Dental Tribune United Kingdom Edition

scan and virtually placing the implants and abutments with a CEREC over-lay. This enabled me to assess how much height would need to be obtained by reducing the bone height and increasing the ver- tical dimension. An interesting incidental finding was a previous silver point root filling in her UL7 appears to have exited her root apex, through the alveo- lar bone and projects up to 2cm into her maxillary sinus. The patient was unaware of this, and has never had any symptoms from this tooth. The CBCT was sent to a Consultant Oral Maxillo-facial radiologist who recommended leaving the UL7 alone and only inves- tigating it if the area becomes symptomatic. If the UL7 needs extracting in the future, re- moval of the silver point filling through the tooth first could be attempted. Due to her TMJ problems, I was reluctant to increase the patients OVD by very much. I began by opening her bite by a few millimetres and seeing how she coped. One of the benefits (or some might say downsides) of implant den- tistry is that it can take months before the implants are ready to be loaded. In cases such as these, its during this time where I concentrate on restor- ative issues, and carry out any other necessary forms of treat- ment. Fortunately, she did very well and thinks it may have even reduced her TMJ discom- fort. This may mean that part of her TMJ pain was caused by her over-closing and sub- sequent loss of vertical dimen- sion. We elected to place the implants under IV sedation. Although this lady wasn’t an especially nervous patient, she struggled to maintain a normal opening for any length of time. Once she was sedated, she was much calmer and managed to maintain a very reasonable level of mouth opening for the duration of the surgery. Two Astra Tech Osseospeed TX im- plants were placed achieving very high primary stability. The area healed with- out complication and after 2 months a 2 unit composite temporary bridge was made. This allowed us to assess aes- thetics, soft tissue profile, oc- clusion, and phonetics. A few alterations were made in the final bridge which comprised of two Atlantis Zirconia abut- ments and a 2 unit e.max bridge. The patient was delighted with the final result and will be seen by me every 6 months for examinations and regular hygienist visits. As you can see, this is just a brief synopsis of what was car- ried out, making the hole and placing the implants is only part of the overall treatment. It’s not as easy as it looks.... DT About the author Dr Nilesh R. Par- mar Dr Nilesh R. Parmar BDS MSc MSc was voted Best Young Dentist in the East of Eng- land in 2009 and runner up in 2010. He was short-list- ed at the Private Dentistry Awards in the category of Outstanding Individual 2011. Nilesh has master’s degrees in Prosthetic Dentistry from the Eastman Dental Institute and a master’s degree in Clinical Implantology from Kings Col- lege London. Nilesh is one of the few dentists in the UK to have a degree from all three London Dental Schools and is currently studying for his 3rd MSc in Orthodontics. His main area of interest is in dental implants and CEREC CADCAM technology. Nilesh runs a successful 5 surgery practice close to London and is a visiting im- plant dentist to two central London practices. Nilesh was voted the 8th Most Influential Person in UK den- tistry by Dentistry Magazine 2012, the youngest person in the Top 10. Nilesh regularly speaks for national and in- ternational meetings including The Dentistry Show 2012 Future Dentist Conference, the IDA in Jaipur and for Sirona in Germany and the USA. His direct and easy-going presentation technique makes him a sought after speaker in Europe. Nilesh has a nev- er-ending passion for his work and is famed for his attention to detail and his belief that every patient he sees should become a patient for life. He offers training and mentoring to den- tists starting out in implant dentistry, more information can be found on his website. www.drnileshparmar.com Fig 1 Initial presentation Fig 2 Lack of vertical space Fig 5 Implant placement Fig 6 Closure of implant site Fig 7 2 unit composite temporary bridge, note the restoration of the vertical dimen- sion Fig 8 Soft tissue profile after 2 months with the temporary bridge removed Fig 9 Atlantis Zirconia abutments Fig 10 2 unit e.max bridge Fig 11 Abutments in-situ Fig 12 Final bridge cenented in place Fig 13 Occlusal view of temporary bridge Fig 14 Final bridge at fit, note soft tissue profile Fig 3 CBCT image NILESH R.PARMAR Surgical Instrument Kit When I first started placing dental implants in practice, I wasn’t sure which instruments I would need. Yes, I had placed implants in hospital, and was aware of the retractors, elevators etc that were used, but that was all I knew. So when I told my local rep I wanted to buy some surgi- cal instruments I was a little bit confused by the variety. Over the years, and on my travels, I have picked up instruments of all shapes and sizes, some are fantastic, and some are useless. Recently, I have been asked by dentists who are new to implants, to send me pictures of my surgi- cal kit so that they could duplicate my chosen instruments. This had developed into me forming a partnership with Hu-Friedy to design and produce my own Implant Surgical Kit. The NILESH R.PARMAR Surgical Instrument Kit is comprised of 31 instruments in 2 cassettes which are everything a dentists needs for simple to moderate implant cases. I have been using these kits for a few months now, and am very impressed with the quality and lightness of the Hu-Friedy instruments. Available from most dental dealers, Hu-Friedy also has a huge range which you are welcome to substitute and amend to whichever variation of instruments suit your clinical work best. Fig 4 CBCT image to show silver point filling into sinus ‘One of the benefits (or some might say downsides) of implant dentistry is that it can take months before the implants are ready to be loaded’ 27ClinicalMay 7-13, 2012United Kingdom Edition