Dental Implants

Just to orient you, I’ve been involved with Nobel Biocare implants since 1985 when Dr. Don Scott and I went to one of the very first courses on placing dental implants.  Don recently retired as a Periodontist, but at that time, only specialists were allowed to place implants, and I would do the restorations on implants that he placed.  We did a lot of cases, mostly for people who had no teeth.  Several implants would be placed, and either screw in bridges to replace all the teeth in an arch, or clip in dentures were all that were done in those early days with very severe restrictions laid out by the inventor, Dr. Bränemark of Sweden. 

I remember in those days everyone felt that single implant supported teeth were simply not possible.  As time went on, a number of dental specialists tried different things, and it was discovered that single teeth did just fine when supported by only one implant.   As time went on the world got comfortable with that concept, and certainly in the last 15 years, the bulk of the implants placed are to replace single teeth.  In the beginning, the esthetics were not important to the European dentists, but the American beauty conscious dentists really developed ways to make them look perfectly natural. These days it’s difficult to tell an implant tooth from a real tooth.  I know in my situation, I often have to look at the x-rays to tell which of them is an implant.

Somewhere in around 2005, the Dental College allowed general dentists to place implants.  I was one of the first to take courses to be able to do that.  I took any of the more in depth courses that I could find, particularly the hands-on ones.  What I learned early on, is that once you have placed even one implant, you need to know how to modify the bone and tissues for those situations that are less than ideal.

Also, when you lift the gums back and have to somewhat guess where you are placing the implants, it’s a bit unsettling, so I was looking for a better way.  In 2012, the Dental College allowed general dentists to purchase Cat Scan x-ray systems.  Previous to then, only Dental Radiology Specialists could own them.

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I had read that you could place implants virtually on a 3D x-ray.  That concept would take away most of the risks of placing implants, since you know where the nerves, sinuses, and other risky areas are located. I was one of the first to order the 3D x-ray system from the Siemens company.  The application process to the Dental College took about a year to have all the details and courses in place to be allowed to purchase it.  It arrived in 2012, and we placed our first “guided” implants, and haven’t looked back.   We have since placed about 200 of them, and have done them all using the guided system.

What “guided” means is that we take a 3D picture of the mouth with our Cerec camera which we use to make crowns. That 3D picture with a virtual crown designed, is superimposed over the 3D x-ray.  Since there is a catalogue of virtual implants within the 3D x-ray program, it is very easy to chose the one we’d like to place, and digitally insert it into the x-ray/ picture combination.

 

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We adjust it so it avoids the nerves, goes exactly where we want it to go, and has the part that is going to hold the tooth (implant) centered exactly under the crown that we have designed.

 

 

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This digital information is then sent to Germany where employees of Sicat, (a subsidiary of Siemens) create a custom plastic guide that fits exactly on the patient’s teeth.  It has a metal ring in it which guides our instruments while preparing the bone to install the implant. 

SICAT GUIDE

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They usually send us the completed guide within about 2 weeks of our sending the information to them.  

We then freeze up the procedure site with anesthetic, place the custom made guide in the mouth, and we use drills that fit exactly into the guide’s metal ring.  The drills have a little ledge at the top of them that stops the drill exactly at the level that we had planned. The ring keeps the drills and the implants within 1 degree of what was planned, and the depth within 1/10th of a millimeter.

So you see, everything is very tightly controlled this way. We can spend literally hours ahead of time planning the implant placement, and considering all the variables. The actual implant placement takes very little time, and goes exactly where you’ve planned it.

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I knew this was where I wanted to get to with implants, as it makes it so safe.  When I ordered the CT scan machine, I asked, “are lots of dentists ordering these to place guided implants?”   I was told by the sales rep yes!  What came as a surprise to me when we got the machine was that there were no courses available to learn how to use it. 

When I asked why, I was told “because there are no other dentists placing guided implants!”  They’re all placing them by raising flaps, and placing them freehand.  My staff and I were suddenly at the forefront in Ontario, learning as we went, finding information wherever we could.  Luckily there was a Dental Specialist in Columbus, Ohio who had been involved in the development of this system with Sicat, and I took his courses.

We love doing implants this way, because it is so safe, and the implants end up in exactly the position that we want for creating beautiful crowns with natural appearance. 

I call patients that we’ve worked on each evening, and what is amazing to me is that they all report no pain whatsoever, other than that tender feeling from the freezing coming out.  There is no bleeding problem, no sutures, again no pain, no infections, and general disbelief that implants have been placed, after hearing all sorts of stories from others of post op problems.  One patient even jokingly accused me of not doing anything that day because they were trouble free!

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If there is not enough bone to support an implant, we now do procedures where we can get the body to grow new bone.  I took a year long course with the GIDE institute and Loma Linda University with several international professors, and now have a Masters Certification in implants and implant bone regeneration procedures.

Some of the more extensive cases I’ve done in the past three years involves a full arch where the patient cannot, for whatever reasons, continue to wear conventional dentures.  These cases, whether they are full upper or full lower, are referred to as “all-on-four.”

You often see “Teeth in a day” adverts regarding “all-on-four” and in fact it is true. We can place four implants and a temporary denture, commonly known as “bridge” same day and you are set for approximately 6 months before you return to have a permanent one made. 

We can sometimes use the denture you currently have been using and modify it to install as your temporary “bridge”.  This time span between the temporary and the permanent allows you to make any adjustments before the permanent one is made.  Some of the best candidates for an “all-on-four” are those who are tired of wearing ill fitting, wobbly dentures that constantly rub on the gums and make them sore.     

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 In July of 2017, I’ve signed up to take a course with Istvan Urban, an internationally known expert on bone regeneration in Budapest, Hungary, which I’m very excited about.  The learning never stops, and I am always looking for ways to make dentistry safer, more reliable and pain free.  This is a very exciting time in dentistry.