Last Tuesday the Conejo Simi Implant Study Club held a lecture featuring the guest speakers of Donald Nikchevich Jr DDS and Jonathan Shadi, DDS. The study club met in the normal facility at Los Robles Regional Medical Center and Dr. Nikchevich began by explaining the new staffing at the Westlake Oral & Plastic Surgery office introducing Dr. Jonathan Shadi as the new associate to the practice and reiterating with the members of the study club that Dr. Bennion was working 3 days a week and had Mondays and Tuesdays off and Dr. Nikchevich and Dr. Newton were working 5 days a week. Also that Dr. Wayne Ozaki was continuing to work on Thursdays at the office and the remaining 4 days would be spent at his new position at the University of California Los Angeles as the Director of Craniofacial Surgery.
The members of the study club had no questions with regards to this and the lecture began with Dr. Nikchevich talking about the emergency implant. The emergency implant is an implant that is referred into the office on an emergency basis and treated immediately. The best examples of emergency implants and methods of temporization were all covered. The Westlake Oral & Plastic Surgery office has almost a 20 year history of treating emergency implants and within the last 7-8 years, have treated about 5-6 emergency implants per week. These are implants where the tooth was fractured traumatically, a crown was broken off due to caries, there was a chronic resorption that was noted by a referring dentist or there was minor apical pathology with pain. All of these were great candidates for emergency implants. Patients who would not be good candidates for an emergency implant would be those where there was significant frank pus, significant buccal erythema, high mobility with a broad range of radiolucency around any of the apical areas.
With this knowledge base, the surgical technique that would be used would be the removal of the tooth atraumatically, curettage and irrigation of the area with copious amounts of normal saline, and then the placement of the implant. Ideal placement of the implant would involve 3 mm or more of apical bone beyond the apices of the existing tooth for good stability. A five wall defect is optimal where bone will heal in exceptionally. Good thick gingival bio type is optimal and having adjacent teeth with no disease process is also optimal. With these concepts in mind, the referral base understood what to look for in their referring of emergency implants. At this time Dr. Nikchevich went over the basics of temporization which included the standard Flipper, the Essix retainer as well as an immediate temporization. Slides were shown giving examples of immediate temporization using the immediate temporary abutment from Nobel Biocare versus standard screw retained temporary abutments that most manufacturers supply. Clinical slides showed this in depth and also occlusion was talked about, how the patient would have to not bite heavily on the area, keep the area out of occlusion and the fabrication of these temporary restorations would not allow active loading by the patient during the healing phase. Healing phases were discussed with the average being 10-12 weeks following the placement of implant with the patient being followed on average 3 times during that period. Final radiograph and clinical testing would be done on the implant before they were referred back to the general dentist or the prosthodontist for impressions and fabrication of the restoration. Statistics were given with regards to a 2 year from April 2012 to April 2014 study that showed the immediate extraction and immediate emergency implant placement with temporization and there were 848 implants, 26 of those were deemed non integrated giving us a 97% success rate. So that 97% success rate was within a 2 year period of consecutive implants placed immediately under emergency situations.
That concluded the talk with regards to emergency implants and Dr. Shadi then took over the podium and described 3 cases that he had completed in his residency in the Fresno Hospitalsystem. These were all cases that involves significant bone grafting due to extensive defects. The cases were in status right now, and had not received final restoration, but were progressing in that direction. The materials used for these cases were a combination of Puros and Bioss and Bioguide membranes. It was shown how significant releasing of the flaps was necessary to get primary closure and how the bulk of the grafts were significant due to overbulking initially. One of the cases was the case that showed the complete absence of the maxilla secondary to a failed orthognathic procedure and this case was in its final process of being completed but showed a significant grafting in the area to lead to the placement of dental implants and a final restoration. The study club ended at 9 o'clock and questions were fielded by the speakers. The next study club would be in approximately 2 months at Los Robles Hospital, speaker to be determined.
DONALD NIKCHEVICH JR, DDS
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