Ridge splitting for lateral ridge augmentation

An alternative method of augmenting a narrow ridge is by ridge splitting instead of onlay grafting. This technique can be applied in selected cases. It requires that the alveolar ridge has two cortical plates separated by a layer of cancellous bone in a preoperative CBCT image. This situation is normally confined to alveolar ridges featuring an orofacial thickness of more than 4mm.

Ridge splitting can be performed simultaneously with implant placement. This is the only way to obtain primary stability in this scenario is by engaging the bone at the apical region of the implant. In selected cases, it may be possible to stabilize the mobilized buccal plate with bone screws if required.

It is advisable to perform the splitting with minimal flap reflection to expose only the crestal region of the ridge. A somewhat higher level of surgical skill and experience is needed for flapless ridge splitting compared to conventional bone grafting .

The main indication for ridge splitting is to expand a horizontally reduced ridge in the maxilla and take advantage of elastic and cancellous quality of this bone and its peripheral type of blood perfusion.

Splitting a narrow mandibular ridge is possible but technically more difficult due to brittle, thicker, and more cortical nature of this bone .

A flapless approach in the maxilla offers the benefits that even small bone fragments remain attached to periosteum and are contained by the intact soft-tissue envelope. On balance, ridge expansion via splitting is effective but does have its limitations.

Onlay bone grafting, with addition to particulated grafts and a membrane for protection, is the more versatile and widely used approach

For more details, join the next batch of Advanced Implants Continuum: www.sachdevadentalcare.com or www.dentalcoursesdelhi.com

Regards :Dr.Prof.Rajat Sachdeva

Edentulous Mandible: Implant – Retained Overdenture

Overdentures get support and retention from a superstructure attached to the implants. This superstructure defines the character of the denture that can be provided. We differentiate between tissue-supported, tissue/implant-supported, and mainly implant-supported overdentures.

In tissue-supported overdentures, the retentive mechanism of choice is a magnet, a ball attachment, a locator attachment, or a conical crown. Tissue/implant-supported overdentures get their retention via a superstructure consisting of two implants interconnected by a bar attached to gold caps that in turn are screwed onto the implants. Implant-supported overdentures rest primarily superstructure connected to the implants. The superstructure is placed on at least four implants, to interconnect them.

Patients with an edentulous mandible may experience problems with conventional dentures, such as a lack of retention and problems concerning self-esteem. Any fixed dental prosthesis on implants or implant-supported overdenture increases patient satisfaction.

Furthermore, research has shown that a one-phase implant insertion technique can achieve the same good results as a two-phase technique. This would mean that one-phase technique is more patient-friendly, because a second surgical stage is no longer required.

SURGICAL GUIDE

 A surgical guide to the edentulous mandible can be based on an existing functional denture or on a wax-up of the new dental prosthesis in the correct maxillomandible relationship in an articulator. Implants in the edentulous mandible intended to supporting an overdenture are inserted between the two mental foramina. They should be equidistant from the midline, and the inter-implant distance should be between 15 to 20 mm. When inserting four implants, the most distal one must be placed about 5mm mesially of the mental foramina.

TWO UNSPLINTED IMPLANTS AND AN OVERDENTURE

Two implants with ball and clip attachments should be adequate where the mandible has the height of at least 10 mm and a patient requests more stability and retention for complete denture. Two implants with ball attachments, Locater abutments, magnets or telescopic crown are most often used when the patient’s oral hygiene is a problem. An insufficient vertical dimension or a tapered shape alveolar ridge would lead to a bar design covering the frenulum of the tongue, thus impairing the function.

TWO SPLINTED IMPLANTS AND AN OVERDENTURE

With two implants interconnected by a bar as a treatment option, the implants are frequently placed at or mesially of the position of the canine teeth. The bar should be placed directly below the incisal edges of the lower teeth. This reduces the tendency of the mandibular denture to rotate around the fulcrum created between the two abutments. With a bar and clip on two implants, it is advisable not to use a round bar, since this facilitate denture rotation.

Benefits: Higher stability and retention of the overdenture

Limitation: Not applicable in the V-profile mandibles and where the residual height of the mandible is less than 10 mm. Oral hygiene is more demanding.

FOUR (OR MORE) SPLINTED IMPLANTS AND AN OVERDENTURE  

Four implants and a bar and clip mesostructure are advisable when the alveolar bone height is less than 10 mm, since the bone-to-implant surface area becomes relatively limited when shorter implants are inserted. Four interconnected implants should also be inserted if the opposing jaw has (Partial) natural dentition.

FIXED DENTAL PROSTHESIS IN THE EDENTULOUS MANDIBLE

As a patient cannot remove the FDP, oral hygiene is important. Not all edentulous patients can be considered good candidates for FDP’s as they are not capable of their oral hygiene.

An FDP can only be considered if sufficient lip support can be provided. Diagnosis treatment planning, Crossbites, maxillomandibular relations , intermaxillary space, and so on must analyzed properly. As Prosthodontics dictates the amount, site, and type of implant, a mockup is essential.

For further information join the next batch of Comprehensive Implant Training in India: www.sachdevadentalcare.com or www.dentalcoursesdelhi.com

Regards : Dr.Prof .Rajat Sachdeva

+919818894041,01142464041

Harvesting Autologous Bone

Bone may be harvested from several intraoral sites, most commonly in the mandible from the buccal cortical plate of the horizontal ramus or the symphysial (chin) area. The maxillary tuberosity area and the zygomaticoalveolar crest are also used.

Most patients will experience less discomfort from intraoral than extraoral donor site. As recently in a controlled study comparing effects of extra versus intraoral donor sites on OHRQOL-HRQOL (oral-health-related and health-related-quality of life) outcomes.

HARVESTING BONE FROM THE MANDIBULAR RAMUS

The surgical rationale being that confining the procedure to the cortical portion of the mandible will eliminate the risk of injury to the mandibular canal or any teeth located within the cancellous portion of the mandible completely.

If the mandibular molars are present, two alternative incision lines can be used to access the area: 1) Marginal incision with a short oblique releasing incision toward the ascending ramus

 2) Paramarginal incision directly over the external oblique ridge within the alveolar mucosa. A less preferable variant is a paramarginal incision within the alveolar mucosa, starting atleast 3mm buccal from the Mucogingival junction of the first molar.

If grafting is planned and the posterior mandible and the molars are missing, the same flap is used for both the donor and the recipient site. The procedure is started by performing sulcular incision at the residual teeth and extending them distally at the crest of the ridge, splitting the keratized tissue in two. Then the incision is angled (45 ̊) and extended bucally toward the ascending ramus in the third molar region.

For more details on bone harvesting, join the next batch of Clinical training on bone augmentation in Implantology .Contact Dr.Prof. Rajat Sachdeva  01142464041 for details

  Log on to  : http://www.sachdevadentalcare.com/implanto-dontia.html

Surgeries For Vestibular Deepening

Surgeries have explored rising trends in dentistry with its own skew. The speed at which new concepts enter the dental field often outpace our ability about tissues when we think we might get closer to make sense of it all.

Bone tissue is a specialized & mineralized connective tissue, most resilient with significant physical properties as high resistance to tensile, stress & compression forces with some elasticity.

Throughout existence the bone mass has a tendency to be remodeled through bone formation & resorption,specifically in the oral cavity due to lack of stimulus there is gradual bone loss post extraction in the alveolar process from the initial 12mm /year post extraction to 0.2mm /year after 2 years.

This chronic, irreversible, mounting process of alveolar ridge resorption prevails on an average of four times greater in the mandible compared with the maxilla.

Preprosthetic surgeries

Vestibuloplasty is a preprosthetic mucogingival therapy for the purpose of increasing the attached gingiva by repositioning the mucosa of bone augmenting the contact surface area of the denture to restore the stomatognathic function in cases where stability for prosthesis has lost or implant placement is contradicted.

The main indication of vestibuloplasty is lowering of the smile line for rehabilitation of the masticatory system.

It is also associated with implants to recontour the alveolar crest along with graft like hydroxyapatite or biomaterials. It may be performed in inflammatory areas & tissue recession around implants by traction of mentonian muscle to facilitate soft tissue health adjacent to implants.

The surgical techniques for vestibuloplasty may be divided into four groups: submucosal, secondary epithelisation; by transposition flaps; by grafts.

The following are some of the commonly used techniques:  secondary epithelisation; vesitbuloplasty by mucosal advancement; skin grafts i.e. mucosal or allogeneic and partial thickness material; the Clark technique for augmenting the depth of floor of the mouth; the obwegeser technique for augmenting the vestibular region & the depth of the floor of the mouth with grafts.

Kazanian technique consists of an incision in the labial mucosa of the mandible at 1.5 cm,elevation of the mucosal flap,& its repositioning in the bottom of the new sulcus.The technique described by the obwegeser is combination of kazanjian and Clark used simultaneously together with the aim of deepening the floor of the mouth.

Misch recommends vestibulolasty associated with the use of implants, with the intention of increasing the height & shape of  the vestibular ridge tissues & muscle insertions upto the height of the periosteum filling with hydroxyapatite or biomaterial (freeze dried bovine bone).

Predominantly the objective of such reconstructive surgeries is to establish a base to support the insertion of a dental prosthesis, transforming the anatomic structure into functional biologic platform for support or retention of prosthetic rehabilitation.

Regards

Dr.Prof.Rajat Sachdeva

General Dentistry Clinical Training

COURSE DURATION: 1 MONTH

Every participant will be provided with total no. of 25 patients

MODULE 1: Endodontics

Demonstration and hands on (using hand files, hand protaper files, Rotary endodontics)

– Access cavity preparation of anterior, premolar and molar on extracted tooth.

– Biomechanical preparation of canals using STEP BACK & CROWN DOWN technique

MODULE 2:

– Working length determination using apex locator.

– Clinical diagnosis in endodontics.

– Interpretation & use of RVG in endodontics.

MODULE 3:

-Demonstration and hands on of Different Obturation techniques.

-Clinical knowledge about use of various Intracanal Medicaments, Sealers in endodontics.

-Prevention and Management of fracture of instruments and ledge formation.

– Retreatment in endodontics & Demonstration of GP removal.

MODULE 4:

-Prosthodontics, Aesthetics & Restorative Dentistry

– Diagnosis and treatment planning in fixed partial prosthesis and steps of crown preparation

– Demonstration and hands on of Light cure Class I – V Composite restoration

-Demonstration and hands on of vital tooth Bleaching & Non Vital tooth Bleaching (Walking Bleach)

– Clinical Diastema Closure.

-Tooth Jewellery

MODULE 5:

– Restoration of endodontically treated tooth (Post and core) [hands on] – prefabricated & customized

– Gingival retraction and multiple impression material technique in fixed partial prosthesis

– RPD cast designing

– Pontic design discussion classes

– Tooth Preparation, Impression making and cementation procedure.

MODULE 6: Oral surgery, Periodontics

EXTRACTION

-open & closed

-Local anesthesia – Nerve block

-Flaps

-Management of trauma cases

-Splinting of mobile teeth

-Impactions

-Extraction of grossly carious teeth

MODULE 7:

 Sutures

-Materials

-Techniques

-Hands-on

-Medically compromised patients

-Minor Oral Surgery

MODULE 7: Pedodontics

Direct and Indirect pulp capping

Different materials available including MTA

MODULE 8:

Pulpotomy, Apexogenesis and Apexification

Cosmetic Dentistry Training in india

Dr.Sachdeva Dental Institute’s certified programme in Aesthetic Dentistry provides the General Dental Practitioner with an educational route to acquire the skills and knowledge required of a Dentist with special interest in the growing art of cosmetic dentistry.

The unique features of this course include:

Delivered by a team of academics, many of whom are world-leaders in their field; the course’s emphasis is placed on the clinical component with a focus on a broad spectrum of modern cosmetic treatment methods. This programme focuses on contemporary practice, teaching evidence-based principles and systems to ensure an optimal outcome for the patient and practitioner

The unique features of this course include:

  • Opportunities to master advanced aesthetic techniques using a variety of contemporary materials during patient treatment
  • Over-the-shoulder mentoring by remarkable clinicians
  • Practical treatment planning of complex restorative cases

SESSIONS FOR TRAINING AND HANDS-ON ARE AS FOLLOWS:-

SESSION 1

BLEACHING

What is Bleaching?Why do we need Bleaching?History and Categories of BleachingTypes of BleachingMechanism of BleachingVital and Non-vital BleachingProblems with BleachingAdvantages & Disadvantages of in-office BleachManagement of Sensitivity after BleachingPrognosis after BleachingHome applied techniquePrecautions and instructions

SESSION 2

COMPOSITES RESTORATION

Introduction to compositesConventionalMicrofilledHybridShade selection and tooth preparation for compositesDesigns for tooth preparationIndications and contraindication for compositesPrevention of shrinkage and discolorationC factor

SESSION 3

BONDING AGENTS

What are bonding agents?The classification of bonding agents based on generationsHow to apply bonding agents clinically

SESSION 4

DIASTEMA CLOSURE

Introduction for esthetic proceduresIsolationShade selectionUsage of matrix bandPolishing the restoration to prevent discoloration

SESSION 5

• REPAIR OF ELLIS FRACTURES

• Proper treatment planning

• Shade selection

• Isolation

• Tooth preparation

• Restoration

• Polishing the composite

SESSION 6

COMPOSITE RESTORATION

Class I, Class II, Class V cavity design for compositeSandwich technique in deep cavity casesRetention features in cavityRubber dam placementPrevention from shrinkage (from light and material part)Common problem with compositesMatrix band placementPolishing

SESSION 7

INLAY AND ONLAY

Introduction on appropriate treatmentCavity preparation for inlay and onlayImpression makingFixing the restorationChair side inlay restoration Anterior Tooth Preparation (metal free restorations) Diagnosis and treatment planningArmamentarium requiredSteps in tooth preparation

Gingival retraction Techniques Materials Demonstration Impression in FPD Materials Techniques Putty wash Custom tray Demonstration Temporization in FPD Direct method Materials Demonstration Material science Discussion on ceramics CAD/CAM in dentistry Application in our clinics Shade selection Color scienceLatest advancements Cementation in FPD Materials Procedures Posterior Tooth Preparation Diagnosis and treatment planning Armamentarium required Steps in tooth preparation

Gingival retraction Techniques Materials Demonstration Impression in FPD Materials Techniques Putty wash Custom tray Demonstration Temporization in FPD Direct method Materials Demonstration Material science Discussion on ceramics CAD/CAM in dentistry Application in our clinics Shade selection Color scienceLatest advancements Cementation in FPD MaterialsProcedures

SESSION 8

DENTAL LAMINATES/ VENEERS

History and evolutionIndications/contraindicationsTypes Direct and Indirect ArmamentariumDesign considerationsSteps in tooth preparationIsolation and soft tissue managementImpression makingShade selectionTemporizationTrial and luting of restorationsPrecaution and maintenance

SESSION 9

• SMILE DESIGNING
• INTRODUCTION
• GOALS OF SMILE DESIGNING
• COMPONENT OF AN ESTHETIC SMILE
• The basic shape of the face
• Square
• Tapering
• Square tapering
• Ovoid
• The lateral profile
• Straight
• Convex
• Concave
• Vital elements of smile designing and their role (dental composition)
• Tooth components
• Dental midline
• Incisal lengths
• Tooth dimensions
• Zenith points
• Axial inclinations
• Interdental contact area (ICA) and point (ICP)
• Incisal embrasure
• Sex, personality and age (Dentogenic concept)
• Symmetry and balance
• Soft tissue components
• Gingival health
• Gingival levels and harmony
• Interdental embrasure
• Smile line
• Golden proportion (Lombardi),
• Recurring esthetic dental proportions (Ward),
• M proportions (Methot) and
• Chu’s esthetic gauges.
• Soft tissue component of smile design
• Gingival health
• Interdental embrasure (cervical embrasure)

SMILE MAKEOVER

“Smile” It’s the one feature that immediately tells the world how we’re doing!

With age our smile can loose its vibrancy due to discolouration, tooth loss, excessive grinding or decay leading to cavities. Yet no matter what our tooth trouble might be, there’s likely a solution for everything from a one-day bonding to whitening procedures, crowns and even gum contouring to give your patient the smile they have always dreamt of.

ADDITIONAL FEATURE: COSMETOLOGY PROCEDURES

This course curriculum will also include a combination of cosmetic medicine procedures such as:

Botulinum Toxin-A
Dermal Fillers

SESSION 10

CLINICAL STEPS

Diagnosis and treatment planning Importance of diagnostic waxup Use of a face bow and semi-adjustable articulator Anterior deprogramming devices Shade selection Tooth preparation Soft tissue management Impression making Temporization Trial and luting of final restoration.

SESSION 11

TOOTH JEWELRY

DISCUSSION ON DENTIST –LAB RELATIONSHIP

Instruction to the labBrief discussion on how to look out for a good labAssessing the quality of product you get from the lab
LIVE PATIENT DEMONSTRATION AND WORKING ON PATIENTS FOR ALL THE SUBSEQUENT CASES GIVEN ABOVE

Oral Surgery Clinical Training

This oral surgery course will cover all surgical procedures required in dental practice with video and live demonstrations and practical training on patients.

  • Infection Control
  • Local Anesthesia – Technique & Pitfalls
  • Radiographic interpretation for exodontias
  • Extraction
    • Technique
      1. Open
      2. Closed
    • Complications
  • Flap
    • Design
    • Rationale
  • Sutures
    • Materials
    • Techniques
    • Hands-on
  • Medically compromised patients
  • Impactions
  • Minor Oral Surgery
    • Biopsy
    • Frenectomy
    • Alveoplasty
    • Oro-antral communication
  • Hands- On
    • Flaps
    • Sutures
    • Extraction Technique
  • Patient – Extraction by open technique
  • Emergencies in dental office

Course Duration: 4 Days, 2 WEEKENDS

Advantages of Operating Microscope in Dentistry

Dentistry is a branch of medicine that requires a great amount of knowledge and skill. However, a dentist’s knowledge and skill has to be supported by a complementary set of medical equipment too.

Among the many investments a dentist has to make on the medical equipment, a dental surgical microscope should be on the top of the priority list.

Operating or surgical microscopes are a type of optical microscopes that have a wide range of applications in the branches of medicine that involve microsurgeries. Endodontic treatments (dentistry) is known to be a skilled branch of medicine that requires great amount of precision and care while performing microsurgeries. These advanced surgical microscopes can make a lot of positive difference in a dentist’s practice through their advanced machinery, design and technology involved.

They are designed to evolve with time and are manufactured based on meticulous research and valuable feedback from practicing dentists and other medical experts. Here is a list of advantages in using dental operating microscopes in dentistry to make a difference.

1. Outstanding LED Illumination

Lighting is crucial in making a detailed and informed study about the causes and concerns of the damaged teeth under examination. Dental operating microscopes are equipped with advanced lighting systems made of LED that cast a shadow less illumination on the aspect and come with a color temperature closet that is closest to the natural day light.

2. Advanced Optical Systems

Dental operating systems stand out from other dental equipment mainly due to their optical efficiency and high quality imagery. These systems produce sharp contrast and resolution at every step of the examination, also promising anti-scratch and anti-reflective properties.

3. Well-Designed Ergonomics

Dentists are known to suffer from neck and back pain after long hours of intense surgeries and check-ups. The main reason being, the outdated dental equipment are badly designed and their ergonomics tend to hamper the overall productivity. Dental operating microscopes that come with advanced lighting and angled optical systems are also well-designed to be mounted on walls, ceilings or tables.

Apart from the above mentioned advantages, dental operating microscopes have many other benefits that contribute to the overall productivity of dentists and precision in their practice.

PERIODONTAL LASER THERAPY

Periodontal Care for Gum Disease in India

Dr.Prof. Rajat Sachdeva is proud to offer the latest technology available for periodontal therapy: laser treatment in India. There are numerous advantages to using laser therapy as opposed to the traditional methods requiring a scalpel and sutures.

Benefits of using laser technology in dentistry :

Comfort:

With laser treatment, there is reduced or no bleeding, minimized swelling, no charring, and no drill noise or vibration. The stress and anxiety often associated with dental work is therefore eliminated when you experience quick, effective, and essentially pain-free laser procedures. Also, postoperative sensitivity is greatly limited by laser dentistry, and recovery time is much quicker than with traditional methods. In fact, due to the less-invasive nature of the laser technique, the mouth begins to heal immediately after work is completed!

Reduced Risk of Infection:

The laser’s high-energy light beam acts as a sterilizer on the area it is working, thereby reducing the risk of bacterial infections and relapses.

Anesthesia Limited or Eliminated:

Because laser dentistry is virtually painless, no longer will you suffer with fear of injections and numbness. Often, only a light anesthetic spray is required. Laser treatment eliminates the complications and cost associated with anesthesia.

Uses:

Dr.Sachdeva can perform a variety of procedures using laser technology, such as a frenectomy, osseous surgery, gum grafting and treatment of gummy smile.

Dr. Rajat is also able to use laser technology as a way to regenerate healthy gums and remove diseases areas in a virtually painless way. This method also encourages healthy gum to regenerate and attach to the teeth. There is a much lower chance of gum disease returning when laser therapy is used as opposed to traditional surgery.

Piezosurgery

Dr.Rajat Sachdeva utilize advanced technology to make your dental surgery more effective and comfortable for you.

What is Piezosurgery?

The piezosurgery system uses ultrasound waves to cut bone without damaging soft tissue. Whereas traditional methods of bone-cutting, such as drills and burs, result in some tissue and bone loss regardless of the dentist’s precision, piezosurgery technology eliminates this risk. This means Dr. Rajat Sachdeva is able to perform procedures such as tooth extractions, crown lengthening, ridge expansion, periodontal therapy, and implant site preparation with increased accuracy and minimal discomfort.

Benefits of Piezosurgery:

Accuracy Hard tissue is surrounded by soft tissue including arteries, nerves, and sinus membranes. In traditional surgery, there is great risk of damaging this precious tissue, but with piezosurgery, the system is so accurate and specific to the surgery site that this risk is eliminated.

Comfort If you fear the trauma associated with drills and burs, piezosurgery eliminates this problem as well. The procedures completed with piezosurgery technology result in minimal bleeding and swelling, and reduced pain.

Healing Time Healing time is accelerated when piezosurgery technology is used. Not only will you heal faster than with traditional surgery, but you will experience minimal post-operative pain or discomfort.

Safety Piezosurgery techniques are extremely safe.