Skip to content

Brady Frank Dentist

June 20, 2012

Top Implantology Breakthroughs for the GP from Brady Frank Dentist Course Description & Overview

Brady Frank DDS (special contribution from Ryan Swain DDS)

Short Description:

This course is designed to load the general practitioners arsenal with multiple minimally-invasive techniques that can be implemented immediately.  Not only do the techniques discussed increase the level of patient care but add significant increase to the productivity of the general practitioner.  Multiple case studies are used to demonstrate no-drill implants, the 5-minute implant, abutment and crown and the 5 top flapless techniques used by GPs in today’s implant-geared practice.

Long Description:

This program features several case studies which demonstrate the continual emergent trend of reducing the invasive nature of implant surgery.  Topics discussed include:

-Utilizing shorter implant sizes to accomplish successful implant placement without expensive, time-consuming and invasive grafting procedures.

-Utilization of flapless implant techniques to allow for final prosthetic impressions to be taken immediately after implant placement.

-Multiple techniques are explored in relation to immediate implantation into a fresh socket site.  The concept of no-drill implants is explored utilizing an osteoconverter to prepare the socket site.

-Short term orthodontics is explored as an efficient treatment modality in the preparation of edentulous sites wherein the patient desires implants.

Educational Objectives:

At the end of this program participants will be able to:

-Identify the suitable clinical situations for and learn to complete the 5 flapless/sutureless soft-tissue surgical implant access procedures (to include the direct, highspeed handpiece, tissue punch and mini-envelope procedures).

-Identify situations that lend themselves to the clinical application of the “no-drill” implant procedure.

-Be able to  identify clinical situations where an implant can be predictably placed into the site of a freshly extracted tooth without the use of a drill.

-List several implant final prosthetic techniques that reduce the overall number of appointments necessary and minimize rework.

-Define specific marketing medium and specific ads to place in that medium to vastly increase new patient flow and ultimately place more implants.

-Understand why short-term orthodontics is an ideal accompaniment to efficient implants in the GP practice.

Educator bio:

Over the last ten years, Bradford Frank has owned and managed multiple practices. Dr. Frank is a sought after speaker and Continuing Education trainer, and has addressed thousands of dentists at popular seminars throughout the country including Excellence in Dentistry,Phasing-Out Seminars (over 20 presentations delivered), and Schein/Camlog Seminars. Dr. Frank’s topics include Implantology, Dental Transitions, and Entrepreneurial Satellite Practice Ownership.  Dr. Frank’s  implant efficiency training at the Implat Efficiency Institute has been called the best in the industry. After completing the training, the average dental practice increased by twenty six percent in the first year. Dr. Frank’s unique 12 module system allows a general dentist to become completely comfortable and confident in providing simplified, efficient, lifetime implant solutions to patients.  Dr. Frank is uniquely qualified as an implant trainer in that he has placed thousands of implants in his home practices and has contributed several inventions to the field of implant dentistry.  Graduates of Dr. Frank’s 2-day mini-residency become well versed in no-drill implants, the 5-minute implant, abutment and crown procedure and the top 5 flapless/no-suture/minimally-invasive implant techniques.  Dr. Frank is the chairman of the board of OsteoCore Dental Implants.

————————————————-

Garrett Gunderson recently stated in a lecture to general dentists, “leveraging hot topics in your practice is one of the top ways to build business equity.”. I think that we would all agree that implants, particularly minimally-invasive/efficient techniques, are at the pinnacle today.  This article is an exploration of the ever increasing arsenal of implant efficiency techniques available to the general practitioner.  The most popular protocols are demonstrated through the selection of several case studies.

Case Study:  4 Maxillary implants and a fixed-detachable hybrid bridge with mandibular implants site #19 and #30.  6 efficiency techniques are explored

Dental implant techniques and technology has been evolving at a similar rate to what has been witnessed in the PC and smartphone market over the last few years.  Dental implants have become much less invasive and more efficient causing this procedure to be the most talked about and hottest topic in dentistry from both a patient’s and clinician’s perspective.  This case study will highlight six efficiency techniques that you will be able to incorporate into your practice right away.   If you add these techniques to your practice you will recognize great value from both a time savings and overall patient comfort perspective.

The patient presented with an ill-fitting maxillary denture and a mandibular distal-extension partial that had not been worn in months due to discomfort.  Please view the pre-operative PAN below.The patient had a moderate gag reflex which prevented the upper denture from being worn comfortably.  The distal third of the palate had been removed in an attempt to relieve the gag reflex.  The  patient elected the ideal treatment plan which involved replacement of the upper denture with a fixed-detachable hybrid bridge to be screw-retained and supported by 4 maxillary implants.  The lower plan involved replacing the existing partial with implants, teeth numbers 19 and 30.  All implant procedures and final prosthetic impressions were completed in a 90 minute appointment at the Implant Efficiency Institute.

Efficiency Technique #1: Sizing and angling the implant to utilize available bone rather than manipulating the bone through grafting procedures to accommodate a certain sized implant.  Recent advances in implant stability at the time of insertion have allowed implantologists to chose an implant size in relation to available bone rather than manipulating the bone via grafting procedures.  This has allowed implant dentistry to be minimally invasive and achieve new levels of efficiency within the general dentistry practice.  In this particular case there is very narrow bone height just inferior to the maxillary sinus as demonstrated on the PAN.  There is more than sufficient bone just medial of the inferior wall of the sinus.   An implant placement following the angle of the wall of the sinus will allow for enough bone to place 4.7 X 13 internal hex implants.  This saves both the clinician and patient additional appointments needed to recover from more invasive sinus grafting surgery.  Thus, greater efficiency. On the mandible, 4.7mm X 10mm length implants were selected.  Even as little as 8 mms of available bone height (to accommodate an 8mm  implant) has been demonstrated in numerous studies to be sufficient to maintain a 97% success rate.   A 2009 study published by the Journal of Oral and maxilofacial Surgery concluded: “Placement of short dental implants is a predictable treatment method for patients with decreased posterior mandibular bone height.”1

Efficiency Technique #2: High speed gingival access and start to osteotomy.  after analyzing the PAN the maxillary ridge was palpated to assimilate the alveolar ridge anatomy.  This allowed for the accurate entry points into the tissue to be determined.  After deciding on the ideal entry points, A high speed handpiece was used with a special long surgical bur.  Small circular movements were used to enlarge a hole through the keretinized tissue using the surgical high-speed bur and simultaneously creating a 5-6 mm hole in the bone to initiate the osteotomy.  After all 4 tissue accesses were opened a 2.3 mm drill was used to creat the initial full length osteotomy.  The drill was buried to the length of 16 mms to compensate for 2-3 mms of gingival tissue.  A PAN was taken with the drill inserted to length to verify correct angulation and to ensure that the sinus cavity was not being encroached upon.  After verifying correct position, the final osteotomies were created one drill short of the final drill to allow for greater Bone compression and thus greater torque/primary stability.  A 3.8 mm is one short of the final 4.4 mm which is used for a 4.7 mm diameter implant.  All 4 upper implants were torqued to 40-60 N/Cms.  Note the picture of implants in place with transfers.  This technique is much less invasive than an approach involving a full thickness flap and also requires fewer appointments.  Thus, more efficiency.

Efficiency Technique #3: Creating a custom bar/framework template in mouth immediately after implant insertion with final bite, midline and inter-pupillary smile-line.  Oftentimes at this stage in the procedure the clinician will place cover screws or healing caps over the implants and wait for several months.  This efficiency technique involves beginning the prosthetic process immediately after implant insertion.   This technique is recommended when the implants are able to be torqued to a level of around 60 N/Cms.  After insertion of the implants the transfers were removed and 18 degree angle correction multi-unit abutments were placed.  The angled abutments were approximated to create a certain degree of parallelism but additionally to allow for the prosthetic screw to be accessed from the lingual of the anterior teeth and occlusally in the posterior.  The multi-unit abutments used are able to accommodate an angle differentiation of up to 20 degrees.  After achieving an acceptable angulation of the multi-unit abutments, cast-able copings that are generally used by the lab in fabricating the framework were screwed into the abutments.  The cast-able copings were then adjusted using a high speed to approximate the vertical dimension.  Three stops are recommended for an accurate stop.  After establishing the vertical, two strips of Triad light-cured custom tray material were cut from a sheet using a Barred Parker blade.  The strips were approximately 5 mms wide.  The strips were then formed around the cast-able copings, one on the lingual and one on the facial/buccal.  The material was palpated into an ideal bar location based on visualization of the ideal position of the maxillary teeth.  After light curing the material in the mouth, a blue-mouse was taken to relate the correct bite and vertical to the bar.  A cotton swab was embedded into the blue-mouse to correlate the inter-pupillary smile line and the midline was marked.  The screws were then removed from the cast-able copings and a pick-up impression was taken.  This efficiency technique has saved both the patient and clinician several steps and created a more exact communication with the lab.  In the past frameworks and bars necessitated sectioning and new impressions due to minute discrepancies in the final impression with implant analogs.  Not so with this technique as all 4 implants are a fixed unit via the rigid light-cured acrylic.

Efficiency Technique #4: Utilizing a mini-envelope incision (flapless approach).  After completing the upper final impression, the initial soft-tissue entry for implants site #30 and #19 was initiated.  Due to a slight deficiency of keritinized tissue on the buccal aspect of the implant sites, a mini-envelope incision was chosen.  This is basically a small slit made at the crest of the ridge to reflect a 4 mm wide portion of keretinized tissue to the buccal.  This will allow for a nice cuff of keritinized tissue around the implant.  I use a sharp instrument commonly used for sculpting composite resin.  It works well for releasing the tissue from the bone and creating a small envelope.  Next, a surgical bur in the high speed handpiece was used to create a 4-5 mm hole in the cortical plate of the bone.  Using this hole the osteotomies were initiated and completed to a length of 13 mms from the gingival height.  This allowed for 3 mms of tissue which accommodates a 4.7 X 10 mm implant.  Implants were placed and a final impression was taken for the prosthetic portion of the procedure (cemented porcelain fused to metal restorations).  No sutures or flap saves both clinical time and an appointment as the final impression was taken immediately after implant insertion.  In 2002 The Journal of Oral and Maxilofacial Implants published a study that concluded: “Flapless implant surgery is a predictable procedure if patient selection and surgical technique are appropriate.”2

Efficiency Technique #5: Utilizing a  3 in 1 implant system.  Several implant companies now provide the option of 3 in 1 systems to their customers.  This basically means that the implant body, a customizable abutment and a transfer all come attached to one another in the same package.  This provides efficiency because the clinician does not need to track down numerous small parts.  Also, the impression for final prosthetics can be taken seamlessly immediately after implant insertion with a very accurate closed-tray impression technique.  As this implant is being inserted it is very easy to visualize the ideal placement of the margin of the final abutment.  Simply screw down the implant until ideal margin in relation to the tissue is achieved.  Not only is this technique efficient but it is also very overhead-friendly.

Efficiency Technique #6: Taking the final prosthetic impression and bite immediately after implant placement during the same appointment.  As has been mentioned, the final prosthetic impressions for both arches were taken at the end of the surgical stages for both arches.  The next appointment is the final seat appointment for both the upper and lower restorations in 30 to 90 days.  Is early loading OK?  In 2007 the Journal of Oral Maxilofacial Implants published a study that concluded : “Early loading of endosseous dental implants placed in healed ridges offers select benefits to clinicians and their patients.”3. Final restorations seated approximately 1 month after implant placement showed a 97% success rate in recent studies.

Case Study: No-Drill Implants with an Osteoconverter

 

Paste pic from catalog

 

Efficiency technique #7:  Immediate placement of an implant into a fresh extraction site, particularly no-drill implants.  This involves the extraction of a compromised tooth and the immediate placement of an implant without the use of a drill. The procedure is atraumatic and predictable. Why is this procedure preferred to using a drill in the fresh extraction site? The drilling action can fracture fragile bone around the extraction site or remove thin buccal/facial bone, which would ideally be retained around the implant.  The Osteoconverter acts to expand the extraction site while keeping wanted bone intact. The Osteoconverter also scores the internal aspects of the extraction site in roughly 1mm increments which increases blood flow to the implant interface.  This improves osseointegration and provides bone expansion which converts the irregular root circumference oval shape into a cylindrical shape that is accommodating to the implant.  The Osteoconverter has a flat end much like an osteotomb so in areas just inferior to the maxillary sinus, it gently converts the socket site without damaging the fragile sinus floor.  The Osteoconverter also serves as a measuring device; once the socket site has been converted, a simple measurement is made in order to select the correct size implant.

It certainly sounds nice to avoid picking up a drill when placing implants, but what are some contraindications to this procedure? Perhaps the most common is acute infection around the apex of the tooth. Experienced Implantologists often clean out the infected area and place the implant directly into the area that had infection. In fact, The Journal of Periodontology published a study in 2001 with the following conclusion: “The present study shows that when a screw-type dental implant is placed without the use of barrier membranes or other regenerative materials into a fresh extraction socket with a bone-to-implant gap of 2 mm or less, the clinical outcome and degree of osteointegration does not differ from implants placed in healed, mature bone.”4. Therefore the use of bone grafting materials or membranes is not necessary for superior outcomes.  Interestingly the majority of the teeth had long-term infection associated with the tooth.  It has been found that implants are very resistant to infection in socket sites due to the fact that bacteria can not feed on titanium so once the source of the infection is gone, the tooth, the area is quickly exterminated of remaining bacteria by killer T cells and lymphocytes.   What if the root is too short to place what you think to be an ideal sized implant? Drilling beyond the apex for a sufficient length with the pilot drill will solve that issue. In these cases it is prudent to under prepare (use one size smaller drill) beyond the apex and use the Osteoconverter to convert the site. This will assure primary stability and an excellent success rate.  If the apex of the socket site is right against the floor of the sinus, like many are, the Osteoconverter will gently push against the sinus floor and allow for the apex of the implant to be even with the floor of the sinus or less than 2mm. The cells between the sinus membrane and bone on the sinus floor are highly bone-forming.  This will provide for bone at the apex of the implant. This PANO of full maxillary extractions and four implants with locator abutments to retain an upper prosthesis was placed without the use of a drill.

Case Study (contributed by Ryan Swain DDS):

This approach and most of the others were simply not options to the implantologist just 3-5 years ago.  This is a huge benefit to patients and clinicians alike as treatment times are vastly reduced and clinical success rates are increased.  Join the growing trend of general dentists today who have embraced implant efficiency and watched their practices reach new levels both financially and from a professional satisfaction standpoint.

If you would like more info covered in this article or to view upcoming Implant Efficiency Institute training programs please go to http://www.osteocoredentalimplants.com or e-mail info@osteocoredentalimplants.com.

1. J Oral Maxillofac Surg. 2009 Apr;67(4):713-7.

Outcomes of placing short dental implants in the posterior mandible: a retrospective study of 124 cases.

2.Int J Oral Maxillofac Implants. 2002 Mar-Apr;17(2):271-6.

Flapless implant surgery: a 10-year clinical retrospective analysis.

Campelo LD, Camara JR.

3. Int J Oral Maxillofac Implants. 2007 Sep-Oct;22(5):791-800.

Three-year evaluation of single-tooth implants restored 3 weeks after 1-stage surgery.

Cooper LF, Ellner S, Moriarty J, Felton DA, Paquette D, Molina A, Chaffee N, Asplund P,

Smith R, Hostner C.

4. Immediate Implantation in Fresh Extraction Sockets. A Controlled Clinical and Histological Study in Man

Dr. Michele Paolantonio

Department of Periodontology, University “G. D’Annunzio” Chieti, School of Dentistry, Chieti, Italy.

Marco Dolci

Department of Oral and Maxillofacial Surgery.

Antonio Scarano

Department of Oral Medicine and Pathology.

Domenico D’Archivio

Department of Periodontology, University “G. D’Annunzio” Chieti, School of Dentistry, Chieti, Italy.

Giacinto Di Placido

Department of Periodontology, University “G. D’Annunzio” Chieti, School of Dentistry, Chieti, Italy.

Vincenzo Tumini

Department of Periodontology, University “G. D’Annunzio” Chieti, School of Dentistry, Chieti, Italy.

Adriano Piattelli

Department of Oral Medicine and Pathology.

Journal of Periodontology

Vol. 72, No. 11, 1560-1571(Volume publication date: November 2001)

DOI: 10.1902/jop.2001.72.11.1560

10 Questions for 2-Part Article series

1. In recent studies by multiple sources 8mm implants have been shown to have just as high a success rate as standard length (10-13mm) implants.  T or F

2. As the field of implantology has developed over the years have we as a profession found that bone grafting procedures are MORE needed or LESS needed than in the past. (Circle correct answer)

3. Using a high speed handpiece for the initial soft-tissue access hole and start to osteotomy:

A. May cause osteonecrosis

B. Is inaccurate for the general dentist

C. Causes excess tissue trauma

D. Is generally the most exacting and least traumatic for the patient

4. If a general dentist begins placing implants or begins placing more implants this will damage relationships with local specialists. T or F

5. Implants that are manufactured to include both the straight abutment which is attached directly to a transfer allow for fewer patient appointments and a more minimally-invasive nature.  T or F

6. Due to the fact that implants are such a hot topic among the general public, implant marketing tends to receive much more favorable results than that of other general dentistry procedures.  T or F

7. The 6 mm rule basically means that the clinician maintains a 6 mm buffer zone in relation to the mandibular nerve or mental foramen.  T or F

8. Flapless procedures are considered by some to be preferred to a flap becuse there is less of an opportunity for oral microflora to invade the site and patients experience much less post-operative discomfort.  T or F

9.  Which of the procedures below is included in the top 5 flapless procedures used by general practitioners in the US:

A. Direct

B. High-speed handpiece

C. Mini-envelope

D. Tissue punch

E. All of the above

10. A no-drill implant involves the placement of an implant directly into a fresh extraction site without using the implant drill. T or F

Key: 1: T 2: LESS 3: D 4: F 5: T 6: T 7: T 8: T 9: E 10: T

Advertisements

From → Dentists

Leave a Comment

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s

%d bloggers like this: