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12-16-05 ... Update ... All our implants are going well .... Yesterday we seated a full gold crown on a Zimmer implant #19 molar area .. went perfectly as usual ... This case was a little unique because 7 years ago, before she was our patient, a Periodontist first placed and implant here without a stint or template ... it was to steeply angled to the mesial to place a crown on ... but she still wanted that implant so our local oral surgeon removed the incorrect one with a round core saw .. was very easy to do and very easy on the patient .. grafted a little bone in ... we waited a few months and he placed the new implant with a stint this time. I waited 8 months for total interossious integration ... She literally danced a gig when we placed the final restoration. I am placing 2 maxillary anteriors on her husband next month and we have already made a stint for a bicuspid and molar on his mandibular right side which we will be doing with the latest Noblel Biocore telescoping triangular implants. Plus ... Zimmer has been very hard to deal with, especially for the Oral Surgeons and the laboratories.
Zimmer is the only outfit that does provide the implant post to the surgeons which also doubles as the insertion tool ... But ... The surgeons routinely throw them away and don't usually even understand what an impression post is ... Thinking that it is also the post used to place the implant crown on. It is hard enough getting which one of the 3 possible gingival cuff bevels they used so we can order the correct impression post.
8/18/04 ... a note on a couple of problems we had with a couple of recent cases .... the first .. a spline .. the oral surgeon didn't get the healing cap down completely over the implant which allowed bone to grow into the small space left ... I found this on our xray we took during our impression post appointment .. it was more than just the usual small amount of tissue ... went fine later after the oral surgeon went back in ... I think it would be really great if they took an xray just as we do for our impression posts to be sure their healing cap is seated all the way too.
The 2nd was a failure in the Tapered Screw Vent insertion assembly ... the small hex at the bottom of it broke off down inside the implant while the Oral Surgeon was screwing the implant post into the bone ... the oral surgeon spent a half hour trying to put the proper healing cap on ... gave up and used a gingival cuff from a different spline set up instead that had a longer screw ... Later ... I found a 2mm gap on our xray ... again at our impression post appointment ... and luckily was able to remove the small broken hex from inside the implant ... then easily replaced the proper beveled and larger gingival cuff for a couple of weeks and then everything went fine! ... So .... who ever is screwing the implant into the bone needs to inspect the very bottom of the insertion device to be sure the small hex is still on it after removing it from inside the implant it's self!!!!! .. Now back to our old redundant implant page .. sorry this has not been updated in a few years ...
I am going to show a case we just placed yesterday (2001) further down on this page. We used David at Sun Labs in Eureka, CA. 530 246-7600. Sun labs specializes in only implant lab work. They ship nation wide. David will rent all the instruments, torque wrenches, etc. and sell any brand implant one might like to try out so you don't have to buy a different set up each time. They also use binocular microscopes for that great fit.
We use high noble Gold on everything, but it is most important to be used on all implants as the non-precious metals wear the implant in the bone out much faster. The case shown further down the page was done in Ivoclar (softer porcelain) and high noble Gold.
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We start a possible implant with a consult with the oral surgeon to see if they are a candidate for an implant. Enough bone, grafting, patient health, etc. If all is well we start with a surgical template or stent made of clear plastic that snaps over the existing ridge and teeth to aid the oral surgeon in placing the implants in the ideal angles and position.... The photo above shows the instructions to the oral surgeon to consider for the implant and the photo just below this shows what a clear surgical template looks like. Getting the post in at the spot, the right angle and in enough bone is the surgical goal! Why take a chance without a template?
We leave the surgical post in the bone to heal in the lower jaw for 5-6 months before we build the new crown on it and leave it to heal in the upper jaw for at least 9 months because the bone there is more porous. I know this is longer than many dentists allow .... but having been in the trenches for so many years and having waited for such predictable implants like we have now and seeing over the years that the ones that were left in the longest before loading held up the best .... "I will not load an implant before it's time"!
We have been doing more multiple implants lately ... everything is working great so far!... I like the tapered screw vent the best so far. .... still pick and choose the cases though.
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On your appointment to place your implant crown your dentist will first, again, remove the gingival cuff. He will then place the recessed post screw (#3) down into the crown post (#4) and then screw the post into the implant (shown on model #6). This is then torqued into place with the hex drive insert (#2) that is placed into the torque wrench (#1). Each implant brand has it's own torque wrench with it's own setting.
David at Sun Labs makes the above pictured key that shows us that the spline implant is locked down in the right position. It also insures that the crown post is seated all the way, as the key is made to fit perfectly over the top edge of the post. after trying on the crown and checking the bite, if all is well, the post is torqued into place.
A small cotton pellet is placed in the top of the post so none of the temporary cement we glue these implant crowns on with gets down in the recessed part of the post, in case we ever have to remove it again later.
