DOCTORS PAGE 4

- WHAT IS BONE ENGAGEMENT? - HOW TO PLACE VERY LARGE IMPLANTS IN VERY SMALL SPACES....MAXILLARY 1ST MOLARS

OF ALL THE LOGOS, MARKETING AND PRINT ADS I'VE DESIGNED, THIS ONE IS MY FAVORITE. I LAUGH EVERY TIME I LOOK AT THE "MAD DENTIST" THEN QUICKLY CRINGE AT THE THOUGHT OF HOW MANY TIMES I FELT (and probably looked) THIS WAY AT THE OFFICE.

PLACING MINIS INTO THIN IRREGULAR RIDGES WITHOUT LAYING A FLAP CAN DO THIS TO YOU FAST. I'VE SEEN NUMEROUS "EXPERTS" STRUGGLE DURING LIVE SURGERIES AND HAD MY FAIR SHARE OF PROBLEMS MANY YEARS AGO AS WELL. MY BONE ENGAGEMENT SURGICAL STENT PROTOCOLS HAVE ELIMINATED THESE SORTS OF MINI IMPLANT COMPLICATIONS.

OBVIOUSLY I CAN'T SHOW YOU HOW SURGICAL BONE ENGAGEMENT WORKS ON A LIVE PATIENT AS WE DON'T LAY GINGIVAL FLAPS. SO WE PRODUCED THE FOLLOWING MODEL SERIES FOR DETAILED TRAINING IN THE MEMBERS PAGES, BUT YOU ARE WELCOME TO A PREVIEW HERE. BY THE WAY, MEMBERSHIP IS AUTOMATIC WHEN YOU PURCHASE A B.E.S.T.IMPLANT KIT (CLICK HERE), BUT I DIGRESS. BACK TO THE SHOW.....


THE FOLLOWING SERIES SHOWS THE SURGICAL USE OF A B.E.S.T. IMPLANT PLACEMENT SYSTEM. FABRICATION & VERIFAICATION PROTOCOLS ARE IN THE MEMBERS PAGES, AS WELL AS FABRICATION OF A DRIVER STENT.

IMG_54621.jpgSO HERE IS OUR FINISHED BONE ENGAGING SURGICAL STENT WITH PILOT DRILL GUIDE TUBES INSERTED. IT FITS SECURELY ON THE PATIENTS RIDGE.


IMG_5485.jpgAFTER LOCAL ANESTHESIA EACH P.D.G. TUBE IS PRESSED DOWN WITH A BEVELED AG CONDENSER, A GLICK 1 OR A SMALL BALL BURNISHER. REMOVING THE STENT, WE SEE THE INDENTATIONS IN THE SURFACE TISSUE THAT ARE LEFT BEHIND.


IMG_5482.jpgWE USE A COARSE DIAMOND OF APPROPRIATE SHAPE FOR THE IMPLANT USED, TO REMOVE THE TISSUE PLUGS AT THE POINTS INDENTED. ALWAYS REMOVE ANY TISSUE TAGS WITH TISSUE FORCEPS.


IMG_5476.jpgREMOVING THE P.D.G. TUBES FROM THE STENT ONE BY ONE, WE TAKE A #4 SURGICAL LENGTH ROUND BUR (HIGH SPEED LONG SHANK) AND PLACE IT IN EACH STENT HOLE AND CREATE A SHALLOW PENETRATION HOLE LESS THAN 1 MM DEEP IN THE SURFACE OF THE BONE. YOU CAN VERIFY THE SPOT WITH A PERIO PROBE OR ENDO EXPLORER. (I USE A SLOW SPEED ANGLE THAT ACCEPTS HS SHANKS - MINES FROM STAR)


IMG_5488.jpgTHE STENT IS PLACED BACK ON THE RIDGE AND EACH P.D.G. TUBE IS PUSHED DOWN ...THE LEADING EDGE ENTERING AND ENGAGING THE PENETRATION HOLES. THIS "LOCKS" THE STENT FIRMLY TO THE JAW.


IMG_5493.jpgNOTHING UP MY SLEEVES, NO WIRES OR STRINGS.... HONEST ... HOLDING THE STENT ONLY.... IT DOES NOT RELEASE FROM THE RIDGE.

I KNOW... THE PATIENT DOESN'T WEIGH VERY MUCH HERE BUT THE STENT IS FIRMLY ATTACHED AND THE 2 TUBES IN BACK ARE NOT EVEN ENGAGED YET. BESIDES AS YOU KNOW, DENTISTS ARE ALL ETHICALLY PURE AND WE NEVER LIE !!


IMG_5494.jpg WE TAKE A PA XR TO VERIFY ENGAGEMENT

WILL SOMEBODY GET THE APRON PLEASE??

TAKING XRS AT 90 DEGREES WILL VERIFY ENGAGEMENT.

THIS XR OF THE MODEL SHOWS HOW ENGAGEMENT WORKS. SIZE, DESIGN, AND EXACTING TOLERANCES DURING MANUFACTURING ENSURE THE TUBE STOPS AUTOMATICALLY AT LESS THAN 1 MM.


IMG_5495.jpgBUT LET'S BACK UP A SECOND AND SEE WHY ENGAGEMENT IS IMPORTANT. MOST IMPLANT COMPANIES (mini and standard) TALK ABOUT FREE HANDING PILOT HOLES AS PART OF NORMAL PLACEMENT PROTOCOLS. THEY USUALLY SUGGEST A ROUND BUR FIRST TO ESTABLISH A PURCHASE POINT IN THE BONE FOR THE SKINNY PILOT DRILL. IF YOU GET IT PERFECTLY IN THE CENTER OF THE KNIFE EDGE, (WHICH IS HARD TO VERIFY) YOUR PILOT DRILL MAY FIND IT AND MAKE A DECENT PILOT HOLE. (SEE PHOTO)


IMG_5503.jpgHOWEVER, IF A ROUND BUR USED ON A THIN RIDGE MAKES A HOLE THAT IS NOW MISSING A WALL (SEE THE HOLE ON THE LEFT OF THIS PHOTO) IT CREATES A DANGER ZONE YOU CAN'T SEE BECAUSE YOU DIDN'T LAY A FLAP. WHEN THE TISSUE IS BLEEDING, THE NERVOUS PATIENT IS MOVING ABOUT AND YOUR HAND IS SHAKING (3 CUPS OF COFFEE...REALLY?) IT'S VERY EASY FOR THE PILOT DRILL TO SLIP & SKIP OUT THE OPEN WALL AND YOU END UP DRILLING THE PERIOSTEIUM. OR YOU DRILL WAY OFF LINE, THINNING OR CRACKING THE WALL AND PERF THE SURFACE WHEN TURNING DOWN THE IMPLANT.


IMG_6469.jpgSO THE NEXT PHOTO IS JUST 4 P.D.G. TUBES ENGAGING THE PENETRATION HOLES WITHOUT BASEPLATE MATRIX IN THE WAY OF YOUR VIEW. LIKE A FILLING MATRIX BAND, THE P.D.G. TUBE RE-CREATES 4 WALLS FOR THE PILOT DRILLS GUIDANCE. PRETTY SLICK HUH? AND BETTER THAN THAT ..IT WORKS. ALSO SINCE THE DRILL GUIDE IS 1 MM BELOW THE SURFACE OF THE BONE YOUR DRILL WILL STAY ON YOUR PREPLANNED LINE LONGER. YOU DON'T GET THAT PRECISION WITH ANY OTHER GUIDE.


IMG_5496.jpgNEXT WE ARE MAKING OUR PILOT HOLES. AN ADDED BENEFIT IS THAT WE FILL THE P.D.G. TUBES WITH STERILE H2O AND YOU HAVE GUARANTEED COOLING FOR YOUR PILOT DRILL. NO OTHER FLAPLESS NARROW DIAMETER PILOT DRILL PROTOCOL ALLOWS FOR THAT FEATURE.


IMG_5499.jpgWE USE A DRIVER STENT (NOT SHOWN) TO MAINTAIN PERFECT PARALLEL POSITION WHILE DRIVING SELF TAPPING IMPLANTS IN. I'M SURE EVERYONE READING THIS KNOWS THAT FREE HANDED SELF TAPPING IMPLANTS VEER AWAY FROM DENSE BONE INTO AREAS OF LESS DENSITY. THIS CAN MESS UP YOUR BEST LAID PLANS OF PRE-DETERMINED ANGLES AND PERFECT PARALLELISM.


IMG_5512.jpgXR SHOWS PERFECT PLACEMENT! PHOSPHORUS PLATE XRS BEND NICELY AROUND THE CURVE OF THE LINGUAL ANTERIOR JAW, MORE SO AT THE BOTTOM THAN THE TOP, AND THIS RESULTS IN THE GENTLE TILTING OF THE IMPLANT APICES TO THE MIDLINE IN THE IMAGE.


IMG_5547.jpgDRILLING MULTIPLE PILOT HOLES ON A THIN RIDGE WITHOUT LAYING A FLAP IS LIKE THREADING A NEEDLE WITH YOUR EYES CLOSED!! THE B.E.S.T. IMPLANT PLACEMENT SYSTEM IS THE MISSING LINK BETWEEN ALL THOSE SEMINARS AND LIVE SURGERIES YOU'VE BEEN TO AND ACTUALLY DOING IT RIGHT THE FIRST TIME AND EVERY TIME THEREAFTER. JUST GIVE IT A TRY...IT WORKS... AND REMEMBER... DENTISTS NEVER LIE.


IMG_5513.jpgAT THIS TIME WE OFFER A "BASIC KIT" IN ADDITIONAL TO THE INTRO KIT. THE BASIC KIT INCLUDES INSTURMENTATION FOR SIX OR MORE IMPLANTS AS THIS CASE DISPLAYS. MAKING A LARGE "HARD" OR COMBO "HARD/SOFT" BONE ENGAGING SURGICAL STENT DEMANDS PRACTICE. SO I RECOMEND TRYING THE "INTRO" KIT FIRST TO PRACTICE MAKING A SMALL HARD STENT. (CLICK HERE) TO GO TO OUR STORE.


Scan_201505031.png

Anita_Clark3.jpg

A 110 LB FEMALE PRESENTS WITH LIMITED BONE #14 WITH MORE HEIGHT ON THE DISTAL OF THE SITE I COULD USE A 6 X 6 MM STRAIGHT UP THE SITE BUT I REALLY WANT TO USE A 6 X 8. IT JUST FEELS BETTER AND IT WOULD SATISFY THE 1ST TENENT OF DENTAL IMPLANTOLOGY. " I GET SINUS INFECTIONS ALL THE TIME " SHE SAYS....SO FORGET THE LIFT.

Anita_Clark4.jpg

XR OF DIAGNOSTIC B.E.S.T. SHOWS MY ANGLE WAS PERFECT FOR CAPTURING ADDITIONAL BONE ON DISTAL UPSLOPE OF SINUS. SO I SIMPLY TAKE OUT THE STENT FABRICATION GUIDE PIN FROM THE BASEPLATE MATRIX AND REPLACE IT WITH A PILOT DRILL GUIDE TUBE, PUSH IT IN WITH A CLICK 1 AND ENGAGE THE BONE SURFACE WITH THE LEADING EDGE. WE MAKE OUR PILOT HOLE AT PROPER DEPTH, GO TO OUR FINAL DRILL VIA A COUPLE INTERMEDIARIES. AND PLACE THE IMPLANT UNTIL IT SETTLES INTO THE FLOOR OF THE SINUS ON THE DISTAL UPSLOPE. 3 DIFFERENT ANGLED XRS SHOW PERFECT PLACEMENT.

Anita_Clark2.jpgAnita_Clark5.jpgAnita_Clark11.jpg

GETTING A 6 X 8 INTO THIS SPACE IS A GREAT ADVANTAGE FOR THE PATIENT. IT IS MUCH BETTER THAN A 6 X 6 IMPLANT. I WILL FINISH THIS RESTORATION IN A COUPLE WEEKS CONSIDERING HER WEIGHT AND LIGHT BITE. IF I WERE ONLY ABLE TO GET A 6 X 6 IN FREEHAND, I WOULD NOT LOAD IT FOR AT LEAST 2 MONTHS! PRECISION PLACEMENT BENEFITS THE PATIENT AND THE DENTIST GREATLY, BOTH IN TIME AND MONEY..

STILL NOT CONVINCED?? WELL LET'S VISIT THE B.E.S.T. SYSTEM & WIDE DIAMETER IMPLANT CASES. TRADITIONAL IMPLANTOLIGISTS ALWAYS TALK ABOUT THE UNIVERSIAL TRUTHS OF IMPLANT TREATMENT PLANNING. FIRST ON THE LIST ALWAYS SEEMS TO BE THAT YOU SHOULD USE THE LARGEST IMPLANT YOU CAN IN THE AVAILABLE BONE AT THE IMPLANT SITE. THE BETTER YOU CAN FULFILL THIS TENENT OF IMPLANTOLOGY, THE MORE SUCCESSFUL YOU WILL BE.

REPLACING MAXILLARY FIRST MOLARS IS ALWAYS DIFFICULT. DRASTICALLY REDUCED BONE VOLUME IN PATIENTS WHO REFUSE TO HAVE SINUS LIFTS PERFORMED, SEEM TO BE THE NORM. SO YOU HAVE TO BE TECHNICALLY PERFECT TO SUCCEED. IN THIS WRITER'S OPINION, NO SURGICAL GUIDE OUTPERFORMS THE B.E.S.T. SYSTEM WITH MAXILLARY MOLARS.

THE 2 XRS PRESENTED HERE ARE OF 2 DIFFERENT #14 CASES. BOTH WERE GRAFTED POST EXTRACTION AND I WAS MODERATELY HAPPY WITH THE RESULTS. THE IMPORTANT THING TO REMEMBER IS THAT GRAFTING USUALLY PREVENTS BUCCAL WALL COLLAPSE. THEN WE CAN USE 6 OR 7 MM WIDE IMPLANTS. DETAILS ARE IN THE OUTSIDE COLUMNS.

START TO FINISH BOTH CASES WERE EXAMINED, DIAGNOSED, TREATMENT PLANNED VIA IMPRESSION VIRTUAL SURGERY WITH THE B.E.S.T. IMPLANT PLACEMENT SYSTEM, AND SURGICALLY COMPLETED PERFECTLY IN ABOUT 2 HOURS. PROSTHETICS INVOLVES A BIT MORE TIME.

ALL MATERIAL ON THIS WEB SITE IS THE INTELECTUAL PROPERTY OF JAMES L TEDESCO DDS. NO REUSE OF OR PASSING ON THIS MATERIAL AS YOUR OWN IN ANY WAY OR IN ANY FORUM INCLUDING BUT NOT LIMITED TO: PRINT, VIDEO, ONLINE MEDIA,YOU TUBE, CLASSROOM OR STUDY CLUB MEETINGS, DENTAL SEMINARS OR IMPLANT CONGRESS MEETINGS, IS STRICTLY PROHIBITED. ALL LEGAL RIGHTS RESERVED

BASICALLY WE HAVE TAKEN 2 SIMULAR CASES, AND UTILIZED THE PRECISION AND SPEED OF THE B.E.S.T. IMPLANT PLACEMENT SYSTEM TO PLACE THE LONGEST IMPLANT POSSIBLE. ALL WHILE CAPTURING THE BONE ANTERIOR OR POSTERIOR TO THE SINUS AND STILL REMAINING 1.5MM FROM THE ADJACENT ROOT.

WE USED IMPRESSION VIRTUAL SURGERY TO IDENTIFY AND PERMANENTLY RECORD THE IDEAL BUCCAL/PALATAL LINE ANGLE.

Scan_20150503111.png

Chris_Szczesniak13.jpg

A 45 YEAR OLD MALE 22O LBS. HAS A VERY STRONG BITE. OVER 20 YEARS HE HAS PREMATURELY BROKEN MANY RESTORATIONS I HAVE PLACED FOR HIM. WE NEED TO USE THE BIGGEST IMPLANT I CAN POSSIBLY SQUEEZE INTO THIS SPACE ! HE REFUSED SINUS LIFT. A 6 X 8 IS EASY BUT IF IT'S TILTED JUST RIGHT TO THE MESIAL I CAN GET A 6 X 10 IN THERE.

Chris_Szczesniak12.jpg

ABOVE YOU SEE THE XR WITH MY B.E.S.T. DIAGNOSTIC IN POSITION. DIGITAL XR SOFTWARE ALLOWS ME TO DRAW AND MEASURE ON THE IMAGE. THE RED LINE EXTENDED TO LENGTH SHOWS MY ANGLE IS TO CLOSE TO #13 ROOT FOR A 6 MM WIDE IMPLANT. WE MAKE ADJUSTMENTS WITH THE WORKING MODEL AS NOTED PREVIOUSLY AND XR THE ADJUSTED STENT.

Chris_Szczesniak6.jpg

THE ADJUSTED STENT IS PERFECT AND BECOMES MY WORKING STENT.YOU DON'T REALLY NEED TO MAKE A PENETRATION HOLE ON WIDE RIDGES SO WE IMMEDIATELY MAKE OUR PILOT HOLE.

Chris_Szczesniak5.jpg

WORKING LENGTH XR SHOWS WE ARE ON LINE. PERFECT PLACEMENT ALLOWS US TO CAPTURE THE ADDITIONAL BONE ON THE UPSLOPE OF THE ANTERIOR SINUS GIVING US A 2MM LONGER IMPLANT. AS YOU KNOW, EVERY MM COUNTS IN IMPLANT DENTISTRY!

Chris_Szczesniak9.jpg

ONE MORE TURN IN AND THE APEX SETTLES INTO THE FLOOR OF THE SINUS' ANTERIOR SLOPE. I WILL PLACE ABUTMENT AND CROWN IN A FEW WEEKS.. I'VE NEVER HAD A PROBLEM LOADING A 6 X 10 QUICKLY. KNOCK ON WOOD...I LOVE THIS IMPLANT.

MISCELLANEOUS RUMBLINGS

THE BONE ENGAGING SURGICAL STENT IS A LOW TECH SYSTEM, UTILIZING OLD TIME DENTAL PROCEDURES. OOPS ! I JUST HEARD HALF OF MY AUDIENCE CLICK OFF! FOR AN OLDER GUY, I DO REALLY LOVE TECHNOLOGY AS MUCH AS ANYONE. BETWEEN THE HOME AND THE OFFICE WE HAVE 4 SMART PHONES AND 18 COMPUTERS. IF I HAD THE SPACE I'D HAVE AN I-CAT IN THE OFFICE. BUT, AT ANY POINT IN TIME, WE CAN ONLY DO THE BEST WE CAN WITH WHAT WE HAVE TO WORK WITH.

SO WHAT WE HAVE HERE, I LOOSLY DEFINE AS "IMPESSION VIRTUAL SURGERY " WE ARE USING IMPRESSIONS INSTEAD OF COMPUTERS TO IDENTIFY OUR SURGICAL SPACE, SET AND RECORD THE ANGLES WE NEED FOR PERFECT PLACEMENT IN THE B.E.S.T.

I'LL ALSO CALL YOUR ATTENTION TO THE FOLLOWING:

  1. I PREFER SOFT PHOSPHORUS PLATES FOR MY PA'S AND USE SOFT BITE TABS WITH ENDO XR GRIDS.
  2. I PREFER POLYETHER IMPRESSION MATERIAL FOR ITS ACCURACY AND THE FACT THAT SILICONE DOESN'T STICK TO IT.
  3. I EXTEND MY STOCK TRAYS WITH BOARDER WAX, SPRAY THE TEETH WITH 'PIP' SPRAY TO GET THE DEEPEST, BLEMISH FREE IMPRESSION I CAN.
  4. AND I BONE SOUND EVERY CASE....SOMETIMES 2 OR 3 TIMES! EVEN IF I HAD AN 'I- CAT' IN THE BACK ROOM I'D STILL BONE SOUND BECAUSE DENTISTRY AND IMPLANTOLOGY IN PARTICULAR, IS A TOUCHY / FEELY BUSINESS. SO MUCH SO.... THAT DOCTORS PAGE 5 IS DEDICATED TO BONE SOUNDING. (CLICK HERE)

Contact Us

Our Address

Office Hours

Monday:

Closed

Tuesday:

9:00 am-4:00 pm

Wednesday:

10:00 am-6:00 pm

Thursday:

9:00 am-4:00 pm

Friday:

8:00 am-3:00 pm

Saturday:

9:00 am-2:00 pm

Sunday:

Closed