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As a result of this condition, significant amounts of bone may be lost from around the person's teeth, to the point where if they are extracted there may be an inadequate quantity of bone in which to place an implant.
In some cases, the bone deficiency may be due to a previous surgical procedure such as a difficult tooth extraction or the removal of a cyst or tumor.
The dentist must search for evidence of pathology within the jawbone including tumors and cysts. Additionally, impacted teeth and tooth root fragments remnants of past extractions need to be identified and removed as the dentist feels it's needed.
We discuss one such grafting procedure termed a Sinus Lift. It's frequently performed in association with placing implants that replace upper back teeth.
A portion of the dentist's clinical examination must also involve an evaluation of the soft tissues of the patient's mouth.
Of course, they must find that these tissues are free of pathology and appear to be healthy. They must also evaluate both the quantity and type of tissue that exists in the immediate area around the implant site.
The right type of gum tissue attached gingiva, gums tightly bound to the bone underneath them must surround the implant to ensure its long-term success.
Authorship : Written by Staff Dentist. Staff Dentist. Really, only a dentist to whom you went to for a second opinion would be able to answer this question.
From the patient's view, we get that some services that are performed often seem just to be profit centers, or utilized just to help to pay for expensive equipment that has been purchased.
At the same time, the dentist no doubt wants everything about the procedure to be successful and clearly 3D imaging does provide a higher level of information.
And legally they are obligated to practice dentistry at the same level as other practitioners so if most dentists would have used cone beam imaging for your case and your dentist didn't and a complication arose Per our AAOMR references above, theoretically it's expected that a dentist will initially evaluate their patient using more conventional types of radiographic exam panoramic x-ray and then make a decision for 3D imaging based on that.
It seems reasonable that a dentist would share with their patient what they see on that x-ray that suggests that CBCT imaging is indicated.
While we didn't mention and as you seem to suspect, yes many implants are placed without the assistance of CBCT radiography.
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Skip to main content. Implant vs. Root Canal. Evaluating the suitability of the patient's jaw for an implant. In some cases, a simple combination of the following radiographic techniques will be satisfactory for planning and performing a patient's procedure.
Nearby anatomical structures must not be impinged by implant placement. The location of anatomical structures, such as sinuses , nerves , blood vessels and the roots of adjacent teeth must be identified.
This is important because implants must be placed so they are suitably distant from these objects. An adequate amount of bone must exist for an implant.
Since the success of a dental implant will be greatly dependent upon the bone in which it's placed, the treating dentist may feel that it's necessary for them to perform bone grafting so an adequate amount exists.
This is typically a separate procedure that must be performed and allowed to heal prior to placing the implant. Authorship : Written by Staff Dentist Content reference sources.
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The disadvantages of this approach are that the preparation broaches can be difficult to use in sclerotic bone, and these sleeves are intrinsically specific to one implant system.
Porous Tantalum Cones The surgical technique for porous tantalum metaphyseal cones has previously been described [ 8 , 27 , 43 , 44 ].
Once the surgeon has decided to use a metaphyseal cone, a trial intramedullary stem or reamer may be used to create the appropriate positioning of the cone.
Trial sizing of the cone is done by inverting the cone to match the size most closely to the proximal part of the defect in the tibia or the distal part of the defect in the femur.
Due to the variability of bone defects, cones can be contoured, usually to accommodate large defects. The bone is then contoured free hand with a high-speed burr to ensure optimal press fit.
The cone is impacted into its final position, and trial components and stems are inserted. The final sized implant and stem are inserted through the cone into the correct rotational alignment.
The interface between the cone and stemmed implant is reinforced with cement. It is our preference to only utilize cemented stems.
When using a cemented stem proximal to the femoral cone or distal to the tibial cone, the stem is passed through the cone, placed in the cement, and held in place until the cement hardens.
Bone graft is used to fill any voids that exist between the host bone and the cone. The advantages of these metaphyseal cones are that there are multiple shapes and sizes to accommodate a large spectrum of bone defects in the moderate to severe range of bone loss.
Additionally, the porous tantalum can be cut with a high-speed burr to alter the shape and size if needed.
The primary disadvantage of these cones is that the bone preparation is done with high-speed burrs in a freehand manner, which results in a less than optimal bone preparation in many cases and is often quite time-consuming.
Additionally, the size and shape of these implants often require considerable bone removal, and this is particularly true of the femoral cones.
Based upon the intended size of the prosthesis, a target range of cone sizes can be anticipated to gauge the depth of the central symmetric cone reamer Fig.
In the tibia, a determination can then be made as to whether or not it is desirable to proceed with additional bone preparation for the lobed-shaped cone.
If so, a side reamer is used in the appropriate position to prepare the lobe portion of the bone preparation Fig. Symmetric and lobe-shaped trials are then used to judge final position of the cone in relation to the prosthesis.
In the femur, the cones are bilobed. The femoral bone preparation is also medullary guided, initiated with a central reamer, and then finally with two-side lobe reamers Fig.
Bone graft is generally not required to fill any voids that exist between the host bone and the cone because of the precise nature of the bone milling preparation Figs.
The disadvantages of this system are yet unknown as there have been no clinical studies yet reported. Key Technical Points When bone defects are encountered in revision TKAs, there are five general steps that are critical: 1.
Classify intraoperative bone defect using the AORI classification system. Contour the metaphysis to get an optimal fit with a sleeve or cone. Impact the sleeve or cone.
Fill defects between the sleeve or cone and host bone with bone graft to promote bone ingrowth. Bypass prosthesis and cone with mid-length cemented stem to provide rigid initial fixation until cone has time to ingrow.
Clinical Outcomes Metaphyseal sleeves and cones, in comparison to their alternative allografts, have several advantages: implementation through a simpler technique, shorter operative times, decreased risk of transmitting infection, and potentially more durable fixation [ 45 — 48 ].
Recent literature has further stressed these advantages. Metaphyseal Sleeves Metaphyseal sleeves have been available for revision TKAs for almost four decades, yet most data is relatively short term Table
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