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Basics of Dental Implants

4th March, 2015

Understanding Cosmetic Dentistry: Dental Implant Types and Connectors

There are different manufacturers of dental restoration materials such as implants and crowns. These allow dentists to find the specific one that suits their patient’s needs. Dentists categorise dental implants either by their placement and shape or the procedure of placing them.

Dental ImplantsTwo Basic Types of Dental Implants

The most common type of dental implant that dentists use is endosteal implants. Typically for double stage procedures, it is directly implanted in your jawbone and works well as an alternate for bridges and detachable dentures. It has three main kinds: bladed, cylinder or smooth, and screw or threaded.

Difference between Single and Double Stages

Consult your dentist whether you want a single or double stage procedure. For single stage, a crown may be fitted right after the end of the healing period. The double stage, meanwhile, requires you to go back after the healing period ends to uncover the implant and attach the temporary teeth.

Types of Connectors and Different Sizes

There are three main types of connectors that attach or screw the abutment to the implant post: internal hex connectors, external hex connectors, and internal octagon connectors. These openings and locations in the implant head are where dentists fix the abutment and restoration into. Dental implant size is essential in the procedure; you can choose among wide, standard, and mini.

Getting your broken or missing tooth restored is important to maintain good oral health. Nevertheless, it’s more important that your dentist provides you with the type of cosmetic dentistry service you need. At Cranmore Dental & Implant Clinic, we offer dental implants to bring back the function you need in your teeth. Contact us now and let our team of cosmetic dentists provide you with premier services.

The Good, The Bad and The Ugly

11th February, 2015

Private Dentistry reports from David Nelson and Luke Barnett’s lecture at the Private Dentistry Conference…

Seven words that will evoke any number of images in the minds of dentists of a certain age. A stand-off; Lee van Cleef’s piercing eyes; the noose as Eli Wallach looks up; the enigmatic man with no name; Ennio Morricone’s haunting theme. So, big shoes to fill for a dental presentation of the same name.

The aim of this presentation was to consider perspectives of both surgical and prosthetic aspects of dental implant placement and the challenges that can sometimes arise. David and Luke wished to raise delegates’ awareness of critical factors in aesthetic implant placement.

David is the Clinical Director at the award-winning Cranmore Excellence In Dentistry, in Belfast (including the Private Dentistry Awards 2011 Practice of the Year), and dedicates his area of practice to dental implants. He is a Tutor at the School of Dentistry at Queen’s University Belfast where he lectures on dental implants to undergraduates. He has also established the Cranmore Implant Year Course, for dentists interested in becoming involved in the surgical and restorative aspects of dental implants.

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Luke has more than 38 years’ experience in dentistry and as well as running the highly regarded Luke Barnett Centre (which now includes a peripatetic Clinic as well as the laboratory), he is an active member of the British Academy of Cosmetic Dentistry and also a judge of the Private Dentistry Awards.

After these introductions to the two speakers, we were invited to consider a number of ‘implant disasters’.

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David then went on to talk about the time that needs to be invested by dentists if they are to carry out dental implants to an ethical and high clinical standard. This begins with a structured training pathway, observing others and then having a trusted helper (mentor) observe your cases as you develop your potential.

What is Good?

There are two different audiences who will consider this question. Clinicians, who will expect to see:

  • A healthy restored implant in the correct position with the desired aesthetic result

A patient though may have a different set of expectations and will very often be led by concerns such as cost, lack of pain and that it looks perfect. This neatly took us to patient expectations and how to manage these effectively and not all patients have the same expectations. In the end though, it is the patient who will decide whether the implant is good – if they don’t, beware the disenchanted patient.

What will also be weighed up is:

  • Function
  • Aesthetics
  • Phonetics
  • Psychological

These combined with the patient’s expectations ultimately decides what is good, bad or ugly.

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Caption: All patients need to have their expectations managed! They need to be realistic Dentistry by Dr James Russell

Smile Design Principles

All good dental implant work will begin here. We still need to consider:

  • Tooth Length
  • Golden Proportion
  • Axial Inclination
  • Length/Width Ratio
  • Gingival Architecture
  • Contact Points and Embrasures

We then moved on to bone – an implantologist will often spend much of their career searching for or grafting additional bone! As the science of implantology has progressed, bone can be placed (almost) anywhere. David then considered the options available if there wasn’t enough natural bone and offered practical hints and tips for guided bone regeneration, bone manipulation using osteotomes, sinus grafts as well as contraindications (e.g. heavy smokers in the case of sinus grafts). Special attention was given to block grafts and in particular the comparison between Autogenous – the gold standard, and Xenograft where much less impartial evidence is available. David invoked the friends and family test and asked the delegates, what would you want for them or yourself? Alternatives to sinus floor elevation such as All-on-4 and and Zygomatic implants were also discussed.

Implant Placement

The ideal scenario for implant placement should be well known (see Figs 1 -4 Slides 185-188)

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and should always follow a restoratively driven approach. This was backed up by a number of cases and the watchwords, ‘Millimetres Matter’. 1mm and 2mm in implant placement really do make a huge difference.

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We then moved on to a matter of some debate, the two anterior teeth conundrum – two implants or one?

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David said that, in his opinion it came down to biology and some key principles:

  • Is there a bone peek and will I get the papillae back?
  • Space and can I keep 3mm of bone between the implants?
  • Often not enough space between central and lateral for two implants.
  • Do I need to get more than 3.5mm in soft tissue height?

 

Good, Bad or Ugly?

Case 1

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Caption – Provisional dentures

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Caption – Retracted

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Caption – Full smile

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Case 2

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Caption – Before (Dentistry by Dr Anshul Pangotra)

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Caption Metal Try in (Dentistry by Dr Anshul Pangotra)

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Caption – Completed case showing slight recession (Dentistry by Dr Anshul Pangotra)

Case 3

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Caption – Trauma

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Caption – Restoratively driven placement, gingival manipulation with provisional crown

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Caption – Final full smile

 

We had now reached the point where we had to decide; Good, Bad or Ugly? A selection of cases were presented (of which three are included with this article) across a wide range of scenarios including full mouth rehabilitations, implant retained bridges and that most difficult of all, the single central. To be fair to David and Luke, it was clear that they hadn’t cherry-picked the cases to present themselves in a more favourable light (and I am quite sure that with their combined experience, they could!) – the cases were clearly chosen for their educational value so that the audience could all learn from them. Luke also took this opportunity to explain and outline the technical processes involved from initial wax-up right through to the fit stage. In one particular case, that of Richard, Luke talked us through why a ‘Mark 2’ was needed (see slides 381 and 382) and what lessons were learned for the future.

There were positives and negatives in all of the cases and looking around the room at many delegates furiously scribbling notes, this was one of the parts of the presentation that really resonated with the audience. The lecture ended with David reiterating that it really is vital to get to know, and work closely with your technician for the best results.

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To conclude, this lecture was particularly useful as it offered a perspective from both sides of the coin, with David’s experienced clinical advice partnering neatly with Luke’s expert viewpoint – who, as a technician, offered up some fascinating insights often unconsidered by dentists. (The only thing that I don’t believe that we got to the bottom of is which of David or Luke was either Clint Eastwood, Lee van Cleef or Eli Wallach?!)

 

ENDS

 

About David Nelson:

David Nelson BDS MSc (Imp Dent)

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David is the Clinical Director of Cranmore, a multi award winning practice, which combines a referral and general practice with training facilities. It is the only practice from Northern Ireland to be a member of the Leading Dental Centers of the World.

Having graduated from the University of Birmingham in 1999, David subsequently was one of the first dentists in Northern Ireland to obtain a Masters Degree in Dental Implantology. His area of practice is dedicated to dental implants and he regularly accepts referrals from other dentists for all aspects of implant treatment.

David is a Tutor at the School of Dentistry, Queens University Belfast, where he delivers lectures in relation to dental implants to undergraduates. He also lectures on the surgical and restorative aspects of implant dentistry for dentists and nurses.

He is a Fellow of the International Team for Implantology (ITI), a non-profit organization of dedicated practitioners who champion the correct utilization of implant dentistry for the benefit of patients. He also holds the position of Communications Officer for the ITI.

In 2013, David was awarded the UK Single Implant Award at the Aesthetic Dentistry Awards recognising his clinical skills in implant dentistry.

Committed to continuing education David established the Cranmore Academy, which delivers a series of clinical and non-clinical CPD accredited study clubs for all members of the dental team. He also hosts the Belfast Study Clubs f or the ITI and British Academy of Cosmetic Dentistry.

 

 

 

About Luke Barnett:

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Luke Barnett started his career in technical dentistry in 1976 and after qualifying took a special interest in dental ceramics, setting up his own business in 1985. Luke and his team have established themselves as one of the UK’s most influential ceramic specialists working from his state of the art facility in Watford, Herts. Luke is also an owner of the Precision Coping Company. In 2014, Luke launched The Clinic – a peripatetic centre of excellence for clinicians to use on a session by session basis.

Luke is on the editorial board of Dental Technician, Private Dentistry and Premium Practice Dentistry and Luke is also a member of the British Academy of Cosmetic Dentistry (BACD). He was the first technician to achieve the levels of excellence required to obtain BACD Accreditation and sits on the accreditation board of examiners. He is a judge for the Aesthetic Dentistry Awards and is also a member of the AmericanAcademy of Cosmetic Dentistry.

His laboratory was voted Private Dentistry Laboratory of the Year in 2010 and 2011 and he is now a member of the Private Dentistry Awards judging panel.