Retreatment: Fractured Implants Due To Biomechanical Overload (Continued)

Preparation for surgery:
The patient was prepared for surgery using the standard sterile protocol, appropriate cleansing of the mouth, and antiseptic cleaning of the perioral tissues. Complete sterile drapes were used to cover the patient and an adhesive sterile plastic drape was applied to the lips and face.

Anesthesia:
Local anesthesia using both Marcaine 1:200,000 epi and Lignospan 1:50,000 epi was administered throughout the mandible.

Surgery:
A full crestal incision from the right to left first bicuspid region was made with buccal and lingual full thickness flaps elevated. Once the neurovascular bundles were identified and dissected, the incision was extended posteriorly to the region of the second molars.

Implant Removal:
Inflamed and hyperplasic Next Column

tissue was debrided from around the fractured implants (Fig 6). Using a trephine drill (Fig 7) and copious sterile saline irrigation, bone was removed from the area immediately around the three fractured implants. The thickness of the trephine was 0.75mm, removing a minimal amount of bone. All bone "dust" was collected for future autogenous grafting if required. The trephine was taken to the depth just short of the implant apex. Elevators (Fig 8) and extraction forceps were used to loosen and remove the implants. Dense cortical bone was noted at the apex of the implant socket (Fig 9).

The neurovascular bundles were identified bilaterally. Using a small dissecting probe to protect the superior aspect of the bundles, a diamond drill was used to remove the thin layer of bone above the canal. The exposed bundles were carefully lifted out of the canals and moved bucally.

Continues Below

POST-SURGICAL CARE
The patient was not permitted to wear his denture for two weeks after the implant placement surgery. Postoperative medications included antibiotic therapy for ten days, steroid and analgesic medications, and a Chlorhexidine mouth rinse.

Suture removal occurred two weeks post surgery. The construction of new interim dentures also began at that time. The patient experienced a transient paresthesia for four months

following surgery and manipulation of the inferior alveolar nerve.

FINAL PROSTHESIS
Following an extended healing period of six months (three months is considered adequate healing for the anterior mandible) the healing abutments were removed and a combination of five standard and two EsthetiCone abutments
next column

IMPLANT PLACEMENT
Seven implant sites were selected based on the biomechanical principle of broad load distribution. These sites were uniformly distributed from the area of the first molars bilaterally. The implant osteotomies were prepared using a series of graduated sized drills. The threads were then tapped through the inferior border of the mandible to accommodate the Brånemark implants. Seven 3.75 mm diameter implants of three lengths were placed: one 7mm, two 8.5mm and four 10mm (Fig 10). Autogenous bone gathered from the implant sites was placed in the area of the three fractured implants that were removed (Fig 11). Titanium healing abutments were placed on all implants and the mucosal flaps were irrigated with a tetracycline solution prior to closing with vicryl sutures.
next column

were fastened to the osseointegrated implants (Fig 12). A conversion prosthesis was constructed at the previously determined vertical dimension using the interim denture. This prosthesis was then transferred to the master cast for articulation. Two additional visits for a casting try in and delivery of the final prosthesis (Fig 13, 14) completed the doctor's treatment.

LONG TERM EXPECTATION
Based on numerous similar treatments over an 18-year experience, we anticipate positive bone remodeling around the implants and in the body of the mandible. Frequently, bone density increases in the posterior mandible and is often accompanied by an increase in bone height distal to the last implant (Fig 15). The patient reports complete comfort and full function. Expectation for continued bone remodeling and maintenance of oral function is excellent.
next page

Continued Page 2
Continued Page 3
Graphics
Back to Insights Newsletter Main Page

Prosthodontic Insights Newsletter - April 2002, Vol. 15, No. 1.

Acknowledgements:

1. The dental implant team at Pi Dental Center

2. Robert Winkelman, CDT, MDT

Fort Washington Dental Lab, Inc.

Tel: 1-800-541-3490

Email: fortwdental@aol.com

Click here to see an Overview of Pi Dental Center

More Information

Home | Write Us | REQUEST INFORMATION

To make an appointment for an evaluation, call:
1-800-PI-TEAM-5
1-800-748-3265

All information is intended for your general knowledge only and is not a substitute for dental or medical advice or treatment for specific dental or medical conditions. You should seek prompt dental and medical care for any specific health issues. See disclaimer.


WELCOME TO PI Info About PI Why a Prosthodontist? Meet Our Doctors Research Programs What's New At PI? Free Video Offer DENTAL TREATMENT Dental Implants Treatment Options Prosthesis Types Bone Grafting Dental Implants & Congenital Deformities Bad Breath Orthodontic Treatment Combined with Procera Crowns HEALTH-ISSUES AND DENTISTRY Bone Loss and Aging Heart Illness & Dentistry Snoring/Sleep Apnea Osteoporosis Cancer Information Drugs and Dentistry Smoking & Implants Other Medical INSIGHTS NEWSLETTERS Fall 2004, Vol. 17, No 2 Spring 2004, Vol. 17, No.1 Spring 2003, Vol. 16, No. 1 April 2002, Vol. 15, No. 1 Nov 2001, Vol. 14, No. 2 April 2001, Vol. 14, No. 1 May 2000, Vol 13, Num 1 Oct 1999, Vol 12, Num 2 May 1999, Vol 12, Num 1 Nov 1998, Vol 11, Num 2 Jan 1998, Vol 11, Num 1 Feb 1997, Vol 10, Num 1 Sept 1996, Vol 9, Num 2 August 1995, Vol 8, Num 2 Sept 1993, Vol 6, Num 2 October 1990, Vol 4, Num 2		Retreatment: Fractured Implants Due To Biomechanical Overload (Continued)
		Preparation for surgery: The patient was prepared for surgery using the standard sterile protocol, appropriate cleansing of the mouth, and antiseptic cleaning of the perioral tissues. Complete sterile drapes were used to cover the patient and an adhesive sterile plastic drape was applied to the lips and face. Anesthesia: Local anesthesia using both Marcaine 1:200,000 epi and Lignospan 1:50,000 epi was administered throughout the mandible. Surgery: A full crestal incision from the right to left first bicuspid region was made with buccal and lingual full thickness flaps elevated. Once the neurovascular bundles were identified and dissected, the incision was extended posteriorly to the region of the second molars. Implant Removal: Inflamed and hyperplasic Next Column		tissue was debrided from around the fractured implants (Fig 6). Using a trephine drill (Fig 7) and copious sterile saline irrigation, bone was removed from the area immediately around the three fractured implants. The thickness of the trephine was 0.75mm, removing a minimal amount of bone. All bone "dust" was collected for future autogenous grafting if required. The trephine was taken to the depth just short of the implant apex. Elevators (Fig 8) and extraction forceps were used to loosen and remove the implants. Dense cortical bone was noted at the apex of the implant socket (Fig 9). The neurovascular bundles were identified bilaterally. Using a small dissecting probe to protect the superior aspect of the bundles, a diamond drill was used to remove the thin layer of bone above the canal. The exposed bundles were carefully lifted out of the canals and moved bucally. Continues Below


			POST-SURGICAL CARE The patient was not permitted to wear his denture for two weeks after the implant placement surgery. Postoperative medications included antibiotic therapy for ten days, steroid and analgesic medications, and a Chlorhexidine mouth rinse. Suture removal occurred two weeks post surgery. The construction of new interim dentures also began at that time. The patient experienced a transient paresthesia for four months following surgery and manipulation of the inferior alveolar nerve. FINAL PROSTHESIS Following an extended healing period of six months (three months is considered adequate healing for the anterior mandible) the healing abutments were removed and a combination of five standard and two EsthetiCone abutments next column
	IMPLANT PLACEMENT Seven implant sites were selected based on the biomechanical principle of broad load distribution. These sites were uniformly distributed from the area of the first molars bilaterally. The implant osteotomies were prepared using a series of graduated sized drills. The threads were then tapped through the inferior border of the mandible to accommodate the Brånemark implants. Seven 3.75 mm diameter implants of three lengths were placed: one 7mm, two 8.5mm and four 10mm (Fig 10). Autogenous bone gathered from the implant sites was placed in the area of the three fractured implants that were removed (Fig 11). Titanium healing abutments were placed on all implants and the mucosal flaps were irrigated with a tetracycline solution prior to closing with vicryl sutures. next column
					were fastened to the osseointegrated implants (Fig 12). A conversion prosthesis was constructed at the previously determined vertical dimension using the interim denture. This prosthesis was then transferred to the master cast for articulation. Two additional visits for a casting try in and delivery of the final prosthesis (Fig 13, 14) completed the doctor's treatment. LONG TERM EXPECTATION Based on numerous similar treatments over an 18-year experience, we anticipate positive bone remodeling around the implants and in the body of the mandible. Frequently, bone density increases in the posterior mandible and is often accompanied by an increase in bone height distal to the last implant (Fig 15). The patient reports complete comfort and full function. Expectation for continued bone remodeling and maintenance of oral function is excellent. next page
					Continued Page 2 Continued Page 3 Graphics Back to Insights Newsletter Main Page Prosthodontic Insights Newsletter - April 2002, Vol. 15, No. 1.
	Acknowledgements: 1. The dental implant team at Pi Dental Center 2. Robert Winkelman, CDT, MDT Fort Washington Dental Lab, Inc. Tel: 1-800-541-3490 Email: fortwdental@aol.com


Click here to see an Overview of Pi Dental Center More Information Home \| Write Us \| REQUEST INFORMATION To make an appointment for an evaluation, call: 1-800-PI-TEAM-5 1-800-748-3265 All information is intended for your general knowledge only and is not a substitute for dental or medical advice or treatment for specific dental or medical conditions. You should seek prompt dental and medical care for any specific health issues. See disclaimer. Copyright 2008 Pi Dental Center (Prosthodontics Intermedica).