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Case Presentation by: Michael Toffler, DDS | New York, NY |  September 2019
Site #3: Patient requests removal of a titanium implant with peri-implant disease and replacement with a metal-free Zeramex XT implant

Michael Toffler, DDS  is an experienced Periodontist with a demonstrated history of working in the health wellness and fitness industry. Strong healthcare services professional with a certificate of residency in Periodontics from V.A. Medical Center West Los Angeles. He is a Diplomate of the American Board of Periodontology and is well published in refereed journals and has written textbook chapters on sinus floor elevation and it associated complications. 

“There is presently a lack of information if and how titanium (Ti) particles from dental implants affect the tissues in the oral cavity, particularly peri-implant tissues such as bone and connective tissue cells” (Happe et al 2019).

Concerns:

  • Ti particle pollution may be perceived clinically as discoloration of the marginal tissues and histologically, we see lymphocytes in the peri-implant tissues with increased Ti concentration (Zipprich et al 2018)
  • Ti particles can provoke a dual effect, reducing bone formation due to inhibition of osteoblast proliferation and increasing bone resorption by IL-6 osteoblast-mediated osteoclastogenesis (Goodman et al 2016)
  • Titanium wear microparticles shown to activate osteoclastogenesis (Mishra et al 2011)
  • A recent cell culture experiment demonstrated a cytotoxic effect of Ti debris on human osteoblasts and gingival fibroblasts (Happe et al 2019)
  • If Ti particles create an inflammatory cell response or induce bone resorption they may play an important role in peri-implant disease.

Case Report

  • 30 y/o female with history of severe ulcerative colitis. For the last 1.5 years, she has experienced: periodic fever, muscle aches and weakness
  • Implant # 3 placed with transalveolar lift in August of 2017 by another periodontist
  • Patient presents in my office with 25-30% bone loss and 6-7 mm probing depths implant #3. She now wants the implant removed as she feels it may be contributing to her condition.
  • ENT confirmation: no sinus pathology present.
Picture1

4 months after implant removal and grafting the residual osteotomy, there is a subantral bone height of 3-7 mm and a convoluted sinus floor

Toffler Case Presentation Picture 2
Toffler Case Presentation Picture 3

3.5 mm Densah® bur spins CCW 1200 RPM to autograft and lift sinus prior to finalizing with ZERADRILL®

Toffler Case Presentation Picture 4
6mm stop
Toffler Case Presentation Picture 5
8mm stop
Toffler Case Presentation Picture 6
Lift at 3.5 mm Diameter
Toffler Case Presentation Picture 7
Final prep wih 5.5 x 8 mm ZERADRILL & TAP

Placement: 5.5 x 8 mm Zeramex XT implant slightly distalized to engage more subantral bone.
Collar: .6 mm
supracrestal on mesial and distal, 1.6 mm on facial. Sinus lift: 3-5 mm

Toffler Case Presentation Picture 8
Toffler Case Presentation Picture 9

Contact

Want to know more about Zeramex?
Email us at [email protected] with your contact details and we will get in touch with you!

ZERAMEX BROCHURE

Click here to download the Zeramex sales brochure

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ZERAMEX® XT Tapered Ceramic Implant placed in Narrow Ridge https://emerginnova.com/zeramex-xt-tapered-ceramic-implant-placed-in-narrow-ridge/?utm_source=rss&utm_medium=rss&utm_campaign=zeramex-xt-tapered-ceramic-implant-placed-in-narrow-ridge https://emerginnova.com/zeramex-xt-tapered-ceramic-implant-placed-in-narrow-ridge/#respond Fri, 02 Aug 2019 03:47:27 +0000 https://emerginnova.com/?p=4705 Treatment planning and surgical placement of the FDA approved ceramic dental implant
ZERAMEX® XT by Dr. Alvaro Ordonez.

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Treatment planning and surgical placement of the FDA approved ceramic dental implant ZERAMEX® XT by Dr. Alvaro Ordonez.

In this case, Dr. Alvaro Ordonez grafts a large defect utilizing cortical cancellous bone and a membrane prior to placement of the ceramic implant. He uses the Versah Osseodensification burs with a tapered design to match the implant shape. A lot of attention was paid to proper suture of the delicate soft tissue.

Case Report

This patient appeared in my office with a severely compromised tooth at #8. At the time, the patient was not ready for an implant and the decision was made to extract the tooth with the intent to place an implant at a later date. The tooth was carefully extracted using luxators to preserve the soft tissue surrounding the socket. A crestal incision was made from tooth #9 to #7 with a partial pocket flap. The defect was filled with cortical cancellous bone and covered with a PTFE membrane.

After 4 months the patient was eager to proceed with the implant. 2D and 3D scans were used for treatment planning of the case and the decision was made to select a ZERAMEX XT tapered, ceramic implant. A full flap was done to take full view of the hard tissue situation. Utmost care was taken to preserve the soft tissue. Bone density and ridge width were enhanced in this case by utilizing the osseodensification burrs by Verah.

We worked our way through the drilling sequence and finished with the final drill from the ZERAMEX XT Tapered kit to precisely match the shape and diameter of the implant. The implant was placed .6mm supracrestal and excellent primary stability was obtained. The implant with protected with the cover screw provided with the implant. Once again extreme attention was paid to the soft tissue. I enhanced the site with additional cortical cancellous particulate and covered with a resorbable collagen membrane. Final suturing was done with 4.0 PTFE with considerable attention again paid to maintaining the soft tissue.

I will soon come back and share the final outcome. We will take a fixture level impression and send a ZERAMEX zirconia abutment to the lab and a final crown will be connected to the implant using the VICARBO® screw. I am eager to share the results of this challenging case.

Dr Ordonez has been working with ceramic implants since 2005. In his practice ceramic are used as alternative titanium especially for patients requesting a natural and organic solution for missing teeth.

 – Dr. Ordonez is not affiliated with any of the products mentioned in this case –

Learn More About ZERAMEX® XT – CLICK HERE

Zeramex XT System
Dr. Alvaro Ordonez

Dr. Alvaro Ordonez is a trained expert and professor on Temporomandibular disorders, dental occlusion and Orofacial Pain. He was trained at the Gelb Craniomandibular and Orofacial pain Center at Tufts University in Boston, Ma By Noshir Mehta, Albert Forgione and Harold Gelb. He is a recognized expert in the diagnosis, treatment and long term management of TMD that has been refractory to conventional, conservative and surgical treatment.

His field of practice is related to advanced implant dentistry and cosmetic reconstruction of dentitions that have been destroyed by parafunctional habits like clenching and grinding.

Dr. Ordonez is a well known international speaker in the fields of dental implants, TMD, dental occlusion and facial pain. His involvement in the dental community as an expert and educator has span through out his career from the moment he began as a dental student. He teaches and lectures regularly at the University of Florida and the Veterans Hospital in Miami. He teaches residents the clinical and academic aspects of TMD, Dental occlusion and facial pain. He has been an honored guest speaker at the Miami Childrens Hospital, the University of Miami, and the Jackson Memorial Hospital, as well as a professor at both Tufts University and Nova Southeasten University. As a result, he has been recognized by many educational institutions and dental societies.

Contact

Want to know more about Zeramex?
Email us at [email protected] with your contact details and we will get in touch with you!

ZERAMEX BROCHURE

Click here to download the Zeramex sales brochure

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Dental Implant Practices Podcast with Mike Foley https://emerginnova.com/dental-implant-practices-podcast-with-mike-foley/?utm_source=rss&utm_medium=rss&utm_campaign=dental-implant-practices-podcast-with-mike-foley https://emerginnova.com/dental-implant-practices-podcast-with-mike-foley/#respond Tue, 09 Jul 2019 12:15:16 +0000 https://emerginnova.com/?p=3231 Mike Foley has been in the dental implant business for 15 years, and jokes that once you get into it, you can’t get out. In this podcast, you’ll hear all about how he got started with ceramic zirconia implants specifically.

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Mike Foley has been in the dental implant business for 15 years, and jokes that once you get into it, you can’t get out. In this podcast, you’ll hear all about how he got started with ceramic zirconia implants specifically.

And if you’re confused by the term and wondering whether these implants are ceramic or zirconia, don’t worry, you’re in good company and this is a common question. The answer is that ceramic zirconia implants are both. Tune in to learn all about the details of the process of making these implants.

About the Interviewer

Dr. Philip Gordon, DDS

Dr Philip Gordon earned his bachelor’s degree in nutritional sciences from the University of Missouri in Columbia. His desire to learn about anatomical processes and biological sciences, combined with exposure to his father’s dental office early in life are what influenced his decision to attend dental school.

Dr. Gordon grew up in Kansas City, Missouri, and has lived here most of his life. He attended the University of Missouri – Kansas City School of Dentistry Dental School where he received his DDS degree. Since then, he has taken hundreds of hours of continuing education every year in Implant and Cosmetic Dentistry to stay at the forefront of the latest and greatest dental techniques and advancements.

What’s unique about the material in Mike’s ceramic zirconia implants, and what exactly is it?
How can listeners get started in this, get more training, get a kit of implants, and get going?
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To know the answers to these questions, listen to the full podcast interview here:

Contact

Want to know more about Zeramex?
Email us at [email protected] with your contact details and we will get in touch with you!

ZERAMEX BROCHURE

Click here to download the Zeramex sales brochure

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