MTI – CASE PRESENTATIONS

BONE AUGMENTATIONREPLACEMENT OF CONGENITALLY MISSING LATERALSFIXED PROVISIONAL RESTORATIONSORTHODONTIC ANCHORAGEREPAIRING BROKEN BRIDGESSTABILIZING EXISTING DENTURES

BONE AUGMENTATION

One of the major roadblocks to implant treatment is the patient’s perception of a long, drawn out treatment period.

Because of bone resorption in edentulous areas from lack of teeth stimulation, periodontitis and ensuing extractions and/or accidental trauma, many implant treatment plans include some type of bone augmentation procedure. It may involve a sinus lift, replacement of the buccal plate, and/or widening or heightening a ridge. In some cases the bone grafting is done at the time of implant placement and in others, the augmentation procedure is performed prior to implant surgery in order to establish enough cortical bone to receive the implants.

Selling an implant case involves overcoming a patient’s concerns. One of the major roadblocks is the patient’s perception of a long, drawn out treatment period. After convincing the patient that it may be up to one year before they receive their new implant-supported teeth, you hit them with this next gem. “Oh, we need to increase the bone first and that will take an additional year.” Sometimes the patient complains so much, and you are afraid they won’t accept, that you concede to forego the bone augmentation; you attempt to use other sites that may be inappropriate for implant placement and compromise the success of the treatment.

The MTI-Monorail System was designed to overcome a patient’s concerns.

Time no longer becomes an issue once you have demonstrated that for the entire length of the treatment period, regardless of how long it takes, they will have provisional restorations that will be more stable, more cosmetic and more comfortable than what they have at that very moment. Additionally, with proper planning, you can use an MTI- Monorail implant to hold the guided tissue membrane in place so that it does not move laterally or towards the mucosa. Instead of using “tacks” which have to be removed with a more invasive flap, you can make a small slit near the MTI-Monorail implant and pull the membrane out.

Recommended Reference Articles
• Cohen, M., Flake, R. “Special Report 4”, The Seattle Study Club Journal Vol. 5. No. 2 Spring 2001 pgs 32-37
• Poitras, Y., “Symphysis Graft and Implants: The Gold Standard for the Edentulous Premaxilla”, Oral Health, Aug., 2000, pgs 35-44

REPLACEMENT OF CONGENITALLY MISSING LATERALS

Fixed, Cosmetic Provisional Restoration that is Easily Maintained.

Ten percent of the population has congenitally missing teeth, and often it’s the maxillary laterals that are missing. Traditionally, orthodontists have moved the canines mesially to fill the space of the lateral incisors. When this technique is utilized, there has to be extensive reshaping of the canines and removal of much of the enamel. This could lead to problematic functional changes in the occlusion.

The current approach in orthodontics is to establish an ideal occlusal relationship by creating enough space to replace the lateral incisors. Prosthetic replacements include fixed bridges, removable partial dentures, bonded resin [Maryland] bridges or osseointegrated implants.

Historically, a removal appliance has been the first choice of orthodontists because it replaces the missing teeth and serves as an orthodontic retainer. Orthodontic retention is necessary for 9-12 months after the orthodontic therapy is completed, and without it, reversals may result. The problem is that teenagers don’t like wearing removable appliances and the bonded bridges tend to become loose and/or are difficult to maintain.

Replacing congenitally missing laterals with implants has become a widely accepted approach and well documented in the literature. However, orthodontic therapy is usually completed in a child’s early teens when their growth patterns are still very active. In most instances the clinician must wait 3-5 years before placing the permanent implants.The MTI-Monorail System is just “what the doctor ordered.” After local anesthetic is given, they can be placed without cutting a flap that would be more traumatic, especially to a teenager. The bone will continue to grow with stimulation from the implant. The youngster will have a fixed, cosmetic provisional restoration that they can maintain easily. Clinicians will not have to depend on compliance from a teenagers; instead the teenagers will love their new smiles. Everyone wins.

Recommended Reference Articles
• Keller, W., “Temporarily Replacing Congenitally Missing Maxillary Lateral Incisors in Teenagers Using Transitional Implants”,
Implant News & Views, Vol. 3 No. 1 Jan/Feb ‘01, pgs. 1,4,5,10.

FIXED PROVISIONAL RESTORATIONS

Patients are able to continue their present lifestyle without major interruption.

Monorail Modular Transitional Implants can be routinely used to provide a fixed provisional restoration or a stabilized overdenture at the time of implant surgery. In the past, there were major drawbacks to undergoing implant treatment. Patients would have to be without teeth for 2-3 weeks after surgery followed by the prospect of months of sore gums and loose temporary dentures flopping around in their mouth. Most patients have similar concerns about implant treatment. How many months or years will it take to complete? How much will it cost? Will they be in constant pain? When the outlook presented by the dentist magnifies these concerns, often the patient doesn’t accept an implant treatment plan.

This has all changed with the development of the Dentatus MTI-Monorail Transitional Implant System. Think of them like a second set of implants that were designed to alleviate all patient concerns. Now patients never have to be without teeth. During the surgical healing period and the time necessary to complete the final prosthesis, they will have a stable temporary restoration that will be comfortable, enable them to function well and will be pleasingly cosmetic. Patients will be able to continue their present lifestyle without major interruption.

Easy, predictable and safe.

MTI-Monorail transitional implants are a win-win situation for everyone, and are easy, predictable and safe. They can be used in conjunction with any of the definitive implants that are being surgically placed.

For the surgeon, MTI-Monorail means physical protection of the surgical site and an undisturbed healing period for the definitive implants or bone augmentation procedures. Use of MTI-Monorail Transitional Implants will maximize clinical success.

For the restorative dentist, there will be higher case acceptance. He/she will be able to collect a sizeable “upfront” fee instead of waiting 6-9 months to begin receiving payments. All measurements during the process, such as vertical dimension and wax bites, will be easier and more accurate in a stabile environment. Decisions can be made by the restorative dentist in coordination with the patient during the provisional phase as to size, shape and color of the teeth; changes in the acrylic are less time consuming and less costly than altering the final prosthesis. The use of MTI-Monorail Transitional Implant System is a real implant practice builder.

For the patient psychological fears about implant treatment will be overcome, and they will be more likely to accept implant treatment. They will learn proper oral hygiene soon after implant surgery and have months of practice before the final prosthesis is inserted. Patients will become accustomed to the “feel” of a provisional restoration that is similar to the final implant-supported restoration, making that transition smooth, comfortable and easy.

Recommended Reference Articles
• Brown, M. Tarnow, D., “Fixed Provisionalization With Transitional Implants for Partially Edentulous Patients: A Case Study”, Practical Periodontics & Aesthetic Dentistry, Vol. 13, No. 2, March, ‘01 pgs. 123-127
• Petrungaro, P. Smilanich, M. “Use of Modular Transitional Implants in the Partially Edentulous Patient”, Contemporary Esthetics & Restorative Practice Vol. 3, No. 8, Sept. 1999 pgs. 50-62

ORTHODONTIC ANCHORAGE

Utilizing the MTI-Monorail transitional implants during the orthodontic
phase of treatment allows the patient a “trial run” that may change their mind towards permanent fixed, implant-supported restorations.

The utilization of endosseous implants to provide orthodontic anchorage in the absence of posterior teeth has been well established in the literature. However, the technique has many limitations including high costs, more invasive surgical procedures, down time while waiting for osseointegration and the complexity of attaching orthodontic appliances.

The requisite of an orthodontic implant anchor in resisting orthodontic forces is considerably lower than an endosseous implant designed to resist heavy, intermittent occlusal forces. According to orthodontist, Dr. James Gray, the ideal orthodontic anchor should be “small, affordable, easy to place, routinely resistant to orthodontic forces, able to be immediately loaded, useable with familiar orthodontic mechanics and easy to remove.” We couldn’t have said it better ourselves. That’s the perfect description of the MTI-Monorail Transitional Implant System.

Many orthodontic cases with missing teeth are treatment planned to be completed with removable partials. Utilizing the MTI-Monorail transitional implants, during the orthodontic phase of treatment allows the patient a “trial run” that may change their mind towards permanent fixed, implant-supported restorations. After all, they had a chance to experience a relatively atraumatic implant surgery and complete the orthodontic treatment with fixed appliances.

Recommended Reference Articles
• Gray, J., Smith, R. “Transitional Implants for Orthodontic Anchorage”, Journal of Clinical Orthodontics, Vol. XXXIV, No. 11, November, 2000, pgs. 659-666

REPAIRING BROKEN BRIDGES

It’s a matter of “physics 101.” Support the pontic as if it were a tooth and the splinted repair will hold. Here’s the technique:

One of the most difficult patient emergency situations for the practitioner is the intraoral repair of a bridge that has broken between two pontics or between a pontic and an abutment. Chance of long-term success is minimal, and, often, it becomes a financial and stress provoking nightmare for you the clinician. The traditional method of repair involves cutting an occlusal groove or notch in two of the crowns; some type of splint mesh, wire or bar is placed within the cutout as a connection; the remaining voids are filled with composite or amalgam to hold everything in position.

Unfortunately, due to the extreme occlusal forces of mastication or in some case grinding or clenching, it’s usually a matter of time before the repair fails and the patient has returned and so has your headache. If you were the clinician who fabricated the original bridge and it’s less than 5 years old, you probably will end up “eating the cost” of a remake, and it becomes your financial burden. Emotionally, getting a “free” bridge is not enough for the patient. In their eyes, they picture losing more time from their daily schedule for more visits to their dentist with more injections, more impressions and more anxiety.

If this sounds familiar, then you are really going to love what you are about to read. Dentatus has come to the rescue with our MTI-Monorail Transitional Implant System. We have solved the missing piece of the puzzle. Originally the framework for the bridge was cast as one piece or soldered in sections. Typical intraoral repairs fail because while crowns are splinted together, the splint materials become a weak link, and the two sections of the bridge are basically cantilevered.

Recommended Reference Article
• Rasvasini, G. Ugolini, G. Dalla Turca, S. Ravasomo, F. “Protocollo operativo per l’utilizzo di impianti provisori immediati (Mini Transitional Implants-MTI)” Dialog: Rivista Pratica Per II Team Odontoiatrico Edizoni Mattina Bologna, Anno 1’ Numero 1

STABILIZING EXISTING DENTURES

If you are having difficulty making dental implants a routine part of your treatment, the concept of using MTI-Monorail Transitional Implants to stabilize a patient’s existing denture is a great way to “jump start” your implant practice. In fact, most practice management consultants will tell you that internal marketing of your own patients will create a tremendous amount of new dental treatment.

Here’s our recommendation. Contact all your patients who are wearing full dentures, including those who seem to be satisfied with their existing dentures. Make them this offer as suggested by practice management consultant G.I. Johnson, “Would you be interested in a minimally invasive treatment that would slow down the resorption of your ridge and temporarily stabilize your denture for $1,500?” You are allowing your patient to have a relatively inexpensive trial run to experience the “feel” and advantages of a more stable denture, that will permit them a year from now to return to the present situation if they wish. Once the comparison is made, very few patients will want to go in reverse.

Do the math yourself. For example, if 20 denture patients accepted your proposition, one year later you would probably have a large percentage, maybe 18-19 patients, who agree to implant-supported overdentures. Some dentists may hit the jackpot with 1-2 patients requesting fixed implant-supported prosthesis instead. Presenting transitional implants in this manner is less intimidating to the patient both financially and emotionally and will open their minds to accepting more long-term solutions.

Here’s the technique. It’s simple. Six to eight MTI-Monorail implants are placed along the crest of the edentulous ridge. Using prosthetic components from our MTI-Monorail System, an acrylic/metal splint is fabricated and cemented to the MTI implants. The patient’s existing denture is hollowed out under the teeth, and the denture is retrofitted using soft reline material. The patient is shown how to insert and remove their dentures, as well as how to clean under the splint.

The same protocol may be used at the time of surgery when placing conventional implants so that the patient is never without teeth and can return to his/her daily lifestyle almost immediately. During the surgical healing period and the time necessary to complete the final prosthesis, they will have a stable temporary restoration that will be comfortable, enable them to function well and will be pleasingly cosmetic.

Recommended Reference Articles
• Rossein, K. Boris III, F., “Stabilizing a Full Denture with a Transitional Implant-Supported Splint”, Contemporary Esthetics Restorative Practice Vol. 5, No. 3, March 2001, pgs. 68-76
• Bohsali, K., Simon, H. kan, J., Redd. M., “Modular Transitional Implants to Support the Interim Maxillary Overdenture”, The Compendium of Continuing Education in Dentistry Vol. 20, No. 10, October, 1999, pgs. 975-984

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