists, laboratory technicians, auxiliaries, industry representatives, researchers, faculty members, pre and post doctoral graduate dental students as well as the general public.


The I.C.O.I. is Devoted To Dental Implant Education.

Last year’s meeting was centered around Implant Failure. In particular, the seminar focus; Cause For The Dental Implant Failure. Coupled with remedies for dentists to manage failing implants.

The Take Home Message for Me.

Prevention and implant maintenance is critical. In the first place, failures are more common than early reported in the literature. By the same token, do not be despondent if you currently have dental implants or choose to embark in future implant dentistry. On the contrary, the future is bright.

Recent Findings for Implant Failure

1-PERIODONTAL DISEASE can cause Implant failures. When it is diagnosed, it must be eradicated PRIOR to implant placement. The mouth must be periodontal disease free……… The reason : Periodontal disease is a bacterial infection. These bacterium will “jump” from your natural teeth onto your new implant. Subsequently, you will get periodontal disease on the implant. Under those circumstances, this inflammatory condition of bone loss around an implant is called periimplantitis.

2- Smoking causes a higher incidence of implant problems. In other words, non smokers retain more implants. For this reason, smokers should consider a cessation program.

3-Poor Metabolic Control patients. Diabetics have a greater loss of implants. In addition to Immunocompromised patients ( H.I.V.) and those with Chronic Obstructive Pulmonary Disease C.O.P.D

4- Less Than Ideal Placement by the Dentist, can be a factor for failure. The implant needs to placed in the most functional, accessible location to your toothbrush by the dentist. Less than ideal placement, may contribute to its demise. Guided surgery, which I preform in my office helps avoid this complication. Many of my implant cases are driven via guided surgery. Look to my future YouTube posts at Robert Emilio & Associates for my actual guided surgery procedure.

5-Cement contamination remnants. In several words, lack of removal of all dental cement upon placing the final crown can be problematic. Infact, this cement irritant will act as a nidus for bacterial infiltration. Subsequently, an infection around the implant can ensue.

6-Lack of better quality bone. High cholesterol patients tend to have “fatty” bone, of lesser quality. Essentially, not all bone is the same in quality. Lack of Vitamin D is drawing a lot of attention. The data is still formulating. Stay tuned.

Strategy that I have Executed in My Office To minimize failure is pretty simple. This is what I tell my patients……………..

“I want No Problems as much as YOU want No problems. This is what You Must Do!”

My Recommendations Implemented in My Office For My Existing Patients with dental Implants and Future Recipients .

1- With out delay, periodontal disease must be treated prior to implant placement. In this case, scaling and root planning under local anesthetic.

2-For my smokers, I understand it’s an addiction. I am not perfect either. I am not here to judge or point a finger. As a brief aside, I will enjoy a Padron 1926 cigar, if it’s an occasion,,,,but the question to ask yourself…”Are you ready to deal with the consequences?”Consider a Smoking Cessation Program. That’s to say, consult your MD on getting that started.

3-Check Up with your M.D. It must be remembered there is a connection between teeth and body. A good idea is to make sure your cholesterol, Vitamin D levels, and sugar are in normal range.

4-With this in mind, I would prefer an additional Vitamin D uptake of 2000 IU/day.

5-Professional Hygiene Maintenance 3x year by may talented hygienists. In the final analysis, they are my gatekeepers who are responsible for your maintenance education and early the detection of potential problems.

6- Purchase a Waterpik device. For the most part, they are great when used properly. In the long run, a fabulous investment. In brief, you will be amazed “how much you missed”, after you brushed. Are you up to the challenge?

7-In light of the afore mentioned, use a Chorahexadine rinse once a week. In reality, it is industrial strength mouthwash. This is the next best thing to safeguard those implants.

Credits:

Dr. Emilio & Associates,  Always Accepts  New Patients. He especially exceeds at treating same day emergencies patients suffering from tooth ache pains.

His goal is to keep his patients’ Teeth and Gums Healthy For Life.

Feel Free to appoint a Consultation with the Doctor. Open Six Days A Week

OPEN on Weekdays.  7:30am -8:00pm  (M<T<W<T)

Fridays.  7:30am-2:00pm

Weekends (Saturday only).  8:00am-2:00pm

111 East Avenue, Norwalk, Connecticut 06851.

You can always contact me directly via email  blog@robertemiliodds.com

You Tube : Robert Emilio DDS & Associates 

Instagram:  dentist_in_connecticut

Office (203)866-7164      www.robertemiliodds.com

Pass this Link to Your Friends:  robertemilioddsblog.wordpress.com

Put That Gummy Candy Down!

We are flawed……..

You may want to think twice about reaching for that Swedish fish or Gummy Bear. If you are like me, I am flawed when it comes to having something sweet. Despite my professional wisdom, I do on occasion indulge in a chocolate chip cookie or a scoop of chocolate ice cream after dinner. In general, my will power is firm but once and awhile, I will “go for it”.

Scenario

My patient “went for it” yesterday. In reality, she lost. “I felt a sharp pain and heard a pop and knew something was wrong. It was a Starburst”, she added.

Clinical and radiological exam revealed a fractured root. Incidentally, the tooth had been previously root canal treated. In this case, the assessment was to extract and place an immediate dental implant. In fact, existing bone quality and quantity was great. The patient was motivated. I was ready for the challenge.

Treatment

To begin with, I administered 2% lidocaine locally. Without delay, I sectioned the roots and removed the scoundrel segments. In a moment, the dental implant was precisely placed into its proper orbit. Shortly after, donor bone graft was packing to keep everything firm in place. Adjacent to this immediate implant, I placed a second implant to close the molar gap. This had been a longtime desire of the patient. The gap bothered her, when she smiled.

My Philosophy

Life can be challenging . On occasion, after taking care of everyone around us, it is okay to treat yourself to a simple joy such as a delicious sweet candy or an extra glass of Riesling. With that being said, pick and choose your “poison”. For this reason, gummy type candies are equivalent to playing Russian Roulette with your teeth. It is important to realize not to complicate your life with unintended consequences.

The root was under the crown
Split in 1/2

Two implants placed
Two Implants.

Credits

Dr. Emilio & Associates,  Always Accepts  New Patients. He especially exceeds at treating same day emergencies patients suffering from tooth ache pains.

His goal is to keep his patients’ Teeth and Gums Healthy For Life.

Feel Free to appoint a Consultation with the Doctor. Open Six Days A Week

OPEN on Weekdays.  7:30am -8:00pm  (M<T<W<T)

Fridays.  7:30am-2:00pm

Weekends (Saturday only).  8:00am-2:00pm

111 East Avenue, Norwalk, Connecticut 06851.

You can always contact me directly via email  blog@robertemiliodds.com

You Tube : Robert Emilio DDS & Associates 

Instagram:  dentist_in_connecticut

Office (203)866-7164      www.robertemiliodds.com

Pass this Link to Your Friends:  robertemilioddsblog.wordpress.com

What is a Sinus Intrusion?

The Consultation

Several years ago, a new patient presented for an implant consultation. The “spirit of the conversation” went something like this……..According to her, she was in desperate desire to chew again, on her right side. Her two previous dentists told her that in order for her to get the desired dental implant in the upper right side, she would need to get a full blown sinus lift procedure. She implored,” I don’t want that big surgery. The thought of it makes me cringe. My friend had it done and she was swollen for days. Can you help me?”  

My Introspective Thought

After that sincere plea for help it got me thinking about an alternative procedure being promoted at a dental seminar several months prior. I was thinking, rhetorically, can I do this for this beautiful lady? In brief, it was a minimally invasive procedure. Generally, I could potentially create sizable bone for the future implant. Lastly, there would be a minimal discomfort. After all, I wanted to help her. I had the motivation and glimmer of curiosity. In short, I said, “Let’s take a radiograph and I will see what I can do for you.”

The Lateral Wall Sinus Lift Procedure

A Lateral Wall Sinus Lift procedure is probably the most invasive procedure we execute in dentistry. Essentially, the dentist breaks into the maxillary sinus compartment with a drill, teases a thin delicate membrane off the floor of the fractured sinus and raises it, utilizing a set of specifically designed curved curettes. That’s to say, once the Synerderian membrane is gently displaced, cadaver bone is furthermore augmented to the newly created space to create a pseudo sinus floor. Subsequently, this augmented site provides the footing foundation for the future implant fixture. (I write about this in great detail in a previous blog. See “Sinus Lift” or visit my You Tube Channel Robert Emilio DDS & Associates, to witness the actual procedure live).

By the way, the implant can not be immediately placed until this new bone matures. Grafted bone needs to heal. Ordinarily, post operative swelling lasts about 3 days. Furthermore, this newly grafted bone can take up to six months to heal. Lastly, there’s a needed secondary surgery. Similarly, the implant must get inserted later on. Oh yes. Then there is an additional healing period of three months.

Evaluation & Discussion of the Cat Scan

To summarize, I said, “No problem”, with confidence. Furthermore, I continued on.”To begin with, how does it sound if I make a tiny incision and work thru a little tiny hole of 5.0 mm diameter? Next, I will then gently plunge saline water thru this little access hole to “push” the sinus membrane off the sinus floor. In short, it goes like this. Usually, one shot of local anesthetic is all that is needed. Incidentally, one small incision. So I then, push away the sinus membrane off the floor. Lastly, I will insert the bone graft and then finally, simultaneously, place the implant fixture. In short, does that sound agreeable? ” This is called a Sinus Intrusion Crestal Approach. To sum up, as I explained,” I can do it for you. I do it regularly(in my head)! Furthermore, book it today.”

Check it Out Live, If you Dare!

( You can see this procedure live on my You Tube Channel Robert Emilio DDS & Associates. Sinus Intrusion The Crestal Approach

Needless to say. She came in the other day for routine hygiene check. In conclusion, everything looked great. Likewise, see below radiographic progression

The Two Year Radiographic Follow Up

Pre Op Schematic. Tooth #3 Missing
Post Op. Fabulous Bone height achieved on Implant #3 (part of the bridge (#3-#5)

Dr. Emilio & Associates,  Always Accepts  New Patients. He especially exceeds at treating same day emergencies patients suffering from tooth ache pains.

His goal is to keep his patients’ Teeth and Gums Healthy For Life.

Feel Free to appoint a Consultation with the Doctor. Open Six Days A Week

OPEN on Weekdays.  7:30am -8:00pm  (M<T<W<T)

Fridays.  7:30am-2:00pm

Weekends (Saturday only).  8:00am-2:00pm

111 East Avenue, Norwalk, Connecticut 06851.

You can always contact me directly via email  blog@robertemiliodds.com

You Tube : Robert Emilio DDS & Associates 

Instagram:  dentist_in_connecticut

Office (203)866-7164      www.robertemiliodds.com

Pass this Link to Your  Friends

What’s a Sinus Lift?

A Sinus Lift is a very technical surgical procedure, that a dentist will employ to create bone capacity in the maxillary sinus for dental implant anchorage.

The maxillary sinus is essentially a hole in the maxillary aspect of your upper jaw. It is composed of several bones. The maxillary sinus reduces the skull’s weight, produces mucus which moistens our noses and affects the tone of an individual’s voice. Internally, the sinus is lined with a what is called the Schneiderian Membrane. The membrane can be tissue paper-thin or orange peel thick.

When posterior upper teeth are extracted, the superlying maxillary sinus naturally expands to occupy the former root area of the extracted teeth. This is a normal biological consequence of tooth extractions; loss of bone support and atrophy. The extraction of a tooth may seem fine when you are in dire pain, but the subsequent consequences of tooth loss are many, such as: loss of function to eat properly, significant bone loss associated with advanced aging, esthetic nightmares and the obvious social stigma of failure.

Most often people regret the extraction of their teeth and are often confronted with regaining what was. In situations of upper posterior tooth loss and significant bone loss, dental implants may be elusive, unless the Lateral Wall Sinus Lift Procedure is performed.

A dental implant must have at least 10mm of bone to have a long term success. In maxillary expansion after tooth extraction( pneumatization), the floor of the maxillary sinus can expand so much as shrink down the alveolar crestal  bone down to as  thin as 0.5 mm thick from as much as 15mm of bone height when you were a teenager. This process of pneumatization occurs very quickly over a period of several years with the greatest changes in the first 6 months after tooth loss.

My  sinus lift procedure involves,  administering local anesthetic to the upper jaw. A single long incision is made and the gum retracted away from the upper jaw. The underlying maxilla jaw is revealed upon reflection of the tissue. A small window is then created by my dental surgical drill just down to the fine membrane WITHOUT it’s perforation. A dedicated set of instrument curettes are then utilized to reflect the membrane off the inner aspect of the sinus, thus releasing and creating a relative space. Think of sticking your hand in between the pillow (sinus floor) and pillow case (membrane) and making a space. Eventually with patience, a big lift is created into which allograft ( human cadaver bone) is gently packed to create a new maxillary floor (or  new implant ceiling).  Essentially the relative dimensions of space are reformulated to create new “room” for the dental implants to be placed several months later. Once bone is  nicely  packed, I then insert a temporary collagen blanket  seal over the aforementioned window and close the flap down with many sutures. With time, everything heals and the patient’s actual bone cells replace the donated bone graft to create a unified body of gorgeous healthy viable foundation ready for dental implantation.

The patient goes home with ice to the face, pain killers, antibiotics for the week and chills with Netflix for the evening. The procedure is predictable and usually results in a substantial amount of regenerated healthy bone. It takes me about an hour and 20 minutes start to finish.

Check it Out( GRAPHIC BEWARE) !

My You Tube Channel to see Me in Action Live! performing the Lateral Wall Sinus Lift procedure on my patient.

My You Tube Channel,  Robert Emilio DDS and Associates

 

Pre-Op view Panoramic View of maxillary sinuses
Pre-Op View Cross Section of the Right Maxillary Sinus via CBCT
Post Op Panoramic View of Sinus Bone Augmentation of Right Maxillary Sinus

Dr. Emilio & Associates,  Always Accepts  New Patients. He especially exceeds at treating same day emergencies patients suffering from tooth ache pains.

His goal is to keep his patients’ Teeth and Gums Healthy For Life.

Feel Free to appoint a Consultation with the Doctor. Open Six Days A Week

OPEN on Weekdays.  7:30am -8:00pm  (M<T<W<T)

Fridays.  7:30am-2:00pm

Weekends (Saturday only).  8:00am-2:00pm

111 East Avenue, Norwalk, Connecticut 06851.

You can always contact me directly via email  blog@robertemiliodds.com

Instagram:  dentist_in_connecticut

Office (203)866-7164      www.robertemiliodds.com

Pass this Link to Your Friends:  robertemilioddsblog.wordpress.com

Missing Tooth Options.

A patient presented pain free with a fracture to the gum line ( upper left bicuspid tooth). He had minimal pain only  when he pressed his finger on the gum line of the remnant root area. There was no infection noted around the area. The incident when the tooth fractured, was unremarkable “The tooth just snapped off”, as he plainly stated.

Fractured Root canal treated tooth
Fractured Root canal treated tooth Pre-Op picture of Tooth #13

Options were discussed 

1- Doing nothing, essentially leaving the root in place. “Not a good idea”,  as I mentioned because the rotting root would act as potential source for a future infection.

2- Simple extraction of the remnant root. “A very good idea, but what about the space?” I asked. “You can’t walk around like a homeless guy. It’s near the front, for god sake.”

3- Simple extraction of remnant root combined with a bridge to span the gap. The question to ask one self when faced with this predicament, “Do you want to have two of your teeth ground down to stumps, in order to close the gap for the replacement of one tooth?”  I explained. The consequences of possibly creating an unwanted root canal in the process, seems to be an absurd option for a single tooth replacement.

4- Simple extraction of remnant  root and replacement with a removable device, a partial denture. “Terrible idea”, I said. “You are way too young to put your teeth in a cup at night!”

5-Simple extraction of remnant root, socket preservation combined with a staged implant approach…………….Excellent Idea…. we both agreed!

BINGO! And that’s what we did.

Extracted fractured tooth with bone graft
Extracted fractured tooth with bone graft

Post Op-Picture
Extracted Root with Bone graft and Barrier

The patient was informed to return for suture removal in 2 weeks.

I plan to place a dental implant fixture in 2 months via a guided surgical approach.

STAY TUNED !!!!  

You can Visit my You Tube site Robert Emilio DDS and Associates where you can find my entire official……Dental Implant Seminar for your review.

 

Dr. Emilio & Associates,  Always Accepts  New Patients. He especially exceeds at treating same day emergencies patients suffering from tooth ache pains.

His goal is to keep his patients’ Teeth and Gums Healthy For Life.

Feel Free to appoint a Consultation with the Doctor. Open Six Days A Week

OPEN on Weekdays.  7:30am -8:00pm  (M<T<W<T)

Fridays.  7:30am-2:00pm

Weekends (Saturday only).  8:00am-2:00pm

111 East Avenue, Norwalk, Connecticut 06851.

You can always contact me directly via email  blog@robertemiliodds.com

Instagram:  dentist_in_connecticut

Office (203)866-7164      www.robertemiliodds.com

Pass this Link to Your Friends:  robertemilioddsblog.wordpress.com