Extended Implant Surgery for the General Dentist
Dental implant treatment has become more a part of the regular dental practice and for some practices a significant portion of the overall treatment modalities offered. Once considered a specialist only treatment, now a compliment to the one of many routine treatments performed by general dentists.
Performing a good level of dental implant treatment requires a thorough understanding of patient evaluation, anatomy, product knowledge, surgical principals, post- operative management and prosthetics rehabilitation. Many courses are on offer to guide the general practitioner in the science and art of dental implant treatment, ranging from University programs and private courses.
Starting the dental implant journey can often be the most daunting step a dentist can take in their professional careers and seeking a well-structured course can get the dentist off on the right foot. It would be unwise for any dentist to assume that they could learn everything there is to know about treating patients with dental implants over a weekend course. The field of dental implants is rapidly evolving and new techniques and products are regularly introduced.
For the beginner in the treatment of dental implants, uncomplicated cases on uncompromised patients in areas of low aesthetic importance is ideal. A wise clinician can evaluate a patient and determine which cases are within their abilities and proceed accordingly. For cases outside their clinical abilities, referral to a more experienced clinician ensures their patient gets the best quality of care. For the surgical aspects of these ideal cases for beginners, it requires a large amount of bone with little to no risk to adjacent teeth and adjacent anatomical structures. For any dentist performing dental implants,these types of cases are considered ideal and if treated correctly, offer a high success rate and a satisfying result for the clinician and the patient.
Once a dentist has gained some success, confidence and some experience in treating the ideal cases, the more they seek to find these cases. Quite often, the surgical and anatomical factors do not fit into the “ideal” category and the clinician then refers the patient on to the care of a more suitable clinician for that case. For the clinician who would like to treat these cases, the next phase of being equipped with the knowledge and training begins.
Some of these non-ideal cases require advanced and complicated surgical procedures, many often can be treated with more simpler approaches. On the other hand, what happens if a case is assessed as ideal and during treatment a complication arises or there is a small defect? The clinician becomes faced with either completing a compromised treatment, or removes the implant and refers the patient or consider an alternative option?
Being equipped with some additional surgical techniques can increase the treatable cases and allow completing cases with unforeseen complications at time of surgery. In the case of bone loss or tooth extraction, other predictable techniques like socket augmentation are also available to develop and prepare a potential implant site for future simpler and more uncomplicated surgical implant treatment. To be able to provide good surgical implant treatment, a basic understanding of some simple surgical techniques is an advantage.
Defects can be categorized by being either horizontal, vertical or a combination of both. Some of the techniques to treatthese defects include socket augmentation,ridge augmentation, guided bone regeneration and sinus augmentation.These techniques can be implemented to treat small or more advanced defects.
Good fundamental knowledge of these techniques, materials and methods are required to get predictable and successful outcomes. Just like the implant journey, a clinician may start at treating the smaller and more basic defects and after some experience and success, may work up to treating the more advanced and difficult cases.
In this clinical example, a patient presented complaining of discomfort from the upper right lateral incisor. A periapical radiography revealed a substantial periapical radiolucency associated with a previous root canal therapy, post and core and crown. The tooth was given a poor prognosis and after discussing the options for treatment with the patient, the patient elected to consider removal of the tooth and replacement with a dental implant.A CBCT was taken to assess the extent of the defect and the bone available for the surgical placement of a dental implant.
The CBCT revealed that the bone radiolucency was significant and the remaining bone available to insert a dental implant was limited. Whilst the bone superior to the periapical lesion may have been enough to provide some primary stability to the dental implant,complicated guided bone regeneration would be required to augment the defect.
To simplify the process and assure the patient with the highest success rate,a staged approached was decided. This staged approach entailed the removal of the tooth, curette of the residual socket and periapical lesion and socket augmentation with a bovine bone substitute. The residual buccal bone was intact and suitable to contain the bovine bone substitute. It was also decided that rather than compromise the soft tissue at the extraction site by gaining primary closure with the advancement of a flap, that a collagen seal would be utilised to protect the bovine bone substitute underneath and promote soft tissue growth.
In this example, whilst the case was not considered ideal, implementing a socket augmentation technique ensured that the future replacement of the extracted tooth with a dental implant would be morepredictable and less complicated.
Dr Saade Saade is the educational director of the Australian Institute of Implant Dentistry and in collaboration with Implant Direct Australia, holds series of courses on dental implants inS ydney and Melbourne. Dr Saade Saade has a keen interest in digital dentistry and incorporates the latest in digital technology applications in the courses.
If you would like to expand your surgical skills and learn about how you can implement these into your everyday dental implant treatments, contact Implant Direct Australia on +61 2 8870 3099.The upcoming advanced surgical course will be held in Sydney on May 3rd and 4thand Melbourne on June 7th and 8th, cost is$1,644.50 and places are limited.
By Dr Saade Saade