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The Perio Health Implant Study Group is hosting a Continuing Education Course in Houston, Texas on Wednesday, November 16, 2016 at 6:00 pm. Implant Concierge™ CEO Bret Royal will be lecturing about The Digital Workflow of Guided Surgery and how to incorporate it with Implant Concierge™. This event will be sponsored by Perio Health Professionals, Sweden & Martina and our sister company, iMagDent. We look forward to this event and seeing everyone there!
If you have any questions about Implant Concierge™ or if you want to start your first surgical guided case, please visit our website www.implantconcierge.com or call 866-977-2228 to speak with one of our 3D Customer Service Specialists.
Implant Concierge™ surgery-ready provisional along with the CAD/CAM surgical guide was amazing! My surgery was predictable and it allowed me to extract the tooth, deliver the implant and screw-retained provisional restoration faster than I ever imagined. Implant Concierge™ service and expertise is a practice builder! –Dr. Jaih C. Jackson DDS, PA
Patient Profile- 43 year old female with no significant medical history
Synopsis- Female patient with esthetic concerns and desiring to walk out of the office with a tooth, and not a flipper. Patient previously had ortho treatment and presented with teeth #7 and #8 but were periodontally involved and had significant bone loss. CBCT was taken and PVS impressions were sent to Implant Concierge™. CBCT analysis revealed inadequate bone volume to place implant in site #7, on the other hand, tooth #8 had a better long-term prognosis for an implant placement. Plans include a cantilever for tooth #7.
After the CBCT scan was acquired, the PVS impression was digitized and converted to a .stl file by Implant Concierge™ using a 3Shape D700 optical scanner. The digital model was registered to the CBCT DICOM creating a multi-layered file (DICOM + .stl) allowing for accurate soft tissue and hard tissue representation. A 13mm by 3.8mm Camlog™ Screw-Line™ implant was precisely positioned in site #8 during an online virtual surgery hosted by an Implant Concierge™ 3D Case Coordinator Kathryn Correa and Dr. Jackson.
For Implant Concierge™ Immediate Extract / Immediate Place Workflow and other workflows, please visit our support page at www.implantconcierge.com/support .
The image below is of the digitized diagnostic model that was shipped to Implant Concierge™. The .stl file that was created was then registered to the CBCT DICOM, thus aiding in the placement of the ideal restorative position using the hard and soft tissue.
Implant Concierge™ Camlog™ Compatible CAD/CAM surgical guide and surgery-ready single unit provisional.
Implant Concierge™ surgical guide provided an extremely stable and easy to use surgical guide that was compatible with Dr. Jackson’s Camlog™ implant instrumentation.
After the osteotomy was predictably and efficiently prepared, Dr. Jackson delivered the Camlog™ implant through the surgical guide. Dr. Jackson’s Camlog Screw-Line™ implant provided a fully guided option which provides the utmost accuracy.
Dr. Jackson then placed bone graft after implant placement into the fresh extraction socket.
After minor adjustments to perfect the emergence profile and contacts to support the soft tissue, a Camlog™ compatible provisional restoration was delivered at the time of surgery.
At the completion of the surgery, Dr. Jackson takes the final post OP x-ray of the implant and the provisional (The picture on the left is the implant virtually placed during Dr. Jackson’s online meeting).
Implant Concierge™ is now offering implant specific single unit provisionals! Below is a list of current implant manufacturers that Implant Concierge™ is compatible with. If you do not see your preferred implant company on this list, please contact us at 866-977-2228 for more information.
Implant Concierge™ would like to thank Dr. Jaih Jackson with American Family Dental in Bradenton, Florida for allowing us to share this case! Please visit his website at http://www.americanfamilydental.com/
*Additional charges may apply to specific implant brands due to Ti-base compatibility options.
Camlog™ and Screw-Line™ are trademarks of the Camlog Implant System.
Only used for the Sirona Galileos CBCT Unit
There are many different scan protocols being used throughout the industry today, which adds a level of confusion and complexity to guided surgery cases. In an effort to simplify and minimize confusion and mistakes, Implant Concierge™ will automatically generate a patient specific “scan protocol” that will provide instructions to ensure the most efficient digital workflow is followed.
For a fully edentulous case and if using a Sirona CBCT unit, the most predictable results occur by following an alternative process to our standard, Dual Scan Protocol. Due to internal DICOM settings within the Sirona Galileos CBCT unit, this “Alternate Dual Scan Protocol” is recommended. Once again, the “Alternate Dual Scan Protocol” only needs to be followed if you are using the Sirona CBCT unit for fully edentulous cases.
Step 1: Duplicate the patient’s well‐fitting denture with clear acrylic
a. NO radiopaque additives such as barium sulfate or Biocryl-X
Step 2: Attach six to eight 1.0mm X‐ray stickers (1.0mm Suremark stickers )
a. Place 3-4 X-ray stickers on buccal and 3-4 on the lingual at varying axial planes
Step 3: Take a CBCT scan of patient wearing denture WITH X-ray markers
a. Do NOT remove or change X-ray markers from original positions
Step 4: Compress and upload CBCT DICOM file to Implant Concierge™
Step 5: Ship the duplicated denture with X-ray markers to Implant Concierge™
a. Ensure denture is bilaterally stabilized during CBCT scan
Once Implant Concierge™ receives the duplicated denture with X-ray markers, Implant Concierge™ will scan the denture and merge the file with the Sirona DICOM file previously uploaded. Using this protocol, Implant Concierge™ will create and present the ideal restorative based treatment plan to you via a short web-based virtual surgery allowing you to make final changes. After your approval, Implant Concierge™ will design, print and ship the CAD/CAM surgical guide to you within a few business days. Choose from soft-tissue or bone-borne guides. If you are interested in the standard Dual Scan Protocol, click here. To learn more about this and other protocols, call us at 866-977-2228 or to start your surgical guide case, visit www.implantconcierge.com
Implant Concierge Virtual Treatment Plan Coordinator™ provides the digital blue-print to create an accurate CAD/CAM Surgical Guide and Surgery-Ready custom provisional restoration all in one box! Improve your esthetic results with immediate soft tissue support. Save valuable surgical chair-time by eliminating the tedious process of creating a provisional chair-side or scheduling a second appointment. Implant Concierge is your Virtual Treatment Plan Coordinator™, creating your surgery ready smile. From one source, with one invoice and no software expertise required. Now that’s worth smiling over! All Implant Concierge surgery-ready provisionals are milled from shade selected PMMA and bonded to a Ti-Base.
Please visit our website to start your case now! www.implantconcierge.com or call 866-977-2228.
Chance findings in a 57 year old male. In the axial slice a joint space can be seen on the right side (“C2-3 joint”). On the left side an enlarged well defined round opacity can be seen with variable internal density – yellow arrow (“C2-3 joint fused”). This is primary congenital fusion of the joint C2-3 with consequent degenerative process with hyperostosis. There is also hypogenesis of the left C1-2 joint – large space between C2 lateral pedicle marked by red arrow (“C1-2 hypogenesis”). Look at the right side to see a normal C1-2 joint. The C2-3 enlargement reflects advanced degeneration in course of congenital deformities (secondary to chronic change of the physiological function).
Any CBCT with an abnormality like this should be referred for confirmation that this is a benign finding.
Association Between Chronic Apical Periodontitis and Cardiovascular disease
It has been suspected for over 100 years that oral sepsis is associated and probably causes many systemic diseases (Hunter 1900). In recent years there have been many papers describing strong associations between chronic periodontal disease and cardiovascular disease (REVIEW: Hayashi et al 2010). The dental profession is becoming aware of the importance of preventing and treating chronic periodontal diseases. However, less well known is the association between chronic apical periodontitis and cardiovascular disease (CVD). In 2012 Pasqualini D et. al. published an important paper showing an association between apical periodontitis and CVD which makes perfect sense since many of the same organisms found in periodontal diseases are found in apical disease.
For many years, as a radiologist, I have seen and reported on the presence of apical radiolucent areas as “probably apical granuloma and possibly a radicular cyst” as shown in the images below of two lesions seen in the same patient.
Fig 1 #30 mesial apex with 5 mm lucency.
Fig 2 #30 mesial apex with thin panoramic slice to reveal the true extent of the lucency.
Fig 3 Same patient as figs 1 and 2 #3 mesiobuccal apical lucency 6 mm in diameter with associated mucosal thickening of the floor of the right maxillary sinus
Recently I have decided that the research literature is showing such high association between oral infections and other systemic diseases that I would be failing in my reports just to state that oral sepsis is present. When I see a large cyst or possible malignant tumor I always add a recommendation such as “a biopsy and/or consultation with an oral surgeon is advised.” Carotid artery calcifications I recommend “the patient and their MD should be informed” so that they can decide if an ultrasound examination is needed. Apart from providing the best care for the patient it also ensures that you avoid the possible legal situation of failing to diagnose and appropriately deal with a serious medical condition. With regard to apical lucencies I now write “There is an association between chronic apical periodontitis and coronary heart disease (Pasqualini D et. al. Association among Oral Health, Apical Periodontitis, CD14 Polymorphisms, and Coronary Heart Disease in Middle-aged Adults. Journal of Endodontics 2012 38 (12) 1570-1577).”
“The times they are achangin” (Bob Dylan 1964)…….
Hunter W (1900). Oral sepsis as a cause of disease. Br Med J 2: 215.
Hayashi C et. al. (2010). Pathogen-induced inflammation at sites distant from oral infection. Molecular Oral Biology 25 305-316.
Pasqualini D et. al. (2012) Association among Oral Health, Apical Periodontitis, CD14 Polymorphisms, and Coronary Heart Disease in Middle-aged Adults. Journal of Endodontics 38 (12) 1570-1577.
Dr. Douglas K Benn
3610 Leavenworth Court
Degenerative joint disease is common in the Temporomandibular and other joints such as the cervical vertebrae. This 71 year old gentleman has a chance finding of a well-defined opacity in the mid-line in close proximity to the anterior surface of the odontoid process of C2. This is most likely an osteophyte or calcification of the anterior median ligament. It is of no clinical importance. Degenerative joint disease is related to age and most people over the age of 50 years have visible signs of degenerative joint disease such as the osteophyte labeled for C1.
Panoramic radiographs are good for a general assessment of jaw bone size and teeth / anatomical structures. However, the inherent magnification and difficulty of placing the jaws inside the focal trough, together with lack of third dimension can produce significant problems in assessing bone morphology. The panoramic image Figure 1 below of a 76 year old lady shows a moderately atrophic mandibular ridge but there does appear to be bone above the mylohyoid ridge in the posterior regions. However, in Figure 2 the reformatted CBCT panoramic shows none on the left and a little on the right.
Tracing of the inferior alveolar nerve canal in figure 4 shows the mental foramen at the level of the alveolar ridge.
In Figure 5 cross sections across the mandible show the left mental foramen opening onto the ridge crest and a lingual knife edge ridge running from the mental
foramen region posteriorly. A similar appearance was found on the right side. None of this was apparent from the panoramic image although an experienced
clinician might be suspicious of the apparent panoramic ridge height .
If you are planning implants cross sectional CBCT should always be performed after your initial pan assessment.
Dr Douglas K Benn BDS, M Phil, DDS, PhD, Diplomate of Dental Radiology (Royal College of Radiologists, England)
Professor of Oral and Maxillofacial Radiology
Creighton University School of Dentistry
Boyne room 207
2802 Webster Street • Omaha NE • 68178
Our CEO, Bret E. Royal, will be attending the 2016 American Academy of Dental Group Practice Event, taking place Thursday, February 3rd to Saturday, February 6th in Las Vegas, Nevada!
Take a moment to stop by the Implant Concierge booth, #528, and say hi to Bret! He will be there to answer any questions and looks forward to meeting some of our fellow doctors, and of course our potential new doctors!
Implant Concierge hopes to see you there. Have a great meeting!
For more information, please visit: https://www.aadgp.org/