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News - Nothing but the tooth

{ Posts tagged with "Dental implants" }

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Aug 2015
22nd
22nd of August 2015

Dental Implants Replacing Missing Teeth

Are you missing teeth? One tooth? Several teeth? All missing teeth? If so we can help. Dr Nissit Patel has over ten years experience of placing and restoring dental implants using only the best systems available. Dental implants are the best way to replace missing teeth and finding the right dentist to provide the treatment is vital. If you would like to discuss dental implant treatment with Dr Nissit Patel please do not hesitate to contact us. Tel 0207 7311162 e info@progressivedentistry.co.uk

Tagged with:   Dental implants

Aug 2015
7th
7th of August 2015

Dental Implants - All on 4

Dental implants are widely recognised as the best alternative to natural teeth. Implants can be used for single, multiple or all missing teeth. In this article, we would like to discuss the treatment called All on 4, which is designed to replace all missing teeth. The concept is simple. If you are missing all of your teeth on the upper, lower or both jaws then 4 dental implants on the upper and lower jaws can act as the anchors to replace the missing teeth.

There is a great deal of planning involved and the treatment must be carefully thought through and planned to provide a natural, harmonious result which is functional and aesthetic. This will involve comprehensive analysis of the upper and / or lower jaws with CT scans to assess the bone quality, volume and relevant anatomical landmarks. The dental implants will be planned in accordance with your own anatomy. In most cases, we will aim to avoid bone grafting, sinus grafting or any other additional surgical procedure. This way, the treatment is as minimally invasive as possible. 

At Progressive Dentistry, we are able to provide All on 4 dental implant treatment with Dr Nissit Patel as the lead clinician. If you are interested in dental implants then please do not hesitate to contact us.


May 2015
28th
28th of May 2015

Dental Implant Systems at Progressive Dentistry

We have recently been asked which types of dental implant systems we use at Progressive Dentistry.

The answer is: 

1. Nobel Biocare Implant System.

2. Astra Tech Dental Implant System.

3. Implant Direct System.

4. Ankylos Implant System.

5. Southern Dental Implant System.

We also have restorative capability for the Straumann implant system. However, we are happy to accommodate any implant system. 

If you have a problem with your dental implants and need some help, contact us. We will not simply dismiss your case because we do not use that particular implant.


May 2015
14th
14th of May 2015

Screw Retained Dental Implant Crowns

The great advantage of screw retained dental implant crowns is that there is no cement at all. Therefore any of the potential problems of excess cement extruding beyond the crown margin and instigating Peri-implantitis is negated. 

Another advantage is that if the crown needs to be removed, it is relatively easy to do so and there is no damage to the porcelain work by forcibly removing the crown.
 

Planning for Screw Retained Implant Crowns

In general, the screw access hole should be down the long axis of the implant. This is important in relation to ease of placement, avoiding damaging lateral tension forces when torquing the screw which could lead to screw loosening and avoiding the issue of possibly threading the screw if proper access has not been made. Therefore, prior to placing the dental implant, it is important to plan what type of restoration is to be placed. 

However, recent advances in prosthetic design have evolved and Nobel Biocare now have an angulated screw channel. This allows a angulation difference of 25 degrees, which is significant. This can be applied to the posterior and anterior regions. This is possibly a game changer in dental implant prosthetics.
 

Placing Screw Retained Dental Implant Crowns

The placement is generally quite simple. The crown and abutment is a one piece prosthetic device. The crown is then placed within the dental implant. There is only one path of insertion and therefore a placement jig is not required. Initially, screw down gently until the crown is stable and in it's fully seating position. Check the marginal adaptation, contacts, embrasure space and occlusion. Take a peri-apical radiograph to ensure correct seating. If so, make any necessary adjustments. 

Once all of the relevant checks have been made and verified, torque the screw to 20Ncm using a prosthetic torque wrench. The screw should be covered with sterile cotton wool and the access cavity restored with composite. 

Tip: for metal based substructures, to avoid a grey shadow use an opaque flowable composite around the periphery and on the base. Voco have an excellent one which I routinely use to block out dark areas whilst placing composites.
 

Removing Screw Retained Implant Crowns

Simply remove the composite and cotton wool carefully and unscrew the abutment screw. Simple. 

Tip: be very careful not to damage the abutment screw! Use an ultrasonic to remove the final layer of composite.
 

Conclusion

In many cases, screw retained implant crowns are the desired option. With the evolution of the Nobel Biocare angulated screw access, the scope for these restorations has increased hugely. With the huge advantage of no cement, I would suggest considering screw retained restorations for single implant crowns as the first choice option.

An article for dentists by Dr Nissit Patel


May 2015
3rd
3rd of May 2015

Cement Retained Dental Implant Crowns

When restoring dental implants, the choice is screw retained or cement retained. Cement retained crowns will often be used when the screw access hole is not positioned down the long axis of the implant. There may be angulation issues or aesthetic issues that arise from this. Cement retained crowns may also be preferred by the patient due to the unaesthetic appearance of the access cavity for screw retained crowns, which often looks grey and discoloured if the underlying crown has a metal sub structure. Patients now often regard premolar and molar teeth as being in the aesthetic zone and are highly dental aware. Quite rightly, they expect dental implant crowns to look like natural teeth.
 

What Abutment Is Best for Cement Retained Crowns?

In my experience, Atlantis abutments are far superior to any other system. Think about how you would prepare a tooth for a crown and amplify the precision ten fold. With the digital age we live in, technology should be used to enhance the outcomes for our patients. This is one system that certainly does that. There are also other scanning centres which produce excellent abutments. It is worth talking with your dental implant technician and using a few systems. Of course, there is a cost implication involved and Atlantis may not be suitable for all.
 

How To Fit The Cement Retained Crown

When fitting cement retained crowns it is imperative that excess cement does not exude the margins and act as a plaque trap. This is one the main causes of Peri-implantitis and is avoidable. 

There is an excellent technique which will help you to avoid any issues with excess cement: 

1. Once you have verified the margins, occlusion, contacts, embrasure space and aesthetics you are ready to cement the crown. 

2. Use your PVS bite registration material and insert within the crown creating a tag at the end to act as a handle. 

3. Remove this index. 

4. Mix the cement, which is usually a temporary cement (Tempbond NE) or a dedicated implant cement and place within the crown. Do not overfill. Make sure the abutment screw is covered. I use pre sterilised cotton wool. 

5. Insert the index into the crown to remove the excess. This will leave a very fine layer of cement. 

6. Place the crown and wait for setting. There should be no excess at the margins.

7. Perform the usual checks and take a PA radiograph to verify. There should be no exudate whatsoever. 

8. A useful tip for removing any fine smears of Tempbond on the crown is orange solvent. Spray some onto a ball of cotton wool and clean any fine residue. 

9. Review as required.
 

How To Remove Cement Retained Implant Crowns

There are times when implant crowns will need to be removed. For example, if the abutment screw loosens. This is why temporary cements are used. In my experience, cement retained crowns can be removed with minimal fuss. However, you must pre warn the patient that some force is required. I would over emphasise this fact. To avoid damage to the porcelain, use rubber coated crown removing pliers. GC have an excellent one. Grip the crown firmly and exert pressure in a bucco-lingual direction initially and then rotational. The crown should ease off within a few seconds.
 

How To Maintain Dental Implant Crowns

Dental implant crowns, screw or cement retained, require maintenance just as natural teeth. However, your hygienist must be trained in this field. Regular scalers, hand or ultrasonic, should not be used for fear of scratching the titanium. Satelec have introduced some excellent ultrasonic tips for implants. We have invested in these with great success. Specific implant hand scalers can also be used. We are also keen on adjunctive methods of cleaning such as Philips Airfloss.
 

Feedback

Article for dentists written by Dr Nissit Patel. 

I hope this article has been of use. It comes from many years of experience of placing implant crowns, cement and screw retained. I welcome any feedback that you may have, please e-mail me: nissit@progressivedentistry.co.uk 

My next article will focus on screw retained crowns.


Feb 2015
25th
25th of February 2015

Dental Implant To Restore Missing Back Teeth

Our case of the month for February is a dental implant case to restore missing back teeth. Dental implants are used to replace missing teeth to restore function, aesthetics and prevent further problems of shrinkage and teeth movement. In our case of the month, our patient had lost some back teeth and there was a baby tooth remaining which was about to fall out. This severely impacted on her eating and everyday function. Dental implants were the best way to replace the missing teeth with a fixed and secure final end result. Here are some before photographs:
 


Dec 2014
9th
9th of December 2014

Committed To Excellence: Progressive Dentistry's Ongoing Education

We strongly believe in life long learning with continual education. Recently the practice has completed a course on adult and paediatric life support and medical emergencies. This is consider a core subject and is undertaken on a yearly basis. Dr Nissit Patel has also just completed an IR(ME)R course in dental radiography and radiation protection- justification, optimisation and limitation. This was a full day course with Eric Waites as the speaker, a well renowned expert in the field.

In November, Dr Patel attended the American Academy of Implant Dentistry Conference in Florida. This was a comprehensive programme on modern dental implant dentistry focusing on digital dentistry. This is the future of dental implant treatments as well the majority of advanced dentistry. There has never been a better time to replace missing teeth with dental implants.

So, if you would like a dental practice that is fully up to date with the latest procedures, techniques, materials and technology that is evidence based, Progressive Dentistry is for you.


Oct 2014
8th
8th of October 2014

Advanced Dental Implants - Nobel Active Dental Implants

We are constantly striving to improve our services and use the the very best in modern technology and materials. Dental implants is a field where technology is constantly improving and the materials are evolving at a rapid rate. It is important to keep up to date, as not only will modern methods achieve great results but will also allow us dentists to treat cases that were not previously possible.

On such example is when there is very compromised bone quality to place a dental implant. This could be the case if a previous infection had reabsorbed the bone or when the adult tooth was removed, a section of the bone was fractured. In such cases, placing a conventional dental implant would be extremely difficult.
 

Nobel Active Implant

However, the evolution of the Nobel Active implant allows us to place dental implants in compromised sites with confidence. This is due to the unique design of the implant. Nobel Active is truly an implant like no other.

The implant body and thread design condense bone during insertion, leading to high primary stability even in compromised bone situations. This makes it ideal for immediate implant placement. What's more, the design of the placement technique enables us to adjust the implant position for optimal restorative orientation. Therefore if you have been told that you do not have good enough bone for dental implants, it is worth seeking alternative options.

Nobel Active could be for you.


Sept 2014
29th
29th of September 2014

Regain Your Smile: Replacing Missing Back Teeth With Dental Implants

Our case of the month for September is one which involves dental implants to replace missing back teeth. It is crucial to replace missing teeth at the back for a number of reasons. These involve: 

1. To restore function. Without back teeth or molar teeth, it is very hard to chew food. 

2. To prevent unwanted movement of the adjacent or opposing teeth. This could have a detrimental effect on the occlusion (bite) and cause major dental issues for the future. 

3. To prevent the jaw bone from shrinking which can result in causing the soft tissue to shrink. 

4. Aesthetics. Having gaps at the back of the mouth can still be seen. Dark space is not attractive. 

5. For general well being, physical and psychological. In our case, the missing teeth were two molar teeth on the upper right hand side. 

Please view a photograph: