CE Course November 16, 2016 Hosted by The Perio Health Implant Study Group

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!

 

Perio_Health_1Perio_health_2

 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.

CE Course November 16, 2016 Hosted by The Perio Health Implant Study Group

Implant Concierge™ Immediate Extract / Immediate Place Case Study: Camlog™ Guided Implant System with a Surgery-Ready Provisional

Dr Jaih Jackson

 

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.

 

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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.

model

Implant Concierge™ Camlog™ Compatible CAD/CAM surgical guide and surgery-ready single unit provisional.

guide and prov

Implant Concierge™ surgical guide provided an extremely stable and easy to use surgical guide that was compatible with Dr. Jackson’s Camlog™ implant instrumentation.

guide pic

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.

implant pic

Dr. Jackson then placed bone graft after implant placement into the fresh extraction socket.

bone graft

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.

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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).

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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.

Compatible Guided Implant Systems

 

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/

 

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*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.

Implant Concierge™ Immediate Extract / Immediate Place Case Study: Camlog™ Guided Implant System with a Surgery-Ready Provisional

Implant Concierge™ Alternative Dual Scan Protocol

Only used for the Sirona Galileos CBCT Unit

sirona machine
Galileos CT Scanner by Sirona

 

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                 

suremark
Implant Concierge™ sells Suremark Markers in a box of 110 for $40

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

 

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Clear acrylic denture with Suremark markers

 

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™ Alternative Dual Scan Protocol

Surgery Ready Provisionals Are Now Available!

 

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Surgery Ready Provisionals are Now Available!  

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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.

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Please visit our website to start your case now! www.implantconcierge.com or call 866-977-2228.

Surgery Ready Provisionals Are Now Available!

Congenital fusion C2-C3 vertebra and degenerative changes

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).

 

C2-3 joint

Any CBCT with an abnormality like this should be referred for confirmation that this is a benign finding.

Congenital fusion C2-C3 vertebra and degenerative changes

Apical Infection and Heart Disease

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.

Apical granuloma

Fig 1 #30 mesial apex with 5 mm lucency.

Apical granuloma 1a

Fig 2 #30 mesial apex with thin panoramic slice to reveal the true extent of the lucency.

Apical granuloma 2

 

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
Omaha
Nebraska 68105

Tel: 402-953-6264

Apical Infection and Heart Disease

Degenerative Joint Disease of the Cervical Spine

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.

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Degenerative Joint Disease of the Cervical Spine

Panoramic Discrepancies on Atrophic Mandible Ridge

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.

 

dr been 1

 

Tracing of the inferior alveolar nerve canal in figure 4 shows the mental foramen at the level of the alveolar ridge.

 

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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 .

dr been 3

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
Tel: 402-280-5025

Panoramic Discrepancies on Atrophic Mandible Ridge

American Academy of Dental Group Practice Event

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/

American Academy of Dental Group Practice Event

How To Read A CAT Scan

Quiet often, I am asked by dentists if they should get a Board Certified Radiology Interpretation on every CBCT scan.  Since I am not a lawyer, a dentist or an expert, I really can’t answer that question.  However, I always mention to a dentist that if they do not feel comfortable reading a CBCT scan, then it only seems logical that they should get an expert to review their CBCT scan.  With that being said, less than 10% of all CBCT scans acquired at our imaging centers and new cases started at www.implantconcierge.com order an interpretation.

I am surprised by this number, but also thankful because honestly, there aren’t enough radiologist to handle the workload if EVERY CBCT scan taken required a radiology interpretation!  The wait for an interpretation would be months!!  It is common for dentists to provide their own general review and if they see something that catches their eye, then they will order an interpretation.  Of course then, the next question is, “Is there a recommended process or official manner to read a CBCT scan?

To answer this question, Dr. Douglas Benn, one of our radiology partners and XXXXX at Creighton University has created this outline to help a dentist review their own CBCT.

Thank you Dr. Benn!

 

“A structured approach is required as there is a huge amount of anatomy contained within the scanned volume and unless a careful systematic approach is used then it is likely that you will miss something. My advice is:

  1. Review the clinical history, medical history, chief complaints. Know which teeth have been removed in the last few months to explain areas of bone loss with healing/ disrupted bone. Know if bone grafts are present and date of surgery.
  2. Review the axial slices starting with the anterior superior region (Frontal sinus), move down through the jaws and anterior face until you reach the cervical region. Then concentrate on the airway and spine and move up to the cranium. In this way you will cover the whole region. DO NOT THINK ABOUT THE CHIEF COMPLAINT  as this will bias you away from looking at all  the other areas.
  3. Now read the coronal slices from front to back and come back to the mental region.
  4. Lastly sagittal slices from right to left.
  5. Create a panoramic tomograph view and count how many teeth are missing.
  6. Adjust the field of view so you are only looking at the maxilla and in panoramic cross section work from right to left. Carefully examine all apices for widening of PLS, enlargement of the nasopalatine canal and presence of maxillary sinus bony septa as these should be avoided when performing sinus lifts.
  7. Adjust the field of view so you are only looking at the mandible and in panoramic cross section work from left to right. If implants or removal of third molars are planned, trace the inferior alveolar canals. Again check apical areas. In the midline search for the lingual canal if anterior implants are planned to avoid cutting these vessels. A simple arrow can be used to note the position of the canals.
  8. Lastly examine the region/s of the chief complaint/s and note abnormalities.
  9. Allow plenty of time. An average adult 40 years of age with most of their teeth and 2-3 root canals will take at least 20 minutes including make copies of selected slices of interest. A patient with large restorations and multiple root treatments (5+) is likely to take at least 40 minutes as the probability of apical pathology is high.

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The time spent will reward you handsomely as your treatment planning will be more thorough and you will avoid pitfalls of providing implants next to diseased teeth.”

Dr. Douglas K Benn DDS PhD, Diploma in Dental Radiology (Royal College of Radiologists, England)

Oral and Maxillofacial Radiologist
3610 Leavenworth Court
Omaha
Nebraska 68105

https://dentistry.creighton.edu/directory/douglas-benn

http://omahadentalimaging.com/

www.implantconcierge.com

www.ReadCTs.com

How To Read A CAT Scan