Implant Seminars

Live Surgery

Dr. Arun Garg – June 27, 2009

Ramus (Autogenous… not autologous) Block Graft Exposure

After 5 months expose

Vertical releases, midcrestal incisions

Remove screws from bloc

Osteotomy for implant placement

Place implants

Horizontal mattress sutures

Square knot

3 knots, the last one, switch your hands’ directions

Marcaine at the end ½ carpule each site

5 minutes of pressure

Scrubbing In

Sterile technique

Salvin: offers scrub packs and JBlocks

Scrub in up to elbows

Chlorhexidine pre-op rinse and irrigation

Sterile gloves

J-block with BMP

Infiltration with lido w/1:100,000

Midcrestal incision with vertical releases 1 tooth over

Release all muscle apically

Use Piezo to clean off soft tissue from bone

To Decorticate

And to create inlay site

Try-in J-Block

Modify shape of J-Block to fit inlay site

BMP Mixed up

Place JBlock in BMP

Screw has to engage 5mm of natural bone for retention

Screw in J-Block, place bone and BMP collatape pieces

Suture with horizontal mattress

No Peridex 1^st week

Use Augmentin 875 or Clindamycin 300

Grafts are JUST SCAFFOLDS

If infxn: Augmentin 500 tid 10 days start day before sx, Flagyl 375 tid 10 days

FEES

Unilateral 1 tooth 3200

Bilateral 1 tooth 3800

Unilateral 2-3 teeth 4200

Bilateral 2-3 teeth 4800

Unilateral Edentulous 5800

Bilateral Edentulous 7800

I’m in the process of getting my table ordered!

Implant Seminars

Live Surgery

Dr. Arun Garg – June 26, 2009

Psychological Sedation

Garg uses an eye mask as eye pillow

PRP

BTI $5000 – Centrifuge $1000 and Packs $10-15

Harvest $6000 – Centrifuge $3000 and Packs $100

ACE $2000

CT Planning Software

Blue Sky Bio – Now available for no cost

Bone

Osteolife Biomedical: $80/bottle

50-250 microns – Best bone comes out of it

300-500 microns – Good

800-1200 microns

1000-2000 microns (1-2mm) Most difficult to condense and worst to heal, but easiest to handle

WANT MINERALIZED BONE

Dynablast is poorly demineralized

Osteoblast is half mineralized/half demineralized

Autogenous Bone in a Bottle

BMP – $850 per bottle

Wait 6-7 months

There will be a LOT of post-op swelling but no pain

Due to influx of millions of cells from BMP’s signals

1 week of swelling

BMP lasts 3 days

Maxillary Sinus Lift

Window

Superior line: 15mm

Inferior line: Ridge plus 3mm

Aseptico 1:1 Straight handpiece for Sinus Lift osteotomy

Piezo to finalize the window

Elevate sinus SLOWLY

Gauze soaked with 1:50,000 epi for hemostasis

Osteolife small particle mixed with salin

Use Cut off syringe to place bone

Use island of bone for coverage

Then cover Collatape with saline

Dental Health Products

Vicryl Type of suture

Made by LOOK

Close with horizontal mattress

½ carpule: Marcaine at the end for discomfort

Implant Placement

Midcrestal incisions

Primary closure with Vicryl

Note: Use sinus elevators as adjunct for reflection

Stage 2

Steal tissue from palate

Create papillae with palatal tissue

Papilla suture 5-0 needs to be fine

Vertical mattress suture

Flap sutures should be 3-0

Note: Use sinus elevators as adjunct for reflection

Sutures

Gut is good for vertical releases

Vicryl is good for crestal incisions

1 Wall Defect – Maxilla

Open flap, past muco-gingival jxn

Remove all soft tissue on the bone with Piezo

Mix water and BMP particulate

Impregnate collatape with BMP – 15 minutes

BMP binds to collagen

Then put BMP on bone

Place bone, pieces of BMP in collatape

Primary closure with horizontal mattress

Note: Use sinus elevators as adjunct for reflection

Heal time 8 months

Atraumatic Extraction& Socket Preservation

Raise a flap

Vertical releasing incisions

Make sure you pass the muco-gingival jxn

Release the flap so that you can get primary closure after ext and bone graft

Note: Use sinus elevators as adjunct for reflection

Piezo for creating PDL space on an ankylosed tooth

Atraumatic ext

Decorticate socket with Piezo and High speed #8 round diamond

Graft site with small particle with saline

Primary closure with 4-0 vicryl

Close the vertical releasing incisions with either the vicryl or gut

Heal time after bone graft

Molars: 16 weeks

Canines: 12 weeks

Premolars: 10 weeks

Upper centrals: 8 weeks

Lower Incisors & Upper laterals: 6 weeks

Implant Length

Length

Molar – 15mm

Canine – 13mm

Premolar – 11mm

Upper Central – 9 mm

Upper laterals and lower incisors – 7mm

Ridge Split

Raise a flap

Vertical releasing incisions

Make sure you pass the muco-gingival jxn

Release the flap so that you can get primary closure after ext and bone graft

Make it split thickness when it is apical to MGJ

Want to release muscle attachment

Note: Use sinus elevators as adjunct for reflection

Must use a Piezo for ridge split

NO OTHER OPTION

8mm vertical saw blade on Piezo

2 vertical cuts just through the cortical bone

Need at least a 3mm ridge to do this

Basically cutting bone on 3 walls, but maintaining bone at apex

Use ridge split kit to widen ridge

Place tapered implant

Posterior Mandible ridge thickening

Few options:

Ramus block

Chin block

J Block

Ridge split

BEST OPTION

Implant Seminars

Esthetic Outcomes in Implant Dentistry

Dr. David Garber – May 9, 2009

Sinus Lift

Use Metronidazole (Flagyl) in the sinus

Chin Block

Simplant will fabricate a Stereolithographic model out of the DICOM

If you want a LARGE bone block graft, you go through the mandible with Pieso through and through – bicortical cut

Fit the bone to the model, drill through

Vestibule goes back to normal within 2 years

Terminology

EFFICACIOUS – Defined as the probability of benefit of a tx when provided under ordinary conditions by the avg practitioner for the typical pt

He wants to give guidelines to think it though

Multiple Missing Teeth within the Esthetic Zone

Pts don’t come in for implants, they come in for: Esthetics, function, and normalcy

When missing centrals and Laterals, you lose bone buccally, palatally

Lose the arch form

Need to do narrower teeth, placed more lingually

Often times end up with LONG, skinny teeth with BROAD, LONG contacts

They end up being very rectangular teeth

The incisal edge starts to change cervically and lingually

The zenith changes from distal to slightly mesial

Get shortening of the perimeter of the ridge

Lip collapses

Showed us a case with 3 crowns and 3 implants

Difficult to maintain papillae between 2 implants

In retrospect: Instead of 3 in a row, do 2 with a pontic

BIG anterior defect around 3 implants

Salama, Garber 1995 JED: Use 3mm healing abutment with LOTS of CT graft over it acts like tent (The longer the tent pole, the more tissue you get)

Use ovate pontics to develop the site

Bone sounding IHB to visualize

PUT THE MIDDLE implant to sleep, don’t yank it!!!

Just don’t use it

Make sure you look at the entire arch: look for any need for tissue treatment

Crown lengthening?

Essex retainers are excellent for temps

Don’t do a flipper

Vertical bone is MUCH harder to rebuild than horizontal bone

Can get horizontal bone very predictably

Bone between implants and teeth

Esposito 1992: 1.5mm tooth to implant interproximal

Tarnow 2000: 3mm implant to implant

Avg: 3.4mm height of a papilla between 2 implants

That’s an average… 30% will have less than 3mm of papillary height

At centrals… you may want to consider platform switching to maintain the bone

Novaes (Bazilain): Shows that bone comes up between implants when they are 3mm apart, NEVER less than 3mm

Abutment/Implant Junction Inflammatory Cell Tissue Infiltrate (ICT)

2mm down and 1mm outward: Ericsson

Staging

If you have 2 centrals that need to be removed

Take 1 out and pace 1 implant, wait for healing

Then do the next a couple of months later

Platform Switching

Palotrisi: Platform switching

If you have platform switching, you need at least 1mm difference

Protect the developed site

ZEKRYA: Gingival retraction during prepping to save the meat

Trisi Vris: 2 pice platform switching makes a HUGE difference, but 1 piece does NOT

2 or 3 Implants

Do 2 instead of 3 in a row: you will have papillary loss

SOFT TISSUE HARVEST

Go from mesial of 1^st molar distal of canine

1^st Cut 15C is right angle all the way down to bone

2^nd cut 15C is parallel to palate

4-0 silk in X Form

Use 15C blade

Tunneling technique protects the gingiva

If you can’t get coverage, you must use autogenous CT

If you can’t harvest enough tissue, start using dermis

NOTE TO SELF: JOIN AGD, DOCS

Endodontically treated teeth

Can cut them at the gingiva or sub-G and cover it with CT to help MAINTAIN bone

JUST cover it up and put it to sleep

Notched teeth (V-Shaped)

USE GLASS IONOMER: Shofu (no hybrid)

THEN place C or dermis

Management of Fully Edentuous site

Can use his existing denture

Cover with Barium, take a CT

Drill thru the denture

Block it with Barricade (DENTSPLY) – It’s actually a periodontal dressing

For screw access holes

Punch holes on rubber dam

Reline with locators

The zone in the fully edentulous case

SURGICALLY GUIDED stents and model

Place 6 implants, parallel, and make a denture with gold copings

Titanium screw retained substructure

Surgically guided stent

Make titanium substructure

Pink composite

Use Panavia to cement the crowns

Severe Periodontal Disease

Upper, save whatever you can by splinting for now, 1^st visit: PUT IN LOTS OF BONE

1^st Visit: Temp supported by 5 teeth

2^nd Visit: Then a few months later, place 6 implants

3^rd Visit: 6 more fixtures into ext sites

Lower: Keep 3 teeth to maintain inter-arch relationships

2^nd Visit: Get bite relationships

2^nd Visit: EXT all except 3 at first, do a pick up temp denture on all but 3 implants

Screw retained hybrid

2^nd Visit: Place 8 fixtures, do a lower hybrid

3^rd Visit: Finalize and do cermic/metal

For immediate loading you can do it on roundhouse

Primary stability – Purely mechanical (Putting a screw into wood: NO biomechanical)

Secondary Stability – Osseointegration: this IS biomechanical

Cumulative Stability – The total stability of primary and secondary combined

Terrible decay on a Failed Roundhouse bridge

Ext 3 remaining uppers, place 12 implants

Cross arch stabilization

This took him 14 hours to do (first time)

Digital Rendering

Use Simplant

Get Atlantis Abutments made

Severe perio, partially edentulous (lot like Mr. DC)

1: Remove severely compromised teeth, make an essex

Essex uses denture teeth

1: Use Essex with Barium Sulfate and take a CT (Could use TempBond)

2: Plan bone grafting

Sinus lifts, bone blocks

Use laser to open up the short vestibule

3: Roughen snapcaps with prophyjet

Make temp and cement with tempbond

Multiple Teeth Missing

Judge needs them ASAP

Use available bone

Ext’s, guide, place implants

Barricaid

Fill into a syringe, place, wipe off excess with alcohol

PRGF

$1000 for unit, less than $14 per use

Papillae

Can partially recreate papillae AS AN ALTERNATIVE

Orthodontic extrusion if horizontal bone loss

CANTILEVERS MUST BE SCREW RETAINED

PINK CERAMICS: Christian Coachman

Look for his tough pink ceramic cases, look up Christian Coachman

MAKE SURE YOU HIDE THE SEAM WHERE THE PINK CERAMIC/COMPOSITE INTERFACES WITH GINGIVA AND THE LIPLINE!!!

Pink Ceramic, roughen it, create space for FGM, Etch with Hydrofluoric acid, Cover porcelain, Silanate

Then DIRECT PINK COMPOSITE

Needs to be considered IN ADVANCE!!!

Photography

Draw lines on the pictures!!!

Evaluate gingival margins!!!

Evaluate papillae

Evaluate smile line

Do a diagnostic waxup too!

Use this for Essex

Implant Seminars

Esthetic Outcomes in Implant Dentistry

Dr. David Garber – May 8, 2009

 

Dr. Garber

·         Periodontist and prosthodontist

·         “Change Your Smile” Ronald Goldstein

Topics

·         Implants 2009 (What are the main concerns)

o   Rapidity

§  Design

·         Microgeometry

·         Macrogeometry

§  Tissue Engineering

o   Esthetics

§  Labial

§  Proximal

Illusion of Reality

·         Esthetics is about beauty

·         The soft tissue is the biggest factor

·         The CHALLENGE

o   The porcelain is no longer the challenge

o   Redeveloping bone is tougher than porcelain

o   The REAL challenge is THE ZONE: 3mm Papillae, Keratinized tissue

·         PINK, WHITE, LIPS, FACE

Components of Implant Esthetics

·         If the ZONE is intact, the restoration is simple

o   Look at buccal gingival contour compared to contralateral tooth

·         In order to avoid esthetic failure, you need to DEVELOP the site

ALL IS AVAILABLE ONLINE: www.dentalxp.com

·         Type 1 Site

o   Ideal

o   Great bone

o   No loss of buccal plate

o   Normal interproximal contact

·         Type 2 Site

o   Labial plate is gone

o   Great Interproximal bone

·         Type 3 site

o   Interproximal bone loss

§  No way to regenerate interproximal bone

o   Horizontal/Vertical

·         Timing, Positioning and Sequential Staging (Funato, Salama, Garber, Int J Perio Rest Dent 2007; 27:313-323)

o   Look at Table 1: Timing, when to do immediate, staged surgeries

o   Look at Table 2:

Type 1 Case

·         You want to prevent the loss of the buccal plate

o   Use BioOss outside of the buccal plate to have slow resorption and prevent the loss of buccal plate

·         Ronal Jung: 2mm rule – Need 2mm of gingival thickness to prevent visualization of implant abutment (titanium or zirconia)

·         Grimdau (sp?) Another 2mm rule: Need 2mm buccal bone to prevent loss of buccal plate

 

ONE ABUTMENT, ONE TIME

·         Due to bone loss around gingival collar: Occurs within 1 hour

·         Misch claims that the loading stress causes the circumferential bone loss

·         IN REALITY: BACTERIA coming out of the screw hole cause the circumferential loss

o   Affects the biologic width

o   Abraham: check it on DENTALXP.com

·         HOW TO AVOID IT:

o   Platform switching

§  3I and Ankylos do it

§  A way to compensate for bone loss

o   Dentomycin (must get it from Canada)

§  It’s acromycin in a gel form

·         Less Bacteria

§  Sometimes need to use cortisone as well

·         Less inflammation

·         Best abutment connections for bone preservation: BICON (but no way to index the abutment, need to hammer it in, and no threads to implant)

·         NOTE: You need 2mm buccal bone to preserve the buccal plate

CRITICAL THINKING IN ANTERIOR IMPLANT PLACEMENT

·         Avoid stressing the labial plate’

·         Graft the xt socket whether or not you place the implant abutment

·         Allograft/Xenograft for longer term maintenance of scaffolding effect

·         Minimum 2mm of Soft Tissue thickness

·         Minimum 2mm of Buccal bone thickness

·         BIOTYPE

o   If thick biotype: No flap, Atraumatic ext, place implant, try in different types of contoured abutments, find the best one, and seat that one PERMANENTLY (eg Zimmer HLA abutments), Make a temp

o   If thin biotype: Flap it, graft it with bone AND Soft tissue from the palate

·         Submergence profile

o   Don’t see it, but has a HUGE impact on buccal gingiva – should make it concave

o   Concave preserves buccal tissue

o   If convex – Will cause recession (NOT GOOD)

o   If concave – Will cause growth of tissue

·         Emergence profile

o   If you want more tissue, make it less convex

o   If you want to push down the tissue, make it more convex

2 QUESTIONS TO CONSIDER WHEN TX PLANNING

1.       Smile Line?

a.       Is it high?

                                                               i.      Better Make sure you look at things VERY carefully

2.       What are the patient’s expectations?

a.       Not only of the implant, but of ALL the teeth

Type 2 Case

·         Loss of buccal bone

·         USE A BLOCK GRAFT from the ramus or the symphysis

·         Use a pieso: nice clean cut

·         Check bone with sounding: use a #30 endo file

·         These kinds of grafts require Bio-Oss bone as well

·         Wait 3 months before implant placement

Type 3 Case

·         Loss of interproximal bone height

o   CANNOT regenerate interproximal bone height with surgery

o   Need to use ORTHODONTICC EXTRUSION TO GAIN INTERPROXIMAL BONE HEIGHT

·         A hopeless tooth is not useless, it’s actually quite useful

o   Orthodontic extrusion

·         SALAMA & GARBER 1998

o   Papillae presence based upon Interproximal Height of Bone next to the NATURAL TOOTH (Not the implant)

·         Orthodontic extrusion

o   Can extrude a tooth 1mm every 10 days

o   Nitenol wire 012-014 (for lighter forces)

o   Must keep shaving the incisal edge

o   Once at the right level, WAIT for 3 months before ext and implant

LARGE Block Grafts to build mandibular posterior height

·         Wait 4 months before placing implants

Smile Design

·         Make sure you have gingival contours related to the upper smile line

·         G+L+I=Case Type

o   G=Gingival Harmony

o   L=Labial Plate

o   I=Interproximal Height of bone

·         Patient expectations

o   Periodontal

o   Occlusal

o   Structural

o   NOTE: Biotype (if thin, add in costs)

·         Lip Line

o   How it relates to teeth

·         Age

o   Make sure epiphyses are closed (Female: 16y/o)

·         Do an initial SMILE ANALYSIS

o   Look at gingival contours

Semilunar Grafts

·         Semilunar incision at MGJ

·         Sulcular incision Sharp Opthalmic blade

·         Slide down the tissue

Tunnel Technique

·         Use Brassler Tunnel technique

·         Use palatal tissue

·         NO brushing for 10 days

·         KIRK PASQUINELLI on Dental XP

Frenectomy

·         Laser

Loss of Papillae

·         ALWAYS DO ORTHODONTIC EXTRUSION

·         Note: There is a COL between the buccal and palatal papillae – that’s where the contact point is

·         Sounding witn an endodontic #30

On Congenitally Missing Teeth

·         Must recontour the bone before placing the implant

·         Use soft tissueto help the contour of the buccal

·         Place implants deep, especially on buccal side

·         Lateral incisors

o   Missing bone buccally

o   Look at Hand Film to see if the epiphyses have formed (Thick Lamina Dura at the end)

o   See if they changed shoe size, or if they’re growing

o   Too much bone interproximally

o   Need to recontour bone, AND need to augment the buccal with palatal graft

Immediate Placement after Ext

·         Periotomes ONLY to be used on the Palatal, NEVER on buccal

·         Be as atraumatic as possible

·         Schein sells the TITAN EASY EXTRACT: Amazing extraction technique

o   Brasseler is excellent

o   Flatten the root

o   Use the drills in ORDER (White, Red, Blue)

o   Torque it in all the way to the base

o   See the line on the drill bit

o   Try in the tray without the putty

·         ANKYLOSIS

o   Drill through the apex with implant drills, and LOTS of water

o   Drill all the way until you see blood

o   Then use the periotome

o   If you see external root resorption

§  CUT the crown off

§  Core it out

Pieso Surgery

·         Wonderful way to remove teeth

o   Split root with Pieso

o   Infracture the lingual’Then infracture the buccal

·         Also great for harvesting bone form chin, mandible

Technique

·         After extracting atraumatically, Prognastically evaluate the site

·         KNOW YOUR SOUNDING DEPTHS

·         Selection of Implant Diameter & Position

o   1990’s: BIGGEST implant possible

o   2005: Smaller is better

·         Less than 2.25mm between implant and buccal plate: don’t need to graft

Immediate

·         Loading

o   Cross arch stabilization

o   OK

·         Temp Single tooth

o   OK

·         Unilateral bridges

o   DON’T DO IT!

·         40Ncm is OK to load with temporary

·         If you undercontour papillae, the get shorter

o   You need positive connection

·         If you undercontour the buccal emergence profile, the gingiva grows occlusally

o   You need negative contour

Gingival optical Esthetics

·         Zirconium needs fluorescence to make it more natural

Dr. James McAnally – April 25, 2009

American Dental Implant Association
The Miami Implant Update
Dr. James McAnally – April 25, 2009

Strategies for Boosting Implant Case Acceptance

· In Times Like These… How do we succeed
· We are in the business of Marketing and Sales
· What do we do at meetings?
o Learn Techniques
o Dr. Atcha uses McNally
· Business
o Non-dental sales course last 2 years?
§ Yep
o Dental Sales Book
§ Yep
o Non-dental sales book
§ Yep
· 80% of success is just showing up – Woody Allen
· 2003 – Aron Ralston
o More focus, more purpose AFTER getting stuck under a boulder and knowing off his hand
o Today 80% is thinking, 20% is Practical
§ Global changes at work – recession is going on… economics
§ Why get better at sales (Case acceptance)
§ Common worldwide dentist sales frustrations
§ Capabilities vs Opportunities
· Economics and History 801
o The World is Flat
§ While we were fighting terrorism for 10 years, the world kept moving
o Slumdog
§ Many people motivated to work harder
· Creative Destruction
o Look at Kmart, Sears
o Kodak, Plaroid
o Seattle Times, San Fran Chronicle
o ALL GONE
· Law of Accelerating Return
o Progress is EXPONENTIAL, not LINEAR
o Technology is 10 times as fast
o EVERYONE is going to be around a LOT longer
§ 1900: 48 yrs avg life expectancy, now 78
· Get a FLIP
o Testimonials
· What about dentistry?
o It’s only going to get more complex
o Teeth will be needed/wanted longer
o Cost will always go up
o BUT… Patients will want even more SIMPLICITY
· Overview
o Selling (better case acceptance) as a dentist requires
§ Modifying you/your team’s actions
§ Acknowledging that persuasion is a science
§ Altering dr, staff, and pt mindset
· Why get better at selling cases?
o Greed… do more tx
· Why get better at case acceptance for elective tx?
o The dental economy is changing RADICALLY
· New rules emerging in the business of dentistry
o Big chunk of bread and butter middle class is leaving (because of flattening of the globe)
o More tx’s fall outside of insurance
o Dental insurance will become even more obsolete
o Global trends are unchangeable
· It’s the BEST golden age EVER in dentistry
o Newer, better, faster, more esthetic, more predictable
o Training has never been easier or faster
o Equipment, Training
o Rebuild a smile for anyone: it’s life changing
· Reasons to get better
o The economis
o The new dental economy
o The golden age
§ MOST dentistry is ELECTIVE
· Dirty dozen of Universal Case Acceptance Frustrations
o Not knowing what to present with cases
o Pts not owning their problems
o Not having financial ability
o Presenting to pts who aren’t ready for tx
o Difficulty getting large case acceptance
· Sales pyramid
o Close sales (Top)
o Make “NOISE” in the market
o Practice management systems
o Clinical education and technical competence (Bottom)
· Underlying factors
o Capabilities vs Opportunities
§ We have 2 sets
· Clinical Capabilities
o Dental School
o CE
o Residencies
· Non-clinical Capabilities
o Practice Marketing systems
o Case acceptance systems
§ Opportunities
· Patchwork versus Full Mouth
o Capabilities
§ Take a course
§ Easy to get there
o Opportunities don’t get bigger by increasing the capabilities
o To increase our opportunities
§ He have to improve our setup
· How do we get setups?
· 7 common fallacies in thinking that further hinder case acceptance
o #1: Misunderstanding Credentials
§ If I get more letters after my name… I’ll get more credentials
§ Must use, describe the credentials in ways that actually MEAN something to pts
o #2: I need more CE
§ Most dentists need to READ more books
o #3: Believing technology sells
§ They don’t buy the technology, they buy the solutions
o #4: Bigger menu’s are the answer
§ Lava, Procera… Pts don’t care
§ Dental menu’s are TOO complex
· Maximize benefits, minimize losers by KEEPING IT SIMPLE
o #5: Believing Patients are Logical
§ Not really, unless they are engineers or teachers
§ Behavior is the same for most
o #6: Being good at sales means high pressure
§ It doesn’t work for high-cost products
§ Sandler, Gitomer, Sandler, Ziglar
o #7: Not understanding the magic bullet
§ Competition is minimal… Must master the COMPLICATED
§ 20% MAX
· 8 Strategies for next week
o #1 Caveat: NO MAGIC BULLETS
§ Make your marketing messages
§ Match the problem you wish to treat
· Why does this boost results?
o Getting the right pt dramatically boosts case acceptance
o Pts seeking answers to their problem
§ Undertsand Branding
· Pts with problems wanting implants don’t care about you as the brand
§ Freat FREE examples of Medical Messgae Matching
· Cynergenics
o #2: Always remember, The Fear of Loss…
§ Proof:
· Recent financial panic
· Robert Cialdini
§ I (Heart) Dentures
· No one wats them…
· Easy image to sell
o #3: For BIG $$$ implant cases, separate the exam and case presentation visits
§ All in one
· Consult
· Disgnostics
· Fee presentation
§ Effective intervals between visits BOOSTS sales
o #4: Screening systems to find those more likely to say yes to tx
§ Low odds…
§ The “Funnel” principle of marketing
§ Qualifying: Only working with pts that are going to buy from you
§ Extra No’s
· Don’t need to talk all about opening vertical
· How much time Is wasted?
o #5: he larger the $$$ amount, the more professional we should look
§ Got to have PERFECT teeth
o #6: Dr. and staff communicate only in ways that reduce complexity
§ Must practice… forever
§ LOSE all dental Jargon
§ Even applies to marketing
§ Goal: Reduce complexity in the pt’s world
§ As case complexity goes up, tx discussion must be reduced
· 30min max
§ Patients want:
· Respect
· Simple explanantion
· 2-3 options
§ Must monitor yourself
o #7: Develop systems to prevent fee sticker shock
§ I didn’t know it would cost that much
§ Pts have no idea what the cost reference point is for dentistry
§ Use FEE FRAMIMG
· Tell them the range of what stuff costs
· My range is higher because I know how to sell
· Verbally… during diagnostics
· Preemptive… written materials as part of the financial “screening/qualifying”
· Also verbal range of $ during diagnostics
§ BIGGEST problem
· Present fess CORRECTLY
o 1 dr closes the case
o #8: Use appropriate case acceptance technology
§ “What if” imaging is CRITICAL
· http://www.smilevision.net/
o Reduces complexity
o 24” monitor for effect
o Image single teeth, quadrants, everything…
· Permanent solution
o Understand how you arrived at your frustrations
o Acknowledge fallacies in your thinking
o Change your thinking
o Study those who have already fixed their frustrations
o COPY THOSE WHO ARE SUCCESSFUL
o Systems are:
§ Step by step, tested and proven actions
§ 1 or 2 implants: Simple (Single engine plane)
§ More and more specialized (Jet)
o Define your expectations for case acceptance
§ Short term patches and long term systems

Renzo Casellini, MDT – April 25, 2009

American Dental Implant Association
The Miami Implant Update
Renzo Casellini, MDT – April 25, 2009

A New Dimension of Esthetics

· CRAZY introductory video…. Neat!
· 22 yr old in a bar fight lost #8,9
o BAD result of tissue (fired and inflamed) and papillae are flattened
o Needed to use esthetic caps – creates the emergence profile
§ Cut off the chimney and have flipper stay off of the tissue
§ TEMPORIZATION IN anterior zone is VERY important
o Gingiva came back to health
· Teamwork = Success
o Surgeon, Dentist, CDT or MDT, hygienist
· Newest technique in Zirconium
o Full arch fixed: ZirkonZahn
o 1 piece Zirconium bridge
o Connect implant abutments with GC resin… not duralay
o Screw in, cotton plugs, Composite plugs made by lab which get bonded in with flowable
o New zirconium full mouth cases, carved like a key
· http://www.renzoswissquality.com/
· Immediate case
o Index teeth, Immediate ext, place implant, grind extracted tooth, place cover screw, reline extracted tooth with composite, use impressing abutment with composite to get gingival contour and emergence profile à send to lab for temp fabrication, bond ext tooth relieved on cervical by 1.5mm to the adjacent teeth so that there is no load on implant
· Multiple Single Implant Crowns
o Esthetic caps to be used to maintain papillae
o NEED diagnostic wax up
· Titanium CAD/CAM
o Great for Haider bars
· Teeth in an hour
o Reverse engineering
o Need anesthetic and exact depths of gingiva all around missing tooth sites
o Can make porcelain corwns… but don’t fit great
o Would rather recommend temps in a day
· Dentsply makes Esthetic Caps