Wagner Oral Surgeon & Dental Implant Specialists

New Trends In Dental Implants

dental implants

A trending topic right now seems to be the decision to opt for “mini-dental implants” instead of more traditional ones. Below we are going to take a look inside the trend, and lay out some of the benefits and drawbacks so that you can get a better understanding of this exciting trend in dentistry.

Benefits

  • Mini dental implants are usually less expensive than traditional ones, sometimes costing only 1/3 that of regular implants. They take less time to place and are smaller and less invasive, and can be used in small spaces or for those with inadequate bone mass.
  • With mini dentures, smaller dentures can be used, leading to a better tasting experience for the palate than a traditional denture would provide.
  • Mini implants can be placed with minimal recovery time, and usually require very little to no bone grafting.

Drawbacks

Because this is still a fairly new procedure, there are a few downsides. For one, there aren’t enough studies out there on the longevity of these implants, so we don’t know how they hold up over time. A study published in the International Journal of Implant Dentistry in 2016 revealed that traditional dental implant placement has a proven survival rate of 95% or greater. The analysis collected data from over 10,000 implants from 3,095 patients, across three separate private practices over the course of 20 years. For mini dental implants, there isn’t yet enough data to conclude a proper survival rate.

Another concern is that because this is such a new trend there is not as much information or regulation out there. Some practices with claims such as “Dentures-in-a-day” might not do a proper consultation, skipping important steps such as a 3D scan to make sure that you are a good candidate for the procedure.

While it may be some time before this method is perfected and adopted, it is also exciting to see the advancements changing people’s lives in the dental industry every day. Check in with Wagner Oral Surgery & Dental Implant Specialists to find out what tooth replacement options may be right for you!

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DR. NED MURPHY SWORN IN AS WDA PRESIDENT

I could not be more proud to see my friend and colleague Ned Murphy D.D.S. sworn in as Wisconsin Dental Association president. (WDAJ Vol 93(1):8-9, Jan-Feb 2017). Ned has worked tirelessly in the local, state, and national dental associations to seek excellence in dentistry as practitioners in Wisconsin provide for our patients as well as being an advocate for patient’s access to care. He has selflessly given his time and talents to the people in our communities and has been a stellar example for dentists, and for that matter, many practitioners as to what it means to “give back” and share your talents. Thank you, Ned, for all of your work.

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rh BMP-2 VERSUS PRGF FOR SINUS LIFT GRAFTS

The use of Bone Morphogenetic Protein (recombinant human bone morphogenetic protein-2 = rhBMP-2) as a bone induction technique (to gain new bone) has been an accepted and effective technique for many years. (J Oral Maxillofac Surg 74:928-939, 2016). The main limiting factor over the years has been the cost of the materials which is quite high. Because of what seemed to me to be a prohibitive expense, I have used other techniques which evolved over time. Over the past number of years we have been using a combination of human bone allograft and PRGF (platelets rich in growth factors). The bone-PRGF technique has been so successful for me, and is relatively inexpensive, that at this time it is my work-horse procedure to add bone in areas of deficit. This has been especially useful to build up the bone in areas where we want to place dental implants such as with the sinus lift procedure.

One of the biggest problems we have seen over time with the rhBMP-2 is that it causes a significant tissue reaction with a significant amount of swelling after the procedure which ultimately makes the patient more uncomfortable. The bone-PRGF technique is a passive procedure with little discomfort and an excellent tissue response often with little or no swelling.
Where the rhBMP-2 procedure does not require a blood draw or the use of a human bone product, it does not result in as excellent a result as it relates to the ultimate gain in bone height. The bone-PRGF technique gives us great results, more bone volume, is quite a bit less expensive, and gives a stable bone site for subsequent dental implant care.

If you have questions, call Wagner Oral Surgery and Dental Implant Specialists at (262) 634-4646 to learn more.

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RAP – RAPID ACCELERATORY PHENOMEN0N, CORTICOTOMIES, AND ORTHODONTIC CARE

A “corticotomy” refers to a procedure where we make cuts in the bone to disrupt the outer (cortical) bone layer in the area of the tooth roots to cause the release of reparative factors from the bone and tissues. These factors signal the bone and surrounding teeth to heal, but it has been found that these factors also act as signals to the body to be very open to change. That is, the healing or reparative process is also a process that accelerates changes like tooth movements. It is for this response that we perform this procedure. Once stimulated in this way, the surrounding bone and teeth are much more “open” to orthodontic and orthopedic treatments and this can result in tooth movements much more quickly and even tooth movements that were previously not possible. This procedure must be differentiated from corticectomy, which is a much more invasive procedure, and involves removal of the top layer of the bone in the area of the teeth.

I prefer the corticotomy procedure and most recently we have applied this technique in a case of adult orthodontics in a patient who has also undergone orthognathic surgery (corrective jaw surgery for a developmental jaw/bite abnormality).

If you have questions, call Wagner Oral Surgery and Dental Implant Specialists at (262) 634-4646 to learn more.

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TELEMEDICINE CONSULTATIONS IN ORAL AND MAXILLOFACIAL SURGERY

Studies have shown that telemedicine consultations (consultations with a doctor or nurse over an electronic video link such as the internet) are as effective as traditional face-to-face consultations. (J Oral Maxillofac Surg 74:262-268, 2016). We have not yet gone to this method at our office, but it seems that it would make us more efficient and would be friendly for most patients’ busy lives and for those who have routine oral surgery needs. It would certainly be more convenient for most patients with basic needs – it could be done virtually anywhere with your phone. The problems I see are that in most examination and consultation visits, there may be need for more imagining, or other/different concerns may arise that may not be picked up in the telemedicine consult.


I do think that in the near future we will be able to handle most simple consults for wisdom teeth and routine extractions this way. There is some basic infrastructure which has to take place such as making consultation and consent videos, but the web makes that pretty easy and accessible. I will look forward to progress in this area.

If you have questions, call Wagner Oral Surgery and Dental Implant Specialists at (262) 634-4646 to learn more.

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WHAT IS AN ORAL AND MAXILLOFACIAL SURGEON?

Truly one of the most poorly understood professions, Oral and Maxillofacial Surgeons have done a poor job of promoting and providing public awareness of our profession. (J Oral and Maxillofac Surg 74:1109-1110, 2016). The basic definition is that we provide “comprehensive surgical care and treatment of the face, jaws, mouth and teeth.” We are the highest trained and most comprehensively trained in all aspects of dental surgery – moreso than any other dental specialty; and we have the highest medical and general surgical training of any of the dental specialties. Most of us have advanced training in head and neck surgery with overlaps to areas of otolaryngology, facial plastic surgery, and panfacial trauma. We are the highest trained as it relates to dental implants and related surgeries. We are arguably the highest trained subspecialty in anesthesiology. These statements are not cockiness or egocentrism. It is just the truth and I’m proud of it.
If there is a shortcoming in this, it is that the specialty may be so broad that one needs to limit their practice to certain areas of subspecialty in order to “have a life”. I absolutely love being an OMS. I look back on the path to being here and I am so grateful to God and so grateful to so many people who have supported, trained, guided, and loved me through this journey. My specialty is planning a media outreach to do just that – explain and define what it is that we are and do. I hope that campaign is informational and helpful.  

If you have questions, call Wagner Oral Surgery and Dental Implant Specialists at (262) 634-4646 to learn more.

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THE SAUSAGE TECHNIQUE FOR BONE GRAFTING

I first saw Dr. Istvan Urban present on the “sausage grafting technique” several years ago at the Pikos Institute course in Orlando. The grafting technique uses PRGF and bone product in a tube shaped absorbable mesh material. This technique uses materials and methods that are familiar to us, but like many things in dentistry, he applied innovative logical thinking and came up with a new application. I have subsequently used this method to graft bone to areas of the jaws where there was not enough bone for implant care. We were subsequently able to place dental implants successfully in the new bone that was created.

The shortcomings of the procedure are that it takes time – often 6-8 months to complete the process – and it is a tedious, involved surgery. On the positive note, it is not a particularly painful process and our results have been very good. Contraindications would be significant health issues that may affect healing (such as radiation and chemotherapy in the past, vegetarian diet, and cigarette smoking).

The assessment for the procedure would include a comprehensive dental plan, a cone beam scan, and clinical examination. This technique can also be used to best prepare the jaws for comprehensive implant care such as the All on Four/Teeth in a Day technique.

If you have questions, call Wagner Oral Surgery and Dental Implant Specialists at (262) 634-4646 to learn more.

THE USE OF TRANSALVEOLAR SUTURES

Just this morning we performed a surgery where we rebuilt the dental ridge and used Transalveolar Suturing to help preserve the attached gum tissue around our dental implant sites. I first saw this presented at the Pikos Institute bone grafting course a number of years ago and we have used it ever since. The idea is simple; a hole is made through the dental ridge at the surgical sites and a suture is passed through the bone to tack down the tissues to hold them in place during initial healing so swelling and muscle movements do not cause the tissue to heal in the incorrect place.
I remember back in the 80s using a denture or other prosthesis and wiring it or suturing it in place to hold the tissue or a graft. That was a good technique at the time, but now it looks barbaric. Bone tacks and Transalveolar Sutures will soon be replaced by resorbable bone anchors (which already exist, but are still a little costly). The suturing technique is tedious to do, but it gives great results and is not painful nor does it create any disability. To the contrary, it results in great tissue contours and the increased tissue stability during healing gives increased comfort.

If you have questions, call Wagner Oral Surgery and Dental Implant Specialists at (262) 634-4646 to learn more.

MAXILLOMANDIBULAR ADVANCEMENT FOR OBSTUCTIVE SLEEP APNEA SYNDROME

Here is a listing of articles regarding the successful use of orthognathic surgery – MMA (maxillomandibular advancement) to help in the treatment of OSA (obstructive sleep apnea). The expected success with these procedures can be evaluated with a cone beam scan and clinical examination. This is a big surgery and carries a number of risks and limitations, however the reported results are good.

I would still consider the UPPP (uvulopalatopharyngoplasty) if there is a significant secondary tonsilar drape. That procedure removes excess tissue from around the soft palate and throat to better open the airway. This needs to be done conservatively so as not to cause a “rigid palate”. Done well, it is an excellent procedure. The UPPP has been shown to improve breathing, but is again not a cure.  Read the rest of this entry »

TREATING PATIENTS WITH CONGENITAL ABNORMALITIES AND DEVELOPMENTAL DEFECTS

I have blogged on several occasions about the risks that go along with providing care for our general population who are living longer and living with greater medical problems. One area we do not speak of much is that of patients who have congenital problems such as congenital disabilities or congenital heart defects as examples. These patients are also surviving much longer and are found in our patient populations on a regular basis, even for more complicated procedures. (J Oral Maxillofac Surg 74:601-609, 2016). Experience has taught me (along with many of my teachers and mentors) – and now I pass on to others – is that when you see one congenital problem, expect more. It is especially common for patients who have branchial arch or cleft deformities to have other defects that may not be diagnosed. A common example might be a person with a birth defect with a deformed ear or jaw structure who may have never had a heart problem diagnosed. This can show up for the first time when we anesthetize them for an oral surgery procedure. If you have a congenital growth abnormality, make sure to let your surgeon know about this and make sure they are following through with proper presurgical testing. Lastly, make sure they are experienced and well trained. It can make all the difference.

If you have questions, call Wagner Oral Surgery and Dental Implant Specialists at (262) 634-4646 to learn more.