Blending Digital Dentistry and Implant Prosthodontics

Posted by Dr. Thomas Balshi and Joanne Balshi on Jan 30, 2017 4:41:16 PM

ACP Messenger (Winter 2017) 

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Thomas J. Balshi, DDS, PhD, FACP
Joanne Balshi

The Art of Blending Digital Dentistry and Implant Prosthodontics

I first met Michael Frank on a job site where he was artistically and meticulously setting tile for a designer kitchen. Mike exuded energy and had an admirable work ethic. He had a good technician’s eye and measurable pride in accomplishment, but the first time I saw him smile, I knew I could contribute something very valuable to the rest of his life. 

At the age of thirty-three, Mike had a lot going for him. Besides his talent; he was a vivacious athlete with a great sense of humor and an uncommon warmth. Married with two young daughters, he worked a sixty-hour week and played soccer in his spare time. A smile was the only part of his signature that simply did not fit. 

It was not difficult to convince Mike to allow me to evaluate him clinically and present him with a treatment plan. His evaluation revealed advanced periodontitis with extensive bone loss around his remaining teeth in the maxilla and mandible, most likely the result of his heavy smoking and excessive consumption of soda for quite a few years.

Mike's clinical presentation demonstrated extensive flaring of the mobile anterior teeth. Diagnostic casts were made and articulated at the appropriate vertical dimension. These models were scanned digitally and the data files transmitted to a milling center for the construction of the fully milled monolithic PMMA resin provisional dentures. The anterior teeth were repositioned vertically in the 3-D planning software prior to production.

Fig 1: Before -- Fig 7: AfterOn the day of surgery twenty cc's of blood were drawn and Platelet Rich Plasma (PRP) was produced for use during surgery. Local anesthesia was administered to both maxilla (upper jaw) and mandible (lower jaw), and all remaining teeth were extracted. Alveoloplasty was performed in preparation for future implant placement.

In the mandibular arch, full tissue flaps were reflected to identify the mental foramina. The anterior loop of the mental nerve was measured and noted. Beginning with the posterior implant placements in the mandibular right and left sides, a precision drill introduced the initiation of osteotomies (bone drilling). These were placed at a forty-five degree angle posterior tilt.

 Four implants were coated with PRP and installed according to the All-On-4®treatrnent concept protocol. Autogenous (host) bone was gathered during all of the osteotomy preparation procedures and reintroduced into the extraction sites. Angulated multi-unit abutments were installed on the posterior tilted implants and 1mm straight abutments were placed on the anterior axially placed implants.

Following the Teeth in a Day® procedure, special multifunctional copings were installed with guide pins on all four abutments. The rubber dam was then installed to the base of the copings. Using autopolymerizing acrylic resin, the monolithic conversion prosthesis was connected to the multifunctional copings. It was then removed and refined chairside.

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Figures 4, 5, and 6

Fig 4: All-On-4® implants to support non-removable teeth in the lower jaw.

Fig 5: Three months after implant surgery, the final digital upper denture and the All-On-4® monolithic fixed (non-removable) prosthesis for the lower jaw ready for delivery to the patient.

Fig 6: Completion of treatment changes Mike's life.


Flap closure took place with multiple interrupted sutures. The Teeth in a Day conversion prosthesis was then installed using prosthetic screws. The upper monolithic fully milled removable denture was relined, adjusted, and delivered at the same time.

Mike was given post-operative instructions and medications. One week following surgery, he returned for suture removal and minor adjustments to the maxillary immediate complete denture. At ten weeks post-surgery the patient presented for final impressions, initiating the construction of his mandibular fully milled implant-supported prosthesis reinforced with a milled titanium frame. New occlusal records were made and a reline impression made in the maxillary removable immediate digital complete denture.

Both arches were scanned and the data transmitted for the construction of a new fully milled monolithic maxillary removable digital denture and an All-On-4® final prosthesis with milled titanium framework for the mandibular arch. 

Three weeks following the impressions, the final prostheses were delivered to an ecstatic patient whose sparkling personality and boundless energy went up still another notch, proof that at any age, a healthy, aesthetic smile is a priceless asset.


Thomas J. Balshi, DDS, FACP / Joanne BalshiThis article was published in the ACP (American College of Prosthodontists) Messenger (Winter 2017) and written by Dr. Thomas and Mrs. Joanne Balshi.

Dr. Thomas J, Balshi maintains a private practice in Fort Washington, Pennsylvania, where he blends clinical care with scientific research, education, and philanthropy. 

Joanne Balshi has served as Director of Marketing and Public Relations for the Pi Dental Center over the last thirty years. She is a freelance writer and authored Smile Your Heart Out, a coffee table book about the value of a healthy smile and dental makeover.

 

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Terminology: 1acpmessenger.jpg

  • All-On-4 Dental Implant Treatment - uses a prosthesis strategically supported by four dental implants that are biomechanically positioned for maximum stability. 
  • Anterior teeth - front teeth
  • Conversion prosthesis - An interim fixed-prosthesis that the patient wears from the time of uncovering of implants until the final prosthesis is completed. This prosthesis is made from the removable denture or temporary prosthesis that the patient has been wearing since first stage surgery. This removable prosthesis is modified into a fixed prosthesis. It allows the patient to experience the benefits of dental implants immediately after the implants are uncovered.
  • Digital dentistry - Dental treatment that includes utilization of CAD/CAM software enabling the dental specialist to visualize the patient's dental structures in 3D format
  • Mandibular - referring to the lower jaw
  • Maxillary - referring to the upper jaw
  • Monolithic - formed of a single large block of material.
  • Occlusal record - a record of the way teeth come together - a registration of the opposing occluding surfaces of the teeth
  • PMMA - Poly(methyl methacrylate) - a clear plastic
  • Provisional denture - a temporary removable denture
  • Posterior Teeth - back teeth
  • Teeth In A Day® - Click here

Tags: bone loss, Teeth In A Day, All-On-4 dental implant treatment, digital dentistry

Phlebotomy and PRP at Pi Dental Center

Posted by Chris Raines on Aug 26, 2016 3:52:26 PM

Pi Dental Center Staff Hone Phlebotomy Skills for PRP Procedure with Patients

Pi Dental Center clinical team attends phlebotomy training.Pi Dental Center’s clinical staff recently took part in a Phlebotomy training program to perfect their skill in drawing blood, which they do for the Platelet Rich Plasma (PRP) procedure. PRP accelerates healing and enhances bone growth, which in turn stimulates osseointegration of dental implants.

Phlebotomy

Phlebotomists are trained to draw blood from patients for clinical or medical testing, transfusions, donations, or research.  Pi Dental Center’s clinical department participated in a course given by an approved provider of the American Society for Clinical Laboratory Science. This phlebotomy course consisted of an online tutorial followed by small-group training with a certified instructor in our office. The online portion included lessons and quizzes. The hands-on course included placement of the tourniquet, proper techniques for finding a vein and inserting the needle, patient safety and comfort. Participants even practiced drawing blood on one another.

Pi Dental Assistant, Amy Gambone, felt that the course was quite valuable, stating, “Taking the phlebotomy course helped me tremendously. Safety and making the patient feel confident that they’re in good hands are essential. I feel more confident doing a blood-draw.”

Clinical Director, Martha Mendez discussed the phlebotomy course, “I learned the appropriate technique to draw blood, how to prioritize veins and most importantly, safety.  This course will improve our safety protocol for drawing blood and also ensure that our patients’ experience at Pi is as painless as possible.”

PRP

Andrea and Martha discuss the online portion of the phlebotomy training program.During the PRP procedure, a small amount of blood is drawn in preparation for dental implant treatment. 

PRP is a by-product of blood that is rich in platelets. Platelets are irregularly-shaped, colorless bodies that are present in blood. Their sticky surface lets them, along with other substances, form clots to stop bleeding. Platelets contain growth factors (GFs), which serve as effective inducers of normal tissue repair.

PRP allows the body to take advantage of the normal healing pathways at a highly accelerated rate. During the healing process, the body rushes many cells, including platelets, to the wound to initiate the healing process. Platelets perform many functions; one of which is the release of GFs into the wound. These GFs function to aid the body in repairing itself by stimulating mesenchymal stem cells (MSCs) to regenerate new tissue. The more GFs sequestered into the wound, the more MSCs are stimulated to produce new host tissue. Simply, PRP permits the body to heal faster and more efficiently.

Correct use of  the syringe is described during Phlebotomy training program at P Dental Center.An article in The International Journal of Periodontics and Restorative Dentistry detailed a study regarding use of Growth Factors in molar sites with bone defects.  It advocated the use of Growth Factors in immediate placement of implants at the time of tooth removal. This is because of the high degree of predictability for successful treatment, preservation of bone and soft tissue form, the reduced period that a patient must live without teeth and superior esthetic results.

Dr. Glenn Wolfinger states, “PRP is used to stimulate and accelerate the healing process in the Teeth in a Day® protocol.  We strongly believe that PRP is a critical component of the high success of this protocol.”

As stated in the Journal of Oral Implantology, “Integrating this technique into common practice provides important benefits for patients regarding esthetics, without the risk of infection or transmission of diseases.”

To learn more about PRP click here.

More about bone and healing:

To ask us about dental implant treatment, PRP, or to schedule an appointment:

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Terminology:

Phlebotomy:   the practice of drawing blood

Osseointegration: The biological process by which living bone (osseo) fuses with the titanium dental implant to form a man-made tooth root.


Articles:

Immediate Postextraction Implant Placement Using Plasma Rich in Growth Factors Technology in Maxillary Premolar Region: A New Strategy for Soft Tissue Management. Oral Implantology, Vol. XXXIX, No. One, 2013.

Platelet-Derived Growth Factor – Mediated Guided Bone Regeneration in Immediate Implant Placement in Molar Sites with Buccal Bone Defects, The International Journal of Periodontics and Restorative Dentistry, Vol. 35, No. 6, 2015.

Tags: dental implants, PRP for dental surgery, Teeth In A Day

Sink Your Teeth Into This One! Pi Dental Center is Serving “the Capital Smile”

Posted by Joanne Balshi on May 23, 2016 2:25:01 PM

Sink your teeth into a sumptuous steak dinner (Photo from Bridget's Steakhouse)

After thirty years courting revolutionary exploration of prosthodontic possibilities, The Pi Dental Center is proud to announce another new concept in smile building. Because we can now engineer superior durability with no sacrifice to translucent, natural esthetics, we are naming the ultimate Pi dental restoration our “Capital Smile.”

The name comes from the complaint most often brought to the Pi Dental Center — “I can’t eat anything that tastes good.”  Taking that to the highest level solution, it is our goal that our patients can enjoy the most sumptuous premium steaks at establishments like The Capital Grille with no worries.  No pain. No motion.  No chewing issues.  No breakage.  Just pure dining pleasure.

Capital GrilleThe specialty of Prosthodontics has been impacted over the years with ever changing science and technology leading to a man-made third set of teeth.  The first giant steps were cosmetic. Laboratories developed artistic ways to shape and color teeth so that crowns and veneers no longer appeared horsey, and in the hands of a skillful clinician became indistinguishable from natural teeth.  Later the advent of dental implant restorations with CADCAM technology made the architecture of the smile more solid and functional, promoting longevity of the restoration prosthesis.  Seemingly the profession was on the threshold of the ideal smile, even if a bit costly for the average pocket.

Halfway through 2016, it’s an intensely blended dedication of engineering, product development, cosmetic experience, fresh ideas and collaboration with the worldwide expertise of Global Dental Science, Inc., headquartered in Scottsdale, Arizona, creator of AvaDent digital removable dentures. Pi has always been about providing our patients the highest quality in the shortest time possible with consideration of the investment. The “Capital Smile” will upgrade technology, increase durability and longevity, and become a more cost effective way to sport a young, healthy smile.

Look for it first at Pi Dental Center, home of Teeth in a Day® dental implants. Consider dental implant treatment so that you can sink your teeth

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* Photo of steak dinner graciously submitted by Brian Forrest

Tags: tooth replacement, dental implants, removable dentures, dental health, teeth, Teeth In A Day, sink your teeth

Open House Draws Celebrity to Fort Washington

Posted by Joanne Balshi on Apr 8, 2016 9:00:00 AM

National Prosthodontics Awareness Week is celebrated by Drs. Balshi, Wolfinger, Pi Team and rich Zeoli with the WPHT Radio Staff

As part of Pi Dental Center’s week long celebration of National Prosthodontics Awareness Week, WPHT radio personality, Rich Zeoli, broadcasted three hour daily show “live” from Pi, followed by a “meet and greet” engagement with the dental center’s visitors and guests.  Zeoli, who frequently endorses Pi’s philosophy of smile care on his network, was the center point of a week long “Open House,” showcasing new prosthodontic technology and providing prospective patients the opportunity to have questions answered without a formal appointment.2015_0405OpenHouse-_9.jpg

2015_0405OpenHouse-_2.jpgTwo board certified prosthodontists, Dr. Tom Balshiand Dr. Glenn Wolfinger lead the Pi facility which is a center for comprehensive clinical care, education and research.  They are known for their trademarked Teeth in a Day® streamlined dental implant procedures as well as innovative dental solutions for patients without sufficient bone for traditional implant treatment.  They are also the East Coast “hub” for futuristic AvaDent dentures.

National Prosthodontics Awareness Week raises public awareness about the having a healthy mouth and the importance of maintaining good dental care.

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Tags: dental implants, AvaDent digital dentures, board certified prosthodontist, National Prosthodontics Awareness Week, Teeth In A Day