The preservation of jawbone en mass is highly contingent on maintaining good implant health, which is facilitated by positioning of the fixtures in a manner that facilitates hygiene as well as with proper biomechanical considerations.

In my prior article I focused on the causes for bone atrophy, in particular as it relates to Iatrogenic causes and how this can be controlled with timely removal of diseased teeth, avoidance of dentures, and proper positioning of implants.

It was put then to me by a colleague that we are all taught early in our careers that implants preserve the jaw bone, the hard question is: where is the evidence that (well positioned) implants do in-fact preserve jawbone?

If we are talking about alveolar bone that is present around healthy teeth, then as I stated in my prior article on natural atrophy this cannot be stopped, and it cannot be reliably preserved even with implants. What I am talking about in my article is stimulation of deeper basal bone through functional loading.

The picture below illustrates the loss of alveolar bone irrespective of the presence of dental implants …

In the last picture the implants in Quadrant 2 (on the right of the picture) were removed and replaced with new implants in deeper basal bone. Overall this sequence illustrates the difference between placement of implants in alveolar bone, which limits restorative space, hampers hygiene, and does nothing to preserve bone, versus placement in basal bone which allows for improved restorative space, flat and hygienic underside, and involves a bone type that is not naturally predisposed to bundle-bone loss.

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Removal of teeth is something that is very difficult for us as dentists to recommend, and we battle with this every day. When the outlook for the teeth is not great, I often emphasise that a better result can be achieved by addressing things early before the further spread of disease and destruction of bone.

Some of the questions put to me by a colleague on facebook are to do with the effect of tooth removal on bone atrophy…

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REFERRAL LETTER FROM A COLLEAGUE:

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I was honored to present back-to-back at NYU Linhart College of Dentistry, New York, followed by the 4th Evidence Based Symposium on Oral Rehabilitation, Beijing.

My presentation was about simplifying the workflow of complex surgical cases, assessment and management of the terminal dentition, Zygoma ‘Plus’ and quality standards in advanced oral implantology.

I showed cases with terminal dentitions ranging in age from 20’s to 70′ with decay, gum disease and total deterioration. The most important question before offering these patients any kind of treatment is how did they get to that point in the first place?

There are many causative factors for tooth loss leading to a terminal state, but perhaps the critical ones are neglect due to poor hygiene, sugar consumption and/or poor compliance. These in turn can be the result of a poor dental IQ (“…I had no idea I had to floss or avoid energy drinks) or due to fear and distrust because of a poor past dental experience.

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Below is a recent post on Facebook by an esteemed colleague who encountered some complications with Zygoma implants. Complications that were also common in my own practice, and which led to our development and implementation of Zygoma-Plus.

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A DENTIST’S DILEMMA FOR HIS YOUNG PATIENT WHO WANTED DENTURES

In Part 1 of this series I responded to a dentist’s dilemma about carrying out treatment requested by his young patient and committing her to dentures. It is not uncommon within our professional environment to face this or other similar situations that challenge our moral and ethical compasses. In this segment I explore how these might affect our professional conviction, …and whether this may be limited by an inexperience?

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A DENTIST’S DILEMMA FOR HIS YOUNG PATIENT WHO WANTED DENTURES

One dentist had a dilemma about his young patient who had numerous decayed teeth, and who asked him to remove all of her teeth (including some healthy teeth) and get dentures. The dentist refused and posted his dilemma to the wider professional dental community. Below is the dentist’s post on a professional platform:

After engaging many dentists around Australia, I was asked to comment and provide my view on this.

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Is our society so blinded by religious and political activism that we forget one of the most fundamental values that we all beleived already defined us as a nation …equal rights?

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Click here for ENGLISH version

仕事として初めて訪れた日本旅行を有名な新幹線に例えるとしたら、主催者および同行者の方々の対応はファーストクラスですが、旅そのものは夜行寝台列車に近いものでした。というのも全ての駅に停車したかと思うくらい色々なところに立ち寄ったからです。

今回は4日間の滞在期間に4つの都市を訪問しました。空港から鉄道の駅そしてタクシーへと入れ替えたちかえ移動し、東京、名古屋、大阪で合計3つの講義をし、また多くの著名な歯科医師の方々を訪問しました。しかも全て35℃という蒸し暑いさなかに･･･。ですが実際は聞いて想像するほど厄介ではありませんでした。非常に興味深い先生方にお会いできる機会に恵まれ、歯科インプラントによる口腔修復分野においてサブエコノミー経済を築く礎となる関係を築くことができました。

行動しなければ始まらない

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ビジョンある日本人との交流

If my first professional visit to Japan was synonymous with the famous Bullet Train, whilst similarly first class as a testament to my hosts and entourage, this one more closely resembled an overnight sleeper train …stopping all stations!

I visited four cities in as many days, shuffling between airport, bullet trains stations and private cars, conducted three lectures in Tokyo, Nagoya and Osaka, and visited numerous high profile clinicians, …all that in humid 35 degree heat. But it was not as onerous as it sounds. I had the pleasure of meeting some very interesting people, and forged relationships that will likely be a basis to the establishment of a sub-economy in Oral Rehabilitation with Dental Implants. Let me explain …

You’ve Got To Be In It to Win It!

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The common meaning of the word Specialist is “a person who concentrates primarily on a particular subject or activity; a person highly skilled in a specific and restricted field.” In other words a specialist is expected to have expertise in a specific area, and this can be facilitated through training, focus and experience, as well as through individual skills and talents. However, in dentistry, a “Specialist” does not carry its common meaning, – instead it means a Registered Specialist. As such, clinicians who may indeed fall under the common definition of a “specialist” which the public understands, are actually prohibited from advertising themselves as such.

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All-On-4 dental implants must be placed in ideal positions in order to optimise aesthetics, ease of cleaning and comfort.

When there is poor or inadequate jaw bone present the situation is such that surgeons are often forced to place implants wherever they find some bone, which means that the positioning of …read more

Meticulous, systematic, minimalist, and bullet-trains, …that’s Japan. So why would an invitation to speak be any different: fly-in Wednesday, do two lectures, visit a couple of clinics and fly out Thursday, …oh, and on 3 weeks notice, …plenty of time, right!?

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With the advancements made in dental medicine and oral surgery, dental implants have become not only an increasingly viable option, but a preferred solution for patients seeking a more permanent and aesthetically pleasing alternative to loose dentures. However, there are situations where conventional dental implants simply will not work, such as cases with advanced jawbone atrophy caused by long-term denture wearing or from severe infections in the past, cancer or even the common gum disease that can also destroy the jawbone over time.

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When Geistlich Pharma AG invited me to do a roadshow in China, I thought this was going to be just “another day in the office”. What I didn’t expect was a cultural and culinary experience that would leave a lasting impression.

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A recent dental graduate recently posted a complex case on dental Product Review. He faced a dilemma of how to plan a young 35 years old woman, who had numerous missing teeth and a Class III skeletal discrepancy. Here is an image of this dentist’s post, and me reply below:

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After years of teaching English in China, it wasn’t hard for Yi Yu to acclimate to her new home when she relocated close to her family in Australia in 1995. Life was pleasant until five years ago when Yi Yu’s speech began to progressively slow down. Her daughter, Min, was alarmed and took her mother for medical testing. The doctors diagnosed that she had suffered a mini-stroke, which negatively impacted her speech. She lost her ability to communicate clearly, which became even more problematic when she couldn’t explain to her family why she was regularly refusing food.

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There are numerous registrable and recognised dental specialist titles such as endodontists, paediatric dentists, orthodontists, oral & maxillofacial surgeons, prosthodontists, periodontists, among other specialties. These specialists practice in a niche area of dentistry in which they were trained. However, most of those various areas of dental practice are also part of the training that general dentists receive, and the question often arises amongst my colleagues when to refer?

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Last night I reviewed one of my patients who I treated with the  Zygoma-Plus technique, a method that I developed, borrowing from the traditional Zygomatic Implants and sinus grafting techniques, with some critical modifications. I presented this technique at the India International Dental Conference.

The patient is a successful businessman/entrepreneur, with a busy life and completely time-deprived.  He lost his upper teeth in 2008 and received dental implants from his periodontist, who planned to maintain the natural lower teeth at the time with gum treatment. The upper implants were done using a traditional 2-stage approach,whereby the implants were fitted with locator abutments, and supported a removable clip-on denture.

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