Study Club Member Justin
Study Club Member
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Justin posted an update 2 months ago
I have a patient that I am placing an implant on #19. He is missing #18 and #20 has class II mobility due to trauma from occlusion. I would like to place #19 with possibly having to place an implant on #20 in the future in mind. I know the minimum distance from an adjacent tooth is 1.5-2mm and distance away from an implant is 3mm. However,…
drcajee3 Comments-
Made a quick little diagram for ya. Does this help? You’re right that you should not place it within 2mm from #20. Besides that you need to consider the Mesio-Distal length of #20.
SInce the average MD length of a mandibular molar is 10mm, the furthest you’d want to start your prep is 5mm away from #20. As shown in diagram. LMK if that helps or…
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That being said I would still place it less than 5 or countersink it two mm so I had papilla formation. Nothing sucks more than a black triangle at the finish line.
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Justin posted an update 2 months ago
Hello Everyone,
I have a patient I recently saw for an impression for an implant crown. I completed a two stage implant surgery. I didn’t note any complications at time of implant placement or uncovering.
The patient returned after three weeks for her impression. I noticed some inflammation surrounding the buccal of the healing abutment. There…
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Was the healing abutment down all the way? Typically nothing should get between the healing abutment and implant if that connection is snug. I’ve seen ones where stuff gets in there with it not being down all the way.
Oral hygiene? This absolutely makes a difference when you have a fresh surgical site (even just for an uncovery) and can cause…
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Hey Justin,
Thank you for sharing this case with us.
Let’s rule out some possibilities.
1. Was the healing abutment brand new? If it was brand new, was it sterile? Some docs sterilize old used healing abutments and re-use them on other patients. Unfortunately, that sometimes results in transfering debris from one patient to another, which is…
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Justin posted an update 3 months ago
Hello,
I recently placed an implant that I’m worried about the prognosis. My previous cases have all been free handed. I had my lab make a guide for this case. I ended up relying too much on the guide and placed the implant too close to the adjacent tooth (0.8mm). Has anyone else placed one this close and had it fail or be successfull? Im…
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Anecdotal Suggestion
While this situation can be super stressful, it doesn’t necessarily mean disaster.
Anecdotally, I have at times, and many others have placed implants closer than we wish we would have to adjacent teeth. It’s happened once or twice. And aside for a few sleepless nights, I (and the patient) have had zero issues from it.<br…
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Appropriate Next Steps?
In my humble opinion, the first thing is to take a step back and not stress too much. Thing will be okay.
Now, here are some potential options:
Option A: Take the implant out and re-do the implant placement. You still have time if you wan to do this.
Yes, it does feel stressful to explain to the patient why you want… Read more
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Justin posted an update 5 months ago
What would you do here for possible implant in 21 location? Space is limited ~6mm. My PA measures 6.5 between roots and 5.7 between crowns. I was able to get a 6mm caliper between the contacts.
1) Enamelplasty
2) Ortho to open space
3) 3.2mm diameter implant
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I would do enamelplasty and a narrow implant. Ortho treatment for these cases can be more ideal, but in some cases can tip the roots in a way that may be more restrictive
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Justin posted an update 8 months ago
I have this implant case for tooth #28. I am worried about the anterior loop of the IAN here. It looks like it terminates at slice 62 and 63 but then I have a circular radiolucent area in slice 65. Do you think this is still the mental? If so I have about 10mm from the crest of the ridge. Do you think I’d be safe with an 8 mm implant here?
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Just looking at what you provided it looks like there is sufficient room for an 8mm implant and that other slice I believe around 65 just looks like a void around the bone that looks similar to the pano version of the cbct and doesn’t present in other slices, nerve appears to be below that area.
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Hey Justiin are you able to share the CBCT on a google drive link?
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Justin posted an update 8 months ago
What are your thoughts on what this radiolucent area in the anterior mandible could be? Should I be concerened with placing an implant into it?
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I’m not sure just from those slices but more reward and less risk in other locations. Around the mandibular midline you have your superior and/or inferior foramina relative to the genial tubercle/mental spine which can very in size greatly from pt. to pt. and often times very apical where no teeth have been before you can have more variability…
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100% in agreement with @restoredsmiles While the anterior mandible is easy pickings for implants, it is very important to pay attention to things like this in the x rays.
It looks like if you drill into that spot you may get a bleeder that might be difficult to manage. I would also recommend opting for modifying your plan to stay away from that finding.
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Justin posted an update 8 months ago
For an mandibular 2 implant overdenture what do you think is bare minimum width for a 3.2mm implant? I know we try for 1.5 mm but I also know Ivan said we could get away with 1mm for lateral incisors. Is this the case for an overdenture in this area too?
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You typically want 2mm all the way around your implant b/c implants require much more bone and biology around them than teeth do. If less than try to favor the buccal bone more (i.e. more bone to buccal of implant than lingual). 1mm only all the way around will not be successful consistently so try to have more bone especially for overdentures…
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One tool to keep in mind is mini implants. People love to hate them–but they are great for situations in which you have minimal bone and it may not be feasible or practical to undergo significant grafting.
for example, 80 year old woman that just wants her dentures to not move around. I wouldnt recommend a hip graft. Instead i would use a couple mini’s.
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Justin posted an update 9 months ago
When placing two immediate implants for a mandibular overdenture how deep sub crestal would you recommend to place the implants?
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For implants I place for overdentures I prefer to place them more subcrestal than other implants. Typically 2 to 3 mm below the crest of the bone. Over the years I just find I have better overall crystal bone and less issues and more compromised patients as bacteria tend to leak down those locators more frequent overtime and this helps…
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Here are some screenshots of the CT for the case I am planning. Should I be concerned about the circular radiolucent area below 22 on page 2? When I traced it back I only saw it in a few segments. I remember Ivan saying there could be anterior branches of the IAN or vasculature in this region.
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Justin posted an update 10 months ago
Hello All,
I have placed 15 free handed implants so far but they have been on very straight forward cases with a lot of bone and far proximity of the sinus. This patient is a family friend and I would be doing the case for free. I’m contemplating testing my abilities with this case. It looks like I can sneak in an 8mm implant but may have…
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Well, that’s a decision. You definitely have to make especially with the family friend. Bit of advice is I would definitely charge even if it’s just a little bit. You don’t wanna get in habit of giving those away for free. You should be able to squeeze it in there, but you wanna make sure that you do not place it too far to buccal cause you…
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