Implant Tribune Canada No. 2, 2016
Graft lets surgeon improve gums’ support for existing implants / Industry
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IMPLANT TRIBUNE
The World’s Dental Implant Newspaper · Canada Edition
APRIL 2016 — Vol. 4, No. 2
www.dental-tribune.com
From the Journal of Oral Implantology
Graft lets surgeon improve gums’
support for existing implants
Dental implants are usually needed
when teeth are lost because of gum disease or injury to the soft tissues that support and protect the teeth. These same
problems can affect the soft tissue that
protects dental implants. These clinical
soft-tissue issues can make it a challenge
to place fixed dentures or crowns.
An article in a recent issue of the Journal
of Oral Implantology explains how a newer type of xenograft can help improve the
existing soft-tissue support for existing
dental implants. A stent helps the oral
surgeon properly place a soft-tissue graft
that ensures the soft tissue stays in its desired position during the first few days of
healing.
It’s best to augment soft tissue before
placing dental implants, but this is not
always possible. The oral surgeon may
discover after the implant surgery that
additional soft tissue is required. Several
types of soft-tissue grafts made of tissue
from humans or another species, such as
domestic pig, can be used. The author of
this article used a porcine collagen xenograft to augment the existing soft tissue.
Other researchers have studied the collagen xenograft and found it to be as effective as other graft materials. However,
previous studies typically used porcine
collagen xenograft with natural teeth, not
dental implants.
The article outlines the process used
to augment the gingival soft tissue of 11
patients who had fixed partial dentures
or splinted crowns. All patients underwent the same procedure. The surgeon
removed the stents five to seven days
post-surgery and checked for healing. In
the subsequent four to 12 weeks, the surgeon evaluated how well the soft tissue
had healed.
In all cases, the surgeon controlled
bleeding early-on to avoid the collection of blood under the stent. The author
placed the xenograft to cover the surgical
wound, and then strategically placed a
stent made of a bis-acryl material and
quickly shaped the material before it
hardened. The author noted the importance of using a piece of collagen that is
8 to 10 mm wide and as long as needed to
fill the surgical wound. Narrower collagen
pieces did not create enough supporting
tissue for the implants.
All patients healed uneventfully. However, the new soft tissue was not the thick,
protective type of keratinized tissue that
” See GRAFT, page B2
Photos and chart/Provided by Dr. Dennis Flanagan and the Journal of Oral Implantology
Fig. 1: Implant-supported crowns with inadequate facial immobile tissue (Patient TW). Fig. 2: The facial mucosa is demonstrated with
compression using a probe. Fig. 3: A partial-thickness surgical wound is created to accept the porcine collagen.
Fig. 4: Bleeding is controlled with a saturated
aqueous tranexamic acid tamponade. Fig. 5:
Festooned segment of porcine collagen fits into
the wound and is covered with the bis-acryl
before the collagen becomes saturated with
blood. Fig. 6: The bis-acryl is gingerly placed over
the site directly from the mixing gun. The tip is
cut and flattened to produce a ribbon of material
to cover the site without significant creases or
surface cavities.Fig. 7: Site at the first post-op
week. Fig. 8: Site at eight post-op months.
Fig. 9: A maxillary left posterior site at one postoperative week (Patient JK).
Fig. 1o: The maxillary left posterior site at 19 postoperative
months. The tissue appears to be and seems to function as
attached gingiva.
[2] =>
X X X X IN CHIEF
FROM THEXEDITOR
B2
Implant Tribune Canada Edition | April 2016
10 rules of order
in implantology
Common sense to live by if you practice implant dentistry
IMPLANT TRIBUNE
Publisher & Chairman
Torsten Oemus t.oemus@dental-tribune.com
President/Chief Operating Officer
Eric Seid e.seid@dental-tribune.com
Editor in Chief
Dr. Sebastian Saba feedback@dental-tribune.com
Group Editor
Kristine Colker k.colker@dental-tribune.com
Managing Editor Implant Tribune Canada
Robert Selleck, r.selleck@dental-tribune.com
Managing Editor Implant Tribune U.S.
Sierra Rendon s.rendon@dental-tribune.com
Photos/Dr. Sebastian Saba
Managing Editor
Fred Michmershuizen
f.michmershuizen@dental-tribune.com
By Sebastian Saba DDS, Cert. Pros.,
FADI, FICD, Editor in Chief
1. Choose one well-documented, scientifically supported implant system. Any
dental implant system demonstrating
ongoing research and design will achieve
high success rates and be adequately
equipped to deal with most clinical challenges. Surprisingly most successful
implant systems are similarly designed,
making the thought of owning different
implant systems in the office redundant.
Implant macro- and micro-topography
may vary, but similar success rates are
seen. Prosthetic connections and abutment designs appear very similar.
2. Not all dental implant companies are
created equal; warranties, customer service, availability of representatives and
technical support may be highly variable.
Companies that tend to merge may have
a transition stage where customer support may vary.
3. If you pursue both the surgical and
prosthetic phases of treatment, be ready
to assume twice the responsibility for
diagnoses and clinical execution. As a
prosthodontic specialist, keeping up
with the prosthodontic and laboratory
literature alone is complicated enough. I
rely on my surgical team to provide the
most up-to-date surgical information to
guide my prosthetic objective.
4. If you fiddle with any implant, restored or not, you just bought it. On a
larger scale, this involves the topic of
informed consent. It’s common to see
patients with prosthetic complications
relating to implant dentistry. Make sure
you have a full disclaimer regarding
any proposed intervention; otherwise,
Product/Account Manager
Will Kenyon w.kenyon@dental-tribune.com
Product/Account Manager
Humberto Estrada h.estrada@dental-tribune.com
Product/Account Manager
Maria Kaiser m.kaiser@dental-tribune.com
BUSINESS DEVELOPMENT MANAGER
Travis Gittens t.gittens@dental-tribune.com
Education DIRECTOR
Christiane Ferret c.ferret@dtstudyclub.com
Accounting Department Coordinator
Nirmala Singh n.singh@dental-tribune.com
Tribune America, LLC
Phone (212) 244-7181
Fax (212) 244-7185
Published by Tribune America
© 2016 Tribune America, LLC
All rights reserved.
you may be held responsible for a preexisting condition.
5. All screws loosen with time; its not if,
but when. Properly supported prosthetic
designs and proper torque execution
will minimize such complications. Remember one screw loose per week is too
many.
6. Most insurance companies don’t recognize implant prosthetics. Properly inform your patients of this reality.
7. Even good implant systems can have
complications and failures. Poor surgical
execution, patient selection or management and/or poor prosthetic design can all create problems with the
best of systems.
8. Some single-implant
cases are quite difficult,
and
some
multipleimplant cases are quite
simple. Not all singleimplant cases are pre-
dictable (i.e., matching a central incisor);
while multiple, implant-supported, posterior bridges can be quite predictable.
9. Implant prosthodontics is not simple.
In general, any prosthodontics case is not
simple, regardless of what a salesperson
might tell you. Prosthetic components
can be technique sensitive, and they
can be difficult to select. Step-by-step
instructions can oversimplify and misrepresent the clinical challenges.
10. The likelihood that an implant is
malpositioned is directly related to the
surgeon’s resistance to a surgical guide.
Sebastian Saba, DDS, Cert. Pros.,
FADI, FICD, is a graduate of the
Goldman School of Dental
Medicine, Boston University. He has
published extensively on the topics
of prosthetic and implant dentistry
Tribune America strives to maintain the utmost accuracy in its news and clinical reports. If you find a
factual error or content that requires clarification,
please contact Managing Editor Robert Selleck at
r.selleck@dental-tribune.com.
Tribune America cannot assume responsibility for
the validity of product claims or for typographical
errors. The publisher also does not assume responsibility for product names or statements made by
advertisers. Opinions expressed by authors are their
own and may not reflect those of Tribune America.
Editorial Board
Dr. Pankaj Singh
Dr. Bernard Touati
Dr. Jack T. Krauser
Dr. Andre Saadoun
Dr. Gary Henkel
Dr. Doug Deporter
Dr. Michael Norton
Dr. Ken Serota
Dr. Axel Zoellner
Dr. Glen Liddelow
Dr. Marius Steigmann
and has a private practice in
Montreal limited to prosthetic and
implant dentistry.
Corrections
Implant Tribune strives to maintain the
utmost accuracy in its news and clinical
reports. If you find a factual error or
content that requires clarification, report
the details to managing editor Robert
Selleck, r.selleck@dental-tribune.com.
“ GRAFT, Page B2
typically surrounds teeth. Instead, it appeared to be an immobile
form of a softer, elastic tissue similar to that lining the floor of
the mouth and cheeks. Not withstanding this variation, the new
tissue created protection for the dental implants from distortion
that is frequently caused by the pull of facial muscles.
The author concluded that the graft was effective in providing
the intended support for the existing dental implants. “This work
may provide a quicker way for implant dentists to provide the necessary protective soft tissue for atrophic edentulous sites with
fewer morbidities,” said Dr. Dennis Flanagan, author of the article.
“However, as with previous and concurrent work, the resulting
type and amount of keratinized tissue is not predictable.”
Full text of the article, “Stented Porcine Collagen Matrix to
Treat Inadequate Facial Attached Tissue of Dental Implant Supported Fixed Partial Dentures,” Journal of Oral Implantology,
Vol. 42, No. 2, 2016, is available at: http://www.joionline.org/doi/
full/10.1563/aaid-joi-D-15-00050.
Tell us what you think!
Table: Patients treated with porcine collagen graft with an acryl stent
at various postoperative measurements; measurements were taken
from the crest of the gingival margin to the junction of the immobile
mucosa or perceived attached gingiva and the flaccid mucosa.
Do you have general comments or criticism
you would like to share? Is there a particular
topic you would like to see articles about in
Implant Tribune? Let us know by emailing
feedback@dental-tribune. com. If you would
like to make any change to your subscription
(name, address or to opt out) please send us
an e-mail at database@dental-tribune.com
and be sure to include which publication you
are referring to.
[3] =>
.
[4] =>
B4
XXXXX
INDUSTRY
Implant Tribune Canada Edition | April 2016
Headlight transfers
across loupes, frames
ODA
BOOTH
530
Go wireless: Cut the cord without sacrificing light
Designs for Vision’s new LED DayLite®
WireLess™ not only frees you from being tethered to a battery pack, but the
simple modular design also uncouples
the “WireLess” light from a specific
frame or single pair of loupes. Prior
technology married a cordless light to
one pair of loupes via a cumbersome in-
Ad
tegration of the batteries and electronics into the frame. The compact design
of the DayLite WireLess is independent
of any frame/loupes.
The patent-pending design of the LED
DayLite WireLess is a new concept: a selfcontained headlight that can integrate
with various platforms, including your
existing loupes, safety eyewear,
lightweight headbands and
future loupes or eyewear
purchases.
The LED DayLite WireLess is not limited to
just one pair of loupes or
built into a single, specific
The LED DayLite WireLess
headlight can integrate with
various platforms, including
your existing loupes, safety
eyewear, lightweight headbands and future
loupes or eyewear purchases. Photo/Provided
by Designs for Vision
eyeglass frame. The LED DayLite WireLess can be transferred from one platform to another, expanding your “WireLess” illumination possibilities across
all of your eyewear options.
1.4 ounces
The LED DayLite WireLess weighs only
1.4 ounces and, when attached to a pair
of loupes, the combined weight is half
the weight of integrated cordless lights/
loupes.
The LED DayLite WireLess produces
up to three times the light intensity of
other cordless lights, according to the
comapny. The spot size of the LED DayLite WireLess will illuminate the entire
oral cavity. The function of the headlight is controlled via capacitive touch.
The LED DayLite WireLess is powered
by a compact, rechargeable lithium-ion
power pod. It comes with three power
pods. The charging cradle enables you to
independently recharge two power pods
at the same time and it clearly displays
the progress of each charge cycle.
Designs for Vision also has been showing the Micro Series this year. The Micro
3.5EF Scopes use a revolutionary optical
design that reduces the size of the prismatic telescope by 50 percent and reduces the weight by 40 percent, while
providing an expanded-field full-oralcavity view at 3.5x magnification.
The new Micro 2.5x Scopes are 23 percent smaller and 36 percent lighter than
traditional 2.5x telescopes, and enlarge
the entire oral cavity at true 2.5x magnification.
The Micro Series is fully customized
and uses the proprietary lens coatings
for the greatest light transmission.
You can “See the Visible Difference®”
yourself by visiting the Designs for Vision booth, No. 530 at Ontario Dental
Association Annual Spring Meeting in
Toronto. Or arrange a visit in your office
by telephoning (800) 345-4009 or emailing info@dvimail.com.
(Source: Designs for Vision)
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