Minutes of meeting April 27, 2000
Submitted by George F. Green, D.D.S.
 
Introduction - Dr. Bernard Gantes & Dr. Jason Yamada

Upcoming meetings this year: May 27 - New Topics in Implant Dentistry.  June 22  - Dr. Max Crigger "Techniques to Become a Critical Scientific Reader". October 26 - Impression
Techniques.

Minutes of meetings are available for review on web site:    implantsforteeth.com

Tonight's presentation is by Dr. David Matthews - a periodontist from  Tacoma, Washington.

Developing the Site in Congenitally Missing Lateral Incisors in the Adolescent and the Adult  -  Dr. David Matthews

Implants and Soft Tissue Management in the Esthetic Zone
  Key: "overbuild" the site for the restorative dentist
   Immediate placement = preservation, minimal surgery. Dr. Matthews' personal rule: only contraindication to
   immediate placement is inability to achieve initial stabilization of fixture.
   Difficult to create a natural papilla between two implants.
   * Ridge evaluation = must analyze papilla height and gingival level.
   Facial gingiva should have bulk = overbuild for ovate pontic. Excess tissue can then be carved/molded.

Maxillary Lateral Incisor Implants - The Interdisciplinary Challenge
 Adolescent
  Key - create/maintain bone in lateral site. Accomplished by allowing canines to erupt in lateral position.
  Canines are then orthodontically moved distally, bone is preserved in lateral area. If canines do not erupt in
  lateral area, bone will not be developed and will need to be created (grafted).
  Will edentulous ridge resorb with time? A lot of bone volume is lost within 6 months of extraction.
  Following orthodontic movement, less than 1% of bone is lost in buccal-lingual direction.
  At what age should implants be placed? Most girls = 15-1/2 to 16, boys = 19 (when growth stops). Odman =
  no implants should be placed until permanent dentition is fully erupted. Ceph tracing = most accurate
  determination of growth. Wrist films give median numbers = not accurate.
  Implant Placement - stent guides angulation. Height/depth = head of implant placed 3-4 mm apical to
  anticipated gingival margin.
  Punch uncovery - use guide with smallest diameter punch = maximum preservation of keratinized gingiva.
  Punch is displaced slightly towards palate.
  Proper gingival framework results in inconspicuous restoration.
  (An excellent series of slides showing clinical cases was shown that demonstrated papilla reaction when opening space in the esthetic zone)
  Narrow platform (NP) fixtures can be used in the 7 and 10 position. Dehiscence at fixture placement is OK as
  long as fixture is stabilized. Can be accomplished by engaging nasal spine.
  *Important to leave gingival embrasure spaces open when temporary is created. This will allow papillas room
  to develop.

Tissue Levels With Single-Tooth Implants
(A series of slides/case presentations was used to illustrate this portion of the presentation)
Case 1 - implant placement too far apical.  With immediate placement, try NOT to use flap. No need to fill socket with fixture. Do NOT instrument labial plate of bone.  Use short
healing abutments and graft over.

Case 2 - gingival margin error prior to extraction. Gingival margin always migrates apically after extraction.

Case 3 -  #8 vertical fracture, labial plate dehisced to apex. Tx plan: orthodontically erupt tooth to bring bone and gingiva coronally. #8 stabilized 3 months prior to extraction to
allow bone maturation. Very careful extraction using periotome. Screw-retained temp to eliminate possibility of subgingival cement/irritation.

Case 4 - Ridge and papilla preparation.  #8 vertical fracture, unrestorable. Attemped ortho eruption, tooth fractured below crestal bone. Screw-retained temporary.

Case 5 - Missing #6. Laboratory must understand contours. *Must keep embrasure space open to allow development of papillae.

Case 6 - Two adjacent implants = most difficult situation for creating natural-appearing papilla. Problem = attachment apparatus of teeth is different from implants. Pt. = congenitally
missing #10, #11. ery difficult case: very deficient in bone/tissue, deficient mes-dist space. Bone graft with Ti-GoreTex membrane.
Protocol:
 1. place fixtures
 2. index
 3. healing abutments
 4. CT graft
 5. punch uncovery (no flap)
 
Meeting adjourned at 9:20 PM.