CLINICAL IMPLANT TRAINING IN INDIA

ICOI Affiliate Study Club providing ICOI Membership / Fellowship / Mastership & Diplomat. British academy of Asian Centre for conducting Courses on

IMPLANTS, ULTRASONIC PEIZOELECTRICAL BONE SURGERY, LASERS, ENDODONTICS, ORALSURGERY, COSMETIC SURGERY & GENERAL DENTISTRY

under the guidance of Prof Dr.Rajat Sachdeva, Delhi, India and his team.

The most proficient clinical training on live patients & ICOI Affiliate course

100 hours of comprehensive lectures including live surgeries, demonstrations and hands-on sessions with non commercial, non sponsored course covering the spectrum of  10 Implant systems in detail.

Certificate of Completion is awarded by the British Academy of Implantology and the sponsoring institutions.

In depth review of surgical and prosthetic protocols with flapless approach, Immediate implants, Ridge Augmentation, Bone expansion & Ridge expanders.

Guidance to select an implant system that would work in your practice

Implant prosthetics in detail from single crowns to full mouth rehabilitation, Stents for full mouth restoration

Conventional and CT based – Diagnosis & treatment Planning, Rationale for All on 4 ,All on 6 & Hybrid prosthesis

Practice management module that provides ideas to market your implant practice.

Eligibility to further pursue the requirements for Fellowship status of the ICOI.

 In several parts of the world the Associate Fellowship or Fellowship is an acknowledged credential that represents quality training in implantology and skill in the art and science of implant dentistry.

 Clinical Session Consists of 5Implant placements under guidance and Restorations with direct & indirect sinus lifts with SCA, SLA, DASK Kits + Ridge Splitting on Patients.

 Bone modification techniques, Bone condensation, Osteotome techniques & Bone graft harvesting

 Block bone using Parasymphysis & Ramus bone

 Guided bone regeneration technique, Graft materials, Grafting protocols

Implants in compromised maxilla, Zygomatic Implants, Pterygoid Implants

 Learn PRF, CGF, AFG & how to make sticky bone, Role of Growth Factorsin Implant Dentistry

Peizosurgery units for implant surgeries

 Principles of Impression making, Understanding Prosthetic components while working on live patients & Implant Over dentures

The “All-on-4” Concept for Implant Rehabilitation of an Edentulous Jaw

When a patient loses all of their teeth, they are essentially relegated to living the life of a “dental cripple” and are compelled to see  Dr.Sachdeva’s Dental Institute, India to find resolution. The teeth are very essential to any human being and when a tooth or all teeth are lost, chewing efficiency is lost, their level of comfort declines and often they appear to age prematurely. The teeth provide more than a bright smile on someone’s face. A complete set of dentition maintains the bite and keeps all the structures in harmony. When changes occur after teeth are lost, patients begin to seek the dentist.

Edentulism can be a result of poor oral hygiene and dental disease. Sometimes patients who have received previous restorations meet a failure in their cases and their teeth are deemed restorable and hopeless. A growing number of the population possess a terminal dentition and the ability to retreat is restricted due to the poor remaining tooth structure and support, combined with limitations from the financial burden of full mouth reconstruction. How and why a person is edentulous varies. When patients come into the clinic, their oral condition is assessed and the appropriate solution is planned and presented—all encompassing the health and financial capacity of the patient.

It is well recognized that an edentulous condition has a negative impact on your life:

    • You need your teeth to eat because otherwise you will be limited to a soft, unappealing diet.
    • You need your teeth to smile, to flash a confident set of pearly whites to people.
    • You need your teeth to maintain the integrity of your facial structure, otherwise your bite will collapse and along with it, the face will sag and make you look much older.
    • You need your teeth to maintain the health of the jaw. The temporomandibular joints (TMJ) rely on the teeth. When the bite collapses, the changes that occur can be very damaging to the joints.

All-on-4” implants have become a leading choice in many teeth replacement cases.

A REVIEW ON BOTOX IN DENTISTRY

None can deny with the fact that everyone wants to look younger than one’s age. Hence one option available as BOTOX comes to the rescue to fulfill the needs in cosmetic & esthetic dentistry.

Chemically BOTOX is a toxin produced by bacterium clostridium botulinum also produced commercially for medical & cosmetic approach. There are two main commercial types: botulinum toxin type A (Botox, Dysport & Xeomin) & botulinum toxin type B (Myobloc).

Injecting Botulinum toxin type-A causes localized reduction in overactive muscle activity for some timespan by inhibiting the exocytosis of acetylcholine on cholinergic nerve endings of motor nerves preventing the vesicle where the acetylcholine is stored from binding to the membrane where the neurotransmitter can be released.

The use of Botox in Dentistry can be applied in bruxism, dental implant surgery, temporomandibular joint disorders, gummy smile, and mandibular spasm.

Botox is a safe, conservative, non surgical reversible, minimally invasive treatment modality for cosmetic needs. Training is absolutely required for dentists to administer this technique as a learning curve.

As we all know bruxism ultimately leads to periodontal trauma characterized by clenching by bracing of the mandible. Botox has shown promising results by alleviating the symptomatology of bruxism with botulinum toxin type A injections into temporalis & masseter muscles.

Post implant surgery overloading of muscles of mastication can impede osseointegration of implants. Hence the muscular relaxation is achieved with injecting botulinum toxin type A to the masticatory muscles therapeutically.

The appearance of excessive gingival tissue in the maxilla upon smiling is both an aesthetic issue as well as oral hygiene problem which require complex procedures as a cure. In such cases it is applied in small, carefully titrated doses proportionately weakening the contraction of upper lips particularly levator labii superiosis.

Botox is an emerging, latest, attractive treatment option as compared to other surgical alternatives. However there are still many dental conditions which require FDA approval to be treated by botulinum toxin. The use of BOTOX will surely progress the dentistry profession to one step ahead.

MAXILLARY SINUS LIFT

The tendency of the alveolar ridge to progressively resorb after tooth loss & typically poor quality of posterior maxillary bone, rehabilitation of this region with implant supported prosthesis has been challenging.

Anatomically maxillary sinuses are largest paranasal air cavities limited by six walls, separated from the nasal cavity, containing the neurovascular bundle & covering the tooth root by a Schneiderian membrane. The blood supply of the maxillary sinus is derived from the branches of maxillary artery, posterior superior artery, infraorbital artery & descending palatine artery. Anatomical knowledge of sinus vascularization is necessary to prevent bleeding complications during the sinus lift procedure.

Therefore, the surgical procedure of maxillary sinus lift has undergone considerable development & different variations with autogenous bone regarded as the preferred option.

Factors to satisfy the criteria for sinus augmentation are:-

-residual bone <10mm in height

-absent pathological condition/fibrous scars

-absence of multiple maxillary teeth & need for strong sinus floor for multiple implants

Preexisting local pathological conditions is an absolute contradiction to sinus lift procedure as grafting procedure can lead to fluid stagnation & exacerbated sinusitis.

At present there are two surgical approaches for maxillary sinus floor lift procedure.

First the lateral antrostomy (traumatic) being classical one described by tatum.The transcrestal approach has less morbidity but nevertheless it requires enough residual bone height for primary stability of implants i.e. prerequisite residual bone height should be >6mm to enable placement of implant 10mm in height. It is indeed a one stage procedure & less time consuming but as every procedure has its own pros & cons, its drawback is that only 2-4mm of bone height can be increased & its highly technique sensitive.

More recently, second approach i.e. crestal one (atraumatic or conservative) has been advocated by Summers using osteotomes.It includes same procedure as that of lateral approach with a crestal incision followed by full thickness flap raised & implant site prepared 1-2mm shorter than the subantral bone height using drills & osteotomes while in lateral approach antrostomy is performed using a round bur to create a U-shaped trapdoor on a lateral buttress of the maxilla.

The main advantage of this approach being less invasive procedure, improves the density of the maxillary bone allowing greater stability of implants which can be unproven if the residual bone height is <6mm.

Restoring edentulism with dental implants needs careful treatment planning especially in the posterior maxilla where the pneumatized maxillary sinuses can limit the amount of alveolar bone for implant placement. Hence maxillary sinus floor lift offers the most common & predictable preprosthetic procedures to address this problem.

Regards: Dr. Prof. Rajat Sachdeva

Director & Mentor

Dr.Sachdeva’s Dental Institute

www.sachdevadentalcare.com 

www.dentalcoursesdelhi.com

+919818894041, 01142464041

Alveolar Ridge Preservation

Tooth loss and subsequent ridge collapse continue to burden restorative implant treatment. Henceforth careful management of the post-extraction tissues is required to preserve the alveolar ridge.

The dimensional changes of the alveolar ridge after tooth extraction occurs due to alveolar atrophy by the osteoclastic resorption of the bundle bone in a more apical and lingual/palatal level resulting into modification of the alveolar ridge in both vertical & horizontal directions.

Clinical trials have been reported that mean loss of 3.87mm in the width and 1.67 mm in the height of the ridge post 3 months of healing.

Alveolar ridge preservation has been suggested to preserve ridge dimensions & soft tissue contour to facilitate implant placement with an emergence profile in the pontic area.

 This technique includes minimally traumatic tooth extraction with or without a flap approach,autogenous bone graft,freeze dried bone allografts,guided bone generation,use of growth factors or bone morphogenic protein or plasma rich fibrin.

Few alveolar ridge preservation procedures with a positive outcome in limiting post-extraction ridge dimensional loss & promoting partial bone regeneration in the extraction sockets are:-

Alveolar ridge preservation using GBR & barrier technique

-A full thickness flap is elevated through intracrevicular incisions depending upon osseous defect not extending more than 3-4 months from the buccal/lingual bony crest

-The tooth is atraumatically extracted by means of periotomes/luxators.During luxation extreme forces are avoided in the buccal plate & granulation tissue or any residual pathology is removed by means of bone curettes followed by saline rinsing

-before grafting any blood clot formed in the extraction socket is removed to ensure the graft is placed at the buccal & lingual/palatal plate to restore any possible fenestration/dehiscence defects avoiding any overfilling.

-A single or double layer of a resorbable barrier used to cover the graft is stabilized under the lingual & buccal flap extending 3mm on the sound bone surface.The flaps are coronally positioned & sutured by vertical mattress/double interrupted sutures interproximally & horizontal cross mattress suture in the mid part of socket

Alveolar ride preservation using the socket seal technique

– In-lieu of surgical augmentation to correct a ridge defect, the socket-shield technique offers a promising solution to support the buccofacial tissues

-Intracrevicular/intraligamentary incisions are made around the tooth to be extracted to dissect   epithelial and connective tissue attachment without raising any flaps.

-After atraumatic extraction followed in the previous technique marginal soft tissues are    deepitheliased by means of a fast angled hand piece & a thin diamond or micro scalpel.

-A free gingival epitheliased graft with a thickness of 2-3 mm harvested from the palatal site is filled into the socket.

By comparison, ridge preservation techniques may reduce the amount of ridge resorption but cannot prevent the loss of interdental bone and papillae. Preservation of supracrestal fibers however can better develop pontic sites in turn preserving the papillae.

Thus it has been shown that the retention of the tooth contiguous with the PDL, its fibers interconnected with bundle bone, avoids the physiological remodeling of the alveolar crest.

IMMEDIATE IMPLANT IN AESTHETIC ZONE WITH EARLY LOADING

   Dentistry has been revolutionized by the routine inclusion & higher rate of success of dental Implants. Implant insertion in aesthetic zone i.e. anterior maxilla or anterior mandible is the most challenging thing because of definite relationship between the implant& its adjacent restorations, bone, mucosa, lip line considered to fabricate a prosthesis corresponding to the natural dentition.

Standard implant treatment protocol has been challenged by various experiments aimed to reduce the number of surgical procedures resulting into implants being placed at the time of the extraction known as IMMEDIATE IMPLANTS rather than waiting for the healing period post extraction.

When implant placement is delayed for a period of time after tooth extraction,soft tissue healing may provide opportunities to maximize tissue volume to achieve proper flap adaptation & acceptable soft tissues, but it’s the bone loss which hampers the aesthetics.

The greatest reduction of the alveolar bone occurs after extraction in the first 6 months to 2 years. After implant placement bone loss occurs, gingival architecture will be collapsed leading to aesthetic compromise & inadequate bone for implant following conventional procedure.

Hence in the modern dentistry the driving philosophy behind recent implant / restoration protocol is PRESERVATION. This is aimed to determine the success rate of implants placed immediately into fresh extraction sockets. The concept of immediate implant loadinghas been accepted due to reduced number of surgical treatments & overall time between tooth extraction & placement of definitive prosthetic restoration, decrease in bone resorption, preservation of alveolar ridge, most importantly increase in patient’s acceptance & psychological benefit.

Immediate implant placement following tooth extraction is a viable & predictable solution to tooth loss.This procedure is technique sensitive and more difficult to execute than the conventional procedure.For the overall success of any immediately placed implant to succeed, primary /mechanical stability must be adequate to enable the implant to resist micro movement until adequate secondary stability is sufficiently accomplished i.e. the minimum insertion screw has to be equal or superior to 32 N/cm.