This afternoon I viewed a patient who was in for an implant placement on #9. The 25 year old female had the tooth extracted over 10 years ago because the tooth would not erupt and was not able to be orthodontically erupted. Prior to the implant surgery a bacterial culture was taken because of a few severe localized pockets on select molars and premolars, which may be indicative of post-juvenile periodontitis. (See Image #1) The bacterial culture was taken by placing paper points into the facial and lingual sites of each deep pocket location for a few seconds, and then placed into the culture solution. The culture will be sent to an oral microbiology lab for testing and further treatment will be decided on then.

The patient received profound anesthesia prior to the implant placement. The size and location of the edentulous area indicated the use of a 3.5mm x 12mm implant in the area of #9. (See Image #2 and #3) Radiographs were taken to verify the placement and seating of the implant and healing abutment and sutures were placed to reapproximate the tissues for successful healing. The patient has been wearing a flipper for approximately 8 years and therefore the seating of the flipper post-surgery was confirmed and no adjustments were necessary.

N.S., New York University College of Dentistry

42 year old female presented for an implant placement in the space of tooth #18. Previously it was noted that the patient was having periodontal problems, had undergone several rounds of scaling and root planning and had been placed on amoxicillin with metronidozole to resolve the condition. A periodontal culture was taken to determine the type of pathogens and if any resistant strains were present. The lab results showed gram negative rods resistant to both of the antibiotics. The patient was placed on 500 mg Cipro BID 7 days. A follow up visit revealed the gums were in a better condition. The patient was also referred to Dr. Keith Berkowitz (www.centerforbalancedhealth.com) to test for fasting blood sugar levels due to the suspicion of a systemic cause of the periodontal condition, prior to implant placement. The blood test revealed a fasting blood sugar level of 139 and the patient was diagnosed with diabetes.  Dr. Berkowitz recommended controlling the diabetes with diet modification for this health-oriented, compliant patient.

Today, the patient was anesthetized and given proper surgical dressing. A flap was made from teeth 20 to18. A 6 x 9 mm implant was placed, as well as a 5.7 x 3mm healing abutment was placed out of occlusion. Slight enamelplasty was done on tooth 18 to allow room for the healing abutment, due to the severe mesial angulation of tooth 18. A panoramic film was taken to verify proper placement of the implant as well as proper seating of the healing implant. The tooth was left without a temporary for the time being to allow integration of the implant and bone.

N.D., New York University College of Dentistry

33 year old female presented for second stage implant surgery on tooth #10. Tooth #10 was lost due to an extraction by a previous dentist. It was mistakenly taken for a primary tooth. The implant was placed 6 months prior with no complications, and temporized with a Maryland bridge that was bonded to teeth #9 and #11 lingually.

Today the Maryland bridge was removed. Local anesthesia was given, and an envelope incision made. A healing abutment was placed and the occlusion adjusted to leave the abutment out of occlusion. A periapical xray was taken to demonstrate the proper seating of the healing abutment, and then it was torqued into place. The abutment was temporized using a duralay temporary and adjusted for proper occlusion. No sutures were needed. After proper healing of the tissue, a final impression for an implant crown will be taken.

N.D., New York University College of Dentistry

Last Monday was a very educational and rewarding experience. I observed many procedures done by different specialists.

The first one that I participated in was Phase I Therapy of single implant placement on a middle-aged male patient. The surgery was done by an oral surgeon. He used an approach of first creating a flap to help visualize the path of implant insertion. I asked him afterwards whether there was a specific reason that he created a flap first instead of directly “drilling into bone”, and he said there wasn’t, except for the fact as I mentioned to enhance visibility (good reason for me if it means implant will be placed correctly). I was able to see on the x-ray the alignment of the placed implant, and according to my still limited knowledge, it was excellently positioned.

The treatment of the same patient was continued by the general dentist who cemented a temporary bridge in area where implant was placed.

In another treatment, the endodontist performed a root canal therapy on the mandibular molar of another patient. She demonstrated the lateral condensation technique when obturating all 3 canals. This time I saw her using an apex locator, a great device which as she explained showed her the apex both radiographically and clinically. She told me that it is the best to stay within 0.5 mm around the apex when placing master cone with the cement, because that will prevent excessive widening of the apex and perforation of the canal. Upon completion of the RCT I saw the final radiograph, which again showed a very successful end result.

After RCT, the patient was transferred to a different room, where the treatment continued with the core buildup and crown prep done by the general dentist. The patient did not need post and core placements because there was enough tooth structure to ensure longevity of the fixed restoration with the composite core. The finish line of the crown prep was a combination of shoulder with bevel and chamfer, done as such to avoid unnecessary compromise of the tooth structure. After the final impression and shade selection, a temporary crown (constructed at the chair-side via “block technique”) was cemented and patient was dismissed.

Throughout the entire time, what was most apparent in the office was the nature of the comprehensive and personalized treatment, excellent pain control and sensitivity to patient’s comfort. Interaction between Doctor and Patient was constant and conducted in comfortable yet respectful manner. The pain control was done not only during the procedure but also after the visit; because at the end of the treatment Dr Dorfman made sure the patient received post-op instructions and pain medication.

E.T., New York University College of Dentistry, Observation