CASE STUDIES

Dr. Rainier A. Urdaneta is a Prosthodontist with significant clinical experience in the surgical placement of implants in areas with limited bone available. He has established himself in the Worcester area at 1010 Dental on Elm, 70 Elm St, Worcester, MA 01609, (508) 755-1293, and recently expanded to Brookline, at the Brookline Dental Center, 1199 Beacon Street, Lower Level, Brookline, MA 02446, (617) 734-2222. Dr. Urdaneta would like to introduce some of the techniques he is currently using.

“Today, we can place implants in the vast majority of patients with minimal grafting. If you want more information or have a patient that can benefit from this treatment, do not hesitate to contact me. A Lunch & Learn Session can be easily arranged.”

MYTH:

Implants cannot be placed less than 1 mm to an adjacent tooth

REALITY:

Recent research has demonstrated that plateau-root form implants may be placed in close proximity without damaging an adjacent tooth [see footnote 1]  In the image presented to the left, the clinical photograph is superimposed on the actual radiograph for the case.

Clarifying Common Misconceptions
MYTH:

If an implant is placed too close to an adjacent tooth, both the implant and the tooth will lose bone.

REALITY:

Close tooth/implant proximity is not associated with bone loss or the failure of plateau root form implant, and it does not damage the adjacent tooth [see footnote 1].

MYTH:

Short implants do not work.

REALITY:

Research consistently has demonstrated that short implants have similar survival rates to long implants.

I have research experience in the subject [see footnotes 1-5]. In fact, we have demonstrated that for implants 5 mm wide, the bone is better around a short, 8 mm long implant when compared to a long, 11 mm implant. Why? We have hypothesized that since bone mineralizes when submitted to strains, and there are larger strains in bone surrounding short implants, the bone response is better around short implants.

COMMON PROBLEMS ENCOUNTERED IN OUR PRACTICES
PROBLEMS:

a.  The cost of a sinus lift procedure, the time it takes to heal, and the concerns some patients have about using bone from bovine and cadaver origin discourage patients from sinus lifts or socket preservation procedures.

b.  We have all referred a patient for an extraction and an implant placement, and instead the patient returns with a graft, no implant, a huge bill, and no longer has the money for anything else.

c.  For cases with 3 mm or less of bone height remaining in posterior maxilla, is an external sinus lift grafting procedure the only choice the patients have?

SOLUTION

All of the above problems have the same solution: the use of newer grafting procedures such as L-PRF grafting. In a significant number of cases, a short implant can be placed without any sinus lift or grafting. The use of newer grafting procedures accelerates the healing process so that the implant is usually ready to be restored in 4 months or less.

Using the patient’s own blood, and with a procedure that takes only 8 minutes, the leukocytes, platelets, and stem cells are harvested on the same day of implant surgery. This blood is used to form the membranes and plugs, and no other materials are needed for grafting. The membranes/plugs can be used for sinus lifts and/or socket preservation. The usual healing time is only 3-4 months.

PROBLEM:

There is not enough bone to place an implant without first doing an external sinus lift.

SOLUTION:

Use of L-PRF grafting in tandem with the placement of a short implant.

An external sinus lift is not always necessary to restore cases like this. The tooth was extracted, and the implant was placed at the same time as a sinus lift graft with L-PRF. The case was restored after 4 months of healing.

The tooth was extracted, the sinus floor lifted, and L-PRF graft was used immediately before inserting the implant.

After 4 months of healing, the graft is now bone. The implant is ready to be restored.

A month after uncovering, 5 months after placement, the implant is restored. Nowadays, using their own white cells, patients can be restored with minimally invasive, lower cost treatments.

ADDITIONAL PROBLEMS/SOLUTIONS
PROBLEM:

The mandibular nerve is too close, and the bone is thin so we cannot place an implant without serious complications or complex surgeries such as block grafting or ridge splitting. The CT-scan images A and B, shown to the right, present a case where the crest of the bone is narrow (less than 6 mm), and there is proximity to the mandibular nerve (less than 10 mm).

SOLUTION:

Use of ultrashort, narrow implants.

Images C and D demonstrate two ultrashort 4×5 implants placed after 1 year of loading. Both implants were restored with single crowns by the referring dentist.

Periapical radiographs at crown insertion (Image E, 2015 and Image F, 2016) demonstrate excellent crestal bone stability. The use of ultrashort implants reduces the need for grafting, the cost to the patient, and the possibility of complications.

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Urdaneta RA, et al. A Retrospective Radiograph study on the effect of natural tooth implant proximity and an introduction to the concept of a bone loading platform switch. Int J Oral  Maxillofac Implants 2014;29:1412-1424

 

Urdaneta RA, et al. The Effect of Increased Crown-to-implant Ratio on single-tooth Locking-taper implants. Int J Oral Maxillofac Implants 2010 Jul-Aug;25(4):729-43.

 

Urdaneta RA, Daher, S, Leary J, Emanuel K, Chuang SK. Factors associated with crestal bone gain on single-tooth locking-taper implants: The effect of NSAIDs. Int J Oral Maxillofac  Implants 2011;26:1063-1078

 

Urdaneta RA, Leary J, Emanuel K, Chuang SK. The effect of implant size 5 x 8 in crestal bone levels on single tooth implants. J Periodontol 2012;83:1235-1244.

 

Urdaneta RA, Daher S, Leary J, Emanuel K, Chuang SK. The survival of Ultrashort locking taper implants . Int J Oral Maxillofac Implants 2012;27:644-654.

 
 
 
 
 
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