chair side implant length selection

HOW TO SELECT AN IMPLANT  OF SUFFICIENT LENGTH NEAR iAN CANAL 

Selecting maximum lenghth for an implant close to the ian canal is always a challenge,  A cbct is definitely invaluable and so are pans but not all clinics with facility for implants have access to pans in an operatory We  order  cbct images in difficult cases Panorams are requested  as a pre  - post operative assessment tools but we depend hugely on digital IOPAs intraoperatively and for selection of the implant lenghts 

The following procedure describes a simple method to determine the length of available bone from the crest to the superior border of the inferior alveolar nerve canal.

.Using a preoperative IOPa, select an endodontic post ,as a tentative length

We use mani stainless steel posts which are available in 4mm-19mm lengths 

 The selected post is measured in an endobloc

mani ss post

 Mani provides endodontic posts
in an assorted box






Cover the sensor with a cello foil,

Use cyano acrylate quick set adhesive, dip the selected post in the adhesive and with a pair of tweezers place it parallel to the  to the sensor , the post adheres immediately and will not fall off accidentally during imaging ,an additional security measure would be to insert this assembly into a protection sleeve.

Imaging is now carried out as routinely, A calibration tool in the imaging software can now be applied to calulate the elongation or shortening. The errors can be virtually eliminated if we use a rinn holder, however it is advisable to manually measure 

Repeat the xrays with still bigger post till the selected post is 2.5 mm superior to the superiormost radioopaque border of canal

A color temperature tool will demarcate the anatomy precisely

color tool

 The use of holders will keep the post parallel to adjacent roots and in the same intended path of implant placement

a rinn type of sensor hoder

 We can go on to prepare the osteotomy without the fear of accidentally perforating the inferior alveolar canal , a safety margin of 2 mm is recommended

scope of dental implants in general practice

General dentists in several countries can place implants after receiving training in implantology, courses are available in various modules , weekend courses etc, in a recent survey it was found that more and more general practitioners are placing and restoring their own cases.(http://thewealthydentist.com/surveyresults/20_dentalimplants_results.htm/

The situation in india is no different , as a general dentist trained in implantology I am  able to schedule my cases according to my convenience and time,since I am already providing general dental care to my patient, I can better understand his/her perceptions and expectations.Patients too are more receptive but of course the general practitioner should have sufficient exposure to be able to handle the clinical scenario presented.

We should spend time on presurgical evaluation and not hesitate in ordering dentascans ,lateral cephs or OPGs, they do burden the patients pocket but provide valuable information which might be missed out in routine x rays, and can have positive bearing on the final outcome. 

macro views of nobel replace kit

nobel replace taps

dear friends
here are some macroshots of the  nobel replace internal irrigated drills and components
We have tried three systems so far
MIS
Leader
and Nobel replace

nobel replace 2 mm pilot drill

marking drill

unigrip driver

parallel pin

narrow platform drills

wide platform drills

the layout