Case: Immediate Implant placement, sinus lifts and function

Patient had class 3 occlusion, not skeletal, but due to shifting upon overload of anterior teeth. Missing posterior dentition and not very proper fixed/removable prosthesis, with undetermined occlusal scheme. Most of the teeth were periodontaly involved, some were class 2-3 mobility, most perio/endo pathology. The suggested and performed treatment plan involved full moth reconstruction with immediate function. Some teeth could have been retained, however would require connecting implants with natural teeth, which would require endo/perio treatment. And I wasn’t comfortable with. Based on a fact, implant therapy will offer predictable long-term result; full implant reconstruction was the choice. Sinus lifts and immediate implants with good primary stability enhanced by rigid connection by means intraoral welding, gives a good predictable result. With I/O welding achieved rigid cross arch stabilization. Occlusion: in centric relation, anterior guidance and canine disocclusion, posterior dot contacts only. Distal cantilevers are out of occlusion, to fulfill the arch. Probable could have more implants. Case is in function for over year and a half and pretty stable. Thanks for your comments Dr. Hughes, makes me think even more the full version movie on site lower left corner http://www.islandimplant.com/ Mike Shulman

Hi, Yes, it could have more implants posteriorly or just distally position the last ones. The small cantilevers are not in CO. It was done to secure the patients expectations, he was concern with distal spread on the temps. “Patients counting teeth” He would have been ok with out it, but. I/O welding; Overall the treatment time is not reduced, but secure the immediate load for sure. By reducing lever and creating cross arch stabilization. Thanks mike

There were bilateral sinus lifts and immediate implant placement and immediate function. I’m not a big fan of all in 4. We gave the patient the implant occlusion at least in a first molar area. Direct bone load. Should work better with neuromuscular concept, for those, who believe in. I/O welding came from Italy. Good food and so on. They have this technique for over 30 years. It was used for Garbaccio's, Tramonte’s, Linkow’s (blade) as well as Niddle implants. They are mono or one stage (one piece) implants. Now we are using and teaching techniques for 2 pieces implants. And the indication immediate load (function). The results are pretty good. The new publications coming up in Implant Tribune (CE article) and JOI. Thanks mike

Hi, CRS Thanks It is not my technique, but it’s a good one. Learned from Italian colleagues. I was skeptical at first. But utilizing it for a few years and using for our advanced courses in Jamaica. Last advance course, we welded about 50+ implants. The lasers, not sure, it is hot and time control is very important, few µSec. Not to over heat, also the design with copper beaks, they absorbed the heat before it gets to the implant. Very intelligent idea. Cheers mike

Hi Steven, it is a delicate question, we consider a lot of different factors, and I’d say From 34 and up At our courses we discuss how to make extensive treatment cost effective. At that age, most patients have Medicare and fixed source of income. So we work hard to help a lot of patients. mike