Augmentation Post Implant Failure

if there is at least one bony wall support no need for any kind of support ,all you need is flap under tension .which mean you reflect the flap minimally as required to see the defect place the graft do not dissect the flap for release and stretch it for maximal closure (3 mm exposure is acceptable .not more. for vertical, there is another technique with printed titanium foil shield ,which is left uncovered. not mash. it is completely defferent technique in the near future we will publish this technique .

of coures i scaled it , the bone in such cases can reach until the maximum hight of the proximal bone . there are also different techniques in which we can treat this case .i choose that technique with bone cement because its enable me to perform this case in the most less invasive protocol and fast and predictable procedure .we need to remember it looks easy ,it is easy , but it is completely deferent than conventional method and the key success factor is the application and the flap with tension (not tension free as we used to )

thank you

i agree

i do believe that there was a connection between the implant failure and the connection to the molar even so ,i saw many implants which are connected to natural tooth that function well as well ,but I thing that it might be related to the periodontal situation ,personally i don't like to connect implants to natural tooth .defferent mechanism of stability

The type of bony crater around the Alphbio SPI failed implant suggests overtorquing of implant in dense mandibular bone. This is typical pressure necrosis seen in spiral implants placed in dense bone. This kind of defect doesn't arise due to splinting implant to natural teeth. If you see apical thread are integrated. a tapered deep thread spiral implants has specific indications and they should be followed for best results.

Thank you, doctor Matt, for your compliment and for your question there are few main reason to work with BA , such as : 1. surgical protocol, 2. handling, and surgical procedure length 3. membrane, 4 outcome, 5.costs. 1-surgical protocol with BA is the most less invasive because you must have tension on the flap and not tension free as with other grafts among them also Bio- Oss .therfor no need for flap dissection for release, less pain, less swelling to our patient and less complication due to exposure. 2-handling and the surgical procedure length -the entire graft placement and stabilization with BA is in less than one minute, instead of 15-25 minutes in conventional grafts. 3- membrane -with BA you don't use a membrane, therefore, you don't block the periost , you don't disturb the healing, you save time and unnecessary additional expenses 4- outcome -with all existing grafts including of course Bio Oss the outcome is integration which means that the patient is not going to have its own bone back with BA due to the biphasic calcium sulfate within it. regeneration of the bone take place ,instead of integration. therefore in 3 months most of the site is already new vital bone of the patient himself -you can see very nicely the replacement in the consecutive radiographic images where it appears radioopaque during placement after 2-3 weeks it disappear and then in 3 months it becomes again radioopaque with the same trabecular form of the native bone. the entire healing period is only 3 months at this stage you can place or load your implant. 5- costs -no membrane, and saving an average of 50 minutes from every working hour, make the calculation ,you will save thousands of dollars and at least 10 entire working day every year .and as many procedures that you will do more ,you will earn more. nevertheless, it is important to be aware IT LOOKS EASY -IT IS EASY -BUT IT IS DIFFERENT. and you need to work acording to its protocols

Thank you for your detailed, EXCELLENT, and well-documented reply, Dr. Amos! Indeed you are right: the difference in bone regeneration with BA as opposed to integration of Bio-Oss is palpable. The x-ray tells the whole story! Personally I've never seen an x-ray with this high quality, dense bone trabeculation after Bio-Oss augmentation. Additionally, with Bio-Oss, upon re-entering the site and doing the osteotomy for the implant, one can actually feel that the density of the bone is just not the same as real bone. Needless to say that your point nr. 5 is quite true and invaluable. As for it being different and having to work according to its own protocol should be no big deal to any one. If the differences discourage them so much, they probably shouldn't be doing implants anyway. Adaptability and evolution should be in the tool-box of any dentist/surgeon worth his mettle. Don't you think? :) Thank you again for taking the time, and I wish you many more happy cases! KUDOS!!! PS: Do you have a Facebook page or a website?

@Paul: You are right Paul: organized dentistry is indeed a circus of incompetence and ignorance. In my many years of practice doing it all, I’ve seen it “all”. It is up to US, THE PROFESSIONALS, to decidedly shun companies like Augma and send a clear signal that we are not stupid. It is up to us to not spend thousands of dollars on every new expensive kit or toy with all kinds of claims, some more dubious than others, and then have to increase our fees to cover our increased costs. Experience has clearly shown that one or two simpler but sound instruments and/or methods are worth much more than a thousand fancy and expensive toys, and it keeps costs down, thereby often granting patients access to treatment that they ordinarily could not reach. We ARE Dr’s and we do have a body of knowledge, so it is up to us to use that knowledge and our imagination to find newer and better ways of doing things. As in this example, it is up to us to use cross-sectionality, and adapt proven techniques and materials from other medical fields, like Dr Amos did with Bond Apatite. Calcium sulfate has indeed been used in orthopedic surgery for a very long time. I’ve used it myself a lot (probably before Dr Amos) with great success, but with slanted looks from colleagues who were too rigid to allow a new concept to penetrate despite the evidence – it is what motivated me to ask him the questions that I did out of pure curiosity to see his reasoning. It is sound! We are being inundated by big-name companies pushing their “magical” and expensive wares, and it is the patients who suffer due to decreasing access caused by ever-increasing costs. No doubt, some of these companies do, and did, have their role in dental material and techniques advancements, and we have come a very long way indeed. We have made great strides and have access to wonderful technologies not even dreamed of a mere half century ago. Yet somehow I feel that we are lagging, that with all this wonderful technology and research we should be further along in our scientific and clinical progress. For while some ideas that should be within our grasp have been ignored, other things of lesser value are over hyped. The endodontic microscope is a perfect example of over-hype. How does anyone think they'll do a root canal any better with a microscope, if they can't do it well without one? Everyone is singing "the microscope virtues" but EVERYONE FORGETS that the microscope's line of sight stops at the first canal curvature. Past that curvature lies only one thing: the dentist's knowledge, talent, feel, and clinical experience. And no two-left-handed dentist will ever comprehend that or do a proper root canal, not with a thousand microscopes. Don’t get me wrong here: the microscope is a great tool and I use it myself, but it’s not what we would call indispensible, really. And how much did dentists have to raise their fees, and how much additional pressure and stress did they have to put on themselves to "produce" more to cover the cost of that microscope? Wouldn’t it have been much better to invest all that research, instead of in a microscope, into ways that we can actually eliminate the need for root canals? I really do believe that with present day technology and the state of the art in research we can find ways to preserve the dental pulp in at least 40-50% of cases and avoid that RCT. We have forgotten that a root canal is, by its very nature, a brutal amputation of a part of one’s body. N’est pas? We have stem cells available, and they are finally being clinically used successfully to treat recalcitrant bone fractures that don’t heal. Why isn’t anyone researching a way to preserve the dental pulp with stem cells? Or to REGROW teeth with stem cells? I bet that maybe 200 years from now we will have forgotten all about implants because we’re regrowing teeth. Implants are great but let’s face it: we are putting metal screws into maxillaries, and these screws are not all that different than a simple wood screw! Yet they cost inffinitely more than a box of wooden screws. I’m joking and exagerating, of course, but I’m sure you (and everyone else here) get the point. It is up to us to demand that government stop over-regulating and allow the local pharmacies to compound biphasic calcium sulfate the old-fashioned way. Unfortunately compounding the old fashioned way has un-necessarily long been eliminated. And it falls to us to find ways to make proper dental care more affordable to the general population. But in a world where the tools and materials we need to provide proper care are increasingly more expensive, and the dentists' bottom lines are getting increasingly squeezed from every direction (and I say this without ANY greed here) our job as true health-care providers has been forced to morph into one of more business and less dental care. That is the reason dentistry has NOT behaved like mainstream medicine, and unfortunately the results show: world-wide dental health and patient education are down, while other fields are advancing and providing the general population with better technology and an improved standard of life. There are civlized countries in Europe where dental standards are behind by at least 50 years, and patients’ attitudes toward dental care are lagging by 100 years. What do you say to the patient who says “I have no money for implants or expensive dental work, I’ll eat with my gums”? There are way more people with this kind of attitude than you can possibley imagine! How can we correct this downward trend? Only by being vocal at all levels, by educating, and by being innovative and imaginative in our own right. So all those recipes really do start and end with us. It is our job!

Yes Dental materials should be cheaper to make dentistry available to the poorest segment of society. But why do think stem cell would be economical and make dentistry available to the poorest?

@Dr Sanjay: I wasn’t trying to say that stem-cells would be affordable to the poorest. Of course they would not be at first. That was on the topic of advancement that I was referring to, a completely separate topic from that of the current cost of dental materials. Sorry if my writing style didn’t clarify that.

Sterile saline

Dr. You need to calm down a bit. Did you know there were no clinical studies of parachutes when they were developed and still they were used hundreds of thousands of times? Amazing. You don’t like the cost of the material then don’t use it. Do you realize the material has been used in orthopedics for hundreds of years? It’s 1cc of graft that can be used with out a membrane. Do your cost analysis and you will come close to the cost of a 1cc of allograft and collagen. The material doesn’t fail. It’s the doctor or the patient that fails. I have been using the material for three years and love it and love the results.

Michael, Michael , Michael, since when does asking for post-op follow up pa's qualify as not being calm? Are we living in different universes with different values, perchance? I know I am from Terra. And you? Methinks you might be the one who needs to calm down a tad. I'm glad you're satisfied with the material, and you should continue to use it, no doubt. There were no clinical studies for disc brakes either, but that doesn't make them -- or parachutes, for that matter -- fail-safe. N'est pas? Don't like my comment? Don't read it! Or don't tire yourself replying. My -- very reasonable -- request for follow up x-rays stands!

Oh, and by the way Dr Katzap, do the cost analysis yourself and you'll see that there is no combination of graft material/collagen or /membrane that reaches almost $1000 per ONE implant site. Additionally, Dr Amos himself clearly stated in his post that he is "sharing my cases and other clinician cases with the healing sequence flow and the outcome". I hardly call the lack of long term post-op evaluation radiographs a complete healing sequence with the final outcome! My request for long term post-op pa's STANDS! And while we're at it, let's see some 2 and 3 year follow up pa's, to make the picture truly complete.