bridge – Implants By Paresh

Mini Dental Implants What would we do without them? Go around without teeth?

December 9, 2010/in Blog, Uncategorized /by Paresh Patel

I guess I must be a pretty scary dude… . Dr patel

It seems like all the patients that need to come see the dentist wait until the very last minute to ask for help. We really are not that bad here at Lake Norman Mini Dental Implant Center.

My next patient had a Cone Beam 3D scan done in March of this year. She had a failing root canal on one of her upper front teeth. She must talk to some of my other patients because she had done the same thing as several others…..super-glued her post and crown in at least a dozen times. Should I just consider superglue to sell here at the office?

All kidding aside…I must say its pretty creative what patients will think up to solve their dental problems. I know it takes a lot of courage to come into the dental office. Those patients who are deathly scared of us please know that we are here to help. We will not judge. We only offer solutions and a range of them to fit what your goals are.

Clinical photo of the crown and post that the patient had super-glued back into place. X-ray shows the failing post and crown.

On her 3D CBCT we can see the HUGE defect in the bone where the dental abscess is at the tip of the root canal tooth.

And this is from March…its now December…hopefully I could thread in a Intra Lock 2.0mm mini dental implant into the Palatal(roof of the mouth side) bone to hold a temporary crown.

I took the tooth out preserving as much of the bone as possible. It was now time to try and get the Intra Lock Mini Dental Implant in.

The Intra Lock mini dental implant was rock stable (over 40ncm) and now we would pack the defect with some bone grafting material and a collagen membrane. In a few months we should have good bone to work with. My initial thoughts are that the mini is going to integrate(heal) into the bone. If it does not we should have enough new bone to place a new mini implant.

Bone grafting material in place, mini dental implant in place and gum tissue closed up and ready for a temporary crown.

Temporary Crown made chairside over the mini dental implant. This way the patient does not have to wear a flipper type of partial one tooth denture.

Final x-ray of the mini dental implant. We will see how the bone fills in and what our next steps will be. She will return after a few months to check the healing and treatment plan the final restoration.

Mini Dental Implant Roundhouse ~ Full Arch Crown and Bridge for Fixed Teeth

December 2, 2010/in Blog, Uncategorized /by Paresh Patel

My next patient was going to be a traditional implant case. The treatment plan he wanted was to replace all his upper missing teeth with regular implants. This would require a sinus lift on both sides where the lost teeth had allowed the sinus to drop down with no bone left under the gum tissue.

I did the sinus lift on the patients right side first. When I went over to the left side there was a thin section of tooth root left. Upon removal of that root there was enough damage to the sinus membrane that I elected to let the sinus heal and would come back at a later date to finish.

Flap for Sinus Lift and

Pizzotome to cut lateral window

Bone packed into Sinus Cavity

Sutures being placed

Although he healed just fine….the patient elected not to do the sinus lift on the other side and asked if I could change his treatment plan to accommodate a full fixed roundhouse bridge on mini dental implants. Of course I could…there was good bone where we did the sinus lift and I would not have to expand the bone in the anterior maxilla(front upper jaw). This is what I believe in…minimal surgery, minimal augmentation of the bone, place what will fit and enough of them to equal the surface area of a regular size implant.

I had the dental lab produce a wax up model of what I wanted the patient to 'test drive' in his mouth. A 12 tooth bridge. I would make this out of chairside arcylic much like a temporary crown that you wear while the dental lab is making the final porcelain crown.

Based off the 3D Cone BeamiCAT scan I decided to place some OCO Biomedical 3.0mm mini dental implants to support the back teeth and OCO Biomedical 2.5mm mini dental implants to support the front teeth.

OCO Biomedical mini dental implants in place to support a full fixed roundhouse porcelain fused to metal bridge. This will be like any other bridge that the patient does not remove and will brush and floss like his own teeth.

3D CT slice showing how thin the bone is in the front upper jaw. As thin as the bone is we were able to place the OCO 2.5mm mini dental implant fully supported in the bone.

3D CT slice in the area where I did the sinus lift. You can see the new bone that has filled in from the middle of the implant to the tip. The OCO 3.0mm mini dental implant is centered in the ridge for proper crown placement.

A standard full arch impression was taken. The lab will insert the OCO mini dental implant analogs and will make the full roundhouse bridge supported by our mini dental implants.

My patient immediately after the placement of the OCO Biomedical 2.5mm and 3.0 mini dental implants. He left the office with a totally mini implant supported temporary bridge that was made off the diagnostic wax up. It was made chairside with Luxatemp temporary material.

Final pan x-ray of the 11 OCO mini dental implants in place with the resin temporary bridge over the top. When I get the final bridge new clinical photographs will continue the post.

Can Mini Dental Implant Crowns & Bridges Look Good and be kept clean?

November 23, 2010/in Blog /by Paresh Patel

I get asked this question a lot from both dentists and patients. I think the answer is most likely yes. Lots of variables contribute to the successful outcome of any implant and the crown or bridge that goes over the top of it. Tissue type, bone level and sometimes how much time and funds the patient has to invest.

But for the most part I think patients, if given all the information, can be happy with the aesthetic outcome with mini dental implants and the crown or bridge they support.

My next patient was in for her normal 6 month cleaning appointment. She stopped me to tell me how happy she was with her fixed crowns on her mini dental implants in her upper jaw.

These crowns and mini dental implants have been in for 1 year now. This case used Intra Lock mini implants. But as I state in most of my posts any well constructed mini dental implant such as the OCO Biomedical mini or micro, IMTEC MDI, or HiOssen mini are appropriate. Even as a dentist I think I would have a hard time figuring out which ones are regular crowns on teeth and the mini dental implant crowns.

This patient is able to keep her mini dental implant Crowns by First Impressions Dental Lab clean with a normal toothbrush, floss, and/or a water pick. The two crowns are connected together and are supported by 3 mini dental implants. The hygienist and patient both can floss between all the mini implants.

Paresh B Patel DDS Dentist Mooresville NC

Mini Dental Implants

Mini Dental Implants to replace a Missing Front Upper Tooth

October 15, 2010/in Blog, Uncategorized /by Paresh Patel

Our next patient was missing one of his front teeth….well actually he is missing a few of his teeth. However our plan is to replace these missing upper teeth with mini dental implants and crowns a few at a time as he can afford to do so.

He has an upper plastic partial denture plate. We will remove the plastic denture teeth as the crowns and mini dental implants are added.

Mini Dental Implants in place ready for impression to send to First Impressions Dental Lab for Porcelain Crowns.

Mini Dental Implants Day of Placement…..notice no gum incision or bleeding in area of placement. Minimal surgery for faster healing and less patient discomfort.

Paresh B Patel DDS Mini Dental Implants

Dentist Mooresville NC

Upper Partial or Mini Dental Implant Bridge?

October 14, 2010/in Blog, Uncategorized /by Paresh Patel

It seems here lately we have had a lot of patients come in that are unhappy, frustrated and just don't like their partial dentures. They specifically want to just get rid of it and replace it with some mini dental implants and a set of porcelain crowns or porcelain bridges.

Photo of my patients existing upper partial denture that replaces most of her upper front teeth. I did not think it looked all that bad for being 7 years old….she just did not like it. The way it kept her from tasting her food, the way she talked with it, the bulk of metal as she put it on the roof of her mouth. She also did not like the lower but wanted to start with replacing the top partial plate with mini dental implants and a bridge.

Like most patients that seem to find me…she had what looked at initial glance good bone. However on the x-ray it was mostly tissue. It had just been too long since the teeth had been extracted and the bone had just melted away. Without roots the body over time just starts taking away the bone. If an ill fitting partial sits and rubs on the bone year after year it accelerates the process of bone resorption.

So we went over the options as usual of traditional implants and some bone augmentation or I could use what bone she had, place at least 6 minis and make her a 8 tooth bridge to replace her missing teeth.

I used her existing upper partial denture plate as a guide on where I could place the mini dental implants. I drilled a hole in the center of each tooth, placed in back in her mouth and with a marking stick located the ideal place for the mini implant.

Of course in her mouth most of the 'ideal' locations had less than ideal bone.

Photo of 6 mini dental implants placed day of. You can see 2 areas where we tried to get the last 2 mini dental implants in but found poor bone. These areas will just fill back in with gum tissue.

A impression was taken of the mini dental implants and off to First Impressions Dental Lab for them to make the 8 tooth porcelain bridge. In three weeks her mini dental implant bridge will be back and I will post the photos.

Paresh B Patel DDS mini dental implant dentist

Dentist Mooresville NC

Mini Dental Implants to Secure a Lower Partial

October 13, 2010/in Blog, Uncategorized /by Paresh Patel

The uses for a mini dental implant never stop amazing me. Today we had a fella come in who had broken his lower little front tooth.

Clinical photo of the broken lower front tooth….it was broken below the level of the gum tissue.

So I decided to extract the root tip for him with some peritomes to save as much bone on the lip side as possible to hold our ????? You guessed it, a mini dental implant.

Picture of extracted root tip and the Intra Lock MILO 3.0 x 15mm mini dental implant in the socket where the root was.

Picture of the mini dental implant 'snap' in place over the o-ball. This is what will fit inside his partial denture to hold this side of the lower partial.

Picture of the impression metal cap fitted over the mini dental implant. This will be picked up in our impression so the lab can place a replica of the implant before the pour the stone model. Once that is done they can process the 'snap' under the replacement denture tooth.

Impression of mini dental implant and partial to be sent to First Impressions Dental Lab to add a snap and a tooth.

Final x-ray of mini dental implant in place where the root tip was…day of placement.

Our goal is to add a few more mini dental implants over time and then get rid of his lower partial denture for either a full set of fixed crowns or a secure lower denture. At the end of the procedure our patient commented on how quick and painless the entire process had been. It nice that such new products exist for us as dentists to offer such a non invasive, non surgical approach to dental implants.

Paresh B Patel DDS mini dental implants

Dentist Mooresville NC

Mini Dental Implants ~ Extractions ~ Immediate Placement and Saving the Bone

September 30, 2010/in Blog, Uncategorized /by Paresh Patel

Another good use for mini dental implants is when we have a failing bridge or a tooth that has had a failing root canal treatment. Our next case is a patient that came to see us after having pain with her temporary bridge. Her old bridge she told me was wobbling around and her dentist told her the post was weak and he needed to make the bridge longer…..only if we had met sooner that might not have been what she had chose to do. G8PBAUAAQB92

We can see on this x-ray (this is the x-ray she brought from her previous dentist before he removed the bridge and made it one tooth longer)the decay under the post that continues down the root on the tooth that has had the root canal treatment. The root canal tooth was very mobile (as in when I took the bridge off to assess the teeth I could move the root in the bone.

We covered all the options with the patient from a new bridge(her previous dentist has already made the decision to make a longer bridge for her that went to the canine tooth in front of the root canal tooth). I told her I thought it would not be a good idea to keep the root canal tooth since is was already mobile.

We talked about 2 traditional implants, or a few minis and single crowns on her natural teeth.

She decided to let me extract the Root canal tooth. There was enough destruction of bone on the cheek side that I explained to her that I would place some socket preservation material (a freezed dried mixture of bone) in the hole where the root was to help her body fill in that hole with good live bone so we could come back in 12 weeks and place a mini dental implant.

Here we have the socket preservation material in the extraction site. Its easy to see how plump the ridge looks. It will stay that way without caving in and will give us lots of good bone to put a mini dental implant.

2 Mini Dental Implants in place to hold a molar size crown. The mini dental implants will be shaped to allow room for her teeth to come together. We will place a Porcelain crown over the mini dental implants.

X-ray of the two mini dental implants in place.
The ghost image of where the root was will fill in with bone and in about 12 weeks we will add in another mini dental implant to support a crown.

I will continue the post with the pictures of the crowns when we get the final mini dental implant in place and the crowns back from the lab.

Paresh B Patel DDS mini dental implants

Dentist Mooresville NC

Mini Dental Implants to Replace an Upper Partial Denture Plate

September 23, 2010/in Blog, Uncategorized /by Paresh Patel

This is actually a case that was done last year. My patient came in for his 6 month cleaning about 6 months late…. Not what I like for patients to do. But he was certainly not the ideal patient and I explained that to him prior to committing my time, energy and mini implants to the case. He is a heavy smoker (around 2 packs a day). A big NO NO for traditional implants or any kind of implants in general. But I told him if I could get the mini's in without having to flap his gum away from the bone the implants would have a better chance of healing. He had seen another dentist about traditional or conventional implants but could not move forward with treatment due to the cost. A familiar story. I told him we could offer another choice…the mini implant choice. Not the same solution but a different solution that might work for him. He had a upper partial to replace his missing 6 front teeth. He had an accident over 10 years ago and had been wearing a cast metal partial that he did not like. His big complaint was the metal hooks and just the bulk of it. He did not really have a complaint on the way his front teeth looked on the partial plate.

View of upper partial denture in place. I cut the metal hooks off so he could see what things could look like once we had the final bridge over his mini dental implants.

6 Mini Dental Implants in place in the upper jaw…day of placement. Note the lack of bleeding. No flap had to be made to insert the mini implants into the gum and bone on the upper.

Upper Partial Denture modified to fit over the 6 mini dental implants that were placed in the upper jaw. This way he would be able to wear the upper partial while the dental lab made his crowns/bridge.

6 crowns with pink porcelain to simulate gum tissue on the stone model from First Impressions Dental Lab

Retracted cheek view of his 6 crowns on six mini dental implants…1 year post placement. Notice all the smoking stain on his lower natural teeth.

Close up view of Crowns

Bite view of the 6 crowns on mini dental implants.

Overall I am happy. I know he is happy. I think his comment was, 'Doc now that I got my show teeth do I really need to get the rest of them fixed?' How do you answer that question as a Dentist?

Now if I could just get him to quit smoking, come in when he is required to for his cleanings and move forward with fixing the rest of his teeth….. But as they say, Rome was not built in a day so we move forward one MINI step at a time.

Paresh Patel DDS mini dental implants

General Dentist Mooresville NC

Mini Dental Implant Upper Denture Tooth Bridge

September 9, 2010/in Blog, Uncategorized /by Paresh Patel

Part II of the fixed hybrid bridge post. You can scroll down 1/2 into the web page to see the complete case…

This is the finished product for our patient that came in just gagging on her upper denture. She wanted to have a solution that would allow her to have the roof of mouth not covered with plastic. Cost was certainly a factor. We offered the solution of 4 to 6 locator's implants and a removable over-denture without a palate. I like to place 6 on the upper arch to withstand the lateral stress if we plan to remove the palate in the denture. This certainly would have been the most elegant solution (easy to keep clean and offers a tremendous amount of retention)but was declined.

I put in 8 mini dental implants to support a metal frame (not a tissue supported upper denture). This metal frame would hold and support her new set of teeth made out of acrylic and denture teeth (a fixed hybrid solution). Since there are no two piece mini dental implants (a diameter of less than 3.0mm) we can either cement the teeth over the mini dental implants or we can incorporate a teflon keeper that is processed into the metal acrylic base. Shatkin First has this option if you need further information.

Mini Dental Implants in place

Cast metal frame with Preat E-Fiber under acrylic

connecting both sides together. I would have preferred to continue that cast framework from one side to the other…but to accommodate the patients bite and other request it did not work out. So the solution to use the e-fiber was decided upon with patient approval. For technical data on the e-fiber you can go to their website. It is 10x more fatigue resistant than fibrekore and 2x as strong in flexural strength. Occlusion is only on the posterior teeth with only light occlusal stops on the lingual of the anterior teeth. This is done to provide the artificial dentition patientt anterior incisal clearance during all posterior masticatory function. All four anterior teeth do touch the lower teeth during incising and protrusive function.

View of Fixed hybrid denture in place with no palate

Smile view of fixed hybrid denture in place

There is about a 1/2mm to 1mm of space to allow for floss and water pick to keep the fixed hybrid denture clean. Lingual side has a tight fit against tissue.

Paresh B Patel Dentist Mooresville NC

mini dental implants

Mini Dental Implant

January 29, 2010/in Blog, Uncategorized /by Paresh Patel

What do you do when its Friday afternoon and this walks in with a crying patient attached to it?

Well I looked in the tool box and thankfully I had a stash. No not anything illegal but a stash of Intra Lock Mini Dental Implants from Shatkin FIRST Labs. Jay Moore (the well respected and highly knowledgeable sales manager) had just sent me 24 mini implants in the 'Cash for Clunkers' trade in program.

The patient stated that the bridge was 'slightly decayed' for a while and that she had noticed some movement over the past few months. Well from where I was sitting I don't know where the 'slightly decayed' came from…..it looked more like a stroll down the street in Anbar Province Iraq.

I was able to tack mush to mush and took a pre op pan xray

Of course I was drooling over the thoughts of Mini Implants everywhere for this patient! But I had to slow down and go over all the options from

1. Do nothing…not really an option….but I have heard that patients can get creative with Super Glue!

2. Extract and recommend a denture or partial.

3. Extract and implants for an over-denture or implants and a fixed bridge.

4. Extract and mini dental implants for a fixed bridge or mini implant retained full denture.

To my surprise the patient had done her homework and had come to see us specifically for mini dental implants and a mini implant bridge.

I told her lets's slow it down a bit. How about we make it the first goal to take out the broken root tips and preserve as much bone as possible with some peritomes(dental instruments to extract teeth with less trauma to the facial bone). Then see about placing some mini dental implants and for certain figure out how to make her a temporary bridge to wear while some healing occurred.

Minis all went in as planned. She will return in a few weeks for a tissue check and I will update the photos.

iCAT CT scan of mini dental implants in place for a fixed bridge

Post operative pan xray of mini dental implant in upper jaw for fixed bridge

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