Blog – Page 4 – Implants By Paresh

Broken Tooth replaced with a Mini Dental Implant and a Temporary Crown

May 5, 2011/in Blog /by Paresh Patel

I am convinced that teeth know what day of the week it is. Why is it always 5pm on Friday that teeth in the front smile area seem to break?

I don't have a great answer but I do have some mini dental implants and some composite.

The patient was given the option of a Root Canal Post and Crown or an extraction and a mini dental implant and Crown. She elected to have the tooth removed.

I selected for this case a mini dental implant that has a high degree of initial stability due to its aggressive thread pattern and ability to lock in the bone at the tip. It is an OCO Biomedical 3.0mm mini dental implant.

OCO mini dental implant in place after the tooth root was removed preserving as much bone as possible. The implant is a solid one piece design.

Temporary crown on the OCO mini dental implant. I will let the implant heal and let the soft tissue (gums) and bone fill in. That will take around 5-6 months. After that time passes we will ask the lab to make her a new porcelain crown to fit over the mini dental implant.

Paresh B Patel

Mini Dental Implants

Dental Implants Charlotte Lake Norman Mooresville NC

Dental Implants Hickory Boone Wilkesboro Asheville NC

Mini Dental Implants Can Replace a Broken Upper Tooth with a Fixed Porcelain Crown

May 2, 2011/in Blog /by Paresh Patel

What do you do when an upper tooth that has had a root canal just breaks one day?

Broken upper premolar tooth. The root is fractured under the gum tissue.

X ray and extraction of the broken tooth

The broken tooth is removed carefully to preserve as much bone as possible. A OCO Biomedical 3.0mm mini dental implant is placed the same day as the extraction. With the design of the OCO mini implant it is able to achieve high initial stability. Enough to place a temporary crown to shape the tissue during healing.

Clinical photo of the OCO Biomedical implant the day of placement.

Tissue after shaping and healing with a temporary crown. The temporary crown was removed to check healing…pink healthy gum tissue with no bleeding. A standard crown impression will be taken and a porcelain crown will be made to fit over the mini dental implant.

Porcelain crown cemented in place over the OCO Biomedical mini dental implant. The patient will brush and floss the mini dental implant crown just like any other tooth.

With a mini dental implant there are lots of solutions that can be offered to patients.

Paresh B Patel DDS

Mini Dental Implants

Dental Implants Charlotte NC

Dental Implants Lenoir Hickory NC

Glidewell Laboratories Introduces the Inclusive Mini Dental Implant

April 12, 2011/in Blog /by Paresh Patel

A leader in the dental laboratory market has introduced a new mini dental implant.

The Inclusive Mini Dental Implant System provides the dentists all the components necessary to start and finish a high quality mini implant retained overdenture.

This package includes the final overdenture, four Inclusive Mini Implants, surgical drill, impression copings, analogs, O-ring housings and all model work. The Inclusive Mini Implant is also available for purchase individually. I anticipate in the near future a competitively priced Surgical Guide made from a Dual Scan CT.

Photograph showing the Inclusive Mini Implant Placement Kit. I was glad to see that Glidewell had the dentist in mind and included:

A drill extender

Torque wrench

3 different size pilot bits

Inclusive Mini Implants are available in three diameters (2.2 mm, 2.5 mm, 3.0 mm) and three lengths (10 mm, 13 mm, 15 mm) and provide many benefits including: a minimally invasive surgical protocol, immediate loading and affordability. Mini implants can accommodate new or existing dentures, which are anchored to the exposed ball heads of the mini implants via a simple and effective O-ring retention system, providing edentulous patients new levels of comfort and confidence.

The Inclusive Mini Dental Implant comes in a heavy duty heat wrapped plastic bag. A glass vile contain the sterile mini implant. The carrier color denotes the size of the implant.

Green = 2.2mm

Orange = 2.5mm

Blue = 3.0mm

Another nice feature is the o-ring housing comes pre-loaded and includes an extra black o-ring. Several other lab support items are available such as a 25 pack of block out shims and lab analogs.

I anticipate good things for General Dentists who want to learn how to improve their patients lives with the security and comfort of a well thought mini dental implant system….

Paresh B Patel DDS

Mini Dental Implants

Dental Implants Charlotte NC

Missing Teeth? Mini Dental Implants Can Help

April 12, 2011/in Blog /by Paresh Patel

It is estimated that over 50% of Americans are missing at least one tooth (not including wisdom teeth or third molars).

Some of these missing teeth can be in the smile area. This picture shows a patient of mine that lost two of her teeth due to fractures in the root. She did not like showing the large gap between her molar and her canine tooth.

For this case I selected a OCO Biomedical two piece 3.25mm dental implant. The picture to the right shows the OCO ERI 3.25 implant being placed. The bone was very soft and the two piece implant was allowed to heal without fear that it would get moved around by biting forces.

OCO Biomedical ERI 3.25mm dental implant in place right below the gum. The gold color you see is the collar of the implant. I think it is a nice touch to mask the grey color of the implant.

The OCO Biomedical Implants with a solid abutment screwed in place. The abutment is the part that is placed into the implant and comes up out of the gum for the crown to cement to. This does add an additional expense but in some cases it is necessary.

X-ray of the crowns made to fit over the OCO Biomedical dental implants.

Paresh B Patel

Mini Dental Implants

Dental Implants Charlotte NC

Dental Implants Hickory Lenoir Asheville Boone NC

Upgrade your Snap in Denture to a Fixed Full Arch Bridge Roundhouse with Mini Dental Implants

March 30, 2011/in Blog /by Paresh Patel

Having done thousands of mini dental implants more and more of my patients are now asking why they can’t have fixed crowns or fixed teeth with dental bridges. Well no real reason if they have enough bone to place a few more mini dental implants.

My patient when we first put in 6 mini dental implants to support a full upper denture.

He had enough bone to add in a few more mini implants so we set out to duplicate what he liked about his denture in a fixed porcelain roundhouse bridge.

I took the existing denture that my patient liked the way it looked and made a copy of it in lab putty. From that Evolution Dental Lab was able to make a exact copy of the denture but out of porcelain and pink porcelain for the gum tissue.

Final full upper roundhouse bridge that will be supported by mini dental implants.

Day of cementation of the fixed full bridge upper roundhouse. The design is the same as if the bridge was made on traditional size implants. The patient will brush, floss or water pick to keep the gums clean.

Paresh B Patel DDS

mini dental implants

Dental Implants Charlotte Mooresville Lake Norman NC

Dental Implants Lenoir Hickory Wilkesboro Asheville NC

Mini Dental Implants ~ Extractions ~ Lower Denture

March 29, 2011/in Blog, Uncategorized /by Paresh Patel

My next patient is a great example of how versatile mini dental implants can be.

Lower ridge with 2 teeth left. Patient has been wearing an all acrylic partial denture. He is going to do a sequenced treatment plan where we place 4 mini dental implants and make a full lower denture. As he is able to accumulate the funds we will add in 4 -5 more mini dental implants to support a full lower porcelain bridge.

The teeth are extracted and the mini dental implants are placed. The only bleeding that occurred in this case is from the extraction sites; not from the mini dental implants.

This kind of placement allows patients to have less healing and less pain.

X ray showing the 2.2mm OCO mini dental implant in place in between the bone. What looked like wide bone in the mouth has a facial and lingual curve making the bone narrower that it appears. Perfect spot to use a mini dental implant.

From here is will be a straight forward overdenture case. We were able to get his first impression today after the mini implants were placed. From that a wax rim will be made with some speaking wax to record how his jaws come together. In a few weeks his denture will be complete; the gums where the teeth were extracted will have closed in and he will have a snap in/ snap out lower full denture all thanks to the mini dental implant.

Paresh B Patel DDS

mini dental implants Charlotte NC

mini dental implants Hickory Lenoir Wilkesboro Asheville NC

Dentist Mooresville NC

Mini Dental Implant vs Regular Implant ~ Whats the difference?

March 29, 2011/in Blog, Uncategorized /by Paresh Patel

I get asked this question a lot from both Doctors and Patients. I think a better way to look at this is to compare one or two piece dental implants.

Mini dental implants are one piece in design…the part that comes up into the gum is connected to the screw part that goes into the bone. One piece means for the patient less expense. But there are one piece dental implants in regular implant sizes. OCO Biomedical has a one piece, 3.25mm + 4.0mm + 5.0mm. Once again the same theme….one piece less expense for the patient.

OCO Biomedical ISI one piece dental implant. Same concept as a mini dental implant with no extra piece to purchase as the abutment (part that come up out of the gum) is fixed to the body of the regular size dental implant.

So when would you use a one piece regular size implant? I think when you have enough stability in the bone that would allow immediate loading. Most of the time that will be in the lower jaw; but in this example we were able to do this to replace an upper missing molar.

My patient had a missing upper left molar.

Our plan was to replace it with a regular size implant (we could have done it with two mini dental implants, but he preferred to have a traditional size solution).

He had been missing that tooth for well over 7 years. This had allow his sinus cavity to ‘drop down’ thus reducing the height of bone we had to place a dental implant. Our plan was to do a ‘sinus tent’ and gain a bit of height by adding some bone through the small hole that was made in his gum. Easy to do and very predictable.

OCO Biomedical ISI one piece 4.0mm implant was selected. The bone was very dense and I was fairly certain I would get over 35ncm of torque to stabilize the implant. If I did not then a two piece 4.0mm implant could have been placed and left to heal into the bone for the next 12 weeks.

Regular size implant in place to replace the missing upper crown. The placement procedure is the same as when I place a mini dental implant. Notice the lack of blood or gum that had to be cut. A temporary crown was made and the patient will come back to have the final crown cemented. In this case the patient needed additional time to collect the funds for his crown. So he would not return for around 8 weeks for his impression.

The lab fabricated a Zirconia Crown to fit the OCO ISI 4.0mm dental implant.

Internal view of the Zirconia crown.

Zirconia crown in place over the OCO Biomedical ISI 4.0mm dental implant.

Final Thoughts: In a well designed implant system placing a larger size implant is just as easy as placing a mini dental implant. With the OCO system the only thing you change is the final drill bit. There are no other drill sizes to work your way through.

What I like even better is the ability to now have either a one piece or two piece implant that offers the same prosthetic abutment. If you do place a two piece OCO and put in a solid abutment you have now created a one piece OCO ISI implant.

The other thing I like about these implants is that you cement the crown to the implant body, not the abutment, so the ‘micro gap’ in internal to the implant crowns.

Paresh B Patel DDS

Dental Implants Charlotte NC

Dental Implants Hickory Lenoir Asheville NC

Mini Mark Mini Prep Implant ~ Small Diameter Implant for Small Crowns from Ace Surgical

March 22, 2011/in Blog, Uncategorized /by Paresh Patel

What do you do when there is a small space between lower front teeth and you need a mini dental implant? There are lots of choices out there, IMTEC MDI, Intra Lock, OCO Biomedical, HiOssen…all these companies make a nice mini dental implant.

In this case I decided to try the Ace Surgical miniMarkMini Prep Implant. It is 2.3mm in diameter and comes in various lengths. The tooth in the center of the photograph was not restorable and had 360 degrees of decay.

X ray of lower incisor that will be extracted and a Ace Surgical miniMark mini prep implant will be placed.

Following our standard protocol of extracting teeth with periotomes or Golden Misch forceps the tooth was removed with little trauma to the gum and bone. You will notice in subsequent pictures the lack of blood or having to cut the gum to place the mini dental implant for the final crown.

Mini Mark mini prep implant in its sterile container.

To place the mini mark implant the step drill was used to make a initial entry point to the bone. Due to the adjacent teeth a drill extender was used to 'get around' those teeth and into the bone. The mini mark placement kit does not include this drill extender. Make certain you have one on hand or consider a different implant placement kit.

mini Mark mini prep implant is now in the extraction site and fully seated using the contrangle implant motor and drill extender.

I could not find on the distributors web page (Henry Schein Dental Supply) the restorative components for this mini implant system.

Most other mini dental implant manufacturers offer:

lab analogs

impression copings

temporary crown copings and/or comfort caps

This could be a limitation for easeof use for the miniMark mini prep system.

But we are not so easily frustrated and decided to come up with our own solution…not as easy as other mini dental implants but will work.

I decided to take an ION crown form one size smaller than needed to fashion my 'own temporary coping.'

The Dr. Patel miniMark temporary coping in place. I cemented in over the miniMark mini prep with Temp Bond Clear and teased it on and off during the setting phase. Notice how nice we were able to get the ION crown to fit around the gum and miniMark mini prep implant. This could have also been done with Jet Arcylic as it will bond to the ION crown forms. The key is to create a coping that will form the gum tissue during the healing phase.

A few dabs of bonding agent, some composite was placed over the ion crown and a temporary crown that could come on and off was fabricated. The patient will return in 12 weeks for a tissue and implant assessment.

Final X-ray of the miniMark mini prep implant in the extraction site for a lower incisor crown. There needs to be at minimum 3mm past the apex of the root that was extracted to provide stability and enough bone to secure the dental implant.

Final Thoughts

I think the mini Mark implant will work just fine. What the General Dentist will need to assess is what kind of cases would he/she like to do? If doing more than just a 2.3mm implant then one must consider a different implant system. If doing a Locator style overdenture and a small implant here and there only then the ACE Surgical miniMark system will work.

My challenge to General Dentists is why limit yourself to this? There are several mini dental implant systems that allow you to move forward in your implant choices, styles, features and sizes. You can get the proper training and open up a world of possibilities to improve your patients lives and make dentistry exciting everyday.

There are several good mini dental implant courses out there; find out which one is for you and get started. As they say: 'The hardest part of getting started is…..getting started'

Paresh B Patel DDS

Mini Dental Implant Course

Mini Dental Implants

Dental Implants Charlotte NC

miniMark Dental Implant Seminar – Online Presentation

March 15, 2011/in Blog /by Paresh Patel

The mini mark dental implant has been introduced to the dental market by ACE Surgical and will be marketed and sold by Henry Schein Dental under the Camlog umbrella.

The one piece Zest Locator mini implant is a welcome addition but I believe its downfall for acceptance and use will be its price point. 2 to 4 times as much as other mini dental implants when you include the purchase price of the housings and retentive rings. The price for one of the miniMark implants is greater than the price of a full body implant from a company like Implant Direct or OCO Biomedical. Something to consider is all I am saying.

Packaging for the miniMark….does not include the Locator housing or retentive rings.

The mini mark implants comes in two sizes: 2.3mm and 3.25, so technically a mini dental implant and a traditional size implant. For different tissue heights there are 2mm and 4mm cuffs for the 2.3mm mini and .5mm and 2mm and 4mm for the 3.25 traditional.

The moment arm created by a 4mm cuff and approximately a 2mm Locator for a total of 6mm does to mini implant I don't know. On a 11.5mm implant over 1/2 the length would be above the crest of bone.

Now onto the Online Seminar Presentation for the mini Mark Dental Implant System

Four mini mark implants 2 3.25mm and 2 2.3mm implants.

Pan with the 4 mini mark implants

Having completed the surgical phase my initial thoughts are:

Too Surgically Intense. A General Dentist who has never placed an implant or drilled into bone this 2 regular size and 2 mini size system is quite intimidating. What if you have never layed a flap?

The system is expensive for what you get. A surgical kit that can only place over denture solutions. What if you decide to do fixed? Do you get additional size implants that will take the same drivers? What about the drill bits? Right now I do not see that as a possibility.

Lack of Immediate Stability. The thread pattern on the 3.25mm miniMark is to weak to offer immediate stability or use. I guess that is why ACE recommends not loading the traditional size ones and only load the mini 2.3mm implants.

All Stress on Minis Initially. Most manufacturers suggest immediate load if you get more than 35N-cm of torque AND load all 4 implants together. No so with this system? I would surmise that 2 mini implants taking all the load will never have the success ratio as 4 minis sharing the load.

Unproven and New System There is not any 'similar' systems out on the market with a Locator type attachment. Why take the risk…unless you are just going to not load any of the implants for around 12 weeks. Then I think all will have integrated enough to load.

Final thoughts: There are too many other good one day courses out there with a larger choice of size and solutions to consider the ACE miniMark Implant System.

To see the final miniMark denture click the blue text miniMark Denture

Paresh B Patel DDS

Mini Dental Implant Course

Mini Dental Implants

Mini Dental Implants for the Thin Ridge ~ Back Molar Teeth Can be Replaced without Bone Grafts

March 3, 2011/in Blog, Uncategorized /by Paresh Patel

I get asked this question all the time. I like to answer this by explaining my philosophy that we try and place what size implant will fit the bone not how to make the bone fit the implant.

This patient has a multitude to dental issues. The one that I want to point out for this particular post is the thin lower ridge of bone. This is what happens over the years after teeth are extracted. This lower ridge is at most 4mm wide…not enough for a traditional size implant.

What can be offered to this patient is a block bone graft (an additional surgery prior to placing the dental implants) OR two mini dental implant to replace one molar.

Why two mini dental implants? Well two of these mini implants will disperse the force created when chewing on a molar size crown. The two mini dental implants also create the same surface area as a larger size traditional regular implant and can be done without any additional surgery, cost, discomfort and healing time.

This photograph demonstrates the versatility of the mini dental implant. Two Intra Lock minis have been placed in a thin ridge of bone. These two minis will be used to support a molar size back tooth crown.

The patient will be able to floss right to the mini dental implant to keep the area clean (crown, gum and mini dental implant). Since the crown that will be made for the minis will be a tissue level there is no part that is not accessible to be kept clean.

Dr.'s sometimes ask me how do you clean in between the two implants? Easy….we place a flossing groove to help guide the patient's floss or water pick. No different than flossing between a bridge.

Example of the underside of a mini dental implant crown. Notice the 'flossing groove'. The clinical photo shows my floss in between the two mini dental implants as I am removing the excess cement. This is the same thing the patient will do to keep the new mini dental implant crown clean…brush and floss.

The mini dental implant…a great solution to have in the dental toolbox to help patients that do not wish to undergo additional surgery prior to dental implants.

Paresh B Patel DDS Dental Implants Charlotte NC

Mini Dental Implants

Dental Implants Hickory Lenoir Asheville NC