Dennis Flanagan

Important arterial supply of the mandible, control of an arterial hemorrhage, and report of a hemorrhagic incident.

Penetration of the mandibular cortex during dental implant surgery may damage 3 important arteries and could lead to life-threatening circumstances. To lessen the likelihood of lateral angulations and cortical perforations, dental implants of less than 14 mm may be considered for the mandible. The courses of the inferior alveolar, facial, and lingual arteries and their branches are reviewed. Management of hemorrhage from a branch of the lingual or facial arteries may require an extraoral approach for ligation, because the mylohyoid, sublingual, and submental arteries can anastomose and be anatomically variable as well. A violation of 1 of these may be difficult to manage and lead to a compromise of the airway. A cortical perforation may be avoided by studying the anatomy of the ridge being treated. This article discusses what procedures to perform to obtund bleeding from 1 of these arteries and the technique of performing an emergency tracheotomy.

Apical (retrograde) peri-implantitis: a case report of an active lesion.

Dennis Flanagan, DDS, is in private practice at 1671 West Main Street, Willimantic, CT 06226. D ental implant treatment can be complicated with infection. There have been reports of infections that are limited to the apical portion of a root form implant.1–3 These infections have been called apical or retrograde periimplantitis. A list of possible causes includes overheating during the osteotomy,4 bacterial contamination from an adjacent tooth,5 residual bacteria from the infected tooth that previously occupied the site, bone microfractures from overloading or loading too soon, and residual space left after not seating the implant to the full length of the osteotomy.1–3,6 Most treatments entail surgical debridement of the lesion and surface treatment (detoxification) of the apical or exposed portion of the implant with tetracycline or chlorhexidine gluconate.7,8 The etiology and treatment of apical or retrograde peri-implantitis remain a topic for discussion.1–3,6,9–13 The following case of periimplantitis was treated with surgical debridement and a paste of calcium hydroxide in water and no implant surface detoxification. This resulted in resolution of the associated signs and symptoms of infection.

The mini dental implant in fixed and removable prosthetics: a review.

Dental implant treatment can restore oral function to edentulous patients. Recently, mini implants have been shown to be successful in minimally invasive treatment. There are initial reports of mini implants retaining removable prostheses and supporting fixed partial and complete dentures. This article reviews the treatment of edentulous patients with prostheses and mini implants and offers guidelines for successful outcomes.

Measurement of the Fatigue Life of Mini Dental Implants: A Pilot Study

The fatigue life of mini or small-diameter dental implants is of particular interest because these implants are used to retain and support fixed and removable dental prostheses. The fatigue life of an implant depends on both the implant itself as well as on the physical properties of the bone. However, the capability to predict the fatigue life of a newly placed implant is currently inexistent. This pilot study represents the first step in developing such a methodology and focuses on the design of a cost-effective device to measure the fatigue life of a dental implant. In our measurements, the implant has been mounted in an essentially rigid support, but test specimens can also be bone mounted in vitro. Furthermore, we developed a finite element-based computer model capable of predicting the corresponding fatigue life. The finite element analysis was performed in ABAQUS, and the results predicted by the model correlated fairly well with our initial experimental results. Most of the 2-mm diameter implants fractured after more than a million cycles.

Implant-supported fixed prosthetic treatment using very small-diameter implants: a case report.

A case report is presented where an edentulous mandibular anterior site is restored with very small- or mini-diameter (1.8-mm) dental implants. The surgical and prosthetic use of very small-diameter dental implants is discussed. Such implants can be successfully used in appropriate sites where there is adequate bone density for immediate implant stability and an implant-protected occlusal scheme.

Flapless dental implant placement.

Flapless dental implant placement is possible in selected patients but limited to those sites with adequate or augmentable attached gingiva and available bone volume and density. Inadequate attached gingiva, available bone, and bone density may be augmented by pre-, intra-, or postoperative procedures. Bone ridge contour can be approximated by using a described fast set polyvinyl siloxane site evaluation technique. Assuming adequate length and height, a bone width of 5 mm is usually acceptable for standard diameter implants (3.5-4.2 mm). However, implant placement in sites with parabolic shaped ridges may need to be placed deeper to avoid vertical bone loss and implant thread exposure. Inadequate bone volume, less than 5 mm of bone width, may be developed by ridge expansion (split ridge) techniques. With ridge expansion, complications may arise such as malposition and labyrinthine concussion. Malposition may be corrected intraoperatively or grafted for a later implant placement. Labyrinthine concussion is usually of short duration but may be treated with head maneuvers. Sites with 2 mm or less width of available bone may not be treated flaplessly and may be more appropriately treated with extracortical augmentation grafting.

A Method to Retrieve a Displaced Dental Implant From the Maxillary Sinus

Dental implants can be displaced into the maxillary sinus. Retrieval by endoscopic or Caldwell-Luc techniques have been previously reported. A modified Caldwell-Luc technique is presented here, where a small round lateral osseous window is created. A plastic surgical aspirator tip is cut and modified to fit tightly into the access window. The sinus is filled with saline, and the patient is placed in a lateral recumbent position in the dental chair with the involved sinus on the underside. The saline acts as a vehicle to bring out the implant. The festooned aspirator is then introduced into the access window, and the errant implant can be successfully brought to the window for retrieval.

A Comparison of Facial and Lingual Cortical Thicknesses in Edentulous Maxillary and Mandibular Sites Measured on Computerized Tomograms

Edentulous ridges suitable for implant treatment depend on cortical bone for implant stability, especially for ridge-expansion procedures. This study was done to find and compare the actual thicknesses of the facial and lingual edentulous cortices of the maxilla and mandible as measured on computerized tomograms. The collected computerized tomographs (CT) of one implantologists practice (D.F.) were measured. The measurements taken demonstrated that the edentulous lingual cortex is almost always thicker than the facial cortex in the maxilla and mandible. The combined maxillary and mandibular facial cortices measurement sites average was 1.79 mm. The combined maxillary and mandibular lingual cortices measurement sites average was 2.33 mm. The average cortical thickness measurement of the maxillary facial cortices was 1.66 mm. The lingual maxillary average was 2.16 mm. The mandibular facial cortical sites averaged 1.83 mm, while the lingual cortical sites were 2.40 mm. These data confirm that the lingual cortex of the maxilla and mandible is thicker than the facial cortex at a ratio of 1:1.3. This ratio was consistent for maxilla and mandible.

Force and Movement of Non-Osseointegrated Implants: An In Vitro Study

Dental implants have enabled a dramatic increase in the quality of life for many partially edentulous and edentulous patents. Immediate loading of newly placed dental implants is a recent advancement that attempts to meet patient demand. However, immediate loading of a just placed implant may induce implant failure to osseointegrate. Some patients can generate a biting force that can reach approximately 1300 Newtons (N) in the posterior jaws. The magnitude of bite force that would cause failure of osseointegration of newly placed implants is currently unknown. It has been proposed that osseointegration would fail if an implant is luxated in bone more than 50 to 150 microns. Fibrous tissue, not bone, would form. This study investigated the quantity of various off-axial forces required to move a nonosseointegrated 4.3 x 13 mm implant 50 microns. The previously published pilot study for this study found that the amount of horizontal force required to displace an implant 50 microns was approximately 150 N. This study found that the force needed to move the implants 100 microns at a horizontal approach, 0 degrees, averaged 50 N, with a range of 23-79 N; at 22 degrees, averaged 52 N, with a range of 27-70 N; and at 60 degrees averaged 87 N, with a range of 33-105 N.

Jaw Bite Force Measurement Device

We describe a cost-effective device that uses an off-the-shelf force transducer to measure patient bite force as a diagnostic aid in determining dental implant size, number of implants, and prosthetic design for restoring partial edentulism. The main advantages of the device are its accuracy, simplicity, modularity, ease of manufacturing, and low cost.