Implant Placement.

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I have been restoring more and more implants lately. The placement is often substandard. Ive said it before...no need for a surgical guide. If I could just provide a model and draw a red circle where the tooth is missing we'd be ahead.

I get 'esthetic' cases to restore anterior teeth with implants placed at wild angles centered interproximally.
Bone level implants right at tissue level.

I believe if a patient is referred to a surgeon, and after looking at Xrays and scans, if the Dr believes they cant IDEALLY place an implant, it shouldnt be done.

Ive talked to the Dentists about these, and the standard answer is, 'They are a surgeon. Theyre doing the best that can be done'.

It all lands in the techs lap, and they wonder why the lab monkey cant do better.

Im just upset.
 
doug

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Every implant deserves a guide. That's been my mantra for years. Surgeons are concerned that the cost of a guide will reduce their profit; that if they tell a patient that ideal placement will require adding some bone, at an additional cost, they will not do anything to restore the area; that they are so damn good that they don't need a guide. Bone level implants have made it even worse. The surgeon thinks that we should be able to work a ****ing miracle since we're coming straight up from the bone. 2th said it earleir that a single tooth guide isn't a money maker, but will lead to more and different types of work that will easily make up for it.
 
2thm8kr

2thm8kr

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I have been restoring more and more implants lately. The placement is often substandard.
The frustration you're feeling and what you are describing is exactly why I started planning services.
QUOTE="user name, post: 307517, member: 1719"]
Ive said it before...no need for a surgical guide. If I could just provide a model and draw a red circle where the tooth is missing we'd be ahead.
[/QUOTE]
Without 3d scan data your red circle is merely a suggested position. Without seeing the condition of the cortical plates, nerve channel, sinus walls, and other anatomical features specific to each patient's condition it's a guessing game.
2d xrays give some information, but scant at best. I attended a radiology lecture once where the instructor posted a 2d xray of what appeared to be a perfectly integrated implant. When he asked the crowd how it looked they all agreed that it was 'textbook'. That's when he informed us that it was a cadaver and he placed the implant inside the cheek and took the xray a few times to get the image just right. His lesson was that 2d xrays can be deceiving depending on the angle of the exposure.
I get 'esthetic' cases to restore anterior teeth with implants placed at wild angles centered interproximally.
Bone level implants right at tissue level.
This is why it is important to do a digital work up or even a hand wax up and scan it to merge with the CBCT data. Implants can be planned and placed as ideally as the patient's anatomy and/or wallet will allow.
3d scan data would let you know in most instances if the platform is too close to the tissue crest.
If the surgeon doesn't have landmarks to orient themselves with, it's a crap shoot if the will be able place the implants ideally for aesthetics. With 3d data sets and digtital work up it is possible to see before the surgery if the implants will be at wild angles or in the embrasure areas. We've had cases that appear to have adequate width buccal/lingual only to get a ct scan and find the ridge is nearly as narrow as a credit card.
Ive talked to the Dentists about these, and the standard answer is, 'They are a surgeon. Theyre doing the best that can be done'.
I've heard it said that an implant case is a success when the patient pays the lady at the desk up front. It's not uncommon to have an old school surgeon say I've veen doing it forever without a guide with success. Point them to the facepalm thread here. Realistically, how much experience do you think a surgeon has restoring their own implants? If they did you would see much better placements.
Without digital planning and the information that brings to the case they are NOT doing the best that can be done.
Does anyone think an attorney would buy it, the best that could be done? The attorney's first question would be did you use a surgical guide? Oh, you're a surgeon, you did the best you could do. Would you like to tell the jury why you didn't use all of this technology available to you? Lol
It all lands in the techs lap, and they wonder why the lab monkey cant do better.
Get involved, steer the boat rather than going with the flow.
Im just upset.
Do something about it!
 
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Contraluz

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Do something about it!
Great post! And it shows that we actually CAN do something about it. But it needs to be an effort on all sides. I frequently hear: the surgeon didn't use the guide provided. Or, just recently, I don't want to throw the surgeon under the bus, after dealing with a set of 'not so ideal' placed implants... So, it needs effort to approach the surgeon and restorative dentist and education. Which may not be an easy task...
 
OP
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Should everything be run through the Dentists, or approach the Surgeons with assistance in planning?
 
2thm8kr

2thm8kr

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Great post! And it shows that we actually CAN do something about it. But it needs to be an effort on all sides. I frequently hear: the surgeon didn't use the guide provided. Or, just recently, I don't want to throw the surgeon under the bus, after dealing with a set of 'not so ideal' placed implants... So, it needs effort to approach the surgeon and restorative dentist and education. Which may not be an easy task...
Teamwork is the key. It starts small with a GP and a surgeon that you can build a rapport with.
It really started for me with 2 GPs that insisted that everything was guided. They will not refer to surgeons that do not use the guides. They both want to be able to put the guide in the patient's mouth when the healing cap is removed and clearly see the implant through the sleeve hole.

If the implants have been placed and integrated that's where they live. No need to throw anyone under the bus. The easiest way is to not refer any more patients to that surgeon. Money speaks louder than anything that could be said.

I've spoken with a lot of GPs around the country about the trend of placing implants themselves. Most every answer was they were tired of poorly placed implants and explaining to the patient why the aesthetics weren't as expected. They didn't speak poorly of the surgeon, they decided to do it themselves and take responsibility for their patient's best interests. Most of these guys are doing the easy ones while gaining experience and referring the difficult cases to the specialist.

This is where the teamwork approach come into play. It's not a new concept. The best of the best in our business always speak of it. Who knows best where the implants should he placed for aesthetics and function? You, the educated dental technician IMO. Who knows the best position for the implant anatomically speaking? Certainly a well trained and competent surgeon. The one who knows the patient's needs best? The GP who has been providing their dental care for years and has a broad understanding of their condition. Everyone involved has expertice that the others do not. It takes some effort on everyone's part, but isn't any harder than other challenges thay have been faced.
 
Contraluz

Contraluz

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Should everything be run through the Dentists, or approach the Surgeons with assistance in planning?
The referring dentist is the first contact. But if you see resistance, you may want to go the the surgeon. But that may be an issue for your client/referring Doc. No easy answer...
 
2thm8kr

2thm8kr

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Should everything be run through the Dentists, or approach the Surgeons with assistance in planning?
You must have a solid rapport/relationship with one or the other. For me it worked out with the GPs. We have worked together for many years they know my abilities and I know theirs. There is a mutal respect. One day I was griping about implant placement on a tough anterior case we did a DX wax up on. We put a lot of effort on our side, but the implants were less than ideally placed, even with an old style thermoformed pilot guide. Lots of extra costs and effort later the case is finished, but could have been better. That started a discussion about guided surgery. The GP asked me what I thought about insisting that every case was guided, Naive me was all for it. So a surgeon we worked started planning cases with the software that came with the CT scanner they had. (Guided doesn't mean perfectly positioned aesthetically speaking, lol) Better, but still not what we were after. Long story short, I made some arrangements with the surgeon to be able to use his planning software in exchange for doing DX work for some of his other referrals. One thing leads to the next and I start trying other planning softwares and now I'm neck deep in it.
 
DESS-USA

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One of the main reasons the angle screw channel ti base was developed was because of the poor placement of implants. I do not envy any of you when dealing with poor implant placement that could be avoided with proper planning and possibly a guide. Unfortunately the ego of many of these guy's prevents them using guides and ignoring feedback from their restorative base and from the labs that support them. Hence why more GP's are also placing more implants now....tired of fixing mistakes.
 
L

LarryRDC

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2th is right, I don't plan surgical guides yet , but I'm gonna learn.... this case actually had a guide, lol. (planned by another lab)
The 3 words us techs always hear....."make it work"Banghead sorry for the crappy pics as ups driver standing there with arms folded..
Make_it_work1.jpg
Make_it_work2.jpg
Make_it_work3.jpg
 
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Bryce @ WhipMix

Bryce @ WhipMix

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When I was still in the lab, I was doing implant restorations for a surgeon that refused to use a guide. Young guy, but very old school. Placed all of his implants traditionally with no guide. His placement was almost always perfect and I'm not aware of any failures. Every surgeon is different. He is likely the exception, however.
 
sidesh0wb0b

sidesh0wb0b

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The frustration you're feeling and what you are describing is exactly why I started planning services.
QUOTE="user name, post: 307517, member: 1719"]
Ive said it before...no need for a surgical guide. If I could just provide a model and draw a red circle where the tooth is missing we'd be ahead.
Without 3d scan data your red circle is merely a suggested position. Without seeing the condition of the cortical plates, nerve channel, sinus walls, and other anatomical features specific to each patient's condition it's a guessing game.
2d xrays give some information, but scant at best. I attended a radiology lecture once where the instructor posted a 2d xray of what appeared to be a perfectly integrated implant. When he asked the crowd how it looked they all agreed that it was 'textbook'. That's when he informed us that it was a cadaver and he placed the implant inside the cheek and took the xray a few times to get the image just right. His lesson was that 2d xrays can be deceiving depending on the angle of the exposure.

This is why it is important to do a digital work up or even a hand wax up and scan it to merge with the CBCT data. Implants can be planned and placed as ideally as the patient's anatomy and/or wallet will allow.
3d scan data would let you know in most instances if the platform is too close to the tissue crest.
If the surgeon doesn't have landmarks to orient themselves with, it's a crap shoot if the will be able place the implants ideally for aesthetics. With 3d data sets and digtital work up it is possible to see before the surgery if the implants will be at wild angles or in the embrasure areas. We've had cases that appear to have adequate width buccal/lingual only to get a ct scan and find the ridge is nearly as narrow as a credit card.

I've heard it said that an implant case is a success when the patient pays the lady at the desk up front. It's not uncommon to have an old school surgeon say I've veen doing it forever without a guide with success. Point them to the facepalm thread here. Realistically, how much experience do you think a surgeon has restoring their own implants? If they did you would see much better placements.
Without digital planning and the information that brings to the case they are NOT doing the best that can be done.
Does anyone think an attorney would buy it, the best that could be done? The attorney's first question would be did you use a surgical guide? Oh, you're a surgeon, you did the best you could do. Would you like to tell the jury why you didn't use all of this technology available to you? Lol

Get involved, steer the boat rather than going with the flow.

Do something about it!
[/QUOTE]
(most) techs need a raise and some significant respect. start there and more might be willing to spend 20hr a day instead of 18hr a day "doing something" for the industry while being pissed on by the acronyms
 
rkm rdt

rkm rdt

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You'll never be taken seriously when you have fellow techs that don't think regulations and accountability have any merit and that the " market" will take care of itself.
 
Tayebdental

Tayebdental

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Oral Surgeons and dentists also have their own limitations with bone structure
 
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OP
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Agree
Agree
Agree.

So now we get to my point. If it cant be placed in a way that will allow a nice restorative solution...it shouldnt be done.
From what I see, it seems no patient gets turned away.
 
L

LarryRDC

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Yep, You can always place it, but you have to decide if you should place it...…...
 
Tayebdental

Tayebdental

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I just texted my son who is a dentist and asked him if some patients are not a good candidates for implants and is not feasible to restore. His reply was, absolutely, and different options other than implants are considered.
 
Tayebdental

Tayebdental

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I am not disputing the fact that we get some implants with hair pulling angulations, but I am able to restore by luck or genius by suggesting different procedures and options.
 
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