Wednesday, May 12, 2010

ANSWERS TO QUERIES:- MINIMIZED DENTAL IMPLANTS: THE COMING WORKHORSE IN IMPLANT DENTISTRY

These reasons can be readily addressed when the facts are laid down clearly:-
(1) Mini- implants are made of titanium alloy, i.e. is size for size, 1.6 times stronger than commercially pure titanium. The diameter of mini- implants range between 2.0mm to 3.0mm. Mini- implants are actually less prone to fracture because it is solid.
Conventional implants are more prone to fracture because they consist of 2 pieces with a connecting screw in between. If a conventional implant is 4.0mm in diameter and the connecting screw is 2.0mm in diameter. The thickness of the remaining wall of the implant fixture is only 1mm. Compare this to the mini implant which is 2.5mm in diameter or thickness, which is stronger? The mini- implant…… believe it or not is stronger than the conventional implant! It is less prone to fracture than the conventional implant.

(2) Additionally, the 2 piece conventional implant is connected by a screw which has a tendency to come loose and even fracture. Also, there is a microgap between the 2 pieces of the conventional implant which harbour microorganisms that causes bone resorption and sometimes implantitis. Such a chronic source of pathogens in the body may cause coronary artery disease with the accompanying sequelae.

(3) Just because mini implants were designed to be transitionals should not mean that they cannot be used permanently. Many mini- implants have been used for crowns and bridges in the last 10 years successfully. The concept that an implant root should imitate the root size of the tooth it is replacing is largely an assumption by the pioneers of implantology. The basis should have been a study of how much osseointegrated surface is required to withstand the masticatory forces of a particular tooth. It should be reasonable to assume that the surface area of osseointegration may be less than the surface area of the periodontal ligament of the tooth to be replaced , since osseointegration square mm to square mm is much stronger a bond than the bond of the periodontal ligament, although without the shock-absorbing ability of the periodontal ligament. It is much more easier to extract a tooth than an osseointgrated implant. In fact, you cannot extract an osseointgrated implant. It is reasonable again, therefore, to assume that an implant that is half the size of a tooth root will give sufficient surface area of osseointegration to carry the tooth and its masticatory functions.

(4) Titanium osseointegrates, and if mini- implants are made out of the same stuff as conventional implants, they osseointegrate.

(5) The whole world of surgery is moving relentlessly towards minimal invasiveness as shown by the rapid change towards laporoscopy and closed surgery as far as possible. 



by Dr. Chow Kai Foo
BDS Singapore; FDSRCS England
Cert. of Oral Implantology University of Frankfurt Germany
FICD; Academy of Medicine; National Specialist Register


President of the Malaysian Oral Implant Association 2009-2011

Currently Advisor to the Malaysian Oral Implant Association

Monday, May 10, 2010

QUERIES:- MINIMIZED DENTAL IMPLANTS: THE COMING WORKHORSE IN IMPLANT DENTISTRY




(1) Mini-implants were considered too small in diameter and therefore its ability to withstand masticatory forces over long periods of time were doubtful.

(2) Mini-implants were used originally as transitories and therefore should remain so.



(3) The surface area of mini- implants compared to a conventional implant is too small and therefore the amount of osseointegration is insufficient to withstand masticatory forces.

(4) Mini- implants do not osseointegrate.

(5) It goes against the original tenets laid down by Professor Branemark where it is accepted wisdom that the size of the implant fixture should imitate the size of the root of the tooth that it is replacing.

(6) The emotional element also comes into play, as in, “How can oral implantology be so simple and easy to do?” Emotionally it is difficult to accept that a previously complex procedure can be bypassed with a simple approach.

(7) How can you load mini-implants so routinely when conventional implants usually cannot be loaded immediately, and when done so, only progressively?



by Dr. Chow Kai Foo
BDS Singapore; FDSRCS England
Cert. of Oral Implantology University of Frankfurt Germany
FICD; Academy of Medicine; National Specialist Register


President of the Malaysian Oral Implant Association 2009-2011

Currently Advisor to the Malaysian Oral Implant Association

Sunday, May 9, 2010

CHAPTER ONE: MINIMIZED DENTAL IMPLANTS- THE COMING WORKHORSE IN IMPLANT DENTISTRY

CHAPTER ONE



INTRODUCTION
While I would like spend a lot of time reading up all the journals I can lay my hands on and including all their references as part of this book, I realize as a clinician with a busy practice and a large family commitment, my time has to be prioritized carefully.

However, the need for this book cannot wait. There is a huge debate currently on whether or not mini implants or small dental implants or as I prefer to call them MOSTDIS (Minimised Osseointegrated Screw Titanium Dental Implants) should or should not be used for the long term fixation of crowns and bridges.

In the last few years, there has been a widespread concession that mini-implants can be used for denture stabilization. I use the word “concession” as (opposed to “consensus”) because previous to that, mini-implants were frowned upon as transitionals pretending to be “genuine” implants. Historically, mini-implants were used as transitionals that were placed between the conventionally sized dental implants to hold the temporary prosthesis while waiting for the conventional implants to osseointegrate. When the time came to remove the temporary prosthesis, some of the transitionals were found to have osseointegrated  and were impossible to unscrew. Often, the head of such osseointegrated mini-implants were cut off and the endosseous part left in situ. Over time, it occurred to some practitioners that transitories or mini-implants can be used in a more permanent or long term manner.

Initially, mini-implants were used more for denture stabilization. Subsequently, some practitioners tried cementing crowns and then bridges on top of the mini-implants and more often than not were found to be successful, especially in the mandible. Such practices were frowned upon and even condemned by oral implantologists because of several reasons:-



by Dr. Chow Kai Foo
BDS Singapore; FDSRCS England
Cert. of Oral Implantology University of Frankfurt Germany
FICD; Academy of Medicine; National Specialist Register


President of the Malaysian Oral Implant Association 2009-2011

Currently Advisor to the Malaysian Oral Implant Association

AN AUDACIOUS ATTEMPT:- MINIMIZED DENTAL IMPLANTS: THE COMING WORKHORSE IN IMPLANT DENTISTRY

PREAMBLE



Why do I want to write this book? Since Professor Branemark gave his landmark lecture in Toronto in 1982, there has been a flood of 400 plus implant manufacturers who mainly copied his two-piece dental implant idea. The promise that dental implants held for the suffering masses of people without teeth has not materialized 30 years later. This is mainly because dental implants are perceived and taught to be difficult and kept expensive because less than 10% or less of dentists have learned to place dental implants. Today, mainly the rich and the brave are benefiting as a result. 

There is a most unfortunate man-made bottleneck of huge demand upon a small supply mainly because of lack of dentists able to deliver implants and the price being too expensive for the common person. The greater usage of minimized cheaper dental implants and this book hopefully will bridge the gap and unblock the bottleneck by making it easy for the dentist to deliver and cheaper for the patient to pay for.

The fact is that it is actually easier for the dentist and safer for the patient to replace a tooth with an implant than to cut a three unit bridge!!!! Cutting abutment teeth is a gross travesty of G.V. Black's principle of conservation of sound tooth structure, especially if the dentist can replace a tooth with an implant. This book, I hope and pray will bridge the gap between great demand and small supply by increasing the supply of empowered dentists and the usage of minimized dental implants.












AN AUDACIOUS ATTEMPT
A private dental practitioner trying to write a dental textbook is certainly an attempt to accomplish a feat that may compromise academic standards. However, I will still do so because I see a vacuum in the area of small dental implants where textbooks are concerned. However, I am calling it a handbook because it will be both informative and practical, based mainly on clinical experience rather than overt prospective studies. As such, there will be minimal listing of bibliogaphy of journals, books and papers that is ubiquitous in many academic texts. Still, it is considered quite an audacious attempt by a non-academician. Implant Dentistry has a long and checkered history. Professor Branemark is among many pioneers of implant dentistry. He stood out however as the first one who did a longterm documented study on dogs and humans and thus laid down solid scientific foundations for implant dentistry to take off. He logically decided to emulate the size of the original tooth root as closely as possible. The first successful osseointegrated titanium fixtures were designed to emulate generally the shape and size of the tooth root that they were replacing, However, due to the increasing understanding that there are differences between a root held by a periodontal ligament and a fixture held by osseointegration otherwise known as the biological cum mechanical bond between the bone and titanium otherwise known as ankylosis, it made sense that titanium fixtures could be made smaller than that of the roots that they are replacing. This is because square area for square area, ankylosis is a much stronger bond than the periodontal ligament. When I first started learning and using dental implants, we were taught to place as big an implant as the existing bone would allow. Currently, the accepted wisdom is that it is not necessary and most implants that are placed today fall within the range of being 4mm or less in diameter and the part that is within bond ranges from 8 to 12mm in length.

In the last 10 years or so since the late 90s of the last century some practitioners have been using small dental implants to stabilize dentures mainly and later increasingly to mount crowns and bridges for long term use. These small dental implants, called transitionals were initially used to mount temporary crowns and bridges while the conventional sized dental implants were osseointegrating. It was discovered that not only did they do a good job holding up the temporaries, sometimes they were osseointegrated firmly, forcing the dentist to cut it of at the bone level and leave them in situ.

Dr Todd Shatkins came up with a retrospective study in 2007 documenting up to 5000 cases of crowns and bridges secured for long term function using exclusively small mini dental implants. But so far, no one has come up with a textbook to teach the use of mini dental implants systematically. Also, there is still a lot of room for the development of reliable and operator friendly prosthodontic solutions for small dental implants.

As a dentist who uses both conventional sized and small dental implants extensively to replace missing teeth and to rehabilitate dental cripples, I believe that small dental implants have an important place in modern dentistry. Because of its small sizing, economy and ease of placement, I foresee that not only will it be an increasingly used modality in dentistry, it is well on its way to becoming the main workhorse of implant dentistry, once the issues of reliability and long term durability and a good prosthodontic solution has been worked out satisfactorily.

In this handbook entitled, “MOSTDIS: An Important Adjunct In Implant Dentistry”, I will attempt to lay out briefly the versatility and usage of small dental implants together with the introduction of a user-friendly prosthodontic solution for small dental implants.

This book is not written as an academic text but as a basic dental implantology handbook suited for the general practitioner with the relevant write-ups of the history and principles of implant dentistry. Many practical cases will also be described with photographs and diagrams. I hope that this book will lay down enough basic theory and practical guidelines for a general practitioner to begin to get started in dental implantology. This book will not attempt to present all that is necessary but hopefully will serve as a beginning text for the many GPs who have realized that dental implantology is here to stay and that the best replacement for a lost tooth is no longer a bridge but a dental implant.

Dental implantology has remained for many dentists a fearful and risky area to delve into even though there is an increasing realization that dental implants are here to stay, and that in order to offer patients the best possible dental treatment, dental implantology must be closely integrated into all the different fields of dentistry, be it conservative dentistry, periodontology, orthodontics, prosthodontics, the oral rehabilitation of dental cripples, or post oral cancer patients and many others. We hope that this book will launch many dentists into the exciting and life changing world of dental implantology.

by Dr. Chow Kai Foo
BDS Singapore; FDSRCS England
Cert. of Oral Implantology University of Frankfurt Germany
FICD; Academy of Medicine; National Specialist Register


President of the Malaysian Oral Implant Association 2009-2011

Currently Advisor to the Malaysian Oral Implant Association



PURPOSE AND CONTENTS:- MINIMIZED DENTAL IMPLANTS: THE COMING WORKHORSE IN IMPLANT DENTISTRY

PURPOSE OF BOOK:  To enlarge and speed up the usage of small dental implants in all areas of dentistry and to encourage the adoption of implant dentistry into the undergraduate curriculum of dental schools. To encourage and teach dentists, especially general dentists how to get started in implant dentistry by using minis first and to grasp the fact that it is easier and safer to place a dental implant to replace a tooth than to cut 2 abutment teeth to replace a tooth using a conventional bridge.

Note: Small dental implants are also known as MINIS or RDIS[Reduced Diameter Implants] or MOSTDIS[Minimized Osseointegrated Screw Titanium Dental Implants]. In this book, they will be mainly called MOSTDIS. COSTDIS[ Conventional Osseointegrated Screw Titanium Dental Implants] are conventional large dental implants.


PREAMBLE: AN AUDACIOUS ATTEMPT

CHAPTER ONE: INTRODUCTION
HOW I GOT HOOKED
A BRIEF HISTORY OF DENTAL IMPLANTS
TYPES

CHAPTER TWO: PRINCIPLES OF ORAL IMPLANTOLOGY
OSSEOINTEGRATION
TREATMENT PLANNING
HARD TISSUE
SOFT TISSUE
OCCLUSION

CHAPTER THREE: PRINCIPLES OF SMALL DENTAL IMPLANT USE
OSSEOINTEGRATION
PLACEMENT
RESTORATION
MAINTENANCE

CHAPTER FOUR: DIFFERENT USES OF MOSTDIS WITH CASES

CHAPTER FIVE: CONCLUSION
INTEGRATING MOSTDIS AND COSTDIS

by Dr. Chow Kai Foo
BDS Singapore, FDSRCS England,
Cert. of Oral Implantology University of Frankfurt Germany
FICD
President of the Malaysian Oral Implant Association

MINIMIZED DENTAL IMPLANTS: THE COMING WORKHORSE IN IMPLANT DENTISTRY

MOSTDIS
An Important Adjunct In Implant Dentistry


A HANDBOOK ON SMALL DIAMETER DENTAL IMPLANT DENTISTRY






by Dr. Chow Kai Foo
BDS Singapore; FDSRCS England
Cert. of Oral Implantology University of Frankfurt Germany
FICD; Academy of Medicine Malaysia; National Specialist Register

President of the Malaysian Oral Implant Association 2009-2011
Currently Advisor to the Malaysian Oral Implant Association