Posting more regularly

Hi Guys, I am admittedly not great at documenting cases and blogspot actually limits the number of photos that I can upload per blog post so that is limiting me to smaller cases. In truth we've been completing as many as 40 full arches of care a year, if you're interested in seeing these message me, in the mean time I'll start trying to piece meal a few of these together.

Thanks,

Tom

Sinus Elevation with Simultaneous Placement

In many instances when there is enough native bone remaining to stabilize an implant (typically between 4-6mm) but not enough for an internal sinus elevation to be completed a lateral window technique can be coupled to dental implant placement. Osteotome's can also be used to dilate the bone increasing the density of the bone locally without removal. This case shows these techniques being used.

Just a simple combo case involving placement of two implants

Sketal anchorage for orthodontic tooth movement

Skeletal anchorage either by way of TAD or anchor plates has become more popular recently in orthodontic treatment planning. The use of these anchor plates takes adavantage of the superior anchorage that can be obtained using fixed devices. I have found that there is no comparison with TAD's vs. Anchor plates, both in terms of predictability but also in terms of PIA tax. I would have to charge more for TAD's because of maintenance associated with them while anchor plates are very easy to work with.

I just thought this was funny

For you oral path nerds out there this was a lipoma, Hope the rest of you can see the humor in this "lesion."

Connective Tissue vs. Free gingival grafts vs. Alloderm

I have received many questions related to the indications for each of the above types of grafts. First I should say that there is some overlap for indications related to these types of procedures and that individuals clinicians may assign value to each of the procedures based on the area of the mouth being treated as well as the quality and quantity of the tissue already present in the area.

I was once told by one of my dental school instructors that there is never a reason to do free soft tissue grafts anymore due to the advent of CT grafting. I believed her for three years, however since then have seen increasing valued for free gingival grafts as both an pre-esthetic/prosthetic procedure as well as in some cases definitive treatment. Although they are not as esthetic in nature as CT grafting I do feel that for the desired result they are more predictable and more permanent in nature. I've seen many fgg that are 30+ years old that look brand new. It should be noted that after a CT graft is a year old you may never be able to find it again so I don't have much basis for comparison. Generally speaking you should be more selective of the cases you elect to perform CT grafts on, sometimes it is worthwhile to increase the band of attached gingiva via a FGG before proceeding to a CT graft.

I don't use alloderm routinely, I just haven't been able to duplicate the results of many of the periodontists who use it routinely. I too have excellent outcomes with alloderm, just not on the same consistent basis that I do with native tissue. When palatal stents are properly used I don't feel that using native tissue needs to be significantly more uncomfortable than using an allograft material and if I were having a graft done I would elect for the native autograft as opposed to a foreign material.

Sinus Elevation with GBR and Immediate placement

This is a combination case which shows the following:

- Removal of tooth #3
- Site preservation (non-resorbable membrane) #3
- Sinus elevation #3/4 areas
- Implant placement into the #4 area.
- Later flapless implant placement at position #3.
- Piezo surgery used for window elevation, small perforation did not require resorbable membrane placement following membrane elevation.
- Sinus elevation was completed using a large particle cortical graft (Puros) GBR with dynagraft bone putty.

Maxillary Overdenture case continued

This case has detailed narrative in the following posting. These implants shown in the below images were decidedly not placed by me.