Implant Ninja | drcajee | Activity

drcajee posted a new activity comment

Sat, 28 Feb 2026 13:44:15 -0800

Great points for discussion.

Osseointegration is not a standardized “oven timer” process; bone healing and growth are governed by a complex interplay of factors ranging from the defect size to the patient’s systemic health. In the real world, 3 months is often just the baseline. If you’re seeing “mushy” bone at 12 weeks, your intuition is…

In reply to - tannersmenard posted an update

In dental school, I was taught I needed to wait a minimum of 3 months after extraction/socket grafting before site was “healed” or “stable” and ready for implant placement. […]

drcajee replied to the discussion Implant lost in max sinus :( in the forum Complications

Thu, 26 Feb 2026 13:57:31 -0800

Reply to Implant lost in max sinus :(

Welcome to the “club” no one wants to join, but every seasoned surgeon eventually does! Honestly, the fact that you were upfront with the patient immediately is the best move you could’ve made—that transparency saves careers. What likely happened is a “perfect storm” where the soft Type IV bone in that #3 spot didn’t transition from mechanical… Read more

drcajee posted a new activity comment

Sat, 29 Mar 2025 14:52:13 -0700

@jostanger every form of practice has advantages and disadvantages. An advantage to our partnership is splitting the administrative workload. However, you lose your full autonomy of decision-making. From personal experience the more symmetrical the partnership arrangement is the better. Ideally, if the partners are in a similar stage in… Read more

In reply to - jostanger posted an update

Practice question— does anyone have a partner or work in a group practice? I might be buying into one and id love any advice on how to handle partner dynamics!

drcajee posted a new activity comment

Sat, 29 Mar 2025 13:54:14 -0700

You’re right, the bite collapse and the uneven ridge in the upper anterior make things tricky. It’s understandable the patient struggled with the partial denture, especially with the adjustments.

Absolutely, orthodontics is something you should be considering, but it’s not the first step. We need to really figure out where we’re going before… Read more

In reply to - Olga posted an update

This patient wants implants. We just finished treating her periodontal disease and she is ready for the next phase, however, she has severe bite collapse. In addition, she has uneven ridge […]

drcajee replied to the discussion Creation of lateral window for sinus augmentation in the forum Implant Tx Planning

Sun, 09 Feb 2025 16:08:06 -0800

Reply to Creation of lateral window for sinus augmentation

Lateral window sinus lifts are indicated when there’s 3 mm or less of residual bone height. In this case, you may still be able to go intracrestal for these lifts.

However, yes, if you do have a bony window you can leave it attached to the membrane when you elevate. It’s basically added bone graft!

I haven’t used those kits so I couldn’t tell…

drcajee started the discussion Controlling Bleeding with Transexamic Acid in the forum Complications

Sun, 09 Feb 2025 01:06:51 -0800

Controlling Bleeding with Transexamic Acid

I have a case share. I have a patient who presented with Pericoronitis tooth number #1 and other impacted wisdom teeth. Medical history significant for von Willebrand‘s disease. I had a difficult time getting a medical status update from her PCP. Upon questioning the patient, it looks like a bleeding issues haven’t been too severe for her.…

drcajee replied to the discussion Sinus lift or not in the forum Implant Tx Planning

Sun, 09 Feb 2025 01:00:37 -0800

Reply to Sinus lift or not

In this case, it looks like a minimal sinus augmentation is needed. There is a technique you can consider for this clinical scenario called a ‘sinus implosion’. For this technique, you drill your osteotomy just shy of the sinus floor cortex and then you place your implant fracturing the sinus floor into the sinus. So it often looks like drill 6…

drcajee posted a new activity comment

Fri, 10 Jan 2025 22:54:06 -0800

Very clean work and great documentation. 👊

In reply to - 87madrigal posted an update

Posterior implant placement with a surgical guide: a case that highlighted the value of precision, even in favorable conditions.

This patient had abundant posterior bone, which […]

drcajee posted a new activity comment

Thu, 09 Jan 2025 16:03:38 -0800

The guideline of maintaining 3 mm between them is still widely recommended.

Bone Health: Keeping 3 mm of bone between implants helps prevent bone loss. If implants are too close, it can lead to complications like bone resorption, which can jeopardize the stability of both implants.

Soft Tissue Support: Adequate spacing is essential… Read more

In reply to - jorbrown posted an update

Distance between implants? Do we still keep 3 mm of bone between implants?

drcajee posted an update: Hey guys. Last week, while I was in the middle of a FBI […]

Tue, 07 Jan 2025 19:28:54 -0800

Hey guys. Last week, while I was in the middle of a FBI #17 case I noticed something interesting. I laid my flap and I saw this structure. Can you guess what it is?

It’s an extra nerve exiting from the bone!

In this case, you can decide whether to sever the nerve or work around it. It reminded me a lesson I learned sometime back – if you don’t…

drcajee replied to the discussion Prolia and medical hx in the forum Implant Tx Planning

Mon, 06 Jan 2025 16:22:19 -0800

Reply to Prolia and medical hx

When it comes to bone grafting, there are a few options like demineralized bone allograft (DBA), freeze-dried bone allograft (FDBA), and synthetic calcium phosphate (like Augma Bondapatite).

– DBA: This is human bone that’s had the minerals taken out, which makes it great for bone growth because may actually help recruit your body’s own cells…

drcajee replied to the discussion Prolia and medical hx in the forum Implant Tx Planning

Mon, 06 Jan 2025 16:13:46 -0800

Reply to Prolia and medical hx

Regarding use PRF for B/MRONJ – not enough data out there to call that standard of care. https://pmc.ncbi.nlm.nih.gov/articles/PMC8140838/

pmc.ncbi.nlm.nih.gov

The Role of Platelet-Rich Fibrin (PRF) in the Prevention of Medication-Related Osteonecrosis of the Jaw (MRONJ) - PMC

Dentoalveolar surgery is probably the major risk factor for MRONJ and for other complications following a tooth extraction, especially in patients affected by systemic diseases. The aim of this retrospective study is to evaluate whether a PRF plug ...

drcajee replied to the discussion Prolia and medical hx in the forum Implant Tx Planning

Mon, 06 Jan 2025 16:09:17 -0800

Reply to Prolia and medical hx

Since she’s paused her Prolia, it’s generally a good idea to remove the tooth soon after that to avoid complications. But definitely recommend checking in with her managing physician to make sure everyone’s on the same page about timing and any other precautions. This way, we can ensure a smooth process for her!

drcajee replied to the discussion Vertical grafting or not? in the forum Implant Tx Planning

Mon, 06 Jan 2025 15:59:43 -0800

Reply to Vertical grafting or not?

When I look at this case, you have enough bone to secure your implant. Regarding the vertical deficiency, I wouldn’t be too concerned as long as the Implant prosthesis has enough tissue support. If it doesn’t, I would consider a connective tissue graft and custom healing abutment.

drcajee posted a new activity comment

Thu, 02 Jan 2025 05:37:19 -0800

@RYAN thanks for sharing

In reply to - drcajee posted an update

I was thinking yesterday, could I substitute Liquid Bandages for PeriAcryl? It could be a significant cost savings. Nowhere on the liquid bandage bottle did it say oral wounds […]

drcajee posted a new activity comment

Thu, 02 Jan 2025 05:36:42 -0800

I use DESS for a lot of restorative components. If you have questions regarding anything, they’re super helpful to take calls.

In reply to - rez posted an update

i was wondering if you can tell me where you buy your angled abutments & locators (as you mentioned for $30-40), Also the non engaging abutments are the same as temp cylinders or […]

drcajee posted a new activity comment

Thu, 02 Jan 2025 05:35:26 -0800

👋 Is there a specific aspect of partnerships you have a question regarding?

In reply to - jostanger posted an update

Practice question— does anyone have a partner or work in a group practice? I might be buying into one and id love any advice on how to handle partner dynamics!

drcajee posted an update: I was thinking yesterday, could I substitute Liquid […]

Tue, 17 Dec 2024 19:11:34 -0800

I was thinking yesterday, could I substitute Liquid Bandages for PeriAcryl? It could be a significant cost savings. Nowhere on the liquid bandage bottle did it say oral wounds are contraindicated. What do you think?

drcajee posted a new activity comment

Sat, 14 Dec 2024 15:33:38 -0800

@ivan-chicchon It’s a Minnesota retractor with a elevator handle. Let me know if you want to try it out.

In reply to - drcajee posted an update

Rethinking Everyday Instruments: The Case of Minnesota Retractors

Have you ever considered the everyday instruments we use that seem poorly designed or cause unnecessary discomfort? […]

drcajee posted an update: Rethinking Everyday Instruments: The Case of […]

Fri, 13 Dec 2024 19:30:58 -0800

Rethinking Everyday Instruments: The Case of Minnesota Retractors

Have you ever considered the everyday instruments we use that seem poorly designed or cause unnecessary discomfort? As someone who spends long hours in the operating room, I’ve certainly had my fair share of frustrations. One instrument that stands out to me is the Minnesota…

drcajee posted a new activity comment

Thu, 05 Dec 2024 18:23:57 -0800

@RYAN You basically have a crown designed to ideal emergence And instruct the lab to cut off what would be exposed above the gingiva. Then at stage two you uncover the implant and close the tissue around it.

In reply to - Ryan posted an update CUSTOM HEALING ABUTMENTS

Hey folks! Hope everyone had a wonderful thanksgiving!

I went down a custom healing abutment rabbit hole yesterday and wound up with a few lingering questions. […]

drcajee posted a new activity comment

Tue, 03 Dec 2024 20:56:56 -0800

One technique I use for posterior teeth is scan the implant position with a scan body at the time of implant placement. Have a custom abutment or temp crown fabricated and place it at stage two uncovery. It saves a ton of time compared to fabricating a custom healing abut chairside.

In reply to - Ryan posted an update CUSTOM HEALING ABUTMENTS

Hey folks! Hope everyone had a wonderful thanksgiving!

I went down a custom healing abutment rabbit hole yesterday and wound up with a few lingering questions. […]

drcajee posted an update: What are your tips or tricks for making sure your implant […]

Tue, 03 Dec 2024 20:49:41 -0800

What are your tips or tricks for making sure your implant is in the correct restorative position?

When placing Implants freehand, it’s easy to judge the mesial and distal angulation, but often tricky to judge buccal lingual orientation. Here’s what you can do to make sure you are in the correct restorative position – use the opposing dentition!

drcajee posted an update: Hey Guys. I have an immediate implant for site #7 with […]

Tue, 19 Nov 2024 13:26:17 -0800

Hey Guys. I have an immediate implant for site #7 with a signif PARL, prob cystic. pt has no significant reported med hx. As this case approaches im asking myself weather physical debridments and pre/post op abx are enough to prevent infection/early failure. Thankfully in general after 8 years of placing implants ive only had a few of…

drcajee posted a new activity comment

Mon, 18 Nov 2024 19:43:43 -0800

Waking up early and having me time before the needs of the day kick in.

In reply to - Ivan posted an update 🚀 Motivation Monday 🚀

⭐️ What is a routine, ritual, or habit that has helped you to be your best self lately?

drcajee posted a new activity comment

Sat, 16 Nov 2024 15:21:21 -0800

That sucks. Put a sign out front that says ‘Dentist on Duty 24 hours’. Might scare them more than the alarm signage.

In reply to - Ivan posted an update

Break in at our practice today 🤦🏻‍♂️ our new practice is still under construction so luckily no dental equipment was stolen. They stole tools and a compressor.

Have you guys had any […]

drcajee posted a new activity comment

Thu, 14 Nov 2024 21:33:15 -0800

That postop x-ray looks so good., It’s painful to see what followed. I think it’s a bone Vascularization issue around the Implant. With versa you already compacted the bone, and then getting high torque further compacted it leaving little blood supply to the implant surface.

In reply to - andanbcx posted an update

Not the best outcome… dont really know why. So I completed this implant with sinus bump using the Densah system about a month ago. Everything went pretty straightforward. Got my little […]

drcajee posted a new activity comment

Thu, 14 Nov 2024 21:29:46 -0800

It’s unfortunate your referral was handed in that way. The whole reason why we have a referral system in dentistry is because no one can be an expert of everything. And you have to be humble enough matter what you’re training is to know that.

The decision to remove the root tip by a caldwell luc or lay window procedure determined by if…

In reply to - Ivan to Ryan

LOST ROOT TIP

To piggyback on the theme of @RYAN ‘s WTF Wednesday post... Take a look at this little complication.

I extracted #14 by sectioning it, however a little piece of root tip fractured off […]