Phelan Dental Seminars

How Do You Treat A Non-Restorable Central Incisor In Your Practice? Immediate Vs Delayed Implant Placement -Part 2

September 7, 2011 By Dr. Jim Janakievski Leave a Comment

After complete healing, the alveolar ridge appeared favorable for a flap-less implant placement approach. This can be a challenge to position the implant platform at the ideal level. If the implant is positioned too shallow, there will be insufficient room to create a proper emergence profile and crown form. If the implant is too deep, it may be a risk for future recession or inflammation.

I was very careful with measurements made clinically from the existing gingival margin and the new planned gingival margin as well as checking with radiographs. Using a computer-generated guide is another option for these cases, but will still require good clinical judgement.

The implant was positioned with the platform 3 mm from the future gingival margin to accommodate a favorable emergence profile. It is important to note that the interproximal bone must be modified to create space for the future restoration; otherwise, it may be a challenge to seat the restorative abutment and there is possible risk of developing bone necrosis due to excessive interproximal pressure. (See radiographs)

Interproximal Bone Adjusted At Time Of Surgery To Provide Room For Future Restoration

Provisional And Final Restoration

The gingival recession on the adjacent central incisor #8 (FDI #11), was improved by a semi-lunar coronally advanced flap.

After the implant has osseointegrated, it is time to shape the abundant soft tissue from that of a circular healing abutment to that of a triangular tooth form. The provisional restoration is fabricated with a sub-gingival profile that will create tissue support and an ideally positioned height of contour to move the gingival margin to the desired level.

After a couple of months, the tissue form created by the provisional restoration can be duplicated by using a custom impression coping during the impression procedures. The final crown should follow these sub-gingival contours to maintain this soft tissue form.

The restorative phase was completed with a custom cast gold abutment and a cemented PFM crown. The crown form was slightly flatter at the mesial line angle than the provisional restoration and we can see the change in the soft tissue form. Overall, the treatment sequence insured a predictable outcome for this patient.

Coronally advance flap #8(FDI #11) and flapless implant placement #9 (FDI #21)

Implant Placed According To Future Gingival Margin

Provisional Restoration

Provisional Restoration At Placement

Provisional Restoration After Tissue Shaping

Final Restoration

Filed Under: Clinical, Dental Implant, Implant, Seminars Tagged With: delayed, Dental Education, Dental Implant, Dr Jim Janakievski, Dr. Stephen Phelan, immediate, immediate provisional, Janakievski, Phelan, Phelan Dental Seminars

Envelope of Function, Part 1

January 23, 2011 By Dr Stephen Phelan 8 Comments

Using a custom anterior guide table with complex cases.

If you are planning to treat patients with more complex dental problems you should consider using an anterior guide table. Many patients with tooth wear, especially pathway wear and restricted envelopes will have milled out the envelope of function that they feel comfortable with.

It would be wise to recreate this pattern in the restorations you make for them when you restore their case. One of the best techniques to recreate this pattern is to make a custom anterior guide table for your case using the accurate, mounted study models on an articulator.

It is essential to have an accurate mounting for this technique to work and I have created my occlusion DVD series to instruct you in the step-by-step process to take the bite records and then mount the case on an articulator. I will also cover this topic in detail during my new occlusion seminar.

Once you have an accurate mounting you or your technician can use the original models to create a custom anterior guide table and recreate the patients pattern of wear and envelope of function in the diagnostic wax-up.

This technique allows you to make esthetic changes to the case but still maintain a familiar occlusal scheme that the patient will feel comfortable with.

I have included some pictures from an anterior guide table my technician, Mr. Harald Heindl has created for the diagnostic wax up for a patient with severe anterior attrition and erosion as well as pathway wear in the envelope of function. I have also included the before and after images of the lower incisors from this case so you can see the dramatic change that occurred during the full mouth reconstruction for this patient

In the next post in this series I will talk about how to transfer the diagnostic wax-up to the patient’s mouth and test the results.

Feel free to add any comments or questions using the link above.

Filed Under: Clinical Tagged With: cosmetic dentistry toronto, Dental Education, Dental Occlusion, Dental Restorations, Dr. Stephen Phelan, Full Mouth Rehabilitation, oakville dentist, Phelan Dental Seminars, Porcelain Restorations

Flapless Dental Implant Surgery: 1 Week Post-Surgical Photos

January 18, 2011 By Dr Stephen Phelan 4 Comments

One Week after Minimally Invasive Implant Surgery

I thought I would share some photos from the one-week post-operative appointment with the implant surgery case I posted last week in this blog. As you can see the case has healed really well at the one-week mark and the tissue looks excellent. The patient reported virtually no pain, swelling or bleeding post surgery and should be ready for the final impression next month.

If you are noticing a subtle difference in the color between the pictures in the 2 posts it is because they were taken in different rooms with different cameras. My dental hygienist Anna using a Nikon D200 camera and a Nikon 105 Macro lens with a Nikon SB 29s Macro Flash took these pictures and I took the pictures in the previous post using a Nikon D3s camera with a Nikon 105 VR Macro lens and the Nikon R1C1 Macro Flash System. I think that both sets of pictures look excellent. Can you see some slight differences between these two cameras?

Feel free to add any comments or questions using the link above.

Filed Under: Clinical Tagged With: Dental Education, Dental Implant, Dental Occlusion, Dental Restorations, Dentistry, Dr. Stephen Phelan, Phelan Dental Seminars

Plumber’s tape for dentistry

January 16, 2011 By Dr Stephen Phelan 7 Comments

Plumber’s tape can have many uses in your dental practice.

One product that is really inexpensive and useful to have around your dental practice is plumber’s tape. You can buy it for a few dollars at the local Canadian Tire or hardware store and it can be very handy for isolation.

If you look at the pictures attached to this post I have isolated the adjacent teeth with plumber’s tape so I can etch and bond the veneer preparations without damaging the adjacent teeth. This isolation technique prevents etchant and adhesive from contaminating the adjacent tooth structure, which can lead to bonding these teeth together when you insert the veneers.

Another use for plumber’s tape is to isolate the screw holes for screw retained provisional implant crowns like the ones in my exclusive video, How To Create A Custom Implant Transfer For Esthetic Implant Cases. In a case like the one in the video the plumber’s tape is used to prevent the cement or composite resin from clogging up the abutment screws and make it difficult to remove or tighten them at a later date. This can be very useful when you have provisional implant crowns that need to be removed one or two times to refine the esthetics before the completion of the case.

With the plumber’s tape you can screw the provisional into place and insert the rolled up plumber’s tape over the abutment screw and then seal the access with composite resin. When you need to remove the provisional all you need to do is drill out the composite resin to the level of the plumbers tape and then remove the plumber’s tape with a probe or explorer.

I used cotton pellets for this technique for years but I now find that the plumber’s tape is a cleaner and easier way to handle these cases.

Do you have any other ways you use Plumber’s tape in your practice?
Feel free to add any comments or questions using the link above.

Filed Under: Clinical Tagged With: Dental Education, Dental Implant, Dental Occlusion, Dental Restorations, Dentistry, Dr. Stephen Phelan, Full Mouth Rehabilitation, Macro Dental Photography, Phelan Dental Seminars, Porcelain Restorations

Flapless Dental Implant Surgery

January 8, 2011 By Dr Stephen Phelan 7 Comments

I wanted to post a couple of photos from an implant I placed on Thursday. The implant was a Straumann bone level implant. The surgery was completed with a Simplant Surgiguide and the implant was placed without a flap through a 4.0 mm tissue punch. I have talked about this technique on my YouTube channel http://www.youtube.com/user/phelandentalseminars and I wanted to share some photos from this case with everyone to illustrate how great the site looks post surgery using this approach. You will notice the only incision is the tissue punch and no sutures were required. I measured the stability with the Osstell and the implant showed excellent results with readings of 86 on the mesial and distal and 76 on the buccal and palatal.

I called the patient the next day and he told me it did not even feel like he had any surgery completed on the area! I really feel this technique is excellent for the patient providing you have an adequate ridge volume. Are you wondering how this ridge is so well preserved for the implant surgery? I will talk about the technique I use for ridge preservation at the time of the tooth extraction in a future post.

Feel free to add any comments or questions using the link above.

Filed Under: Clinical Tagged With: Dental Education, Dental Implant, Dental Occlusion, Dr. Stephen Phelan, flapless dental implant surgery, minimally invasive dental implant surgery, Phelan Dental Seminars

Block Booking for Complex Dentistry and Full Mouth Rehabilitation

December 31, 2010 By Dr Stephen Phelan Leave a Comment

Have you ever had a patient come into your practice wanting some complex dental care completed on a shorter time frame and your schedule was full for the next 6 weeks with less productive smaller restorative treatment? Did the patient eventually go to someone else to have the work completed?

In this post I wanted to talk to all of you about taking control of your schedule. If you are interested about treating larger cases in your practice (anything from 6 to 28 units) you will need the time available in your schedule to devote to these patients without rushing. My best suggestion for you is to implement block booking.

What I would suggest is that you analyze the number of large cases you are planning to treat on a monthly basis and then reserve blocks in your schedule on a weekly or biweekly basis devoted to those cases. With this technique you will have the time available to treat these patients without feeling rushed and having to leave the room to fit in smaller procedures at the same time.

One key for success when treating large cases is to have the time to work on them without a lot of distractions.This way you can focus in and provide the best service for that patient.

The way I do this in my practice is to have two days of the week blocked off for more complex cases. My team members know to only book multi-unit cases or implant surgery into these days and if the space is still available the week before, we will open the time up for shorter procedures and appointments.

You will need to decide the amount of time you need to block off in your own practice and if you are just starting out I would suggest trying one afternoon on the last day of your work week. That would be a great time to use for planning your cases, reviewing treatment plans and completing any model work and analysis, if the time is not scheduled with actual patient care.

Many people ask me how I find the time to treat so many complex care patients, teach, create training videos and find the time for golfing and my family, and I will tell you the best thing I have done to manage the time in my practice is to implement block booking. I hope this information is useful, please feel free to join the conversation and let me know what you think. Comments can be posted by clicking the link above.

Filed Under: Management Tagged With: Block Booking, Dental Education, Dental Occlusion, Dr. Stephen Phelan, Full Mouth Rehabilitation, Phelan Dental Seminars

Have a Happy and Healthy Holiday Season!

December 30, 2010 By Dr Stephen Phelan Leave a Comment

I would like to wish you and your family a safe, happy and healthy holiday season! May the spirit of learning be with you throughout the year.

I look forward to seeing all of you in 2011.

Filed Under: Marketing Tagged With: Dental Education, Dental Occlusion, Dr. Stephen Phelan, Full Mouth Rehabilitation, Phelan Dental Seminars

Full Mouth Rehabilitation with Porcelain Restorations

December 30, 2010 By Dr Stephen Phelan Leave a Comment

I just posted a new video that will provide you with some ideas and thoughts about treating complex full mouth cases. I talk about a case I am currently working on as an example of one way to sequence a full mouth case. My patient has a posterior crossbite and an end-to-end incisor relationship and would like to have longer front teeth with more tooth display.

Filed Under: Clinical Tagged With: Dental Education, Dental Occlusion, Dr. Stephen Phelan, Full Mouth Rehabilitation, Phelan Dental Seminars

Dental Implant Problems and Solutions

December 30, 2010 By Dr Stephen Phelan 1 Comment

I posted a new video about a common problem we all have from time to time with dental implant components. In this video I discuss the problem of stripped screw heads and I share with you the solutions that we used to solve this and make it possible for us to complete the cases.