Suzanne Caudry, PhD, DDS, MSc [Perio]
and the Caudry Education Centre
Newsletter Volume 15
Winter 2015
Ailing or Failing: Discussion of Case A
The Quiz containted in the Fall 2015 Newsletter introduced radiographs from four different clinical scenarios, each
involving a suspected implant complication (Fall 2015 Newsletter; Radiographs A-D; posted on www.drcaudry.ca).
Over the next several Newsletters, each radiograph will be individually addressed.
Through a comprehensive evaluation of all available
case facts and baseline records, our aim will be to
determine whether each implant in question is:
Ailing - logistics (including cost), prognosis
of remedy is predictable; high possibility of rescue.
or
Failing - logistics (including cost), prognosis of
remedy is unpredictable; low possibility of rescue.
(Dr. Caudry definition newsletter)
Baseline records may include but are not restricted to:
•The patients “CC” (if any) and MHR
•Establishment of RC interval for maintenance and records
•Radiograph - clearly demarking implant threads
•Probing data
•PI, GI, BOP (+/-), Suppuration (+/-)
•Occlusal verification preferably with the use of shim stock
•Patient compliance of night guard
•Oral hygiene status and education
•Overall compliance
•Annual assessment of prosthetic integrity
CASE A (Pertinent Case Facts only)
SCENARIO
Four years after this implant was placed (Rad A), a BW showed bone loss.
Patient was referred back to specialist for further assessment (PA Rad B).
PATIENT PROFILE
•Healthy female, 45 years-old
•No known implant-failure risk factors (including Chronic Periodontitis)
•Good oral hygiene status; compliant with a 6M hygiene RC
•No night guard prescribed
RADIOGRAPHIC DATA
MISSING: Radiographic assessment at time of final restoration
MISSING: Any radiographic assessment post-restoration (except a BW at year 4)
•Radiograph A was taken 8 weeks post implant placement. Note bone level around
implants (35 & 36).
•Radiograph B was taken 4 years later: shows bone loss down to the first major
thread of the implant (36) and no bone loss on the distal of implant (35). The
marginal bone maintenance on the distal of the anterior implant indicates that it
may be a localized problem.
A
B
NB: over 4 year no clinical records were taken by the DDS.
PROBING DATA
•7mm at 6 points around 36
•BOP detected at all six sites.
OCCLUSAL VERIFICATION
“Heavy occlusion” detected with use of shim stock (36) and light for(35).
C
CASE A Cont.
Buccal
DIAGNOSIS
The occlusal stresses associated with a poorly designed crown - in particular the
buccal cantilever, the wide occlusal table and the “heavy occlusion” - contributes to
the putitive diagnosis of Occlusal Trauma (D).
TREATMENT
Because bone loss does not extend beyond the first major thread of the implant’s
thread system, it is feasible to consider a rescue procedure and a new crown.
D
AILING IMPLANT
•The one-piece screw-retained crown (D) was removed and a cover screw placed
during treatment
•New crown was fabricated
○○Buccal cantilever removed
○○Narrowed occlusal table – while still allowing enough anatomy for food
deflection (to avoid food impaction when chewing)
•Titanium plasty, Disinfection; Polish; Bone graft and Membrane (Rad C)
•At time of insertion of the new crown (E), note the occlusal verification prior to
filling screw access channel
•The DDS and the patient have now been educated with appropriate strategies to
avoid further complications
E
2016 Study Club:
Ailing vs. Failing Implants: Diagnosis, Treatment Options, Predictability
Thursday, February 25th, 2016 (5:30 - 9:00 pm)
Thursday, September 22nd, 2016 (5:30 - 9:00 pm)
Dinner, CE points: restricted to actively referring dentists.
2016 Course: Implant Surgery for the Restorative Dentist
Course Dates
In 2013, the RCDSO revised the minimum initial educational
requirements for dentists who wish to provide dental implant treatment. Didactic & Hands-on
Dentists who limit their practice to the PROSTHETIC PHASE ONLY
of dental implant treatment are expected to successfully complete
courses involving not less than 35-hours of instruction for the
prosthetic phase and 14-hours of instruction for the surgical phase.
This two-day 14-hour surgical course is intended for dentists who limit
their practice to the prosthetic phase only of dental implant treatment
and wish to pursue a prosthetic course separately.
Friday, April 1, 2016 &
Friday, April 15, 2016
Course time
8:00 am - 5:00 pm Breakfast and lunch provided
Course tuition*
$750
CE Credits
14 hours (category 2)
Course location
1235 Bay Street, Suite 602
Toronto, ON M5R 3K4
Registration
“Get Inspired”
416-928-3444 or
[email protected]
Supported with an educational grant from DENTSPLY Implants.
*Course tuition complimentary for actively referring dentists
Suzanne Caudry, PhD, DDS, MSc [Perio]
1235 Bay Street, Suite 602 • Toronto, Ontario M5R 3K4
Telephone: 416-928-3444 • Fax: 416-972-0640
[email protected] • www.drcaudry.ca