Dentistry News | Dental Jobs | Dentist Forum | CPD Education
 |
| Home | Astratech | Claudius Ash | DIO | QED | The Dental Directory |
Another ‘first’ for The Dentistry Show’s Live Theatre
Guided Bone Regeneration using DIO BioTite-H implants and Fortoss VITAL
On the 4th of March 2011, The Dentistry Show at the NEC, Birmingham played host to another ‘first’ during its pioneering Live Surgery. In front of a packed auditorium, Dr Peter Fairbairn of Scarsdale Dental Clinic, Kensington demonstrated his advanced techniques for fully synthetic guided bone regeneration (GBR). The live seminar was the first time these techniques have been demonstrated in public both in Europe and further afield.
The confined glass Live arena presented problems but with 3 trained nurses to ensure the best possible site preparation, Peter Fairbairn managed to performed two separate surgical procedures with two patients during the two-hour live surgery. One procedure comprised flapless single implant placement with immediately loading to provide a complete temporary crown with wax-up and pull-down; the other was more involved with guided bone regeneration into a failed apicectomy site. Both surgical procedures were a complete success with only one patient requiring a single painkiller following surgery; the other didn’t need any and neither had any pain or swelling the following day.
Figure 1 - Post-Op
The first case comprised a delayed placement of DIO’s BioTite-H implant into a failed apicectomy site in the 12. The case was, in Peter’s words, “a very difficult cosmetic case with a high lip-line.” Peter expressed the importance of soft tissue management, especially in cases such as this and described soft tissue grafting as unpredictable especially in the long term. Peter explained, “I sort the hard tissue out; I let the body deal with the soft tissue. After we’ve restored the hard tissue, the soft tissue will follow-in”. He concluded, “The body is a lot better at sorting out soft tissue”. Peter confirmed that he has hundreds of cases photographed illustrating this technique. In this case, the site had been allowed to heal for one month prior to the live surgical procedure.
During the surgery, Peter addressed some common concerns within the dental community regarding the commonly termed ‘coated’ implants. Peter assured delegates that leading-edge technology is now very advanced and has moved on significantly from the original HA coated implants. He said, “Biotite-H Brushite-surface implants are not plasma coated. These implants are designed for the calcium phosphate to be absorbed in a controlled manor”.
Figure 2 - After 10 days healing
Peter further illustrated the benefits of DIO’s BioTite-H Brushite surface treatment using comparative case slides where notable bone growth had been observed around the threads of the BioTite-H implant due to the release of calcium phosphate from the implant surface into the healing area. (See Figures 1 & 2 for post-op and follow-up review, respectively.) The observation was noted only 10 days after surgery.
During surgery, Peter expressed importance of removing all granulated tissue from the extraction socket before grafting. Peter explained, “If we don’t, we’ll pay the price later on”, referring to the increased potential for infection and subsequent loss of an implant. Furthermore, Peter explained, “The most important aspect of sterility is controlling the number of bacteria [in the patient’s mouth]”. He insisted the patient pre-rinse with Corsodyl mouthwash, which further minimises the potential for infection.As the patient had a failed apicectomy, with numerous attempts to correct it, Peter advised referring dentists, “If the root splits or an apicectomy is failing, get the tooth out and get the solution [implant placement and/or graft] as quick as you can because the bone is definitely not getting better”. He continued, “The longer the situation is left, the worse the bone’s going to be“. It had been 4 – 5 weeks since the defect had been diagnosed and Peter demonstrated that the profile had already been lost. Peter explained, “As Dennis Tarnow, Schropp, Small or anyone who has worked on bone-loss and remodeling understands, we may lose 50% of our bucco-palatal width [when extracting a tooth] in the first month”. Peter explained for this reason he ideally conducts implant surgery at 2-3 weeks for delayed-immediate cases.
Peter explained the reasoning behind the use of a partial denture in this case, which was removed prior to surgery. He expressed the importance of financial considerations in treatment planning. Peter receives many of his patients from NHS practices and explains, “I don’t see why we should deny anyone the benefits of implants”. He continued, “You sometimes have to compromise with solutions and use a partial denture instead of a temporary bridge [which is typically more expensive]”. Peter explained that by using BioTite-H and Fortoss VITAL, you’ve already helped the patient, “firstly by speeding-up the process and secondly, controlling the cost factor because you’re not having to use graft material and a membrane or you’re not having to harvest an autogenous graft”.
Figure 3 - Post-op immediate case
Peter explained his perspective on autogenous grafts which he has not used for 7 years, “Block grafts are great but require a fair amount of skill to do successfully and because of morbidity, 50% of people having block grafts are in discomfort 1 year later. He continues, all you’re creating is a block of dead bone to ‘bulk’ up the site. I know it’s controversial but I think for our patients’ sake, moving on is a good thing”. Peter was referring to ‘moving on’ as embracing synthetic bone regeneration technologies that are available on the market today. Peter explained the background to Biocomposites, the manufacturers of Fortoss VITAL who are UK-based company and one of the world’s most respected companies in the spinal and orthopedic markets. “We should be using the benefits that they can offer us”, Peter said.
As the Fortoss VITAL graft material is stable and therefore there is no need to use a membrane in the graft, a very site-specific flap could be raised. When raising a full-flap, the adjacent teeth may be compromised, as the papilla may not return to the correct place.
Where bone has started to re-model and re-occupy, Peter expressed the importance of ensuring the site is completely “cleaned-out”. During this process of scraping dead and infected tissue, Peter quickly identified a “black lump”, which had to be removed to avoid any future issues along with some brown-black stained tissue, which was also removed. Although bone healing had occurred, holes were still present, supporting the need to ensure the situation be controlled as soon as possible following extraction. He never mixes anti-biotics into the graft material which itself is bacterio-static as he feels it may pollute the implant surface and he avoids the use of Chlohexidine after surgery has commenced.
Figure 4 - Post-op GBR case
During the drilling sequence, Peter explained that he always prefers to use internally irrigated drills. Peter’s patients have experienced minimal site trauma during surgery and a reduced subsequent swelling where implants have been placed using internal irrigation, which is another benefit of his DIO SM implant surgical kit.
When positioning his pilot drill Peter explained that he never assumes he has the correct angle. In normal circumstances where x-rays are possible, he would take an image with the pilot drill in place and correct if necessary when using the taper drill. This technique helps to ensure the implant is placed at the desired angle and that he will not hit the root of an adjacent tooth.
Peter always likes to place his implants by hand. He explained that in doing so the surgeon will get a feel for how the implant and the bone are behaving throughout. Peter also noted that primary stability is an important aspect of implant design and another advantage of the DIO SM implant system. In previous cases, Peter has achieved over 60 Ncms of torque with DIO SM implants however in this case the recommended 40 Ncms was achieved, even with reduced bone from the apicectomy defect. Peter also noted that he would not correct the surface bone with a beveling-burr, due to the importance of primary stability in this case.
Peter questioned whether larger, fatter implants should be used in the aesthetic zone, a view which he supported with an analogy , “If you have a block of wood, its better to keep the wood a little thicker and keep the screw a little thinner”, he said. DIO has a range of implants from 2.5mm to 6.9mm diameters, ensuring there is an implant for every case.
In conclusion, Dr Fairbairn says, “BioTite-H is perfectly compatible with calcium-derived synthetics and complements my techniques very well.” Dr Fairbairn continues, “Using a membrane often restricts the blood supply to the bone. Maintaining a good blood supply together with using the bio-active Brushite implant surface treatment further facilitates healing throughout the bone regeneration process.”
When interviewed afterwards about the implant system used, Peter stated, “DIO implants are a well-designed and cost effective solution. The implants themselves place very nicely with excellent primary stability achievable. The ‘no-mount’ design also makes DIO SM a simple and very easy system to use, even in extreme cases.”
Maximising Profit without Compromise
Many practitioners express concern about changing implant systems due to the cost of set-up and support from implant companies. With grade IV titanium implants (with cover screw) from around £88 and special start-up packages available, DIO enable practitioners to keep their existing implant systems enabling them to manage the migration at their own speed and budget. The somewhat paradoxical convergence of high quality and low cost makes DIO the implant system of choice for the margin-maximising dental practice.
Managing Director for DIO Corporation Ltd, Iain Forster, explains, “Our dentists are able to place and restore a single-tooth implant case for under £200, which includes the implant fixture, cover screw, healing abutment, impression coping, straight abutment and lab analogue. With lab-fabricated crowns available around £150-200, there is a huge potential for achieving additional profit with little or no disruption to existing surgical or practice processes.”
About the Surgeon
Dr Peter Fairbairn is a recent convert to using DIO dental implants, which, he says, are ideally suited to his branch of advanced dentistry. He has performed implant surgery for the last 20 years and has particular expertise in the use of 2nd generation synthetic materials, which are ideal alternative to traditional bone-graft techniques. He has lectured at many other educational institutions throughout the world on the use of synthetic bone grafting materials and has a success rate in excess of 98%. Peter Fairbairn can be contacted at Scarsdale Dental Practice in Kensington, London. Visit www.ScarsdaleDental.co.uk
Have your say
Join the discussion on this article by joining our LinkedIn group: “DIO Dental Implants Forum”.
Follow-up case x-rays are also available on the ADI website.
 |
All DIO implant and BioTite-H business enquiries to: DIO Implants |
