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Video Details
Immediate Molar Replacement Utilizing Narrow Diameter Implants - Allowing Implant Placement in Almost Any Situation - Part 1 of 2

Description:
Immediate molar placement has been widely reported in the literature with excellent results. All the studies insist that a wide diameter implants are essential as they are the only way to achieve primary stability and are the only implants that can handle the forces that molar regions produce. But there are a number of problems with wide diameter implants. This presentation will dispel all these myths as well as show how narrow diameter implants can not only handle the forces but also make immediate molar placement more predictable and possible in almost all scenarios.

Date Added:
8/6/2012

Author(s):

Howard Gluckman, BDS, MChD Howard Gluckman, BDS, MChD
Dr Gluckman completed his dental training at the university of Witwatersrand in Johannesburg in 1990. After spending a number of years in a general practice he complete...
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Online Videos / Surgery / Implant / Immediate Molar Replacement Utilizing Narrow Diameter Implants - Allowing Implant Placement in Almost Any Situation - Part 1 of 2




Questions & Comments
Maurice Salama - (4/6/2014 5:29 PM)

I really do appreciate this approach. Nice job Howard. Do you still approach the Molar in the same way? How would you suggest a novice in implant dentistry approach the area? thanks Maurice

Howard Gluckman - (2/26/2011 8:19 AM)

Thanks Michael. im also a stong believer. difficult to convinve others though. regards Howard

michael ainsworth - (2/6/2011 4:30 PM)

Hi Howard, great to see someone advocating this treatment modality, I have been utilizing this technique using only the intralift kit, hand expansion (no drills) and 3.5 ankylos for a couple of years I use a single type or combination of synthetic graft materials dependent on the site (no membrane) . I have even used it on two members of my family.

Howard Gluckman - (1/17/2011 9:55 AM)

Sameh we always treat our cases with antibiotics preoperatively as per Carl Misches protocol in Implant Dentistry. they were all given a prophylactic dose of either amoxicillin or clindamycin 1 hr before and 6 hrs after. we did not immediately load or temporize any of the cases in the study if they were alone but did do 3 or 4 cases that were part of a full upper reconstruction. we did have stricter criteria for this though and this was a very thick furcation that completely covered the implant with bone. And they needed to have a turn in torque of at least 35Ncm. I have subsequently done some with immed provisionalisation but no loading. they have worked very well but also had the same criteria as mentioned above.

Howard Gluckman - (1/17/2011 9:50 AM)

Hi Wleed. I am using the mectron 3 unit so I am using their implant preparation bits. I only move onto an ankylos drill if the base of the osteotomy bone 360 degrees to actually hold the drill without jumping around. this is most often the case as the furcation bone generally widens at the base. However i have just aborted a case right now where the abscess had eaten distally from the MB root and as a result had weakened and thinned the furcation not allowing me to get primary stability which is so critical in these cases. thanks for the comments.

sameh barsoum - (1/17/2011 6:28 AM)

thank you for the response. 2 more questions:
you mentioned apical radiolucency cases were included in the review. Did you treat them any differently like preop or post op AB?
Was there any of these cases immediatly restored with an abutment and a provisional crown?

Wleed Haq - (1/17/2011 4:47 AM)

Dear Howard, thanks for the presentation - I admire your innovative approach with the ankylos system. If using the piezo to start the osteotomy are you then progressing straight to the Ankylos A drill. Any reaming or tapping? Am I right in saying that you are using the large balance anterior healing abutments for transmucosal healing for your cases? Many thanks

Howard Gluckman - (1/17/2011 1:52 AM)

Hi Sameh thanks for the positive comments. The start of the pilot drill depends on the thickness of the bone. if the furcation is very thick then one can use a normal round drill or lindermann drill or any other system you wish. If however the bone is thin then I prefer the Piezo to do this as it is easy to make your holes without any cavitation at all. it makes a clean pilot hole without any risk of damaging the small furcation. with regards to packing the socket I generally mix only with blood. it is essential to use a periodontal probe to pack the bone as it quickly gets stuck in bottlenecks and thus leaves the apical areas without any bone. although this will most likely fill with the patients own bone I prefer to ensure a complete fill. I do not use PRP or PRF at all I have not yet found any great research to justify their use. PRP has all but been banned in a lot of the European countries as a result of the Bovine thrombin that has to be used that is why the prf is now being used as well as the fact that it is simpler to use. but the research for this use is scarce at best and I see no justification for it in my practice but others might disagree. It certainly cannot harm so if it works in your hands I see no reason not to use it. regards from sunny cape town

sameh barsoum - (1/16/2011 11:41 AM)

You know a speaker knows what he/she's talking about when they answer your questions before you ask.
Excellent presentaion indeed... thank you.
Just a couple of questions:
How do you start your initial dril into the furcation? spear bur, round bur? How dense/deep do you pack the sockets with the graft material? Do you mix the material with blood, prf, prp...?

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