Implant Practice US Fall 2018 Vol 11 No 3 by MedMark, LLC

Predictable immediate guided implant placement and restoration within your practice

Astra Tech Implant System® EV

PROMOTING EXCELLENCE IN IMPLANTOLOGY

Tired of complex workarounds?

Fall 2018 – Vol 11 No 3 • implantpracticeus.com

There’s a SmartFix® for that!

clinical articles • management advice • practice profiles • technology reviews

Dr. Ara Nazarian

Clinician spotlight

Unique two-piece abutment design

Dr. Richard Eidelson

Full arch implant restoration with immediate loading

Corporate profile Welcome to Karl Schumacher

Short, flexible abutment holder

Dr. David Murnaghan

Managing the failing dentition Dr. Komal Suri OsseoSpeed Profile EV

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The power of mentorship

EDITORIAL ADVISORS Steve Barter, BDS, MSurgDent RCS Anthony Bendkowski, BDS, LDS RCS, MFGDP, DipDSed, DPDS, MsurgDent Philip Bennett, BDS, LDS RCS, FICOI Stephen Byfield, BDS, MFGDP, FICD Sanjay Chopra, BDS Andrew Dawood, BDS, MSc, MRD RCS Professor Nikolaos Donos, DDS, MS, PhD Abid Faqir, BDS, MFDS RCS, MSc (MedSci) Koray Feran, BDS, MSC, LDS RCS, FDS RCS Philip Freiburger, BDS, MFGDP (UK) Jeffrey Ganeles, DMD, FACD Mark Hamburger, BDS, BChD Mark Haswell, BDS, MSc Gareth Jenkins, BDS, FDS RCS, MScD Stephen Jones, BDS, MSc, MGDS RCS, MRD RCS Gregori M. Kurtzman, DDS Jonathan Lack, DDS, CertPerio, FCDS Samuel Lee, DDS David Little, DDS Andrew Moore, BDS, Dip Imp Dent RCS Ara Nazarian, DDS Ken Nicholson, BDS, MSc Michael R. Norton, BDS, FDS RCS(ed) Rob Oretti, BDS, MGDS RCS Christopher Orr, BDS, BSc Fazeela Khan-Osborne, BDS, LDS RCS, BSc, MSc Jay B. Reznick, DMD, MD Nigel Saynor, BDS Malcolm Schaller, BDS Ashok Sethi, BDS, DGDP, MGDS RCS, DUI Harry Shiers, BDS, MSc, MGDS, MFDS Harris Sidelsky, BDS, LDS RCS, MSc Paul Tipton, BDS, MSc, DGDP(UK) Clive Waterman, BDS, MDc, DGDP (UK) Peter Young, BDS, PhD Brian T. Young, DDS, MS CE QUALITY ASSURANCE ADVISORY BOARD Dr. Alexandra Day, BDS, VT Julian English, BA (Hons), editorial director FMC Dr. Paul Langmaid, CBE, BDS, ex chief dental officer to the Government for Wales Dr. Ellis Paul, BDS, LDS, FFGDP (UK), FICD, editor-inchief Private Dentistry Dr. Chris Potts, BDS, DGDP (UK), business advisor and ex-head of Boots Dental, BUPA Dentalcover, Virgin Dr. Harry Shiers, BDS, MSc (implant surgery), MGDS, MFDS, Harley St referral implant surgeon

© FMC 2018. All rights reserved. FMC is part of the specialist publishing group Springer Science+ Business Media. The publisher’s written consent must be obtained before any part of this publication may be reproducedvw in any form whatsoever, including photocopies and information retrieval systems. While every care has been taken in the preparation of this magazine, the publisher cannot be held responsible for the accuracy of the information printed herein, or in any consequence arising from it. The views expressed herein are those of the author(s) and not necessarily the opinion of either Implant Practice or the publisher.

e’re halfway through 2018, and it’s been a great year so far. Looking back at all of this year’s growth and positive change has given me pause for reflection. I would not be the person who I am without great role models and mentors, specifically in the world of Implantology. I’ve had the great honor to join Dr. Justin Moody at his implant clinic in Rapid City, South Dakota, this year, and it’s been a life-changing opportunity — but a little background first. As a young implantologist, I consider myself extremely fortunate to have had great role models and positive mentors to help inspire me and show me what’s possible in the world of dentistry and specifically implant dentistry. I grew up in Davenport, Iowa, Chris Barrett, DDS and was fortunate to be exposed to dentistry at an early age. My grandfather, Dr. Larry Barrett, was a past president of both the Pierre Fauchard Academy and the Iowa Dental Association. He instilled in me how important it is to be involved in organizations that help further the causes that we believe in, and if we don’t actively participate, then we are putting our futures into the hands of others. My grandfather’s partner, who is still our family dentist, Dr. Kathryn Kell, is the current president of the FDI, the world’s largest dental organization. As a young man, having spent time with both my grandfather and Dr. Kell, helped shape my ideas of what was possible through the dental profession. Fast-forward through my education at The University of Iowa. I found myself working with Dr. John Bassett in Denver, Colorado. He was a disciple of the great prosthodontist Dr. Niels Guichet and passed down his wisdom of gnathology to me that’s been crucial in understanding proper occlusion for both natural dentition and implant dentistry. I was then fortunate enough to become friends with Dr. Mike Freimuth, ABOI Diplomate. The first time we met, he invited me to his office to shadow him and his amazing team. I would spend my days off watching him perform complicated surgeries and delivering beautiful implant restorations from single units to full-mouth rehabilitations. He would allow me to pick his brain about treatment planning, phasing of treatment, and implant rationale. Never once was I made to feel insignificant even when my curiosities and questions must have seemed sophomoric. Then Dr. Freimuth introduced me to Dr. Moody, ABOI Diplomate. Since that introduction, my implant journey has grown by leaps and bounds. I’ve been invited to be a clinical instructor for Drs. Moody and Freimuth’s Implant Pathway continuum. It has been extremely rewarding and the best part of my job to help guide and mentor dentists who are new to the world of implant dentistry. Recently, I spent a week with Dr. Hilt Tatum Jr. and a group of amazing dentists in France. It was a small group setting where Dr. Tatum gave us a unique perspective on what’s possible in implant dentistry. It was an amazing experience — one that I’ll never forget. As we look toward the future and close out the second half of the year, I want to challenge all of the readers to keep in mind our humble beginnings and to ask that we all start and be as generous with our time and skills to the new generation of implantologists as our mentors were for us. Wishing you all the best for the rest of the year and a wonderful 2019. Sincerely, Chris Barrett, DDS, Associate Fellow AAID

Dr. Chris Barrett earned his DDS from The University of Iowa and completed a GPR at The Iowa City VA Health Care System and University of Iowa Hospitals and Clinics. He has limited his practice to implant dentistry and is currently working toward his American Board of Oral Implantology/Implant Dentistry’s (ABOI/ID) Diplomate. You can contact him at chris@the-dentalimplantcenter.com.

ISSN number 2372-9058

Volume 11 Number 3

Implant practice 1

INTRODUCTION

Fall 2018 - Volume 11 Number 3

TABLE OF CONTENTS

Clinician spotlight Dr. Richard Eidelson, DDS, FAGD

Case study Predictable immediate guided implant placement and restoration within your practice Dr. Ara Nazarian discusses materials and methods that can help fulfill patientsâ&#x20AC;&#x2122; surgical and restorative needs.............................................. 12

30 years to becoming an overnight success

Practice management Communicating change in the dental practice Catherine Cheshire, SPHR, discusses the importance of keeping employees informed.......................................... 20

Corporate profile

Welcome to Karl Schumacher We specialize in great surgical outcomes

ON THE COVER Cover photos courtesy of Dr. Ara Nazarian. Article begins on page 12.

2 Implant practice

Volume 11 Number 3

FULL-ARCH THERAPY ON FOUR IMPLANTS

THEIRS 1.

Place implant.

2. Use reamers to remove and reshape bone, or find a compromise in implant placement between the mesial-distal aspect of the bone.

OURS 1.

Place the OsseoSpeed Profile EV implant at an angle and see how the implant neck aligns with the anatomy.

3. Use every trick in the book to make it work.

Images for illustrative purposes only.

Another workaround made obsolete by Dentsply Sirona Implants. Tired of having to make bone disappear to align an angled implant to a flattened anatomy? Our SmartFix concept for the Astra Tech Implant System EV is designed with attention to detail that can help you avoid workarounds in complex restorations. The sloped design of the OsseoSpeed Profile EV implant allows the implant neck to naturally align to the anatomy when placed at an angleâ&#x20AC;&#x201D; eliminating the need to compromise with submerged implant placement and additional bone removal. Di s cove r Den t spl y Si ron a i mpl an t sâ&#x20AC;&#x2122; l i n e of fully ed entulous s olutions : S C R E W- R E TA INED | ATTACHM ENT-R ETAINE D | FRICTION-RE TAINE D

Implants

TABLE OF CONTENTS

Continuing education Managing the failing dentition Dr. Komal Suri discusses the principles of smile design when dealing with an aged dentition with multiple restorations..................... 28

Continuing education

Full arch implant restoration with immediate loading

Dr. David Murnaghan describes a challenging implant case that needed a thorough understanding of implant protocols and modern technology to meet the patient’s high expectations

Product profiles Next Generation LOCATOR R-Tx® Removable Attachment System 100% satisfaction guarantee from Zest when clinicians upgrade to the next generation of LOCATOR®.......34

Boyd Industries Implant Surgery line Built to Last. Built for You. Built by Boyd. .............................36

What is the real cost of implant failure? Dr. Robert Martino discusses the many consequences of implant failure

.................................................38

Product profile InOffice™ by DentalEZ® ................................................. 42

Small talk Achieve a “personal best” by expanding your comfort zone Dr. Joel Small notes, “Each time we achieve a new personal best, we expand the limitations of our being until these limitations no longer exist”

.................................................44

Industry news .................................................46

Practice management Implant practice inventory management Dr. Brian Young discusses the importance of keeping track of inventory efficiently.......................40

4 Implant practice

On the horizon Image that! Dr. Justin Moody discusses how his imaging has evolved over 2 decades

.................................................48

PUBLISHER | Lisa Moler Email: lmoler@medmarkmedia.com MANAGING EDITOR | Mali Schantz-Feld Email: mali@medmarkmedia.com | Tel: (727) 515-5118 ASSISTANT EDITOR | Elizabeth Romanek Email: betty@medmarkmedia.com VP, SALES & BUSINESS DEVEL. | Mark Finkelstein Email: mark@medmarkmedia.com NATIONAL ACCOUNT MANAGER Celeste Scarfi-Tellez Email: celeste@medmarkmedia.com CLIENT SERVICES/SALES SUPPORT | Adrienne Good Email: agood@medmarkmedia.com CREATIVE DIRECTOR/PROD. MGR. | Amanda Culver Email: amanda@medmarkmedia.com FRONT OFFICE ADMINISTRATOR | Melissa Minnick Email: melissa@medmarkmedia.com

MedMark, LLC 15720 N. Greenway-Hayden Loop #9 Scottsdale, AZ 85260 Tel: (480) 621-8955 | Fax: (480) 629-4002 Toll-free: (866) 579-9496 www.implantpracticeus.com | www.medmarkmedia.com

SUBSCRIPTION RATES 1 year (4 issues) $149 | 3 years (12 issues) $399

Volume 11 Number 3

NAVIGATING THE OVERDENTURE STUD ATTACHMENT MAZE Indications for stud attachments:

• Improving quality of life with only two implants in lower arch, functional capacity increased from 10% to 60% • Allows independent servicing of attachments • Provides retention and improved prostheses stability

Locator

• Lowest proﬁle, 2.73mm x 5.5mm • 8 diﬀerent retention levels • Self-aligning function 40° • Nylon male stays in contact with abutment, housing pivots around nylon male, to reduce abutment wear

Clix

• Small size, 4 x 4mm • 3 diﬀerent retention levels • Angle correction up to 30° • Great for patients with hygiene issues • Female makes patient pleasing audible Clix when engaged for security and conﬁdence. • Ideal for anterior maxillae

Locator R-Tx

• Low proﬁle, 3.1mm x 5.6mm • 4 diﬀerent retention levels • Self-aligning function 60° • Nylon male stays in contact with abutment, housing pivots around nylon male, to reduce abutment wear

O-Rings

• 6mm x 4.5mm tall • 2 retention levels • Minimal angulation correction, 10° • The most resilient attachment system, protects weaker abutments

Magnets

• 2.4mm x 3.9mm • One retention level per size • No path of insertion; corrects up to 48° of divergence • Ideal for patients with limited dexterity

Images courtesy of PREAT Corporation Technical Team

PREAT manufacturers and technically supports the largest selection of attachments and implant parts in North America. Whether you use Straumann, Nobel, Astra, Zimmer, etc. PREAT manufactures thousands of compatible implant components. Let the PREAT Technical Team assist you in making your next overdenture a success!

CONTACT PREAT AT 1-800-232-7732 • www.PREAT.com

CLINICIAN SPOTLIGHT

Dr. Richard Eidelson, DDS, FAGD 30 years to becoming an overnight success

uccess takes time, hard work, and consistently working toward a goal. After 40 years, Richard Eidelson, DDS, FAGD, maintains focus on his goal of serving others with dental needs. That concentrated effort over time yields to the success that the Philadelphia-based dentist has today. It starts with years of learning and educating others. “Any success I have is directly related to education,” Dr. Eidelson said. “For every course you take, it’s like a 3 to 1 multiplier. You can’t take one course. The more you do to learn, it will enhance your productivity and your enjoyment of treating dental problems.”

Learn to be a success The path to an impressionable career in the dental industry begins with an education and continues with ongoing learning. Dr. Eidelson graduated from Temple University School of Dentistry. He then earned a certificate in esthetic dentistry from the University of Minnesota, participated in the Harvard School of Dental Medicine’s Professional Development Program, and graduated from UCLA’s postgraduate certificate program in implant dentistry. During that time, Dr. Eidelson shared his knowledge as an assistant clinical professor in oral medicine at Temple University School of Dentistry, and he served on the university’s Alumni Board as vice president. He was also an adjunct clinical professor of restorative dentistry at Kornberg School of Dentistry.

Dr. Richard Eidelson

“Today’s dentistry is not just the handson learning and academic skills taught in dental school. It has evolved with the fast pace of a digital world, and we must keep up,” Dr. Eidelson added. He continued his personal education and teaching while operating his implant and cosmetic dentistry practice and hosting, “Open Your Mouth” on WABC in New York. Dr. Eidelson says he’s taken the time and worked hard to achieve the success he has today. “The growth of a dental practice is exponentially impacted by a combination of information, clinical skills, and the implementation of new techniques, as well as the application of tried-and-true older techniques of classical dentistry,” Dr. Eidelson stated. “When a dentist applies what he/she has learned and continues to learn, growth will happen. It’s made a difference in my practice.”

Giving back globally

In 2017, Dr. Eidelson was part of a team of 25 top dentists from all over the United States who travelled to Santo Domingo, where they performed 800 dental implants 6 Implant practice

When Dr. Eidelson describes his travels around the world to familiarize himself with teaching techniques in the Dominican Republic, Tokyo, Austria,

and across the United States, he says it’s an honor to learn the methods used in the dental industry worldwide. It inspired him to do more globally and join a team of 25 top dentists in the U.S. to travel to Santo Domingo. There the team performed 800 dental implants in 1 week to help patients in need. Dr. Eidelson’s next goal, after completing this mission, was to fill a void in areas that needed top speakers and educators in the dental industry. He created the Communication Internet Learning (CIL) Institute. Its mission is to expose dentists to new trends and the expertise of various clinicians and product developers who improve the delivery of patient care. In addition to the CIL, Dr. Eidelson developed the Philly Dental Splash to bring together educators, prominent speakers, and dental companies from across the U.S. All of these efforts to learn and give back have not gone unnoticed. Dr. Eidelson received a Fellowship Award from the Academy of General Dentistry — a status that only 3% of dentists have achieved. “Success won’t happen overnight, but it’s possible by taking pride in customer service, learning, and giving back,” Dr. Eidelson said. IP This information was provided by Karl Schumacher Dental.

Volume 11 Number 3

CONFIDENCE IN YOUR HANDS

Karl Schumacher understands when you desire primary closure, optimum outcomes rely on efficient and effective protection of the graft.

For that reason,

WE ARE PROUD TO INTRODUCE: PrecisPoint™ Sutures o Reduced needle breakage & tissue drag o Proven to stay sharper longer

PrecísPOINT SUTURES TM

Premium Surgical Wound Closure

RCMD DRAPE™ Membrane o Soft and very drapable o Repositionable for precise placement o Does not stick to instruments

NEE0007T Castro-Viejo Twist-Joint Needle Holders o Tungsten Carbide inserts provide secure grip of needle o No snags & no breaks

Enter CLOSURE20 at website checkout to receive 20% off any Karl Schumacher Needle Holders, Sutures and/or Membranes

(800) 523-2427

w w w.karlschumacher.com

CORPORATE PROFILE

Welcome to Karl Schumacher We specialize in great surgical outcomes.

The Karl Schumacher team exhibiting at the 2017 Yankee Dental Congress Convention

n a convenience-oriented, one-size-fits-all world, people have come to realize that niche markets and specialties matter. After all, your patients go to a specialist when they need an expert, and we believe you should, too. Welcome to Karl Schumacher. We’re the specialist’s specialist. We know you’ve come a long way — from dental school, to residency, to opening your own practice. You are incredibly proud of what you’ve built. You knew early on that this is what you wanted. But nothing has come easy — you’ve had to work for everything you’ve accomplished. And because of that, you always knew the type of doctor you wanted to be; one that did it the right way, for the right reasons. You don’t cut corners; you pay specific attention to details; you do not skimp on equipment or modern technology. And why? Because it really is about your patients and their overall health. 8 Implant practice

And they come to you for a reason. You are a specialist. You are too humble to admit it, but you change lives. You literally create smiles. You love it, but the stakes are high. A lot is expected of you and your special skills. And you have the same expectations for the brands you use because they are an extension of your education, talent, and passion. They’d better be special because that is the essence of who you are and how you treat your patients and staff.

These are the reasons why we’ve spent the last 70 years perfecting all of our product offerings. All of our instruments are designed to give you the confidence you need to create a great surgical outcome every time you perform a procedure — nobody invests in the specifics of you as we do. And while we could stop with highperformance instruments, we don’t think that’s enough in today’s world. We feel the word outcome has a much broader meaning Volume 11 Number 3

ExcaliBur™ Premium Burs

“Compared to all the other instruments that we’ve had in the office, nothing equals the quality of the Schumacher instruments.”

than it once did. Today, the word outcome refers to end-results of all types, including education, phenomenal ordering experiences, flawless customer service, warranties that matter, and relationships that are technology-driven, but human-based. That’s why when you go into a surgical procedure, we’ll make sure the instrument in your hands and the service you get along the way is an asset, not a liability. Congrats on your journey so far. Let us be a part of where you go next, and together we can create great surgical outcomes and smiles together.

Experience the benefits of buying direct — we don’t use distributors We’ve been selling high-end instruments direct to dentists since our company’s inception, and we continue to guarantee that quality with a warranty on all instruments, a sharpening and repair program, and a lifetime warranty on all dental extraction forceps. This is our way of ensuring we stand behind the instruments and products we offer. Because you can buy directly from us, either online or through your regional account manager, you’ll get a level of engineering and service you won’t get through a distributor, including: Competitive warranties on all of our products We guarantee our craftsmanship to be free of material defects. We offer a lifetime guarantee on our Extraction Forceps that is truly unconditional. All other instruments are guaranteed for 1 year against breakage, assuming proper use. If your Karl Schumacher instrument is under warranty, our highly skilled technicians will determine if the product can be repaired to function comparable to a new instrument, or if the instrument should be replaced. Volume 11 Number 3

– Dr. Jay Reznick, DMD, MD

Continued sharpening on all applicable instruments Our skilled technicians have years of experience in sharpening and will make your instruments like new. We offer free sharpening services within the warranty time frame. This means that over the lifetime of Karl Schumacher Extraction Forceps, and within the first year for all other tools, sharpening is available at no cost. Sharpening services are available for a fee on any dental instruments no longer under warranty, including instruments sold by other brands. We are committed to maintaining the integrity and precision of dental instruments, and will only repair those that can be made to function comparable to a new instrument. For example, our team will reshape the metal on an instrument, but we will not add new metal. If our team determines your Karl Schumacher instrument is irreparable and still under warranty, we will replace the instrument at no cost to you. Knowledgeable Customer Care team to answer questions and act as an advocate for your dental practice Our Customer Care team is dedicated to your success and has extensive product training on all Karl Schumacher product offerings. Whether you have a question about your order or are looking for the next instrument to make an impact at your practice, we’ll be there to guide you along the way.

Premium surgical instruments that doctors depend on As we continue to work with leading

dentists, we constantly research new products to add to our line of high-quality instruments to meet the changing demands of dentists today. We feature a collection of innovative instruments that have changed the way dentists perform surgeries forever. Below are a few of our featured product offerings. Proximator® The Proximator is the ultimate atraumatic extraction instrument that combines the sharp, thin working-edge of the Periotome and the strength of the Luxating Elevator. Designed for severing the ligaments in the periodontal space, the Proximator eliminates the need for traditional elevation and creates a larger path of delivery for the root structure while at the same time protecting the fragile buccal wall. ExcaliBur™ Premium Burs Designed for optimum strength and durability, ExcaliBur Premium Burs are proven to cut up to 2.5 times faster than competing burs. Their superior construction offers a fast, smooth, vibration-free performance that reduces patient discomfort and procedure time. RoBa™ Extraction Forceps RoBa Extraction Forceps are the next generation of atraumatic extraction forceps. They feature the best attributes of the Apical Retention Forceps and the deep, heavy serrations of the Kratzman elevators to prevent root fracture, prevent slipping during luxation, and increase subgingival access. Implant practice 9

CORPORATE PROFILE

Proximator®

CORPORATE PROFILE RoBa™ Aetranox™ Edition Extraction Forceps RoBa Aetranox Edition Forceps feature all the benefits of RoBa Extraction Forceps with the added benefits of a proprietary Aluminum-Titanium-Nitride coating that is significantly harder, scratch-resistant, and non-reflective for long-lasting performance. The increased hardness created by the Aetranox surface treatment ensures longterm integrity of both the beak serrations and forceps overall. Diamond RoBa™ Extraction Forceps Diamond RoBa Extraction Forceps feature all the benefits of RoBa Extraction Forceps with the added benefit of custom diamond-coated tips that provide a radically superior grip in all applications, including wet conditions. The increased friction from the diamond particles ensures better engagement and reduces the potential for fracture, shortening operative time.

We’re more than an instrument company As we continue with our mission of creating great surgical outcomes for doctors and patients alike, we’ve expanded our product offerings to include premier regenerative products that complement our highend instruments. Allograft For use in oral surgical applications, socket preservation, periodontal defect regeneration, dental implant bone regeneration, sinus lifts, and ridge augmentation procedures, all of our allograft tissue

RoBa Extraction Forceps (left), RoBa Aetranox Edition Extraction Forceps (middle), and Diamond RoBa Extraction Forceps (right)

“The quality and consistency of the particulate is really a cut above.” – Dr. Robert J. Mikhli, DDS

Allograft 10 Implant practice

Volume 11 Number 3

CORPORATE PROFILE

PrecísPOINT™ Sutures

is recovered in the United States under the most stringent screening and testing protocols. Our allograft is available in both particulate and flowable syringe (putty and paste) formats. Xenograft We offer both a Xenograft-derived bone graft matrix and a synthetic calcium phosphate bone graft matrix. Structure and

porosity are two parameters evaluated and optimized in the development of the bone graft matrices. Our Xenograft is available in a jar or syringe. PrecísPOINT™ Sutures Minimize the degree of surgical trauma by using needles that are sharper than the leading brand. Independent testing data shows that when using PrecísPOINT Sutures during wound closure, less force is needed to penetrate the tissue, reducing the worry of needle breakage and tissue drag.

Beyond products — continuing education: our commitment to doctors We maintain our mission of creating great surgical outcomes not only through our highend surgical instruments and products, but also through a wide variety of continuing education courses. We partner in continuing education courses available throughout the country that feature clinicians who choose Karl Schumacher products every time they perform a procedure.

Xenograft Volume 11 Number 3

The end result: confidence in your hands When it’s all said and done, you require specific confidence in all parts of your professional life, which results in less stress and ultimately powers your unique ability to deliver the best surgical outcomes. By letting us work with you, we promise: • Unique products, education, service, and experiences that inspire specific confidence in your ability to change the lives of your patients. • A specific and tailored approach to product design and customer experiences that serve your unique needs in the oral surgery space. • A human and honest approach that lets you know we are with you all the way. • A direct, ongoing relationship in which we’ll continue to act as an advocate for your dental practice long after your first purchase. The best relationships never allow anyone to get in the middle. Work directly with us, and get the attention you deserve. Visit KarlSchumacher.com or talk to your regional account manager today, and gain an unrivaled confidence when you go into your next surgical procedure! IP This information was provided by Karl Schumacher Dental.

Implant practice 11

CASE STUDY

Predictable immediate guided implant placement and restoration within your practice Dr. Ara Nazarian discusses materials and methods that can help fulfill patients’ surgical and restorative needs

hen a patient presents to your dental practice with questionable and/ or non-restorable teeth requiring full mouth extractions, the biggest concern is whether or not implants can be placed at the same surgical visit and, if so, if the patient will be able to walk out with fixed teeth. Having the ability to place implants within your practice allows you to load or progressively load, so you can meet the needs of these particular patients; this lets you position your practice on a whole new level. Of course, certain parameters must be met in order to facilitate this type of treatment. This includes, but is not limited to, the quality and quantity of bone, the presence of infection, the patient’s health, and the skills of the dental provider. Additionally, the selection of the most appropriate materials for the most ideal situation must be met. A patient presented to my practice for a consultation wanting to restore his dentition to proper form and function (Figure 1). He complained of generalized discomfort in these teeth due to the gross caries and periodontal disease that were readily apparent (Figures 2 and 3). There were several teeth in both arches, which had so much extensive decay, that only the root tips were apparent upon clinical examination. Also, there was hyper-eruption in certain areas of his posterior dentition, as well as a deep impinging bite in the anterior.

Planning The clinical evaluation included information regarding lip length and support, Ara Nazarian, DDS, DICOI, maintains a private practice in Troy, Michigan, with an emphasis on comprehensive and restorative care. He is a Diplomate in the International Congress of Oral Implantologists (ICOI) and the director of the Ascend Dental Academy. He has conducted lectures and hands-on workshops on esthetic materials, grafting, and dental implants throughout the United States, Europe, New Zealand, and Australia. Disclosure: Dr. Nazarian is a Key Opinion Leader for Carestream Dental.

12 Implant practice

Figure 1: Preoperative retracted frontal view

Figure 2: Preoperative maxillary occlusal view

Figure 3: Preoperative mandibular occlusal view

existing tooth position of the natural teeth, occlusion, restorative space, and phonetics. In addition, digital images of frontal, side, and occlusal views of the dentition as well as facial shots were captured with a Nikon D7200 (Photo Med). A CBCT scan and panoramic radiograph were taken using the CS 8100 3D (Carestream Dental) (Figures 4 and 5) to accurately capture the information needed to properly treatment plan this case ensuring the most ideal outcome, especially since the patient discussed his frustration with previous treatment that did not last very long or address his primary needs or requests. Using the CS 3D Imaging software (Carestream Dental), dental implants were

virtually planned in key positions in both maxillary and mandibular arches (Figure 6). To further develop a treatment plan, diagnostic model impressions were taken using Panasil® (Kettenbach) heavy and light body polyvinyl siloxane impression material (Figures 7 and 8), poured up and forwarded to the dental lab. These models were then mounted on an articulator (Stratos® 100, Ivoclar Vivadent) for further analysis in order to meet the patient’s esthetic and functional needs. Financing options using a third-party payment option (Lending Club) were discussed with the patient. This discussion was a very important part of facilitating acceptance of his care, since it made the cost of treatment more feasible. Volume 11 Number 3

IMPLANTING CONFIDENCE

WORKFLOW INTEGRATION I HUMANIZED TECHNOLOGY I DIAGNOSTIC EXCELLENCE

With open-format image files, implant planning has never been easier. Carestream Dental’s digital imaging and implant planning software simplifies your workflow, allowing you to easily scan your patients and plan the implant placement. Plus, integration with third-party surgical guide software makes placing implants easier than ever.

For more information, call 800.944.6365 or visit carestreamdental.com

CASE STUDY

Figure 4: CS 8100 3D

A 3D virtual treatment plan was further developed from our planning with the CS 3D imaging software and integrating with the photos and models with the assistance of 3DDX (Figure 9). A virtual online integrative meeting with 3DDX allowed for a comprehensive review of the assembled digital and clinical information formulating an optimal treatment plan that would fulfill the necessary requirements for esthetics, form, and function. The implants that would be utilized for this case were OCO Biomedical’s Engage™ dental implants. These implants are known for their unchallenged high implant stability at placement, which is a critical success factor in these immediate load cases. With the combination of their patented Bull Nose Auger™ tip and Mini Cortic-O Thread™, the Engage™ implant system offers practitioners a bone level implant with high initial stability for selective loading options. The Engage™ implant is self-tapping for an enhanced mechanical lock in the bone. The Bull Nose Auger™ tip will not proceed any deeper than the initial pilot drill preparation locking into the base of the osteotomy. Engage™ implants have a proprietary surface treatment designed to increase the surface area of the implant for optimal bone in-growth and stability. Once the virtual plan was orchestrated and fully confirmed, the next appointment would be the planned surgery. The patient was appropriately sedated with IV medications, and local anesthesia was administered in both arches. The maxillary teeth were atraumatically extracted utilizing the Physics Forceps™ (GoldenDent). The tissue was then reflected using the Reflector (GoldenDent) instrument, so that the bone leveling surgical guide (3DDX) would be fully seated and fixed with its respectful retention pins (Figure 10). 14 Implant practice

Figure 5: Preoperative panoramic image

Figure 6: Proposed treatment planned in CS 3D Imaging software

Figure 7: Maxillary impression (Kettenbach)

Figure 8: Mandibular impression (Kettenbach)

Figure 9: 3DDX virtual treatment plan maxilla/mandible

Figure 10: Maxillary bone leveling guide Volume 11 Number 3

CASE STUDY

Figure 11: Maxillary implant surgical guide

Once the appropriate bone leveling was accomplished with the surgical handpiece, the universal implant surgical guide was positioned into the bone leveling guide, and the sites for the implants were initiated with a designated 1.8 mm pilot drill in its appropriate key from the OCO Biomedical Guided Kit (Figure 11) utilizing the Mont Blanc surgical handpiece and AsepticoÂŽ surgical motor (AEU 7000) at a speed of 1200 rpm with copious amounts of sterile saline. Sequential osteotomy formers and keys from the OCO Biomedical Guided Kit were then used to shape the final osteotomies. Once the osteotomies were complete, a rotary implant driver was used to place the dental implants until increased torque was necessary (Figure 12). The ratchet wrench was then connected to the adapter, and the implants torqued to final depths reaching a torque level of about 40-50Ncm. A baseline ISQ reading was taken of these implants utilizing the Penguin (Aseptico) RFA unit. Since the initial readings were

Figure 14: PMMA maxillary/mandibular restorations 16 Implant practice

Figure 12: Engage (OCO Biomedical) dental implant

Figure 13: Implants with corresponding multiunit abutments

Figure 15: Insertion of provisional restoration Volume 11 Number 3

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CASE STUDY

Figure 16: Mandibular bone leveling guide

all above 70 and the quality of bone after leveling was good, multiunit abutments (OCO Biomedical) were tightened into the Engage (OCO Biomedical) dental implants at 25Ncm followed by temporary cylinders at 15Ncm. Any residual areas around the implants or in the sockets were grafted with a cortical mineralized and demineralized bone grafting material to optimize the area for regeneration (Figure 13). The prefabricated immediate provisional arch restorations (3DDX) with pre-drilled access openings were inspected before being tried in (Figure 14). The maxillary provisional restoration was tried in to verify a passive fit over the temporary abutments. Once confirmed, a polyvinyl siloxane gasket was placed to avoid the restoration (Figure 15) from locking on during the relining procedure with REBASE II Fast Set (Tokuyama®) hard reline material. After the material polymerized, the immediate provisional restoration was removed and any access material removed with the Torque Plus (Aseptico) lab handpiece and acrylic bur (Komet). The same procedures were accomplished in the lower arch (Figures 16, 17, 18); however, while the provisional restoration was being trimmed and polished, the mandibular tori were surgically removed before suturing the soft tissue. Once trimmed and polished, the provisional arch restoration was seated and tightened with a torque wrench at 15Ncm. The access openings were filled three-quarters of the way with Teflon tape followed by Cavit™ (3M) filling material. Seven days postoperatively, the patient returned with very little discomfort, swelling, or bruising. He was very pleased with his new upper and lower fixed provisional restorations (Figures 19 and 20). Now that the patient was no longer anesthetized, the occlusion was checked again to confirm there were no interferences in lateral and protrusive movements. The next step in his treatment will consist of full arch impressions for the definitive restorations approximately 4 to 5 months postoperatively. 18 Implant practice

Figure 17: Mandibular implant surgical guide

Figure 18: Implants with corresponding multiunit abutments

Figure 19: Maxillary and mandibular fixed provisional restorations

Figure 20: Postoperative panoramic image

Conclusion Having the ability to take a patient from start to finish with fewer appointments within your practice allows you to position yourself as a provider that can fulfill your patients’ surgical and restorative needs. With the proper training and appropriate materials, a dental provider may provide extraction, grafting, and implant placement within one appointment at one location. Not only does this allow you to reduce the amount of visits for the patient,

but this type of service also helps maintain the cost to the patients since they are not seeing multiple dental providers. Most importantly, this enables the dental provider full control of the surgical and prosthetic outcome. Depending on the patient’s desires, the clinical conditions of the oral environment present, and the skills of the provider, a dentist may choose to extract teeth, level bone, and graft with guided dental implant placement within his/her dental practice. IP Volume 11 Number 3

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PRACTICE MANAGEMENT

Communicating change in the dental practice Catherine Cheshire, SPHR, discusses the importance of keeping employees informed

ost of us go to great lengths to manage communications with patients and referring dentists. Nurturing your internal messaging for your practice team is mission-critical too, especially during times of growth and change. Regular, transparent, and considerate messaging keeps your team engaged and keeps your practice’s culture thriving. Especially if your crew is growing, or some kind of organizational change is afoot (such as adding a satellite office or new employees), it’s time to get strategic about internal communication. In our technology-filled lives, every day, we live and breathe the power of messaging. So we take note of the immediate impact and the on-going ripple effect communications have within our own workspace. If any lesson rings the truest during times of growth and transition as well as in an everyday well-run practice, it’s that communicating any kind of change, and keeping communication constructive when you grow, requires a good and proper plan. Three company culture steps are needed to be sure that your team is ready to receive your messaging.

1. Align your leadership ... and gather intel You need buy-in from your practice team, both the office and the clinical associates. Make sure you have a connected team that gets the “why” behind the changes. Support your leaders, and show them their place in the practice’s future. Your team is critical to the success of your communication strategy. You need them to be ready to reinforce the practice’s internal messaging and to embody

Catherine Cheshire, SPHR, is a people operations and communications consultant, specializing in executive and employee coaching, culture development and employer branding. As a certified practitioner in the Coaching Mindset Index, she helps managers develop self-awareness and enhance their effectiveness as coaches. She has over 10 years of experience as an HR and communications executive, and has a degree in Psychology. You can reach Catherine Cheshire through LinkedIn or via email: catcheham@gmail.com

20 Implant practice

Regular, transparent, and considerate messaging keeps your team engaged and keeps your practice’s culture thriving. the company culture. Integrate their experience and opinions about your operation and communications — they will be critical in helping you with the next step.

2. Create a culture of communication You already have a communication culture in your company. But is it a good one? When you bring a message of change to your team, is your message going to be received from a place of established respect and openness? It’s time to assess where your communications stand. Take a look at how communication flows through your practice. Break down your info-share into “bottom-up” and “top-down” methods. Bottom up: Is there a stronger tendency for your team to communicate upward to the owner/clinician or the office manager, rather than the other way round? For example, do you have feedback programs or open-door managers always ready for questions and employee feedback?

Top down: Does most information filter down from the top to the team? For example, internal emails from management and clinician/office manager intranet updates? Ask your team what communication channels are working, which aren’t, and which are missing. Will your current methods continue to work in your new world order? This includes, a move, addition of a satellite office, or expansion of a current practice? And are those pathways and communication styles constructive? A practice with an organic and non-formalized communication style might find itself stuck when a new hierarchy is introduced or new folks are added to the mix. You might be consumed with new patients and new hires, with a mess of crossed messages, yet-to-be-written processes, and good intentions. You need to identify how your messages will be best communicated to your team, and create a proactive schedule that preemptively Volume 11 Number 3

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PRACTICE MANAGEMENT answers questions you know are coming. And then you need to be ready for the questions you didn’t foresee.

3. Give your team a voice Sounds elementary? Most of us who are into employee engagement in the modern era assume that our team is heard. The truth is that is not always the case. Consider those personalities who don’t speak up — ever. Consider the workplace whirlwind. As you grow, or there is a period of uncertainty, make sure you are ready to hear your team. Set the importance of team input and feedback as a culture priority. And remember to prep your leaders to foster an atmosphere of openness and real communication (you might need to source some coaching!) You want to make sure that information is being shared from the top effectively, and that your team’s valuable inputs are heard and acted on. There’s a recent trend for companies to turn top-down communication on its head. Many company-wide meetings are taking on the traditional townhall approach — a short leader-led presentation followed by ample time for questions and comments from the team. The result? Cohesive, high-morale, highfunctioning companies where ground-level business intelligence is making its way to the top, and making them better.

Be patient while everyone adapts Establishing new behaviors takes time. It can take months for your team to get the hang of asking questions, especially if they are not used to doing so. If it feels like a slow start, stay the course! Be consistent. Encourage feedback — and provide different communication pathways for different personalities. Follow up on that feedback. Act on it, fast, and always reply — as you would for a patient. IP Originally published on Bigsea.co.

22 Implant practice

Key traits to develop your communications Know yourself and your goals. What are your practice’s core values? What are its goals? Integrate what will remain the same, or how the changes reinforce and support the company mission. If there is a culture change afoot, explain how things will be different and why. Be considerate, meaningful, and genuine. Ask yourself and your leaders what impact your team members experience as a result of the changes — operationally, financially, personally, and interpersonally. How will teams and individuals fit into the changes? Note those impacts, and address them in your communications. Deliver clarity and transparency. People are more likely to get onboard if they are treated with respect, and they see the reasoning behind the decisions. Share your business intelligence and clarify how that information links to your mission. What are your expectations of the team? Provide (and communicate) structure and support your people for success. Make updates regular and timely. Foster the expectation that you will be forthcoming with updates and feedback. Surprises are for birthdays, not for major life changes. Put your team communications on a schedule, and hold yourself or your office manager to it. Your people will come to know they can expect an on-going stream and trust you all the more for it. Think about the timing of the information you are sharing. Are you prepared to follow up with updates or lack of updates, and to handle the questions that follow? Are you being transparent while at the same time taking care not to overburden your team with too much information? Say thank you. Recognize the challenges, the sacrifices (family impacts, disruption, comfort zone bursting). Share the tangible results and accomplishments that result from the team’s rally. Who has been instrumental in your recent positive change, or who has helped you go through the challenges — whether it’s teams or individuals, take time to recognize those contributions in a way that is beneficial and meaningful to them. Loop it back! Feedback is your friend. (Constructive) feedback/rich environments are where truly cohesive teams emerge. Establish a means for the team to ask questions, share information to you from the ground. You’ll gain critical insight, and your team will be heard — it’s a base requirement that is directly related to performance and positive associations. Communicating uncomfortable change can be hard. Positive change can come with challenges too, especially if there is confusion from half-baked communication, or parts of your team are going to meet new challenges without the support or resources they need. The good news is that a people-first communication strategy primes you for better understanding between you and your team, and the opportunity to course-correct as you receive feedback. And the ultimate result of people-first communications? A practice team that understands and buys into your mission, stronger engagement, and a vibrant, intact corporate culture. Here’s to your growth!

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CONTINUING EDUCATION

Full arch implant restoration with immediate loading Dr. David Murnaghan describes a challenging implant case that needed a thorough understanding of implant protocols and modern technology to meet the patient’s high expectations

69-year-old female patient presented to the practice in September 2015. She was very nervous of the dentist, had lapsed from attending any dental practice over long periods, and was a smoker. She presented with a failed upper dentition and many failing lower teeth, due to periodontal disease. Unfortunately, following initial assessment, it was determined that the upper teeth had a hopeless prognosis and required a full clearance. Some of the lower teeth also required removal, and this was carried out alongside rigorous periodontal treatment. Quality of life and success depend greatly on patients’ expectations, which can vary dramatically in differing populations (McGrath and Bedi, 2002; 2003). Today, people expect the dental profession to be able to provide restorations beyond dentures. Dentists, therefore, have to try either to live up to and deliver patients’ expectations or explain why it is not possible at the outset, while keeping them happy. Of course, it is not possible to keep everyone happy all of the time, and it can be a balancing act when ensuring we are not applying treatment protocols that could be detrimental to a patient’s health or dentition. Possible treatment options for this patient following a full upper clearance were: • A full upper denture • An implant-retained denture • Four implants with precision attachments or a bar with a full denture as an interim prosthesis • Fixed teeth • Six to eight implants alongside a sinus lift with a delayed approach Dr. David Murnaghan qualified from Queen’s University Belfast in 2006. He completed a yearlong implant certificate in 2007 and also holds an advanced esthetic dentistry certificate from the Eastman UCL. He became a member of the Joint Dental Faculties RCS (Eng) in 2010. Dr. Murnaghan is director of the Northern Ireland Division of the Faculty of the Royal College of Surgeons England. In 2012, he set up Boyne Dental and Implant Clinic, which was voted Best New Practice in Ireland 2016. He has been mentoring local practitioners within the implant field for over 5 years. Dr. Murnaghan won the Rising Star award at the Irish Dentistry Awards 2017. Disclosure: Dr. David Murnaghan lectures for BioHorizons.

24 Implant practice

Educational aims and objectives

The aim of this article is to describe the protocol for an immediately loaded full arch fixed restoration case while showing how to manage patient expectations.

Expected outcomes

Implant Practice US subscribers can answer the CE questions on page 27 to earn 2 hours of CE from reading this article. Correctly answering the questions will demonstrate the reader can: •

Identify this protocol and the requirements for its success.

•

See possible treatment options for this type of condition.

•

Identify the amount if implants that would be advantageous or not for this type of treatment.

•

Identify some prosthetic solutions for this type of treatment.

Figure 1: Original smile

Figure 2: Initial retracted view

Figure 3: Initial occlusal view

Figure 4: Planning CBCT scan

using a full denture as an interim prosthesis • Four implants designed to allow immediate loading, if the implants could be adequately retained with 35Ncm torque in the bone, or delayed restoration with an interim full denture. The patient was very clear from the outset that she wanted to avoid removable teeth, if possible. Fixed teeth, of course, have

the disadvantages of being more complicated to keep clean and more expensive, but the advantages of increased comfort, confidence, and quality of life. However, it is also important to note that adaptation to speech can be an issue, especially when progressing from full dentures. The patient was advised that she had to stop smoking and show commitment in the form of several hour-long periodontal appointments with the hygienist before Volume 11 Number 3

a fixed option could be considered. The patient showed the necessary commitment, which was supported by reduced bleeding scores, after which a higher risk option of TeethXpress® (BioHorizons®) was discussed; namely, extracting all the teeth that needed to be removed, placing all the implants in strategic positions, and fixing a prosthesis screwed into place in a single day.

How many implants? Traditionally, five to six implants would be placed to restore a fixed arch. An alternative, recognized treatment plan originally designed by Paulo Malo using an All-on-4® concept with angled distal implants has been widely used now for more than 20 years.

Figure 7: Provision prosthesis occlusal view

Figure 8: Provisional smile Volume 11 Number 3

The biomechanics of this treatment indicate that the most important factor is not the number of implants but the anterior-posterior (AP) spread of implants (Belivacqua, et al., 2011). Studies have indicated that four versus five implants show no increase in success or reduce complications. It has been said that you can have an All-on-4 but not “all-on-three”; therefore, it is more prudent to place five implants for security. However, a lot of the time, if an implant fails when five were originally placed, it will not act like an All-on-4. This is because the implants will not be in the same strategic position, and therefore, it will be no better than an “all-on-three” (Brunski, 2014).

Choosing the best option When choosing a prosthetic solution, there are several pertinent decisions to be made: • Screw access trajectory — ideal versus non-ideal • Restorative space — acrylic versus ceramic • Opposing occlusion — natural, denture or implant • Arch — maxilla or mandible • Force — high or low

• Speech — possible adaptation challenges • Oral hygiene — commitment to preventive care • Esthetic demand — high or low • Cost As the screw-access trajectory would not be ideal here, multi-unit abutments would be needed to ensure a screw-retained prosthesis. Vertical space would therefore need to be created. The sites would need to heal, and thus, the situation was not ideal for immediate implant head placement. Because of this, an acrylic superstructure was decided upon, to ensure good “pink and white” esthetics. The opposing dentition was mixed restoratively, and therefore, suitable for the less abrasive acrylic. Forces were judged to be moderate from the failed dentition’s mild tooth wear.

Treatment In November 2015, following smoking cessation, extensive oral hygiene instructions, and periodontal treatment, all of the patient’s upper teeth were removed. The sockets were debrided and all granulation tissue removed to ensure only healthy bone was remaining.

Figure 9: Healed occlusal view Implant practice 25

CONTINUING EDUCATION

Figure 6: Occlusal view of titanium cylinders

Figure 5: Planning image from CBCT scan

CONTINUING EDUCATION

Figure 10: Final occlusal view

Figure 12: Final retracted view

Figure 11: Final prosthesis

Figure 13: Final smile

Figure 14: Final smile

TeethXpress is a biomechanically stable, immediate load, and function protocol for fully or partially edentulous patients that use BioHorizons tapered implants with LaserLok technology to provide primary stability for immediate load. More information is available from BioHorizons (www.biohorizons.com). Figure 15: Radiographs of osseointegrated implants 26 Implant practice

Distal implants (BioHorizons tapered internal Laser-Lok速 4.6 mm x 12 mm) were strategically used following planning from a CBCT scan to utilize anterior-posterior spread and avoid the sinuses. Anterior implants (BioHorizons tapered internal LaserLok 3.8 mm x 12 mm) were placed beyond the apex of the original teeth (following bone reduction), utilizing deeper bone and creating space for the restorative components. To improve the emergence profile of the implants, 17 multi-unit abutments were torqued at 35Ncm. Titanium cylinders were then fitted at 15Ncm to bond to an acrylic denture with cold-cure acrylic. The dental technician (Michael Allison of Gordon Watters Laboratory) attended on the same day and assisted with the pickup of the acrylic denture and reformation of it to a neater, more comfortable prosthesis. The fixed denture was torqued at 15Ncm, screw access holes were protected by PTFE tape, and sealed with Fuji IX. The patient was instructed to stick to a soft diet for 2 months and to use chlorhexidine-based PerioKin速 gel and Kin速 gingival mouthwash (Kin) to assist with antibacterial cleaning. The patient was then left to heal for 2 weeks, after which the sutures were removed and the healing process checked. This was left for a further 3 months to allow for healing maturation and osseointegration to take effect. Following 3 months of osseointegration, impressions were taken of the existing bridge in situ, as well as a special open tray impression with Heraeus Kulzer putty, plus a wash impression of the multi-unit copings. The patient was restored definitively in March 2016 and has attended the hygienist every 3 months since placement. The bridge will be removed annually for a deep clean by the hygienist. In between appointments, the patient uses a Waterpik速 Complete Flosser twicedaily to clean effectively. The patient has reported greatly improved comfort during function, and her confidence has increased dramatically. IP REFERENCES 1. Belivacqua M, Tealdo T, Menini M, et al. The influence of cantilever length and implant inclination on stress distribution in maxillary implant-supported fixed dentures. J Prosthet Dent. 2011;105(1):5-13. 2. Brunski JB. Biomechanical aspects of the optimal number of implants to carry a cross-arch full restoration. Eur J Oral Implantol. 2014;7(suppl 2):S111-S132. 3. McGrath C, Bedi R. Population based norming of the UK oral health related quality of life measure (OHQoL-UK). Br Dent J. 2002;193(9):521-524. 4. McGrath C, Bedi R. Measuring the impact of oral health on quality of life in Britain using OHQoL-UK(W). J Public Health Dent. 2003;63(2):73-77.

Volume 11 Number 3

The FMC is designated as an Approved PACE Program Provider by the Academy of General Dentistry. The formal continuing education programs of this program provider are accepted by the AGD for Fellowship/Mastership and membership maintenance credit. Approval does not imply acceptance by a state or provincial board of dentistry or AGD endorsement. The current term of approval extends from 12/1/2016 to 11/30/2018. Provider ID# 325231

Each article is equivalent to two CE credits. Available only to paid subscribers. Free subscriptions do not qualify for the CE credits. Subscribe and receive up to 16 CE credits for only $149; call 866-579-9496 to subscribe today. To receive credit, complete the 10-question test by circling the correct answer, then either: n Post the completed questionnaire to: Implant Practice US CE 15720 N. Greenway-Hayden Loop. #9 Scottsdale, AZ 85260 n Fax to (480) 629-4002.

REF: IP V11.3 MURNAGHAN

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To provide feedback on this article and CE, please email us at education@medmarkmedia.com Legal disclaimer: The CE provider uses reasonable care in selecting and providing accurate content. The CE provider, however, does not independently verify the content or materials. Any opinions expressed in the materials are those of the author and not the CE provider. The instructional materials are intended to supplement, but are not a substitute for, the knowledge, skills, expertise and judgement of a trained healthcare professional.

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Full arch implant restoration with immediate loading MURNAGHAN

1. Fixed teeth, of course, have the disadvantages of being more complicated to keep clean and more expensive, but the advantage(s) of _______. a. increased comfort b. confidence c. quality of life d. all of the above 2. It is also important to note that adaptation to ______ can be an issue, especially when progressing from full dentures. a. speech b. eating c. sensation d. hygiene 3. Traditionally, ______ implants would be placed to restore a fixed arch. a. one to two b. three to four c. five to six d. seven to eight 4. An alternative, recognized treatment plan originally designed by _______ using an All-on-4® concept with angled distal implants has been

Volume 11 Number 3

widely used now for more than 20 years. a. Leonard Linkow b. Paulo Malo c. Victor Sendax d. Per-Ingvar Brånemark 5. The biomechanics of this treatment indicate that the most important factor is not the _______ but the anterior-posterior (AP) spread of implants. a. brand of implants b. material of implants c. number of implants d. cost of implants 6. It has been said that you can have an All-on-4 but not _______; therefore, it is more prudent to place five implants for security. a. “all-on-one” b. “all-on-two” c. “all-on-three” d. “all-on-six” 7. (For this specific patient) In November 2015, following ________, all of the patient’s upper teeth were removed. a. smoking cessation

b. extensive oral hygiene instructions c. periodontal treatment d. all of the above 8. ________ to ensure only healthy bone was remaining. a. The gums were palpated b. The sockets were debrided c. All granulation tissue was removed d. both b and c 9. (For this patient ) Distal implants (BioHorizons tapered internal Laser-Lok® 4.6 mm x 12 mm) were strategically used following planning from a/an _____ to utilize anterior-posterior spread and avoid the sinuses. a. intraoral photograph b. 2D film radiograph c. panoramic X-ray d. CBCT scan 10. To improve the emergence profile of the implants, 17 multi-unit abutments were torqued at ______. a. 20Ncm b. 25Ncm c. 35Ncm d. 45Ncm

Implant practice 27

CE CREDITS

IMPLANT PRACTICE CE

CONTINUING EDUCATION

Managing the failing dentition Dr. Komal Suri discusses the principles of smile design when dealing with an aged dentition with multiple restorations

ncreasingly, the numbers of patients walking through the doors of our practices are those whose dentition is slowly in decline. I am presented on a daily basis with patients requiring replacement of missing teeth, restoration of worn and discolored teeth, and those whose teeth are mobile and would like to be able to function adequately. Often patients are only aware of the localized area of failure and are focused on addressing only that area of their mouth; one or two mobile teeth, one or two spaces that need to be filled, worn and discolored anterior teeth. As the experts, it is our responsibility to provide the patients with a solution to their problem that will have longevity, predictability, and not accelerate the deterioration of the surrounding dentition and supporting structures. Longevity and predictability of the treatment arise not only from the restoration itself but also dealing with the cause of the breakdown and deterioration so that the restoration that has been provided for the patient does not fail in the same way as the natural tooth. This needs to be explained to the patient at the initial consultation so that they can understand why a thorough assessment and diagnosis is required. In my experience, patients invariably agree with the rationale and understand that detailed examination is necessary in order to determine the correct treatment plan for them. This allows for the practice of comprehensive dental treatment and may involve a multidisciplinary approach when necessary.

The role of occlusion When assessing the mode of failure of any dentition, it is advisable to try and determine the root cause of the problem and

Educational aims and objectives

The aim of this article is to describe the key aspects of treatment planning for aging patients with failing dentition.

Expected outcomes

Implant Practice US subscribers can answer the CE questions on page 33 to earn 2 hours of CE from reading this article. Correctly answering the questions will demonstrate the reader can: •

Recognize the importance of planning for occlusal interference when treating patients with dental implants.

•

Recognize the role of occlusion in the failure of the dentition.

•

Identify factors precipitating occlusal trauma.

•

See a treatment plan for a patient with specific dental issues.

•

Realize that treatment should create a stable, functional, and esthetic endpoint.

•

Realize that clinicians need to try and maintain any deterioration or adaptation of the dental functioning system within normal limits and not be the cause of its acceleration.

secondary factors that may be accelerating the loss of teeth, bone, or tooth structure. The roles of caries and periodontal disease in the deterioration of dental health have long been documented. Although the role of occlusion is loosely recognized by many dentists, little credence is given to it either due to lack of understanding of

occlusal factors, lack of knowledge of how to address the treatment, and inability to explain this to the patient. Treatment can often be more extensive if occlusal issues are taken into account (Davies, et al., 2001; Svanberg, et al., 1995). Therefore, better understanding of these factors and treatment modalities is needed.

Figure 1: Pretreatment, smile view

Figure 2: Pretreatment, retracted view

Figure 3: Pretreatment, central view

Figure 4: Pretreatment, right side view

Komal Suri, BChD, is director of Smile Design Dental Practice in Wendover, Bucks, England. She is a graduate of the Kois Centre of excellence in Seattle, Washington, and lectures intensively in the United Kingdom. Her main area of expertise is in complex restorative and esthetic dentistry. Disclosure: Dr. Komal Suri has no commercial interest or conflicts of interest in regard to this article.

28 Implant practice

Volume 11 Number 3

Figure 6: Pretreatment, upper occlusal view

Figure 7: Pretreatment, lower occlusal view

Occlusal function checklist

Figure 8A: Left lateral excursion

Figure 8B: Left lateral excursion

Occlusal trauma

determine the modes of failure and assess the risk of future failure. The “Occlusal function checklist” (above) describes the approach, but there are specific parameters to be evaluated, as laid out in Table 1: Establishing a cause of destruction. In order to show how occlusion can and should be incorporated into a restorative treatment plan, the case presented here involves a multidisciplinary approach to correct a failing dentition that involves occlusal factors.

Primary occlusal trauma results from excessive occlusal forces applied to a tooth or teeth with normal supporting structure. Secondary occlusal trauma occurs when normal/excessive occlusal forces cause trauma to a tooth or teeth with reduced periodontal support. Factors precipitating occlusal trauma: • Increased bite force • Oversized masseters • Tendency to clench — relevance to jaw type • Habitual bruxism • Primary occlusal trauma • Reduced bone support • Post perio disease • Secondary occlusal trauma • Reduced number of teeth • Shortened dental arch • Lack of posterior teeth • Instability • Premature contact — posterior/ anterior • Working and nonworking side interferences • Anterior tooth position • OB — increased/reduced • Retroclined incisors • Distalized mandible • Tooth morphology in relation to envelope of function In order to formulate a treatment plan, the reason for the instability/destruction needs to be discovered. This is carried out by the evaluation of the entire functioning system to Volume 11 Number 3

Patient case — Adele Adele’s upper dentition had been restored with a combination of crowns and bridges

✓

Is the occlusion acceptable or unacceptable … if unacceptable then why?

✓

Is the occlusion a contributory factor to the decline of the dentition?

✓

Does the occlusion need to be addressed as part of the restorative treatment?

approximately 15 years ago. An implant had been placed in the UL6 approximately 10 years ago. Starting 2 years prior to the current restoration, the upper restorations and teeth began to show signs of failure. Adele had not attended the practice as often as recommended due to the distance she lived from the practice (150 miles). After clinical examination, the failure list was as follows: • The crown on the implant in the UL6 position became loose, and porcelain fractured from the crown. • The porcelain on the UR1 facial surface fractured (pontic of a threeunit bridge).

Table 1: Establishing a cause of destruction Parameters for evaluation Temporomandibular joint

Tooth structure and position

Periodontium

Muscles of mastication

Interarch tooth relationship

Joint sounds

How do the teeth look in the face?

Bone levels around the teeth (compared to the norm for the patient)

Tenderness

Assessment of OVD

Pain

Assessment of the curves of Spee/Monson

Presence of lamina dura

Hypertrophy

ICP/ RCP

Limited opening

Inclination of the teeth

Periodontal ligament space

Skeletal class 1,2,3

Deviation on opening and closing

Structural integrity

Gum health

Crossbite

Shape of the teeth

Gingival biotype Gingival scallop

Implant practice 29

CONTINUING EDUCATION

Figure 5: Pretreatment, left side view

CONTINUING EDUCATION

Figure 9: Right lateral excursion

Figure 10: Nonworking side interference

Figure 11A: Anterior guidance

Figure 11B: Anterior guidance

Figure 12: Markings showing heavy occlusal contacts during function on UR7 and UR6

Figure 13A: Recession around the UL4 relating to the bone loss around the tooth

Figure 13B

Figure 14: Before treatment

Figure 15: After lower fixed orthodontics, lower incisor was extracted

Table 2: Prognosis Parameters for evaluation Prognosis

Untreated

If treated

Good

LR 1 2 3 4 5 6 7 LL 1 2 3 4 5 7 UR 3 2 UL 1 2 3 7 8

LL6 UR6

Fair

LL6 UR6

Presence of lamina dura

Guarded

UR7

Hopeless

UL4, UL5

(UR7)

• UL4 became mobile and had deep pockets. • UL5 crown was mobile and had pocketing. • Gingival health declined. • Bleeding on probing increased. • Bleeding score was increased. • Pocket depth increased. • BPE scores increased. 30 Implant practice

• Gum recession on certain teeth increased (UL4, LL6, LR6). • Esthetics started to decline. • Lower teeth were becoming slightly crowded. Radiographic findings • Good bone levels around most teeth and the implant UL6. • Thin lamina dura present in most areas. • Vertical bone loss defects around UL4, UL5, LL6. • Widened periodontal ligaments: UR6, UR3, UR2, UL1, UL2, UL3, LL5, LL7. • Radiolucency in the tooth UL5. Occlusal findings • Group function guidance on left excursion, finishing on the UL5 (Figures 8A and 8B). • Group function guidance on right excursion involving UR1 (Figure 9).

• In right lateral excursion Ul4 and UL5 nonworking side interferences – palatal cusps (Figure 10). • Anterior guidance all on the UR1 (Figures 11A and 11B). • Functional mobility (fremitus) of upper anterior teeth and left premolars on biting in ICP. Diagnosis • Primary and secondary occlusal trauma • Gingivitis • Caries • Localized periodontal pocketing

Prognosis A prognosis for every individual tooth was needed. The prognosis was given with a view that the tooth was left untreated. Table 2 details the prognosis for each tooth. Good prognosis: Teeth with good prognosis were those with good bone support Volume 11 Number 3

Treatment plan In order to create a stable dental functioning system with predictability and longevity, the causes of the current destruction needed to be removed without creating new modes of accelerated destruction. The treatment plan was formulated as follows once the diagnosis and prognosis had been discussed with the patient. • Soft night guard to protect against excessive occlusal forces during sleep. This to be worn during hygiene therapy to reduce inflammation, pocket depth, and bleeding. • Hygiene therapy. • Oral hygiene instructions (OHI). • Mechanical removal of plaque and tartar. • Teeth with hopeless prognosis were left untreated since they were being extracted. • Orthodontic consultation resulting in the decision to have fixed orthodontics on the lower arch to realign the teeth, alter the inclination to a more favorable stable position, and retract the lower anterior teeth.

• Extraction of a lower incisor to create the tooth position and arch form desired. This had been fully discussed with the patient prior to the treatment being carried out. • Retention of the lower tooth position. • Sequential restoration of the upper arch. • Extraction of the hopeless teeth. • Removal of failing restorations. • Provisional restoration placement with the desired tooth inclination, morphology, length, and occlusal vertical dimension (OVD). • Implant placement in the premolar areas. • Definitive restorations. Shade and characteristics After all of the treatment that had been carried out, the final stage was the communication of esthetics and creating a smile that the patient was happy with from an esthetic point of view. The dentofacial appearance of the work carried out also had to be deemed successful for the entire treatment to be a success.

Figure 16: Removal of existing restorations

Figure 17: Refinement of the prepared teeth. Minimal veneer preparation on UL2 and UL3

Figure 18: Extraction of hopeless teeth

Figure 19: Provisional Luxatemp® bisacryl restorations (DMG America)

Figures 20A-20C: Definitive restorations UR2-UL3. Provisional PFM four-unit bridge UR6-UR3. Provisional Luxatemp bisacryl bridge from UL6-UL3 (palatal) Volume 11 Number 3

Implant practice 31

CONTINUING EDUCATION

— lamina dura still visible and there was less than 10% bone loss. Fair prognosis: The LL6 was given a fair prognosis due to the vertical bone loss pattern on the distal side. This tooth was an untreated tooth and therefore healthy. It would be unlikely that this tooth would fail in the future; it could however lose more bone if the trauma (primary occlusal trauma) on the tooth persisted. If the trauma was removed from the tooth, and no further bone loss occurred, the tooth would have a good prognosis. The periodontal health could be managed. The UR6 had a narrow area of interproximal bone and significant buccal recession. This tooth was in working and nonworking side interference in lateral excursion — primary occlusal trauma. The tooth was also a major retainer for a fourunit bridge. By restoring it as a single unit and reducing the interfering contacts and sharing the lateral load, the prognosis of the tooth would improve. Hopeless prognosis: UR7 had greatly reduced bone support and was therefore subject to secondary occlusal trauma. If this continued, the tooth would become more mobile, lose more bone, and eventually need extraction. Extraction of the tooth would have ongoing consequences that could contribute to destabilizing the bite. The lower opposing tooth could overerupt; however, presence of the UR7 should be taken into account when assessing the prognosis of the UR6. If the UR7 continues to experience more bone loss, it could affect the distal bone surrounding the UR6. The decision was made to retain the tooth for now with regular periodontal maintenance and reduction in occlusal pressure. The patient also wears a soft night guard to reduce pressure from clenching. The UL4 and UL5 were deemed hopeless due to the bone loss and mobility around the UL4 and the fracture, caries, and heavily restored nature of UL5.

CONTINUING EDUCATION The initial concerns of the patient were the appearance and function (mobile teeth and cracks). In order to communicate the desired esthetics, the author’s book, Creating Smiles, was used to communicate shape, texture, translucency, and incisal edge characteristics.

Summary Lower arch • Fixed orthodontics • Lingual retention Upper arch • Extraction UL4, UL5 • Implant placement UR4, UR5, UL4 all with Atlantis™ (Dentsply Sirona) abutments • IPS e.max® (Ivoclar Vivadent®) porcelain crowns UR6 – UR3 • IPS e.max porcelain bridge UR2 – UL1 • IPS e.max veneers UL2, UL3 • Porcelain-fused-to-metal bridge UL4 implant – UL6 implant • Both UR7 and UL7 unrestored General • Condylar position CR • No change in OVD • Provision of a soft night guard if the patient clenches in times of stress

Results The results of the treatment have been: • An improvement in OHI and gum health — from 58% bleeding score to 10% • A reduction in pocket depth and BPE score • A reduction of excessive pressure on the teeth • Adaptive mobility within normal limits • Improvement of guidance patterns • Increased stability of bite • Improvement of esthetics

Figures 21A-21B: Uncovering of implants 4 months after placement

Figures 22A-22B: Restoration of Ankylos® (Dentsply Sirona) implants with Atlantis abutments and IPS e.max crowns

Adele now has as much improvement in dental health as could be achieved. The improvement in function and esthetics has increased her confidence both in terms of her tooth structure (not being afraid that teeth will break or fall out) as well as her communication with people.

Conclusion In approaching any dental treatment, the aim should be to improve the patient’s dental health. This can also extend to improvement of the physical health and mental well-being. The aim of treatment should be to improve the prognosis of the teeth and related structures and to reduce the overall risk of any form of dental disease. There are certain parameters within which we need to work, and there are anatomical constraints that we cannot escape. We can do our best for the patient in ensuring that the treatment plans we offer

Figure 23: Restoration of Ankylos implants with Atlantis abutments and IPS e.max crowns 32 Implant practice

and the subsequent treatment we deliver creates a stable, functional, and esthetic endpoint. The human body continues to change and adapt, and we need to try and maintain any deterioration or adaptation of the dental functioning system within normal limits and not be the cause of its acceleration. By adopting a comprehensive approach, treatment can be properly planned, delivered in a phased manner, and executed to a high standard. The maintenance and aftercare program will help ensure ongoing success of the treatment delivered. IP

REFERENCES 1. Davies SJ, Gray RJ, Linden GJ, James JA. Occlusal considerations in periodontics. Br Dent J. 2001;191(11): 597-604. 2. Svanberg GK, King GJ, Gibbs CH. Occlusal considerations in periodontology. Periodontol 2000. 1995;9:106-17.

Figure 24: Fully restored and rehabilitated dentition Volume 11 Number 3

CE CREDITS

IMPLANT PRACTICE CE The FMC is designated as an Approved PACE Program Provider by the Academy of General Dentistry. The formal continuing education programs of this program provider are accepted by the AGD for Fellowship/Mastership and membership maintenance credit. Approval does not imply acceptance by a state or provincial board of dentistry or AGD endorsement. The current term of approval extends from 12/1/2016 to 11/30/2018. Provider ID# 325231

REF: IP V11.3 SURI

FULL NAME

AGD REGISTRATION NUMBER

LICENSE NUMBER

ADDRESS

CITY, STATE, AND ZIP CODE

TELEPHONE/FAX

Please allow 28 days for the issue of the certificates to be posted.

Managing the failing dentition SURI

1. As the experts, it is our responsibility to provide the patients with a solution to their problem that will have _________. a. longevity b. predictability c. not accelerate the deterioration of the surrounding dentition and supporting structures d. all of the above 2. When assessing the mode of failure of any dentition, it is advisable to try and determine the root cause of the problem and secondary factors that may be accelerating the loss of _______. a teeth b. bone c. tooth structure d. all of the above 3. Primary occlusal trauma results from excessive occlusal forces applied to a tooth or teeth with _________. a. normal supporting structure b. reduced periodontal support c. caries d. decreased bite force 4. ___________ occur(s) when normal/excessive

Volume 11 Number 3

occlusal forces cause trauma to a tooth or teeth with reduced periodontal support. a. Primary occlusal trauma b. Secondary occlusal trauma c. Joint sounds d. Tooth amorphology 5. (For patient Adele) The LL6 was given a(n) ______ prognosis due to the vertical bone loss pattern on the distal side. a. excellent b. good c. fair d. poor 6. (For patient Adele, for the LL6) If the trauma was removed from the tooth, and no further bone loss occurred, the tooth would have a ______ prognosis. a. excellent b. good c. fair d. poor 7. (For patient Adele) By restoring it as a single unit and reducing the interfering contacts and sharing the lateral load, the prognosis of the tooth _______.

a. b. c. d.

would improve would deteriorate would stay the same as before treatment none of the above

8. (For patient Adele) UR7 had greatly reduced bone support and was therefore subject to ______. a. primary occlusal trauma b. secondary occlusal trauma c. stabilizing the bite d. bone regeneration 9. (For patient Adeleâ&#x20AC;&#x2122;s UR7) Extraction of the tooth would have ongoing consequences that could contribute to _______. a. stabilizing the bite b. destabilizing the bite c. reduced inflammation d. increasing the lateral load 10. We can do our best for the patient in ensuring that the treatment plans we offer and the subsequent treatment we deliver creates a ________ endpoint. a. stable b. functional c. esthetic d. all of the above

Implant practice 33

PRODUCT PROFILE

Next Generation LOCATOR R-Tx® Removable Attachment System 100% satisfaction guarantee from Zest when clinicians upgrade to the next generation of LOCATOR®

est Dental Solutions will now offer a 100% Satisfaction Guarantee to clinicians when they purchase the next generation of LOCATOR, the LOCATOR R-Tx Removable Attachment System. Leading clinicians and patients are welcoming the improvements incorporated into the new System, including the new Abutment surface technology, increased angle correction, industry standard .050”/1.25 mm hex drive mechanism, and convenient all-in-one packaging. In fact, Zest so strongly believes that LOCATOR R-Tx is a better, simpler, and stronger system than its predecessor, Legacy LOCATOR, that the company has implemented a 100% satisfaction guarantee to all customers. LOCATOR R-Tx was designed and developed based on 17 years of cumulative clinician and implant manufacturer input on the original LOCATOR Attachment System. “We understand it can be difficult for clinicians to adopt a next generation technology

after successfully using a product for many years”, stated Russ Bonafede, Zest Dental Solutions President. LOCATOR R-Tx is built on and enhances that reputation for excellence. Bonafede continues, “While LOCATOR R-Tx is the next generation LOCATOR, the restorative technique and the predictability they have come to expect remains the same. LOCATOR R-Tx

is another world-class overdenture attachment option — the fourth generation for Zest — so we are offering this 100% satisfaction guarantee to demonstrate our confidence in the product.” To learn more about LOCATOR R-Tx, please visit WWW.ZESTDENT.COM/RTX. To place an order and learn more about the LOCATOR R-Tx 100% Satisfaction Guaranteed Program, please call Zest Customer Service at 800-262-2310.

About Zest Dental Solutions Zest Dental Solutions is a global leader in the design, development, manufacturing, and distribution of diversified dental solutions for a continuum of patient care from the preservation of natural teeth to the treatment of total edentulism. The company’s product portfolios consist of Zest Anchors, Danville Materials, and Perioscopy with global distribution through OEMs, dealer/distributor networks, as well as a domestic retail sales operation for the Zest Anchors Portfolio. Zest Dental Solutions’ corporate headquarters is in Carlsbad, California, with satellite operations in Anaheim and Escondido, California. IP This information was provided by Zest Dental Solutions.

34 Implant practice

Volume 11 Number 3

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PRODUCT PROFILE

Boyd Industries Implant Surgery line Built to Last. Built for You. Built by Boyd.

oyd’s tag line is more than an attentiongetting catchphrase — it signifies the commitment that everyone at Boyd makes to each and every one of its customers. From its team on the factory floor to its sales professionals in the field, the company is united in its passion for quality and customer service. It starts by listening to customers about ways to continually improve Boyd products to the consultative doctor-direct sales approach. By keeping the doctors and their staffs at the forefront of its actions, the entire Boyd team works in unison. Boyd has been best known for the durability and reliability of its award-winning dental equipment products. Boyd has accomplished this by combining over 60 years of design and manufacturing expertise to create personalized products that fit the requirements of the doctors they serve. Over the years, Boyd has been known as a thought leader in the design and manufacture of oral surgery products and custom cabinetry for cosmetic dental and implant specialists. The company has excelled at creating highly efficient yet esthetically pleasing office environments. The coupling of these two characteristics with a powerful reputation for producing high-quality and durable products has

S2614-series surgery chair 36 Implant practice

S2615-series surgery chair

been the legacy of the company. Boyd has helped thousands of customers to work with confidence due to the reliability of its Boyd operatory equipment. The design concepts of its cabinetry, durability of its surgical chairs, and variety of office accessories helps Boyd customers to be more competitive in the growing landscape of implant dentistry.

Proven performance The Implant Surgery product line is comprised of surgery chairs and tables, operatory carts, and S200 LED surgery light. Among these products, the S2614 and S2615 surgical procedures chairs are the most popular surgical chairs. These chairs are similar in configuration with the S2614 being a drop-toe version of the S2615 fixed-toe model. The chairs are offered standard with Boyd’s universal rail mounting arm board system, Boltaflex™ vinyl upholstery with standard foam cushioning in two style choices, clear plastic foot protector, body restraint strap, choice of dual articulating headrest, and duplex 115vAC medical-grade receptacle in seat frame. The S261X-series surgery chairs are manufactured using a durable steel frame with ergonomic thin tapered back for easier patient access and quiet low-voltage precision movement DC voltage motors for height, tilt, back, or toe adjustment. The cantileverstyle base has a starting height of 19" with 14" vertical stroke. All chair movements are controlled by a detachable 3-position programmable foot control with emergency stop feature, position lock button to prevent accidental chair movement during procedures, and easy “return to home” button to

return the patient to the full upright position for patient egress. Options include Ultraleather Pro™ upholstery material, memory foam cushioning for seat and back, choices of patient and IV arm boards, detachable hand-held chair movement control unit, and swivel base. In summer 2018, Boyd made improvements to its rail-mount IV arm board mechanism to make it more versatile. This new mechanism will be on display at AAOMS 2018 in Chicago.

New products for 2018 In the fall of 2018, Boyd will debut its next generation of Prestige mobile operatory carts for implant and oral surgery. These carts will be offered in several standard designs developed by compiling several years of market research into the needs of implant and oral surgeons. The carts will be sized to house many devices used in the operatory suite to increase efficiency and safety. The new Prestige carts will be made of light-weight, durable, and easy-to-disinfect metallic drawers and side panels. In addition to the standard designs, the drawer configurations of these carts can be modified within certain parameters to meet your specific needs. These carts will be on display at the 2018 AAOMS Annual Meeting and the AAOMS Dental Implant Conference both to be held in Chicago. For more information about Boyd Industries products, please contact our Sales Department at (727) 471-5072 or email sales@boydind.com. IP This information was provided by Boyd Industries.

Volume 11 Number 3

Built to last. Built for you. Built by Boyd & As a trusted, skilled oral surgeon, you have dedicated

your career to delivering the highest quality, most advanced care possible.

Here at Boyd, expert craftsmen like Conner, Brandon and Hanh not only respect that kind of dedication, but they practice it themselves. Every day, in our US based factory, they help create the highest quality CONNER RHODES Cabinet Design dental equipment and furnishings, using only the ﬁnest materials while adhering to the most demanding manufacturing standards — our own. In fact, Boyd is one of a select few dental equipment manufacturers to have earned the ISO 13485:2016 international medical device quality certiﬁcation.

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PRODUCT PROFILE

What is the real cost of implant failure? Dr. Robert Martino discusses the many consequences of implant failure

veryone has had a procedure in his/her office that has failed. Some things are minor, such as a chipped resin or a crown popping off, but a failed implant is a catastrophe. Studies show that 10% of implants fail, and the number one reason is gum disease (peri-implantitis). Unlike other failed procedures, implant failures come with a much higher cost to your finances, time, and reputation.

Financial impact A significant financial investment has been made by the patient and the office for the implant and prosthesis. Therefore, when there is a failure, the question is, Who bears the cost? Do you redo the implant for free? Does the patient have to pay again? Will you give him/her a discount? Who pays for the temporary/transitional prosthesis? Ultimately, who bears the cost of this failure? Regardless of who pays, you still have the financial effect of lost chair time. From repair to follow-up, to new implant placement, how many hours does this cost your office?

Time There is no quick fix for a failed implant. One of the biggest costs associated with implant failure is time. Once an implant fails and has to be removed, it will take at least 6 months before you can attempt to redo the implant and an additional 6 months for the new implant to integrate. Replacing a filling or retreating a root canal can be done in a timely manner, but to replace a failed implant takes over a year to correct. That’s a long time, which brings us to our next cost — reputation.

Reputation Regardless of the reason for the failure, it is a negative experience for both the patient and the office. For over a year, every time these patients smile or eat, they are Dr. Robert Martino is the CEO of seven West Virginia dental practices and coaches many other practices across the country. His expertise lies in the business side of dentistry, helping other dentists to streamline their operations for better patient care.

38 Implant practice

OraCare’s Implant Post Op Care System

reminded of this failure; and although they may not mean to give you a negative review (some do), it is natural for them to share their story. The best surgical and restorative techniques can be undone by inadequate or improper maintenance. Proper home care is essential to prevent the number one cause of implant failure — peri-implantitis. Do you really want to stake your reputation on your patients’ home care techniques? Remember, the reason many of your patients needed the implant in the first place was due to poor home care. Though a failed implant is often a result of poor patient home care, it is likely the patient will blame the doctor who placed it.

Prevention is the best medicine Peri-implantitis, loss of bone around an implant, is a real problem that needs addressing. As high as 47% of all dental implants have peri-implantitis, and more than 50% of all implant sites have some form of gum disease. The key to preventing

peri-implantitis is to address its cause. The same pathogens that cause gum disease to form around natural teeth (bacteria, viruses, fungi, volatile sulfur compounds, biofilm) also cause peri-implantitis. The best time to confront these pathogens is immediately after implant placement and during the gingival healing phase, which takes 32 to 34 days. OraCare’s Implant Post Op Care System provides a gel for the doctor to place the day of surgery and a take-home rinse to help patients fight these pathogens. Its active ingredients — activated chlorine dioxide, aloe vera, and xylitol — have been shown to eliminate bacteria, viruses, and fungi; neutralize VSCs; and break up biofilm. It’s a simple solution to protect your implants. Let’s face it, a failed implant can be a catastrophe. Using OraCare’s Implant Post Op Care System, will help prevent the costs of a failed implant. IP This information was provided by OraCare.

Volume 11 Number 3

A Failed Implant Can Be A Catastrophe It Can Cost You: Time Money Reputation

PREVENTION IS THE BEST MEDICINE

OraCareâ&#x20AC;&#x2122;s Implant Post Op Care System was designed to help prevent the number one cause of implant failure: peri - implantitis.

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After

PRACTICE MANAGEMENT

Implant practice inventory management Dr. Brian Young discusses the importance of keeping track of inventory efficiently

irtually every surgical practice, whether large or small, faces the same familiar inventory challenge: how to maintain an optimal balance of dental implants, bone grafts, membranes, and abutments. Ensuring adequate levels of these implant-related supplies is a headache without the proper system in place. Unlike general dental supply, implant-related supply carries a high relative cost, making inventory management of these items critical to your functioning practice. One approach to avoiding shortages is an overstock system. If there is abundance of implant-related supplies, the practice can accommodate any patient at any time. However, the overstock method creates a cash-flow burden and is still only a temporary solution. As overstock supply is used, the same typical inventory management issues creep into the office. For example, you may have an inventory of 45 implants on hand, but you still may not have the exact size that you need for a patient right now. Understock can be even more deleterious to the surgical practice. Ordering at the last minute or just-in-time, leads to excessive shipping fees, increased per-unit pricing, and unpredictable delivery schedules due to inadequate supplier stock or weatherrelated factors. As a result, understock can potentially lead to lost production and higher overhead in the practice. Most dental practice inventory management systems endeavor to reduce overstock and control ordering by estimating the officeâ&#x20AC;&#x2122;s needs for a period of time. But implementing a system like this can be a challenge. Understanding what to order, in what quantities, and at what time, and then monitoring daily use, can all amount

to a labor-intensive process that requires burdensome micromanagement.

Inventory management The goal of an optimized implant-related inventory management system should be to establish an efficient, repeatable process that ensures the proper supply level of products in the practice at all times. Such a system not only promotes cost and resource efficiencies, but also offers an avenue to peace of mind for all team members. Managing supply levels requires a simple and established process that allows each member of the dental team to effectively participate. The system should ensure timely ordering of product and real-time tracking of receiving and use. Furthermore, inventory management should be responsive and reflect changes in practice trends over time.

Inventory ordering/Inventory control While manual inventory management is certainly better than nothing, tracking received supplies, consumed supplies, reserved supplies for future cases, and remembering order thresholds and order amounts can be a daunting task for a team member. Manual implant inventory management systems can be costly to the practice as they are time-consuming to manage on a daily basis and fraught with potential mistakes. Ultimately, manual inventory management systems are typically shortlived in the surgical practice as most practitioners find these processes unreliable. Inventory ordering and control can also be managed by software. Inventory software has several advantages over manual systems and is ultimately less timeconsuming and more reliable. In addition,

software has features that manual systems cannot provide â&#x20AC;&#x201D; real-time inventory, usage reports over time, and automated ordering reminders. General inventory software like FishbowlÂŽ Inventory (www.fishbowlinventory.com) can be adapted for dental use. However, specific programs like Implant Manager (www.implantmanager.com) have unique features tailored to the dental implant office such as native barcode scanning, reporting features specific to the surgical practice, automated ordering reminders, and patient lot number tracking. Inventory software creates a more efficient workflow as it typically takes less time to manage than manual systems. In addition, accuracy is improved, making software systems more reliable over time.

Summary Brian Young, DDS, MS, is a graduate of the University of Florida where he earned his Master of Science degree and a certificate in Periodontics. He earned his Doctor of Dental Surgery degree from the University of North Carolina at Chapel Hill School of Dentistry. Dr. Young has a progressive surgical practice with special emphasis on bone and tissue maintenance as well as dental implant tooth replacement. Dr. Young is founder and past clinical director of the Institute for Guided Implant Surgery. He has been involved with research and development of software and clinical protocols for guided surgery technologies. He lectures nationally and internationally about topics related to dental implant surgery. Disclosure: Dr. Young has a financial interest in Kubo Health, a software company that produces Fast Notes and Implant Manager.

40 Implant practice

Strong systems in your dental implant practice will improve consistency. Organizing and managing the implant-related supply manually or with software takes a commitment. However, once in place, your implant practice will be able to sustain controlled growth by allowing your team to be both productive and profitable. IP Volume 11 Number 3

www.implantpracticeus.com

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PRODUCT PROFILE

InOffice™ by DentalEZ®

ince 1958, DentalEZ® Equipment has been at the forefront of developing simple, easy-to-use products that make work easier and more comfortable for dentists, hygienists, and patients. That tradition continues with our new InOffice™ workstation. The DentalEZ InOffice offers the power of flexibility with everything you need to provide the best in-office lab services. In this ever-changing, constantly advancing world, DentalEZ understands that the needs of your practice will be everchanging and constantly advancing as well. With all of the developments in digital restoration and single visit dentistry, for example, the equipment that you need today may not be the equipment that you need in coming years. That’s where the DentalEZ InOffice workstation comes into the picture. 42 Implant practice

Built with durability and flexibility in mind, our InOffice workstations allow you to add features after the initial purchase. It all starts with the basics: a frame, legs, and a counter top. From there, add the features you need, including overhead lighting, an air gun, a handpiece, optional front dust collection, and more. With esthetic choices such as steel color and solid surface countertops, the InOffice workstation gives dental professionals the opportunity to make flexible workstations that work best for them. Built with durability and flexibility in mind, our InOffice workstations allow you

to add features after the initial purchase. With InOffice, you are not “locked in” to the workstation you have. When considering a workstation solution for your in-office lab in the ever-changing environment of single-visit dentistry, choose the product that has the flexibility you need. InOffice by DentalEZ: Experience the Power of Flexibility. To learn more, visit www.dentalez.com/InOffice, or contact your local PSA rep. IP This information was provided by DentalEZ®.

Volume 11 Number 3

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SMALL TALK

Achieve a “personal best” by expanding your comfort zone Dr. Joel Small notes, “Each time we achieve a new personal best, we expand the limitations of our being until these limitations no longer exist”

chieving a “personal best” is a milestone for an athlete. It validates the exceptional effort required to achieve the desired reward. Most athletes will admit that achieving a personal best doesn’t come easily and requires more than physical training. Yes, the physical element is important, but until athletes embrace the belief that the goal is attainable, they remain hindered by their own mentally imposed self-limitation. The same is true for us non-athletes. We too must believe that we can grow beyond our current limitations to achieve our own personal best — whatever that may be. Again, our athletic friends will tell us that developing this mental edge is as much a challenge as developing their physical attributes. For us mere mortals, we develop our professional and personal mental edge by continually expanding our comfort zone beyond its current limit. For our discussion’s purpose, a comfort zone can be defined as an area of great psychological safety and comfort, free of uncertainty in which we can exist anxiety-free and without challenge to our vulnerability. All of us have unknowingly created our own personal comfort zones. Comfort zones have both beneficial and negative effects on our well-being and personal self-actualization. They do provide a positive “safe haven” for us when the demands of the world become overwhelming, and yet they can also represent the siren song that lulls us into a state of complacency. Consider, for example, the difference between listening to a presentation and delivering the presentation. Listening to

the presentation falls well within our comfort zone, but delivering the presentation moves us beyond our comfort zone by creating uncertainty and anxiety. Intuitively, we know that a well-delivered presentation can jump-start our career, yet the fear of failing and exposing our vulnerability becomes a powerful limiting factor that often drives us back to our safe haven. Even worse, by allowing fear to dictate these choices, we diminish our self-confidence and strengthen our self-limiting belief that we are incapable of moving beyond these limiting factors. We can overcome self-limiting beliefs by employing techniques designed to expand our comfort zone. First, we must accept

Joel C. Small, DDS,MBA, ACC, FICD, is an endodontist, author, and certified executive coach. He received his MBA, with an emphasis in healthcare management, from Texas Tech University. He is a graduate of the University of Texas at Dallas postgraduate program in executive coaching and limits his coaching practice to motivated healthcare professionals. He is a nationally recognized speaker on the subjects of leadership and professional development. Dr. Small is available for speaking engagements and for coaching healthcare professionals who wish to experience personal and professional growth while taking their practices to a higher level of productivity. **To receive a free copy of Dr. Small’s “Core Values Exercise,” please contact the author at joel@joelsmall.com. He is also available for a complimentary coaching session to discuss your practice-related issues.

44 Implant practice

that our growth is restricted by certain beliefs. We must then create a vivid mental picture of a better future in which these beliefs and limitations no longer exist. This vision becomes an implicit validation of the benefits we will derive by expanding our comfort zone and eliminating the many detractors that currently hold us hostage. Next, we design small excursions beyond or comfort zone boundaries. Each of these excursions, or “experiments,” has a purpose and is designed to move slightly beyond the comfort zone while remaining well below the “panic” level. Each successful experiment builds upon itself by creating within us a growing sense of accomplishment and self-confidence. Setbacks are a natural and inevitable part of the process, but a coach or trusted friend should be there to reframe these setbacks as learning opportunities and turn them into teachable moments. With each success, we gain the confidence to take bigger steps toward making the vision of our limitless future a reality. Our excitement with each success will become palpable. Each achievement becomes a Volume 11 Number 3

his concept of leadership was distorted with images of history’s greatest, largerthan-life leaders — people like Winston Churchill, Ronald Reagan, and John Kennedy, to name a few. Being an avid student of leadership, I shared with him the stories of other great leaders that changed our world in a quieter and less obtrusive manner. I helped him see that great leaders come in many forms and with very different personalities. Once I was able to convince him that everyone has leadership capabilities, our work progressed. With guidance, he was able to create and embrace a mental picture of a better and more fulfilling future as a leader. It was then that we began the process of developing a logical and actionable game plan for making his vision a reality. Like many self-improvement initiatives, the first step is always the hardest, and he struggled with how to go about introducing this new leadership initiative to his staff. From previous assessments and our work together, I knew that one of his

signature strengths was humility, and by aligning our initial action plan (experiment) with this identifiable strength, we were able to move forward. Being humble, he connected with the concept of “servant leadership” — one of many leadership styles and one that matched his personal strength. Using the principles of servant leadership, he felt more comfortable facilitating a staff meeting and sharing his intention of becoming a better leader and boss. He shared the vision of his desired future with his team. He proclaimed his commitment to being accountable for achieving this goal. Finally, and most importantly, he asked for their help in making his vision a reality. This and subsequent staff meetings served as pivotal points in the transformation of his practice. As a professional coach, I was not surprised to see his practice flourish. I found great reward in his practice’s transformation, but what fulfilled me the most was the ease and comfort he found in becoming the leader that he was always meant to be. This transformation will change his life. IP

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SMALL TALK

personal best that serves as a milestone to be broken by subsequent efforts. Those around us will notice a demonstrable improvement in our demeanor as we gain the confidence to overcome previous barriers that we once viewed as being unconquerable. As our belief in our abilities increases, limitations in other areas of our life begin to disappear spontaneously or diminish in significance. Eventually, our vision becomes reality as we view our world as having limitless possibilities. Recently, one of my coaching clients was struggling with his leadership role within his dental practice. He saw himself as a poor leader and someone who feared moving beyond his current comfort zone. He admitted that staff meetings were seldom held and that he rarely gave feedback to his staff. Even though he understood the value of making necessary changes to become a better leader, previous attempts with practice consultants had failed. Initially, we visited about what being a leader meant to him, and like most of us,

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INDUSTRY NEWS AO’s 2019 Annual Meeting in Washington, DC The Academy of Osseointegration (AO) is now accepting abstracts for Clinical Innovations, Oral Research (Scientific and Clinical), and Electronic Posters (Scientific, Clinical, and Case Studies) presentations for its upcoming 34th Annual Meeting, March 13-16, 2019 at the Walter E. Washington Convention Center in downtown Washington, DC. Deadline for abstract submissions: Friday, October 5, 2018. Student Travel Grants ($1,000 each) are being awarded by the Osseointegration Foundation to the top 20 students with the best abstracts submitted for presentation. Also, heralding the home of the first modern root form dental implant placed and restored in the United States, the Academy of Osseointegration’s (AO) Mid-Atlantic Regional Meeting will be held in National Harbor, Maryland, September 14-15, 2018. “Advances in Clinical Implant Dentistry” will focus on various disciplines within implant dentistry, including the latest in surgical, restorative, and laboratory techniques. The Mid-Atlantic Regional Meeting will also serve as the promotional launch of the much-anticipated AO annual global scientific 34th Annual Meeting. For more information, visit https://osseo.org/.

Registration open for 2018 Global Oral Health Summit, user-centered educational program takes center stage Along with open registration for its 2018 Global Oral Health Summit that takes place at the Gaylord Texan Resort and Convention Center, just outside Dallas, Texas, November 9-11, 2018, Carestream Dental announced an educational program that was designed with the guidance of real practice management software users. New course formats — such as sessions led by seasoned software users sharing results-based, real-life cases and “Future Views,” which gives attendees access to product line managers and other Carestream Dental leaders for the latest updates on their software and equipment — provide attendees with new perspectives on the technology that powers their practices. The 2018 educational program was designed to give attendees the knowledge and resources they need to immediately apply what they learn at the Summit in their practices. The full educational program includes more than 70 courses being led by a combination of real software users; Carestream Dental developers and designers; CS OrthoTrac, CS PracticeWorks, CS SoftDent, and CS WinOMS practice management software trainers; doctors; and consultants. For more information, call 1-800-944-6365, or visit carestream dental.com.

46 Implant practice

October 4-6, 2018 Arizona Biltmore Hotel Phoenix, AZ

Network, Share Knowledge, and Learn at the 3Shape Event of the Year 3Shape will host its first-ever 3Shape Community Symposium, at the Biltmore Hotel in Phoenix, Arizona, October 4-6, 2018. The event will explore technology and workflows that are driving digital dentistry today and dental practices and dental labs in the future. The Symposium is open to doctors and dental laboratories using 3Shape solutions as well as professionals not using 3Shape solutions who are interested in discovering more about digital dentistry. Special sessions and hands-on classes will focus on the specific needs of dental practices and labs. At the Symposium’s “Genius Bar,” attendees will be able to get one-to-one 3Shape solution advice and technical help at the drop-by station. All 3Shape solutions will be catered to, and consultations will be with a designated 3Shape expert with in-depth knowledge of the attendee’s dental specialty, whether it is restorative, implant, orthodontic, or lab. 3Shape Community Symposium participants will also get an exclusive preview into 3Shape technology in the pipeline and can gain up to 15-plus CE credits for attending. Visit http://www.3shapecommunitysymposium.com for more information.

Nobel Biocare® premieres NobelPearl™, the only 100% metal-free two-piece ceramic implant solution at EuroPerio9 NobelPearl™ ceramic implants were launched by Nobel Biocare® during EuroPerio9, June 20-23, 2018, in Amsterdam. An alternative to titanium implants, the 100% metal-free NobelPearl was designed for excellent soft-tissue attachment and low inflammatory response. Its zirconia material especially benefits patients with a thin mucosal biotype. Studies have shown that microcirculatory dynamics in peri-implant mucosa around zirconia are comparable with those around natural teeth. Furthermore, it has demonstrated low affinity to plaque. For more information, visit https://www.nobelbiocare. com/us/en/home.html.

Volume 11 Number 3

Registration for Implant Pathway’s dental implant continuum in 2019 is now open! Drs. Justin D. Moody and Michael Freimuth lead the way in continued education by offering twenty online modules, five cities, five live surgery sessions, three Fast Track options, and the newly introduced Advanced Continuum. in 2019. VISIT US ONLINE www.ImplantPathway.com

CALL US (888) 309-2423

OUR CONTINUUM FOR 2019 ———————

SESSION FOUR: LIVE SURGERY ———————

The core of our continuum is made up of four sessions, and includes online modules, lectures, hands-on training, questions and answers, and concludes with two days of live surgery. Earn 20, 52 or 76 CE Credits by taking Session One, Sessions 1-3 or Sessions 1-4, respectively.

Session One: Online Twenty one-hour modules, on-demand videos and quizzes. Houston, Texas Session 2: Feb. 8 and 9, 2019 Session 3: March 8 and 9, 2019 Chicago, Illinois Session 2: April 26 and 27, 2019 Session 3: May 17 and 18, 2019 Seattle, Washington Session 2: June 21 and 22, 2019 Session 3: July 19 and 20, 2019 Richmond, Virginia Sessions 2 & 3: Sept. 12 - 14, 2019

Complete Sessions 2 and 3 in One Trip!

New York Sessions 2 & 3: Sept. 19 - 21, 2019

Complete Sessions 2 and 3 in One Trip!

E-MAIL US info@implantpathway.com

Two full days of live surgery from the New Horizon Dental Center in Tempe, Arizona. Each doctor places an average of 15 implants per Session Four.

January 30 - February 1, 2019 April 10 - 12, 2019 August 7 - 9, 2019 October 9 - 11, 2019 December 11 - 13, 2019

THE ADVANCED CONTINUUM ———————

Introducing our Advanced Continuum, feautring additional courses that will take your implant education to the next level. Completion of Sessions 1-4 or equivalent dental implant training is a pre-requisite. All courses (except Complications) are held at the New Horizon Dental Center in Tempe, Arizona.

Soft Tissue Grafting March 15 and 16, 2019

Presented by Dr. Lewis Cummings

ONE-WEEK FAST TRACK ———————

Restorative Solutions March 29 and 30, 2019

Due to increased demand, we are now offering three Fast Track opportunities. Fast Track courses sell out very quickly! After completing Session One: Online, complete Sessions Two through Four in only one week in Tempe, Arizona. Exclusive Session 4 for Fast Track registrants only.

Winter Fast Track January 14 - 18, 2019 Spring Fast Track April 29 - May 3, 2019 Fall Fast Track November 11 - 15, 2019

Live Patient Training

Restorative Solutions June 7 and 8, 2019 Live Patient Training

Restorative Solutions November 1 and 2, 2019 Live Patient Training

Complications July 2019 (TBA) Sinus Grafting September 26 - 28, 2019 Live Patient Training

Sessions Fill Quickly! Register Online at www.ImplantPathway.com Implant Pathway (IP) is an ADA CERP provider. CERP is a service of the American Dental Association to assist dental professionals in identifying quality providers of continuing dental education. ADA CERP does not approve or endorse individual courses or instructors, nor does it imply acceptance of credit hours by boards of dentistry. Concerns or complaints about a CE provider may be directed to the provider or to ADA CERP at www.ada.org/goto/cerp. Approval Term: 5/1/2015 through 6/30/2019

Payment Planning, Student / New Dentist and Military Discounts Available. Call (888) 309-2423

Implant Pathway (IP) is designated as an Approved PACE Program Provider by the Academy of General Dentistry. The formal continuing dental education programs of this program provider are accepted by the AGD for Fellowship, Mastership and membership maintenance credit. Approval does not imply acceptance by a state or provincial board of dentistry or AGD endorsement. The current term of approval extends from 4-1-2015 to 3-31-2019. Provider #: 342679

IMPLANT PATHWAY 2019

Leading the Way in 2019 ———————

ON THE HORIZON

Image that! Dr. Justin Moody discusses how his imaging has evolved over 2 decades

y first practice had a dip tank with hand-processed films in a dark room, and that was only 20 years ago, so I don’t think I am that old! Imaging has always been the key to proper diagnosis and treatment planning — without it we would only be guessing and relying on the patient to let us know what is wrong. In the course of my 20 years of being a dentist, I went from hand processing to an automatic processor to digital sensors and now cone beam CT; that’s a lot of innovation in just 20 years. While many may say the digital image revolution is over, I happen to think it’s actually catching its second wind. Not only are the first generation of sensors and CBCT units getting older, but the technology has changed so much that even if the old ones are still working, I feel it’s time to make changes and upgrades. With upgrades in technology comes efficiencies and safety to the patient that just cannot be overlooked. Having recently replaced my first CBCT unit with a newer model, I can see right away that it was money well spent. Not only is the machine faster and the software more intuitive, but the decreased radiation needed to make a sharper image is better for my patients, and that alone makes the investment worthwhile. I believe in this technology so much that I have CBCT units in each of my offices, and it’s one of those rare items in dentistry today for which the price has gone down for a better product! I recently purchased an Acteon® X-Mind® Trium 3D unit for one-third of the price I paid for my first CBCT unit back in 2007 and is there a difference. Superior image quality, high-level software, implant planning tools, and the lowest necessary radiation needed already make this machine attractive, but when you

Justin Moody, DDS, DICOI, DABOI, is a Diplomate of the American Board of Oral Implantology and of the International Congress of Oral Implantologists, Fellow and Associate Fellow of the American Academy of Implant Dentistry, and Adjunct Professor at the University of Nebraska Medical College. He is an international speaker and is in private practice at The Dental Implant Center in Rapid City, South Dakota. He can be reached at justin@ justinmoodydds.com or at www.justinmoodydds.com. Disclosure: Dr. Moody is a paid speaker for BioHorizons®. Dr. Moody has no contract or financial interest in Acteon.

48 Implant practice

Figure 1B: Virtual Implant Placement with the AIS software from Acteon

Figure 1A: Acteon® X-Mind® Trium 3D unit

Figure 1C: X-MIND TRIUM facilitates accurate evaluation of bone density and the positioning of the anatomic structures to be able to place implants more confidently

Figure 2A: Acteon X-Mind Unity™ wall mount unit

Figure 2B: Image quality and clarity from the Sopix2 sensor

couple this with an industry-leading 10-year warranty and its value price, there isn’t much choice, in my opinion. Implant dentistry still needs 2D intraoral sensors for use at the time of surgery and for follow-up/re-care appointments. Having good quality images are important for documenting bone levels around dental implants as well as looking at real teeth. I recently built a new office and installed the Acteon® X-Mind Unity™ wall mount unit with built

in Sopix2 sensor. This is such a timesaver always having the sensor at the head of the unit, no going to get it, no USB connection, no dropping it or throwing it away, and you get the amazing image quality that the Sopix sensor is known for. Technology is an ever-changing aspect of dentistry today. You must embrace it knowing that you are always going to be investing in the future so that you don’t get stuck in the past! IP Volume 11 Number 3

confidence in compromised sites

Tapered Short Implants BioHorizons Tapered Short implants are available in 6 and 7.5mm lengths, offering a solution for cases with limited vertical bone height and minimizing the need for bone grafting. The implant design features an aggressive thread profile and tapered body for primary stability, even in compromised situations. A platform-switched, dual-affinity, Laser-LokÂŽ surface offers crestal bone retention and a connective tissue attachment for flexible placement in uneven ridges.

For more information, contact BioHorizons Customer Care: 888.246.8338 or shop online at www.biohorizons.com

Not available in all countries. SPMP16254 REV D JAN 2018

InOffice

™

Workstations

The Power of Flexibility The InOffice workstation offers everything you need to provide the best in office lab services. Design the workstation you need today, knowing you can add additional features after the initial purchase.* With all of the advancements in digital restoration and single visit dentistry, you’ll appreciate a workstation that can change with your practice.

For more information, please visit www.dentalez.com/InOffice. *If dust collection is to be ordered at initial purchase, or added at a later date, pre-piping (DCPPDDS) MUST be ordered at initial purchase. © DentalEZ, Inc. 2018. DentalEZ is a registered trademark & InOffice is a trademark of DentalEZ, Inc.