Would any one be interested in learning about blade implants, ramus frame implants and subperiosteal implants/

Sun, 03/08/2009 - 01:42 — Richard Hughes DDS

One placing dental implants has to consider how many times they have found that a patient is not a suitable case for root form implants and or bone grafting, and how they would manage this patient. Would you refer or tell them that they are not a candidate for implants, when in fact they can receive other implant modalities. Sometimes patients cannot afford grafting or want to take the time for grafting and there are times grafting (onlay) does not work. I believe we are making this way to complicated and expensive. Any thoughts? The above modalities do work, yes they have limitations bit so do root forms.

Implantology

Fri, 02/26/2010 - 13:24 — Richard Hughes DDS

Why would anyone use blades and subs?

There are time when grafting is not an option (time, cost, patient compliance and other desires of the patient. It may be necessary to have something else in your bag of tricks such as blades, subs and remus frames. We are going through alot of efort to make one modality, the root form work in all cases or telling the patient that they are not a candidate for dental implants. Let's face it root form surgery is simple. Blades, subs and ramus frames require and demand more from the treating doctor. People talk about the failure rate with these, but let's get real, we have failures with root forms too. Granted I place alot of root forms, but when I can make a case happen for the patient because I can provide other modalities, that's a winner and a practice builder. I do not care what the docs down the street are doing. I only care that I am giving my patients the best and with options.

Fri, 02/26/2010 - 10:02 — SL Kang

Does anyone still do blades and Sub P's anymore

Why would anyone still do this today?

Mon, 12/21/2009 - 16:55 — Dean Spivey

Richard Hughes and Greg Kurtzman:Subs P implant education

I agree with both your comments that Sub P could be a good treatment modility and the key is learning the steps to do it.

The problem I see is all programs and weekend courses teach traditional implants so sub periosteal and blades is more of a dying art and thus fading away.

Are there courses that one can go to, to learn about blades and sub p implants so the skill set doesnt disappear?

Sun, 12/27/2009 - 14:18 — Richard Hughes DDS

sub and blade classes

I will teach these modalities if there is enough interest!

Tue, 12/29/2009 - 06:19 — Dean Spivey

Subs and Blade Classes: Richard and Kurtzman

I would be interested in learning more on blades and subs, it is a lost treatment modility that should not be forgotten. What CE is around on this?

Tue, 12/29/2009 - 07:11 — Richard Hughes DDS

CE FOR SUBS AND BLADES

I gave a limited attendance workshop at the recent AAID on this topic. I already have my lectures canned and ready to go. You may want to contact Root Lab and William Nordquist in San Diego, Ca. However I can teach these topics as well, with hands on.

Sun, 12/20/2009 - 09:06 — Richard Hughes DDS

Easy way for subs

This is one modality that requires the treating doctor to master all the steps. You have to have good surgical skills with the single or two stage method. You also have to understand occlusion and maintain the patient on a quarterly recall program. The subperiosteal is more demanding than the root form implant. Just about anyone can place and restore root forms but not everyone can place and restore subs. It's not that they can be taught, but do they have the dedication to learn the principles involved. Many try and have a failure, they say subs do not work but infact they have not mastered the numerous steps invloved. This may rub some people, but these are the facts! So, if you are not dedicated in learning the principles involved, then do not perform the procedure!

Wed, 12/16/2009 - 06:47 — OrthoKing

Greg questions for you on Sub P implants

Do Drs. Willima Nordquist and Douglas Martin have any papers on their techniques, adding bone sounds interesting to me doing a sub p implant.

How difficult is it taking a bone impression? Is CT scan a better way to go?

Brooke

Sat, 12/19/2009 - 09:05 — Richard Hughes DDS

William Nordquist and Martin Papers

Check back in the archives of the Journal of Oral Implantology or phone Dr. Nordquist in his SanDiego office. I think he is on to something good as per subs.

Thu, 12/10/2009 - 16:56 — Dr. Musin Silver

Subperiosteal implants is there and easier way?

I was reading that you have to elevate flaps and then take an impression of the bone ridge. With the advent of cone beam is it easier today to do a sub p implant using a steriolithic model?

Tue, 12/15/2009 - 18:13 — Gregori M Kurtz...

bone impression verses steriolithic models from CT

Stereolithic models generated from CT are an alternative to doing bone impressions and help eliminate one surgical visit. But one needs to be prepared if the sub doesnt fit intraorally then yuo have to take a bone impression and have another sub fabricated. Todays CT take less time for a scan and are more accurate then those of 10 years ago.

Drs. Willima Nordquist and Douglas Martin have a very interesting modification of the subperiosteal implant where in the bone is modified in some places and the frame is placed then covered in osseous graft so that the end result is an endosseous implant.

Mon, 12/07/2009 - 17:26 — Logan MD DMD

Richard what were your views on the JIACD Sub P article?

http://www.nxtbook.com/nxtbooks/specops/jiacd_200911/#/70

25 years not bad ;)

Sat, 12/19/2009 - 09:49 — Richard Hughes DDS

JIACD article on subs

This is a nice gross overview. I would like to see stats of the success/failure on a per arch basis, design and vitalliun vs titaniun for the casted material. You have to remember some basic points: pay close attention to occlusion, primary closure of the flap and baby the surgical site post delivery for about three weeks.

Tue, 12/15/2009 - 18:18 — Gregori M Kurtz...

success rates maxillary vs mandibular subs

maxillary subs have a lower success rate long term then mandibular due to the softer bone the subs tended to settle. But the COII that Nordquist and Martin have been doing the have not been seeing settling as the bone is improved by encasing the sub in osseous graft material.

Tue, 12/08/2009 - 21:24 — Richard Hughes DDS

JIACD SUB ARTICLE

Ty, I found the article interesting however I would like information on the arches involved and the percentages of success and I would like some info as per the design of the subs. These are important but not the be all and end all for information desired.

Sat, 12/05/2009 - 13:37 — Logan MD DMD

WOW Blades and Subs very interesting

I to didnt think many people did these any more, especially with the success of grafting and traditional implants?

Dr Hughes: Whats your success with blades and Subs?

What is your long term success with blades and subs?

What type of complications do you see if ever?

Logan

Sat, 12/05/2009 - 16:55 — Richard Hughes DDS

Ty Logan

The success of grafting after a 4 walled defect is somewhat questionable, time and cost are major issues. My success with blades is 97-98%, my success with mand full subs and max unilaterals are 95%. So it's close to rootforms without the cost and time of grafting. Complications come about from the usual but more so with those with occlusal parafunction.

Mon, 11/30/2009 - 20:37 — HerndonDDS

No kidding? I didn't think many did blades/subs anymore!

Ahh... the thoughts from the past! Seriously, I began my implant experiences with Subperiosteals and blades, including the Ramus Frame, with Robert James at Loma Linda in 1982. I was one of his student helpers.

Subs: ear to ear flap on the mandible (for example), a rubber base impression material to take an actual impression of the osseous ridge, mental nerves carefully identified and protected from the material. Then, impression taken.. I was sucking the saliva and blood (with a suction, of course).. watching.. very interested. Everyone else was in a panic it seemed. Stuff flying everywhere..

Then, the impression FINALLY sets and is carefully removed... and the long piece 3/4 the way down the throat barely caught by yours truly, slurping it's way up the evacuation tube, the patient finally able to breathe... Ah, one of the reasons everyone else was freaking out.

Then the patient is closed and it is off to the lab for pouring the impression. Then, after setting, the proposed frame is drawn on the model, waxed, and case in titanium. Quite a process in those days.. Then, when all is finished and ready to go, the patient comes back in.... (a different day)..

And is opened again, ear to ear. Everyone is more relaxed this time. After the FT flap is elevated, the framework is tried in and fits reasonably well.. a little marking here and there the thing fits OK to place. In she goes.. the 3 transmusocal/transgingival (depending) posts stick through the closed flap.

The patient is complete and the implant is in a state of failure from an integrated perspective, successful to support a denture and make the patient happy to be able to eat better. Graduated and never saw the patients down the road. Not sure what happened in the end, but I can guess.

I have removed a few of these and found it quite a challenge to complete the project without mental nerve involvement and no one has gone numb yet.. I will probably never see any more.

Those were the days of Sapphire and Vitreous Carbon implants, ramus frames (really blades connected one side to the other) placed with a 557 high speed bur, checked with the blade, cut again, bent again, and then finally placed and noted to be solid.. sort of.. Some failed, some made it. None of the sapphire or vitreous carbon implants worked... and some very big bone loss areas later on. Oops. They were learning and Per had not brought his implants over for us then..

I am sure the tech is WAY better than those days, but I rarely find myself at a loss of what to do given the options at our disposal... I seem to be able to manage with the endosseous implants of today. Well, I can see the uses for Blades, but subs? Not the ones of the old days, that is for sure! But, it the result is integration, then I can see the point. Recall the little flat implants used for anchorage for orthodontics... They are essentially subs and provided good anchorage and easy removal if integrated at the surface. Interesting...

Thanks for the memories!

Michael

Wed, 12/02/2009 - 18:59 — Richard Hughes DDS

Thanks for your input on subs and blades Mike Herndon

Yes, my first exposure was with subs at Meharry in 1982. I must say that at that time I thought this was wat too much for a patient to endure. My thoughts have changed. I too was trained by Ralph Roberts in ramus frames and his STR's. He is a true genius. I have removed subs, blades and root forms. There is a time and a place for everything. Subs and blades have a place along with root forms. They all have success under the right conditions and failure under the improper conditions. So to say that subs and blades are out moded is incorrect. I would rather have a mind open with wonder than closed with belief!

Sun, 11/29/2009 - 14:21 — drnaz

I would be intersted in

I would be intersted in hearing more about blades. Dr Linkow came to Misch institute as a guest speaker for a couple hours and a lot of the information he presented was interesting. I am not saying do everything with these, but always good to know other options.

Sun, 11/29/2009 - 16:52 — Richard Hughes DDS

Blade and sub classes

Any one interested in learning about these modalities can e-mail me at erhughesdds@aol.com

Sat, 11/28/2009 - 11:14 — leopold

MORE information

please release more information

Sat, 11/28/2009 - 11:56 — Richard Hughes DDS

More Information

Who would be interested in learning about multi modal methods?

Thu, 11/19/2009 - 08:34 — drnaz

Blades

I would like to hear or see more about different options utilizing blades and subperiosteals. Would you please share with me your insight. Thanks. Ara

Sat, 11/28/2009 - 08:50 — Richard Hughes DDS

Blades

Ara, Would you be interested in a class?

Sat, 11/28/2009 - 11:22 — Ti Doc

Now for blades implants, I see no purpose for them.

With modern horizontal bone grafting techniques, there should be no need for blade imlants in modern dentistry. What would be one advantage or need for a blade implant in today's dentistry? Not trying to be crass, just realistic. Perhaps there is something that I am not thinking of.

Thanks

Sun, 11/29/2009 - 07:08 — Richard Hughes DDS

Grafting vs. blades

One has to consider the time, cost and quality of bone obtained from grafting. The patients just want to be restored. Blades, in many respects cut to the chase and meet the patients requirements. If done correctly, they are just as reliable as root forms. Some people don't know what they don't know. This is to say learn, learn, learn and learn some more.

Sat, 11/28/2009 - 21:50 — leopold

not thinking of what?

what you are not thinking of? it is very important????????

Sun, 11/29/2009 - 07:01 — Richard Hughes DDS

Blades

You are correct. One has to learn the basics. Such as implant design, indications, contraindications, instrumentation, prosthetics and occlusion. Also with any implant one has to learn how to manage complications. I also suggest that one obtains some out of print texts by Dr. Linkow.

Sat, 11/28/2009 - 11:55 — Richard Hughes DDS

Ti Doc

You may not see a need for them now. However, I ask you how successful are your grafting cases and those of others? BLADES ARE RELIABLE IF USED CORRECTLY AND THE TREATMENT IS LESS OF A BURDEN ON THE PATIENTS BACK POCKET. I ask you what is your experience and experience level with blades? At least you have questions!

Sat, 11/28/2009 - 21:46 — leopold

blades need to learn theoretical and practical

i am beginer,need to learn theoretical and practical.

thank you in advance.

Sat, 11/28/2009 - 16:06 — Ti Doc

My only experience with blades is removing them

Honestly, the only blades I have seen are the ones I have removed. I did not know they were even made anymore. I have had to remove a few that were failing. They were in use for many years prior to failing. They did what they were supposed to do.

My horizontal grafting work well for me. I use a variety of different techniques. Changed and evolved over the years.

I am always open to new techniques, so interested to hear any info that anyone has.

Sat, 11/28/2009 - 19:38 — Richard Hughes DDS

Blades failing

Yes this can happen. One has to carefully evaluate the blade design and the status of the natural abutments prior to placement etc. Occlusal parafunction (patients habitual occlusal patterns) also have to be evaluated, because this too can cause the demise of root forms.

Tue, 12/15/2009 - 18:23 — Gregori M Kurtz...

Blades of old and new

The older blades were single peice which had to be loaded immediately. The surgical technique amounted to site prep with a highspeed handpeice and a carbide. This frequently led to fiberous integration. Modifications of the implant and technique have allowed osseous integration as seen with root forms to be acheived. Blades are available with removable heads so the body can beplaced and allowed to integrate before any loading. todays peizo can atrumatically prepare to osteotomy.

Sat, 11/21/2009 - 20:09 — leopold

Primary closure over blades and sub p implants

How hard is it to get primary closure over blades and sub p implants?
What is success rate of your blades?

Sat, 11/28/2009 - 07:08 — Richard Hughes DDS

Primary closure

It's easy to close over a blade. A sub it's critical to maintain primary closure. There are some tricks to this with a sub or ramus frame.

Sat, 11/28/2009 - 21:37 — leopold

?-+ about primary closure

what kind of tricks need to know about primary closure?...?...?...?-...-...-...+...+...+

Sat, 11/28/2009 - 22:41 — Ti Doc

Periosteal release, Superficial Split Thickness, etc.

You need to master these to obtain primary closure. There is no "trick" to primary closure. Just physiology. Not only do you have to get the tissue to be tension free, you also have to use the correct suturing technique. I see alot of folks screw up their primary closure by simply doing the wrong suture technique. Simple interrupted sutures are not a panacea. You want primary closure, you need to learn vertical mattresses, horizontal mattresses, modified vertical mattresses, interlocking mattresses, Lorel loops, and more.

Sat, 06/20/2009 - 15:17 — Arroyodds