Multimodal Implant Dentistry
I place and restore alot of root form implants in my practice, however it is intuitively obvious to the casual observer, that today's treatment of dental implant patients, is driven by the influence of dental implant manufactures, not the tried and true methods that were used to ground this area of prosthetic dentistry! The strict use of root form implants in every case can necessitate extensive and expensive augmentation procedures that do not always result in enough bone for the planned treatment. In these cases, only the very wealthy patients can afford implant dentistry and long periods of time are needed for the completeion of treatment. Multimodal implant dentistry has been using immediate load concepts (subperiosteal, blades and ramus frame etc.) for decades, and is affordable and time efficient, yet more demanding upon the operator. It is incorrect to tell patients that they are not a candidate for dental implants, due to the lack of bone height and width! A true oral implantologist can treat the severely atrophic ridge, whereas a rootformologist has to stop at M-J Division Bor C bone and graft or flat out stop at Div D. bone. We can and must do better than this!
© 2008 Journal of Implant and Advanced Clinical Dentistry. Privacy Policy | Terms & Conditions
Dr. Hughes I am interested in learning more on Blades
Dr. Hughes I am interested in learning more on blades and subs. Where can I learn more. Do you teach any courses?
Courses
Dr. Cohen, you or anyone interested in said courses may e-mail me at erhughesdds@aol.com
Courses
Dr. Cohen, I gava a limited attendance workshop at this years AAID. I will do so when the interest increases. Thank you for your interest. These are great modalities and it's to bad that a good number of implant docs do not understand what they are missing.
Blade implants
Dr. Cohen, I have a 97% success with 2 stage blade implants and aprox 95 % success with a single stage blade. You have to remember to fixate a single stage blade and always pay attention to the occlusion, OH and smoking etc. They are usually cheaper than a rootform and easly lend themselves to conventional prosthetics. They are made of Ti alloy and flat out work. They are great for distal extension cases and need to be abuted to teeth w/ copings. You can even restore an entire arch with blades.
Subperiosteal implants>>>>>Need some questions answered.
I have yet to do any Subperiosteal implants. Can you go through the process from treatment planning, flap design and ultimate placement? How successful are they, and what kind of lab support do you need?
Subperiosteal implants
I strongly suggest that you obtain training forom Nordquist, Misch, Root or even me and there are others that can show you the way. It's a different animal but is learnable and in many respects more predictable than onlay grafting etc.
Are you still doing subperiosteal implants?
I did not know they still made those. I thought they disappeared in the 1980's along with Members's Only jackets.
I could see where they could still serve a purpose. The longterm follow up article in a recent JIACD was interesting. It showed some long term success...less than modern implants, but still good enough to possible offer patients a different option in cases of limited vertical bone availability.
If you are still using subperiosteals, where do you buy them?
Subs implants are still being done and worthwhile.
Yes they are still being done!
Multimodal Implant Dentistry is not without risks
Dr. Hughes I agree that patients should be informed about blades and such. But to me they are somewhat outdated. Unless a patient has such severe atrophy of the jaws that grafting is not possible, I think there is more success with grafting and root form implants.
Blades and subperi are not without problems. Can you give me a example of when you might recommend these over root forms?
What is your success rate with them?
What kind of complications do you see from blades and such?
Thanks.
Risk in all aspects of implant dentistry
Dr Cohen, There are risks associated with all aspects of implant dentistry. The arguement that blades fail or subs fail does not hold water. All implants can fail/break etc. Blades and subs can and do integtate. The big issue is using the right implant modality for the right patient. The treating Doc has to understand occlusal parafunction, occlusion and maintain the patient on an active recall. A good number of patients think this treatment is maintenance free and disappear, then they return after it hits the fan and expect a miracle. The main reasons that subs and blades are not used as much are quite simpla: operators lack of skill and understanding, the manufactures cannot make as much money selling blades and subs are made by laboratories and it's not being taught nor discussed because of the commercial drive,
Blades/Subs
This depends upon the M-J classification of bone. For example Div B.: one can place a narrow root form or a blade. Div C.: you are definately in a zone where you should consider blades and subs and ramus frames. Div D. definately subs and ramus frames. I strongly recommend reading Misches first book and Charles Weiss' Text on dental implants. Even Hilt Tatum states that grafted bone is not the same as what God gave us. Predictability decreases, once you get past a three walled defect. This is a very brief overview. I gave a limited attendenance workshop at this years AAID meeting on this topic.