Mini Dental Implants
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Transcript of Mini Dental Implants
03/05/23 1
Minidental Implants Minidental Implants The MDI Sendax SystemThe MDI Sendax System
Professor Ninian Peckitt Professor Ninian Peckitt FRCS FFD RCS FDS RCS FACCSFRCS FFD RCS FDS RCS FACCS
Oral and Maxillofacial Surgeon / Facial Plastic SurgeonOral and Maxillofacial Surgeon / Facial Plastic Surgeon
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Clinical AreasClinical Areas
Denture StabilisationDenture Stabilisationand and
ConversionConversion
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Dental StatusDental Status
13% Edentulous5.2 million 12% 17% 18% 12%
Market Summary
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Dental StatusDental Status
21 teeth = functional dentition21 teeth = functional dentition
17%17%
6.8 million6.8 million
Market Summary
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Missing Anterior TeethMissing Anterior Teeth
96% anterior upper96% anterior upper
21 teeth21 teeth
87% lower anterior87% lower anterior
Market Summary
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DenturesDentures
16% of dentate adults 16% of dentate adults
wear dentureswear dentures
8 million8 million
U.K. Denture MarketU.K. Denture Market(6.8 million Adults 17%)(6.8 million Adults 17%)
20% Market Share20% Market Share@ £1500 /unit @ £1500 /unit
Market Summary
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Patient AffectPatient Affect
61%61%
27%27%
Market Summary
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Denture ProblemsDenture Problems
41% denture problems41% denture problems
26% eating difficulties26% eating difficulties
Market Summary
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Attitude to CostAttitude to Cost
Market Summary
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Value PerceptionValue Perception
Market Summary
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Private PracticePrivate PracticeMarket Summary
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Mini Dental ImplantsMini Dental Implants
Maxilla
Mandible
Crown and Bridge
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Mini Dental ImplantsMini Dental Implants
Implant – titanium alloy or other implantable material
Implant Dimensions (<2.5mm diameter)
Fused Abutment (for additional strength)
Atraumatic Placement (minimal surgery)
Crestal anaesthesia (no regional block)
Transmucosal placement (no flaps)
Implant placement with (a single pilot hole of defined size) e.g. <1.5mm
Immediate Loading
Demonstrable cost benefit analysis
Specific
ation
Specific
ation ss
IndicationsIndications
1. Immediate stabilisation of a fixed or removable prosthesis
2. Transitional stabilisation of prosthesis (during conventional implant “no-load” healing period)
3. Immediate support for compromised natural teeth (Periodontal Disease / Endodontic Problems)
4. Interim abutment for failing fixed or removable prosthesis
5. Orthodontic anchorage applications
6. Compatible with all existing implant systems
7. Provisional repair of a broken prosthesis
IndicationsIndications
System ComponentsSystem Components
MDI Max Square Head
TransitionalLaboratoryAnalogue
Housing
Shims
Implant EngineeringImplant Engineering
MDI 1.8mm diameter
MDI Max 2.2 mm diameter
Available in 10, 13, 15, 18mm lengths.
Implant and abutment are a single unit.
O-Ball and Flat Head abutment designs.
High-Strength Titanium Alloy construction.
Implant EngineeringImplant Engineering
Unique self-tapping thread design.
Anti-rotational flat on implant thread surface.
Implants are surface etched.
Implant packaged for efficient delivery.
Metal Housing and O-Ring packaged separately
Titanium AlloyTitanium Alloy
(Titanium, 6 Aluminum, 4 Vanadium)(Titanium, 6 Aluminum, 4 Vanadium)
62.5% Higher tensile strength
than the strongest commercially pure, Grade IV CP titanium.
Tensile StrengthTensile Strength
Titanium AlloyTitanium Alloy vs. vs. Pure TitaniumPure Titanium
75 70 65 60 55 50 45 40 35 30 25
Patient GroupsPatient Groups
Medical: Minimal Surgery in nearly all groups
Financial: Low cost
Anatomical: Atrophic ridges
Bruising with Flap Surgeryconventional implant placement
ContraindicationsContraindications
Medical Psychiatric DiseaseChronic Facial Pain SyndromesHistory of Infected EndocarditisRheumatic Fever – not necessarily
Surgical Severe Jaw AtrophyGrade 4 Bone Density – not necessarilyHeavy OcclusionGross Dental SepsisImmediate Tooth replacement
Anaesthesia – Crestal Infiltration
No surgical flap required
No osteotomy site created
Only one drill required
Self-tapping mini-implants
Immediate loading
Multiple restorative options
Surgical PrinciplesSurgical Principles
Implant PlacementImplant Placement
Create Pilot Hole
Insert Implant (Finger Driver)
Tighten with Thumb Wrench
Seat with Ratchet Wrench
Impression or Reline
Peel off labelslot, size, and catalog number. Add to a patient’s chart for tracking
The Implant PackageThe Implant Package
The MDI Implant suspended from a plastic cap in the glass vial. Once the pouch is opened the vial can be placed in a surgical tray awaiting implant insertion.
The Implant PackageThe Implant Package
The MDI Implant can be carried to the mouth utilizing this cap.
Implant Delivery SystemImplant Delivery System
1.1mm drill1.1mm drill
Pilot Drill Pilot Drill This is the only drill necessary
Hole depth is usually
one third to one half the length
of the chosen implant
Step 1Step 1Pilot DrillPilot Drill
Step 2Step 2Implant Insertion ProcedureImplant Insertion Procedure
Use plastic cap and housing to deliver implant
Implant may also be delivered by the finger driver
Insert implant into pilot opening
Rotate clockwise with downward pressure
Rotate until firm bony resistance is felt.
Implant Removed from VialImplant Removed from Vial
Plastic Cap with Implant Plastic Cap with Implant
Plastic Cap with Implant Plastic Cap with Implant
Finger Driver MethodFinger Driver Method
Finger Driver MethodFinger Driver Method
Finger Driver MethodFinger Driver Method
Implant LocationImplant Location
Step 3Step 3Winged Thumb WrenchWinged Thumb Wrench
Winged Thumb WrenchWinged Thumb Wrench
Winged Thumb WrenchWinged Thumb Wrench
Thread the implant until it becomes difficult to turn.
If no significant resistance is met prognosis is poor the site lacks the required density for predictable success.
Step 4Step 4Ratchet WrenchRatchet Wrench
The Extension may be useful when the clinician is attempting to access an MDI implant between two natural teeth.
Use of Ratchet WrenchUse of Ratchet Wrench
Use in small, carefully controlled increments. If great resistance is encountered pause momentarily between turns. This will allow the bone to adjust to the implant.
The finger on the top of the ratchet wrench ensures control of the ratchet and ensures correct seating of the implant
Use of Ratchet WrenchUse of Ratchet Wrench
Seated ImplantsSeated Implants
Ideal length of final seating should allow abutment head to protrude from tissue. No threads should be visible.
Prosthetic TechniquesProsthetic Techniques
Seated ImplantsSeated Implants
Transferring Abutment PositionTransferring Abutment Position
Indelible Pencil
Wash
Wax (Chrome Cobalt Wax Pattern best)
Soft Liner
Custom Putty Jig (Peckitt)
A soft liner impression within the denture of the MDI O-Ball abutments.
Transferring Abutment PositionTransferring Abutment Position
Four Abutment ImpressionsFour Abutment Impressions
Abutment Location on DentureAbutment Location on Denture
Pencil marks on the denture reveal exact locations for Housings
5mm Openings5mm Openings
5mm Openings5mm Openings
Customised Putty StentCustomised Putty StentPeckittPeckitt
Aids positioningAids positioning• Implants• housings• duration 33%
Block Out ShimsBlock Out Shims
Block Out Shims 9mm in length. Prevent the acrylic locking to abutment
Cut to a length so that only O-Ball is exposed.
Block Out Shim PositioningBlock Out Shim Positioning
Each abutment is lubricated to prevent any acrylic lock on.
Block Out Shim PositioningBlock Out Shim Positioning
O Ring HousingsO Ring Housings
O Ring HousingsO Ring Housings
O Ring Housings are placed over ball abutments
O Ring HousingsO Ring Housings
Chairside relineChairside reline
Clean denture
Mix cold-cure acrylic
Fill abutment holes
Wait - until acrylic does not run
Seat denture
Close lightly in occlusion
Allow acrylic to polymerize
Chairside relineChairside reline
The cleaned and dry denture is filled with cold-cure acrylic and allowed to polymerise until it is not runny. The denture is then seated and the patient is instructed to close lightly in centric occlusion
Finishing ProceduresFinishing Procedures
Remove elastomeric shims
Trim flash
Fill any minor voids or discrepancies
Finish denture borders and polish
Perform final occlusal equilibration.
It is important that the shims are always removed. The denture is relieved of flash and any voids are filled.
A reline procedure and occlusal equilibration completes the process. The patient is then instructed in denture placement, removal, and oral hygiene.
Removing Block Out ShimsRemoving Block Out Shims
Dentures with O-Rings in PlaceDentures with O-Rings in Place
OutcomeOutcome
Recall and MaintenanceRecall and Maintenance
ACCESS™ Toothbrush
Plaque removal procedures
Cleaning denture housings
Modification of retention (New O-Rings)
Review placement and removal
Time for a new denture??
ACCESSACCESS™™ Toothbrush Toothbrush
MDI CassetteMDI Cassette
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0
100
200
300
400
500
Outcome MDI Implants (Sendax)Mini Dental Implant Center New York
Outcome @ 4 yearsPresented to FDA
1996 - 2000 166 406 11
Patients Implants Failed Implants
2.7%2.7%Crestal Bone Loss < 1% / yrCrestal Bone Loss < 1% / yr
79,000 Implants79,000 Implants1999-20021999-2002
Failure 1%Failure 1%Data sourceData source
IMETC Quality AssuranceIMETC Quality Assurance
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• History:History: Medical – Dental
• ExaminationExamination
- Sepsis / Perio Status / Occlusion
• InvestigationsInvestigations
- OPT / Lat Chin / P/A’s Bone Density - I.D. Nerve / Sinus Status - Implant Sites / Selection / Templates - Study Models / Crown Bridge - Putty Jig / Suck Down Splint
• Prosthetic EvaluationProsthetic Evaluation
- Existing / Conversion- New Prosthesis
Case PlanningCase Planning
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Case PlanningCase Planning
InvestigationsInvestigations
OPT / Lat Chin / P/A’s Bone Density
I.D. Nerve / Sinus Status
Implant Sites / Selection
Templates
Computer Planning
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Case PlanningCase Planning
No No engagementengagement
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Conventional Dental Implant GuidelinesConventional Dental Implant Guidelines
Fixed Full Arch ProsthesesFixed Full Arch Prostheses
Minimum implants Maxilla
Minimum implants Mandible
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Conventional Dental Implant GuidelinesConventional Dental Implant Guidelines
Fo/Fo OverdenturesFo/Fo Overdentures
Minimum implants Maxilla
Minimum implants Mandible
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MDI Sendax GuidelinesMDI Sendax Guidelines
Fo/Fo OverdenturesFo/Fo Overdentures
Minimum implants Maxilla
Minimum implants Palateless Option
Minimum implants MandiblePeckitt 2003Peckitt 2003
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Dental Implants and Nerve InjuryDental Implants and Nerve Injury
Conventional Dental ImplantsConventional Dental Implants
Nerve Injury thought to mirror that of wisdom tooth removalNerve Injury thought to mirror that of wisdom tooth removal
1.5%1.5%
Flap Surgery Implant Placement
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Dental Implants: 2 Stage PlacementNeurology Status
Ellis: J. Prosthetic Dent 1992
Persistant Parasthesia 13%
Normal Neurology, 87%
Normal Persistant Parasthesia Total
Nerve InjuryNerve Injury
266 patients266 patients
Stage 160%
17%Stage 2
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Dental Implants: 2 Stage PlacementNeurology Status: Site of Parasthesia
Ellis: J. Prosthetic Dent 1992
Lip41%
Chin29%
Gingiva21%
Tongue9%
Lip Chin Gingiva Tongue 266 patients266 patients
Normal Routine88%
Disadvantageous 5%
Nerve InjuryNerve Injury
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Mini-Implants and Nerve InjuryMini-Implants and Nerve Injury
Zone 1Zone 1
Mini Implant Technique - less likely unlikely to injure nerve
- No Flap- Single Stage technique
Zone 2Zone 2
Mini-Implant Flapless Technique – less likely to injure
- lingual nerve- Nerve to mylohyoid
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Mini-Implants and Nerve InjuryMini-Implants and Nerve Injury
Zone 2Zone 2
Mini-Implant Flapless Technique – inferior alveolar nerve injuryMini-Implant Flapless Technique – inferior alveolar nerve injury
- calibrate magnification of OPT settings
- template selection of implant length
- Simplant 8 Computer Planning
- crestal anaesthesia
- angulation of implant
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Criteria for SuccessCriteria for Success Albrektsson et alAlbrektsson et al
implant - immobile when tested clinically
radiograph – no evidence of peri-implant radiolucency
vertical bone loss <0.2 mm annually after 1year of service
an absence of :
pain Infection neuropathies / parasthesia / violation of the mandibular canal
successful abutment systemsuccessful abutment systemPeckitt 2003Peckitt 2003
successful superstructuresuccessful superstructure
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Outcomes Outcomes
Crown & Bridge Outcome 10 years 15 years
Bridge Survival 87% 69%
Meta-Analysis of fixed partial denture (bridges) survival: Prostheses and abutments
Scurria M et al - Journal of Prosthetic Dentistry 1998 79;.4, 459-464
Failure after 15 years – Dental Caries abutments
Crown & Bridge
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Dental ImplantsDental Implants
Implant Abutment Loosening / Fracture
5 to 45% of cases
highest during the first year of function
Reduced by preloading abutment / prosthetic screws
Still a fairly common problem
Nonlinear contact analysis of preload in dental implant screwsSakaguchi R.L. - Borgersen S.E.June 1995
Int. Journal of Oral and Maxillofacial Implants - Vol. 10 No. 3 pp 295-302
MDI SendaxMTI Monorail
Bicon Q-Implants
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Informed ConsentInformed Consent
Treatment Contract
Existing Condition
Treatment Options / Choice
Success Rates / Complications
Terms of Postoperative Care
Funding Arrangements
Complication Management
No Absolute Guarantees
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Informed ConsentInformed ConsentTreatment Contract
ComplicationsComplications
Poor Bone Density Knife Edge Ridge Pain Infection Chrome Cobalt Dentures
Fractured Implant Denture Fenestration New Denture Provision Nerve Injury Implant Loss
A strategy should be agreed with respect to lost implantsA strategy should be agreed with respect to lost implants
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Case ProtocolCase Protocol
Case Selection and Case Selection and Contract
Local Anaesthesia techniqueLocal Anaesthesia technique
MDI TechniqueMDI Technique
Antibiotic CoverAntibiotic Cover
AnalgesiaAnalgesia
Oral Hygiene Oral Hygiene
Keep Prosthesis in 3 daysKeep Prosthesis in 3 days
Review at 1 weekReview at 1 week
Mandatory AuditMandatory Audit
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Case StudiesCase Studies
MDI Sendax ImplantsNinian Peckitt
FRCS FFD RCS FDS RCS
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The Palateless Upper DentureThe Palateless Upper Denture
6 MDI Max Implants
Courtesy: http:// www.imtec.com
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Fo/Fo Bimaxillary Case – 2 hoursFo/Fo Bimaxillary Case – 2 hours
Courtesy: Dr Anthony Coyne BDS
F/FPalateless
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Immediate Hybrid OverdenturesImmediate Hybrid OverdenturesCourtesy: Dr Norman Andrews BDS MGDS RCS
Fo/-
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Immediate StabilityImmediate Stability
Courtesy: Dr Anthony Coyne BDS
Lower Overdenture F/FoLower Overdenture F/Fo
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Excellent RetentionExcellent Retention
Courtesy: Dr Anthony Coyne BDS
Lower Overdenture F/FoLower Overdenture F/Fo
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Courtesy: Dr Norman Andrews BDS MGDS RCS
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Patient Comment @ 1 monthPatient Comment @ 1 month Patient SatisfactionPatient Satisfaction
• Like he has his own teethLike he has his own teeth
• Retention ExceptionalRetention Exceptional
• Post op Pain – Mild toothachePost op Pain – Mild toothache
• Analgesia – 24 hoursAnalgesia – 24 hours
• Eating improvedEating improved
• Taste food “as it really is”Taste food “as it really is”
• Appearance is very goodAppearance is very good
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Hybrid SystemsHybrid Systems
Dental ClearanceImmediate bicon 13 11 21 23 Immediate MDI 45 43 42 46
Loss bicon 13 23; MDI 36
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Hybrid SystemsHybrid Systems
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Hybrid SystemsHybrid Systems
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Hybrid SystemsHybrid Systems
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Hybrid SystemsHybrid Systems
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Best Practice in ProstheticsBest Practice in Prosthetics
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Crown and Bridge SalvageCrown and Bridge Salvage
Suck down splint
Courtesy: http:// www.imtec.com
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Crown and Bridge SalvageCrown and Bridge Salvage Courtesy: Dr Norman Andrews BDS MGDS RCS
03/05/23 109
Crown and Bridge SalvageCrown and Bridge Salvage
Outcome
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Crown and Bridge SalvageCrown and Bridge Salvage Courtesy: Dr Norman Andrews BDS MGDS RCS
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Crown and Bridge SalvageCrown and Bridge Salvage
Outcome
Courtesy: Dr Norman Andrews BDS MGDS RCS
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Crown and Bridge SalvageCrown and Bridge Salvage
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Crown and BridgeCrown and BridgeCourtesy: http:// www.imtec.com
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Telescopic CrownsTelescopic CrownsCourtesy: Dr Anthony Coyne BDS
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Telescopic CrownsTelescopic CrownsCourtesy: Dr Anthony Coyne BDS
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Courtesy: Dr Norman Andrews BDS MGDS RCS
Telescopic CrownsTelescopic Crowns
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Maxillary AtrophyMaxillary Atrophy
Computer PlanningComputer Planning
Defensive Incisions
Sinus Lift
Nasal Floor Lift
Anterior Alveolar Augmentation
Transitional Stabilisation
Delayed Mini-Implant Placement
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Maxillary AtrophyMaxillary Atrophy
Courtesy: Dr Javid Khan BDS
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Maxillary AtrophyMaxillary Atrophy
3 weeks3 weeks
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Maxillary AtrophyMaxillary Atrophy
Transitional Stabilisation @ 3 weeksTransitional Stabilisation @ 3 weeks
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Maxillofacial ApplicationsMaxillofacial Applications
Gunshot Wound
Engineering Assisted SurgeryEngineering Assisted Surgery™™
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Customised Cutting JigCustomised Cutting JigEngineering Assisted SurgeryEngineering Assisted Surgery™™
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Mandibular OsteotomyMandibular OsteotomyEngineering Assisted SurgeryEngineering Assisted Surgery™™
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OutcomeOutcomeEngineering Assisted SurgeryEngineering Assisted Surgery™™
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Lower OverdentureLower OverdentureCourtesy: Dr Norman Andrews BDS MGDS RCS
Engineering Assisted SurgeryEngineering Assisted Surgery™™
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Lower OverdentureLower Overdenture
Registration
Engineering Assisted SurgeryEngineering Assisted Surgery™™
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F.I.R.S.T.F.I.R.S.T.™ System™ System
Fabricated Implant Restorations and Surgical TechniqueFabricated Implant Restorations and Surgical Technique
Immediate tooth replacement
MDI Implant and fabricated Restoration
Model Surgery from Dental Cast
Surgical Template
100 F.I.R.S.T. restorations to date
No failures – Todd Shatkin (personal communication)
1048 MDI Implants1048 MDI Implants3.5 year outcomes3.5 year outcomes
(1 third cases Crown & Bridge)97.65% Success Single tooth
98% Multiple teeth
ReferencesReferences
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Mini Dental Implants: Principles and Practice, by Victor Sendax
Chapter 7: An Oral and Maxillofacial Surgeon’s Role in Advanced MDI Therapeutics: Engineering Assisted Surgery™, MDIs in Functional Reconstructive Surgery within Great Britain and New Zealand Venues.
Publisher: Mosby © 2013. ISBN-10: 1455743860 ISBN-13: 978-1455743865
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Thank you for your attentionThank you for your attention