THE MISCH INSTITUTE NEWSLETTER
IN MEMORIUM
It is with heavy hearts today that we say farewell to one of our close Resnik Implant Institute family members, Dr. Michael D. Ginder of Athens, Ohio. He was a Misch graduate and a favorite of the faculty and staff. He not only was an excellent clinician, he was a wonderful husband, father, and friend to all of us and he will be dearly missed. Taken too early, we offer our deepest condolences to his family during this difficult time.
MISCH INSTITUTE LIVE HANDS-ON SURGICAL COURSE
“You Have Mastered the Didactic, Now Gain the Surgical Confidence”
* NO NEED TO LEAVE THE COUNTRY
* NO NEED TO BRING YOUR OWN PATIENT
* PATIENTS AND MATERIALS SUPPLIED FOR ALL CASESDATE
November 2, 2018
LOCATION
New Jersey
REQUIREMENTS
* Dental License in any US State
PROCEDURES
* Each attendee will perform two surgeries
(Cases Selected by Attendees on a First-Come, First-Serve Basis)
TYPES OF CASES
* Single Implant Placement
* Multiple Implant Placement
(Guided or Freehand Placement)
* Ridge Augmentation
(Membrane or Autogenous Grafting)
* Sinus Augmentation
(Transcrestal or Lateral Wall)
* Dermal Fillers/Botox
* Prosthetic Procedures
(Fixed and Removable – all cases restored)
ZIRCONIA IMPLANTS
The Future of Oral Implantology?
Zirconia implants have recently been introduced into dental implantology as an alternative to titanium implants. Zirconia is an ideal implant material because of its toothlike color, favorable mechanical properties, excellent biocompatibility, and low plaque affinity. Since receiving FDA approval in 2011, zirconia implants have become increasingly popular and have been taunted as the next generation of dental implants. Zirconia implants were initially used in cases of metal-free dentistry and for patients with known metal hypersensitivities. Studies have shown a prevalence of titanium allergy to be approximately 0.6% .
Initially, zirconia implants were only available as a one-piece implant which had numerous disadvantages. The one-piece implant is susceptible to fracture, especially if the implant had to be altered because of non-ideal positioning. In addition, because of its one-piece design, the is susceptible to premature overload. However, recent research and development have led to the introduction of two-piece zirconia implants. These two-piece implants allow for abutments to be modified and customized to enhance esthetic results. Two of the more popular two-piece zirconia implants available today are the Straumann® PURE Ceramic Implant System and the NobelBiocare : NobelPearl™.
Advantages:
- Ideal for patients with metal hypersensitivities
- Increased esthetics
- Retains less plaque and calculus (biofilm) in comparison to titanium
- Excellent flexural strength and fracture toughness
- Favorable bone-implant-contact in comparison to titanium
Disadvantages:
- Lack of long-term clinical studies
- One-piece may be premature loaded
- One-piece implants may require modification depending on positioning
- Zirconia modification leads to reduction of physical properties of material
- Slightly higher fracture rates than titanium
In summary, zirconia dental implants are becoming a new and exciting development in implant dentistry. To date, limited preliminary studies have shown positive results with less inflammation, less biofilm accumulation, excellent esthetics and a favorable bone-implant-contact. With the advent of two-piece zirconia implant systems, zirconia dental implants have the potential to become the ideal alternative to titanium alloy dental implants. However, only time will tell as longer term clinical studies are needed.
Sicilia A, Cuesta S, Coma G, Arregui I, Guisasola C, Ruiz E, Maestro A. Titanium allergy in dental implant patients: a clinical study on 1500 consecutive patients. Clin. Oral Impl. Res. 19, 2008; 823–835
SURGICAL & PROSTHETIC PROGRAMS
ALL NEW CURRICULUM & LABORATORY SESSIONS
SURGICAL / PROSTHETIC PROGRAM SESSION 1
September 14-15, 2018
Caesar’s Palace Casino & Resort
Las Vegas, NV
All New Full Color Lecture
Handouts Of Lecture Slides
- Treatment Planning Principles
- Misch Implant Classifications
- Pre-Implant Prosthetics
- CBCT Radiographic Diagnostic Interpretation
- Evaluation of Bone Volume – Available Bone
- Extraction – Socket Grafting Techniques
- Basic Surgical Armamentarium
- Surgical Principles (flap design, periosteal reflection)
- Ideal Implant Positioning
- Division A Implant Surgery
- CBCT Templates and Guided Surgery
- Bone Density Surgical Modifications
- Implant Economics
All New Comprehensive Hands-On
Lab Sessions
- Implant Placement (freehand)
- Guided Surgery Implant Placement (pilot, universal, fully guided)
- Bone Density Surgical Protocol for all 4 Bone Densities
- Socket Grafting (4 & 5 wall defects)
- Periosteal Reflection (stretching tissue)
- Suturing Techniques
- Atraumatic Extractions
QUESTIONS OF THE MONTH
#1: CBCT ANATOMY QUESTION
Is the radiolucent canal (marked by the green arrows) a large anterior loop?
#2: PROSTHETIC QUESTION
For traditional implant impressions, studies reveal the most accurate impression technique would include:
- Direct (open tray)
or
Indirect (closed tray) - Split Multiple Implants
or
No Splint
(with low shrinkage acrylic/composite) - Polyvinyl siloxane (PVS)
or
Polyether (PE)
(Impression Material)
#3: LEGAL QUESTION
The Statute of Limitations is a legal statute which prescribes a period of limitation for the initiation of legal action against a doctor. How long is this time period?
#4: IMPLANT STUDY OF THE MONTH
Two pioneering studies have evaluated the change in bone levels posterior to mandibular fixed prostheses (FP-3). The bone height was measured under the fixed detachable cantilever prostheses supported by five or six endosseous implants.
Per year, results revealed what percent (%) change in the bone level?
a. Decrease ~ 0.2% per year
b. Decrease ~ 1.6% per year
c. Increase ~ 0.2% per year
d. Increase ~ 1.6% per year
* Wright PS , GlastzPO ,RandowK , et al : The effects of fixed and removable implant-stabilized prostheses on posterior mandibular residual ridge resorption , Clin Oral Implants Res 13 : 169 – 174 , 2002
* Reddy MS , GeursNC , Wang IC , et al : Mandibular growth following implant restoration: does Wolff ’ s Law apply to residual ridge resorption? IntJ Periodontics Restorative Dent 22 : 315 – 321, 2002
TRIVIA OF THE MONTH
Glidewell Laboratories (Newport Beach, CA) is the largest dental laboratory in the world. On average, how many packages does Glidewell handle per day in their laboratory?
a. 5,000
b. 8,000
c. 12,000
d. 18,000
ANSWERS:
#1: CBCT
No, the canal depicted by the green arrows is the incisive canal. The incisive canal contains the nerves and blood vessels which supply the anterior teeth. In the first molar region, the inferior alveolar nerve splits into its two terminal branches, the mental nerve and incisive nerve. The mental nerve exits the mental foramen and the incisive nerve continues anteriorly. There incisive nerve displays no sensory innervation to the soft tissue, therefore drilling through this canal will not lead to a neurosensory impairment.
#2: Prosthetic
- Direct (open tray) vs. Indirect (closed tray)
Almost all current research articles have shown that the DIRECT is far more accurate than the INDIRECT impression techniques. - Multiple Implants (Splint vs. No Splint)
Current research has shown that splinted multiple implants together lead to more accurate final impressions and master casts. Ideally the implants should be splinted with a low shrinkage material (e.g. GC Pattern Resin, Composite Resin) - Polyvinyl siloxane (PVS) vs. Polyether (PE)
In most studies, there exist no difference between PVS vs. PE. However, when implants are significantly angled (i.e. > 25 degrees), PVS is more accurate.
* Cabral LM, GuedesCG. Comparative analysis of 4 impression techniques for implants. Implant Dent. 2007;16:187–194.
* Papaspyridakos, Panos, et al. “Accuracy of implant impressions for partially and completely edentulous patients: a systematic review.” International Journal of Oral & Maxillofacial Implants29.4 (2014).
* Öngül, D., et al. “A comparative analysis of the accuracy of different direct impression techniques for multiple implants.” Australian dental journal57.2 (2012): 184-189.
* Kurtulmus-Yilmaz, Sevcan, et al. “Digital evaluation of the accuracy of impression techniques and materials in angulated implants.” Journal of dentistry42.12 (2014): 1551-1559.
#3: Legal
Statute of Limitations. In most states a patient must bring a medical malpractice claim fairly quickly—often between 6 months and 2 years, depending on the individual state. A failure on the part of the patient to initiate a claim within the applicable statutory time limit will lead to the claim being “time-barred” or past the deadline to file a lawsuit.
(A list of individual states statutes is listed on page 833 in the “Avoiding Complications in Oral Implantology” by R. Resnik and CE Misch)
Implant Study Of The Month Answer
In these studies, a mean bone area index increase of 1.6% per year for a fixed prostheses. For overdentures, the posterior bone area index was reduced by a mean of 1.1% per year.
Trivia Of The Month
d. 18,000