Top Rated Bangalore Call Girls Mg Road ⟟ 9332606886 ⟟ Call Me For Genuine S...
AGD Shatkin FIRST Mini Dental Implant Training
1. Presented by
Todd E. Shatkin, DDS*
*Private Practice-Buffalo, NY, Member of the IAMDI, AACD, ICOI, ACOI, AAID
1989 Graduate of University of the Pacific School of Dentistry
President Emeritus, International Academy of Mini Dental Implants
2. Todd E. Shatkin, D.D.S.
• Owner of Shatkin F.I.R.S.T.,
LLC., a Mini Dental Implant
Specialty Lab & Distributor of
Shatkin Intra-Lock Mini Dental
Implants.
• Director of Case Planning @
Shatkin F.I.R.S.T., LLC.
Developer of the
F.I.R.S.T.®TECHNIQUE
(Fabricated Implant Restoration
& Surgical Technique) (U.S.
Patent No 7,108,511).
2495 Kensington Avenue
Amherst, New York 14226
1-888-4-SHATKIN (1-888-474-
2854)
3. Today’s Discussion
• Using the MDL and MILO Mini Implants for Full Upper Denture
Stabilization
• Using the Mini Implant for Full Lower Denture Stabilization
• Using the Mini Implant for Partial Dentures
• Using the Mini Implant in Fixed applications for Individual
and Multiple Missing Teeth
• Using the Mini Implant for Full Arch Fixed Applications
4. Learning Objectives
After today you should be able to:
• Select appropriate candidates for Mini Implant placement
• Comprehend the technical application and use of the Mini
Implant System
• Appreciate the clinical efficacy of Mini Implants
• Understand the learning curve involved with Mini Implant
placement and the need for participation in a mini-
residency or seminar training program
5. Increase your income $200,000+ per year
and be more productive with your time!
• Implement the mini implant in your practice
• Market it to existing and new patients using our proven
marketing programs
• Use the mini implant for denture stabilization and
replacement of individual and multiple missing teeth using
Shatkin F.I.R.S.T LLC Surgical Stents and Crown and
bridgework in one or two short visits!
6. What is your current average
income per hour?
• Before placing mini implants, my
income was approximately $400/hour
• After placing mini implants, my income
is over $2,500/hour
(Started placing MDI’s in 2000)
10. Mini Dental Implants
Developed by: Michel Chercheve in 1966
• Not marketed until 2000
• Simple and cost effective system to stabilize
loose denture or replace missing teeth
• Continuous improvements in design and new
techniques
• FDA approved and marketed by ADA
• Gordon Christensen is a strong supporter of Mini
Implants
11. Innovations in the use of the Mini Implant
F.I.R.S.T. ®
(U.S. Patent No. 7,108,511 – Todd E. Shatkin, DDS)
FABRICATED IMPLANT RESTORATION and
SURGICAL TECHNIQUES
15. Mandibular Staple Plate
A transosseous implant which is inserted from the inferior
border through the superior border of the mandible
16. Endosseus Implants
Developed by Dr. Per-Ingvar Branemark
• Dozens of companies
• Many designs
• Rely on a 2-8 month healing
period
• Requires Osseo integration
• Usually 2 stage surgery
• Usually requires flap surgery
17. Mini Dental Implants
Developed by: Michel Chercheve 1966
-Simple and cost effective system to stabilize
loose dentures or replace missing teeth
-Continuous improvements in design and new
techniques
-FDA accepted for “Long Term Intra-bony
Applications”
18. What did people use to hold their
dentures in the past?
• Adhesive
• Powder
• Suction Cups
• Tissue Buttons (snaps)
• Sinus Penetration
• Prong Dentures
20. Patient Selection Criteria
Who is a candidate for mini
dental implants?
• Difficulty wearing lower denture
• Slipping, Poor Ridge, etc.
• Cannot tolerate a palate on upper
• Large torus palatinus/mandibularis
or exostosis
• Patient wants more confidence
21. Advantages of MDL and MILO Mini
Implants
• No 4-6 month waiting period
• MDL is FDA indicated for “Immediate Loading and
function for long term intra-bony applications’’
• Cost effective
• Non-invasive, non-surgical procedure
• Immediate results and short healing time
22. Advantages of MDL and MILO Mini
Implants
• Minimal post-operative discomfort
• Can be used on almost any type of ridge
• Can be performed by the patient’s general dentist
• High profit potential for your office
• Nominal investment by the practice
23. Mini Implant Applications
• Immediate stabilization of upper or
lower removable prosthesis
• Immediate support for single crowns
• Immediate support for multiple
crowns
• Immediate support for full
roundhouse bridges
24. Drive Lock MDL/ MILO System
• Three Diameters: 2.0 mm, 2.5 mm, 3.0 mm
• Available in 10, 11.5, 13, 15 & 18 mm (MILO 17 mm)
lengths for denture stabilization and crown and
bridge use
• Implant and abutment are a single unit
• O-ball design includes housing and O-ring
• MDL 30%-40% stronger than a competing 1.8 mm Mini
Dental Implant, independent studies have shown
25. MDL Features (cont.)
• Implants are surface treated
• Sterile packaging and efficient delivery
• Metal housing and O-Ring included
• Unique self-tapping thread design
• High-Strength Titanium Alloy material
31. Bone Quality
Patients with bone of very low density are poor candidates for MDL
The dentist should consider MILO for treatment
32. Bone Quantity
Width Rating: A, B, C
• A – Buccal to lingual > 5 mm
• B – Buccal to lingual = 3.5 – 5 mm
• C – Buccal to lingual < 3.5 mm (May require
tissue elevation or flap
33. POP QUIZ Question #1
An 80 year old man has moderately dense
mandibular bone. You plan to place 4 (18 mm) Mini
Implants. What type of bone does he have and how
deep should you drill the pilot hole?
34. POP QUIZ Question #1
An 80 year old man has moderately dense
mandibular bone. You plan to place 4 (18 mm) Mini
Implants. What type of bone does he have and how
deep should you drill the pilot hole?
Answer: Type 2 bone; pilot hole depth = 10 mm (~ 60%)
36. Bone Quality and Quantity
Vertical Bone Height Rating
• Mini Implants are 10 mm – 18 mm long
• Bone height of less than 8 mm = Poor candidate
for MDL
• Use longest implant possible
*Mandibular – 75% total height
*Maxillary – 90-100%
Why?
37.
38.
39. Are Mini Implants good for ANYONE?
Medically compromised patients?
• In short… YES!
*No incision (in most cases)
*Low morbidity
*Low infection
*Non-invasive
• What about patients taking steroids?
*Contraindicated for most implants, but can be done with MDL
(no heating of bone)
• Patients taking blood thinners
*No problem unless a flap is needed
*Consult with patient’s physician
40. Mini Implants and Patient Finances
• Procedure cost is less than ½ of a conventional
implant surgery
• Prosthesis cost is 25% the cost of conventional
bar/clip type restorations
• Fewer dental office visits
• Can be performed by the general dentist
41. Anatomically Compromised
Patients
• Many patients do not have adequate bone
support to accept the large size of
conventional implants
• Mini Implants can be used in almost any
ridge and on patients with severe alveolar
ridge recession
43. Required Instruments & Materials
• Surgical Guide Stent
• Implant Motor (Custom Pre-set)
• Pilot Drill Guide
• Pilot Drill
• Contra Angle Driver
• Mini Dental Implant
• Ratchet Wrench / Driver
44. Overview
Implant Placement Procedure
1. Radiographic Planning
2. Surgical Stent
3. Mark Denture and Transfer
4. Anesthesia
5. Create Pilot Hole
6. Implant Insertion
7. Complete Insertion
45.
46. 1. Radiographic Planning
Panoramic X-Ray or Cone Beam Scan
• Assists you in planning for placement
• Mark radiograph in region of canine and
1st bicuspid anterior to mental nerve canal
• Mark in region of lateral incisors anteriorly
50. 3. Mark Denture and Transfer
• Using the marks on radiograph as a guide, mark DRY
denture with skin marker
• Next DRY the patient’s arch and place denture in
mouth.
• You may darken transfer spots with marker for
APPROXIMATE placement of implants
51.
52. Chlorine Dioxide or Chlorhexidine
pre-rinse
• Pre-procedural antibacterial rinse
• Immediate post procedural healing
period
• Ongoing maintenance of Implants
and soft tissue
53.
54. Informed Consent
• Patients must always sign
informed consent
documentation
• Mini Implant consent forms
are available to you
59. 4. Anesthesia
• Infiltration: Anesthesia
• Infiltrate between the periosteum
and bone
-On mark
-Buccal to mark
-Lingual to mark
• Block anesthesia is usually not
needed
60. POP QUIZ Question #2
Why is block anesthesia usually not
needed during the MDL placement
procedure and is not recommended?
61. POP QUIZ Question #2
Why is block anesthesia usually not needed
during the MDL placement procedure and is
not recommended?
Answer:
Using Infiltration only affords the patient continued sensation
of the mental nerve. This allows patient feedback during the
procedure reducing the risk of nerve damage.
62. 5. Create Pilot hole
• After measuring depth,
drill pilot hole with a
tapping motion
• Drill depth according to
bone density evaluation
63. 6a. Implant Insertion - Motor
#1 Pick up implant
using either finger
driver or using contra
angle adapter
#2 Insert implant into
pilot opening through
gingiva to bone.
#3 Rotate clockwise with drill or
with hand using downward
pressure until firm, bony
resistance is felt.
67. 6b. Manual Finger Driver & Ratchet Wrench
• Continue insertion of
implant until firm
bony resistance is met
• Ratchet wrench is
recommended to
complete insertion
68. 6b. Manual Finger Driver & Ratchet Wrench
(cont.)
• If bone is extremely dense use of ratchet wrench is
needed
• SLOW incremental turns will allow full insertion
without snapping of implant
• Pressure should be applied downward on the ‘head’
of the ratchet during insertion
• If VERY HEAVY resistance is noticed, back implant out
and make pilot hole deeper
• DO NOT force ratchet or the implant may snap at
neck
69. 7. Complete Insertion
• Complete insertion of all
implants
• Insert implants completely so
that the top of the collar is at
the gum line
• The entire square and ball
should be supragingival
72. POP QUIZ Question #3
When placing transfer marks in a lower denture
for planning MDL positioning, at what teeth
positions should these marks be placed?
73. POP QUIZ Question #3
When placing transfer marks in a lower denture
for planning MDL positioning, at what teeth
positions should these marks be placed?
Answer: In the lateral incisor area and between the
Cuspid and First Bicuspid (bilaterally)
74. Denture Placement and Prosthetic
Technique
• Positioning should be close to
original plan
-Make holes in denture with
lab bur on pre-marked
locations
• Place housing abutments on
implant o-balls
• Try in denture for full seating
Shatkin F.I.R.S.T. Pre-Fabricated Denture with
trough to accept dental implant housings.
75. Denture Placement and Prosthetic
Technique (cont.)
• Fill trough with Shatkin
F.I.R.S.T. HARD reline
material.
• Place denture on O-ring
housings and have patient
bite to seat denture and
hold for setting of reline
material.
76. Denture Placement and Prosthetic
Technique (cont.)
• Remove denture and assess security of housing in denture.
• Add flowable resin (light cured), cold cured acrylic, or
cyanoacrylate if loose.
• Trim excess material and smooth tissue surface of denture
to avoid sore spots.
• Also shorten borders of denture. Why?
77. Postoperative Instructions
• Prescribe antibiotics
-Broad spectrum:
*Penicillin, Keflex, Etc.
• Ice chin 10 min on & 10 min off
• WEAR DENTURES FOR 24
HOURS! Why?
• See patient 24 hours later
• Dentist should be first person to
take new denture out.
78. What did you just accomplish in
an hour of chair time?
• You stabilized a loose uncomfortable denture
• You have given a patient confidence and comfort both
physically and emotionally
• You have provided “new technology” and
quality dental care at an affordable price
• You have earned $5,000.00 in practice revenue
• You will go home feeling great!
IMAGINE DOING THIS EVERY DAY!
79. 24 Hours Later
• Adjustments of denture:
-There will be some minor adjustments required
-Some patients may have denture sores developing
-Adjust spots as needed and check occlusion
• See patient post-operatively in 3 days and 1 week later
• Instruct patients to wear denture as much as possible
over the following week and call if there is a problem
80. POP QUIZ Question #4
Following Mini Implant placement for
denture stabilization, why must the
prosthesis be worn for the first 24 hours?
81. POP QUIZ Question #4
Following Mini Implant placement for
denture stabilization, why must the
prosthesis be worn for the first 24 hours?
Answer: To prevent soft tissue swelling and to
allow tissue adaptation around the implants.
82. Other Applications
• Stabilization of failing fixed bridges
-Salvage cases
• Retention of Partial Dentures
-Cu-sil dentures
-Wireless partials, etc.
83. Other Applications (cont.)
• Fixed Crown and Bridge
-Single tooth – replacing any missing tooth
-Distal abutment – Free end saddle
replacement of removable partial dentures
-One implant per root if possible
*2 for each molar (2.0 or 2.5)
*1 for each bicuspid/anterior tooth
• Pier abutments – Long span bridgework
• Roundhouse bridge with 10-12 MDL’s
84. Mini Implant Manufacturers & Labs:
Mini Implant Manufacturers:
Glidewell Dental, Newport Beach,
CA 800-854-7256
OCO-Biomedical, Albuquerque,
NM 800-228-0477
Park Dental Research, New York,
NY 212-736-3765
Shatkin F.I.R.S.T. Intra-Lock,
Amherst, NY, 888-474-2854
Sterngold Dental, Attleboro, MA
800-531-2685
Zest Dental, Carlsberg, CA
800-262-2310
Mini Dental Implant Labs:
Glidewell Dental, Newport Beach, CA
800-854-7256
Shatkin F.I.R.S.T., Amherst, NY 888-
474-2854
138. Use of Mini Implants in Maxillo-facial
Prosthetic Reconstruction
Following Head and Neck Cancer Surgery
Slides Courtesy of:
George C. Bohle III, DDS
Assistant Professor in the Department of
Otolaryngology
Head and Neck Surgery in the Division of Dental and
Oral Medicine at the John Hopkins Medical Institute
139. Patient #6 G.B.M.C.
Med. Hx.: 81 y/o male, SCCa of Right
Sinus
Plan: Surgical resection, obturator
prosthesis, immediate mini implant
placement
145. Using the Mini Implants for Crown and
Bridge
• Individual tooth replacement
• Multiple tooth replacement
• Extended length bridgework
• Roundhouse and full mouth reconstruction
197. Evidence Based Dentistry
• The greatest predictors of Mini Implant survival are:
-Anatomical location
-Prosthetic treatment modality
-Previous implant failure
• In addition, bone characteristics and denture status play a
role in survival
• There is a learning curve associated with MDL placement
• MDLs demonstrate a predictable survival rate
205. Survival Analysis
• The median time until implant loss is
approximately 5 months
• The survival curve is right-skewed:
-Most implants fail early (within the first 5
months)
-If an implant survives the “threshold” it has
most likely attained Osseo integration
207. Clinical Considerations
The beginner Mini Dental Implantologists may wish to be
selective with his or her candidates for the first several
months of Mini Implant use and avoid:
-Heavy smokers (>1ppd)
-Patients with poor bone characteristics (Type III
and/or class C)
-The posterior maxilla
208. Recommendations Based on 16+ years
Experience and Thousands of Mini Implants
• Have proper training and knowledge of MDL protocol
• Preoperative planning and case selection
• The clinician should perform all prophylaxis and restorative
dentistry prior to MDI procedure
• DO NOT DRILL ENTIRE LENGTH OF IMPLANT
• DO NOT PENETRATE OUTSIDE OF BONE
• ALWAYS use prophylactic antibiotics post-operatively
209. Recommendations Continued:
• ALWAYS use a proper sterile surgical technique intra-
operatively, including the use of a drape
• ALWAYS USE preoperative tissue cleansing scrub or (RINSE)
• Be sure that mandible has sufficient bone height and width
to avoid fracture
• Space the mini implants properly, avoiding angulation
toward adjacent teeth roots
210. Recommendations Continued:
• Instruct the patient to wear the denture all the
time for the first 24-48 hours
• See patient regularly during the initial healing
period to adjust sore spots and evaluate tissue
and implants
• See patient after initial healing period every 3
months during the first year and every 6 months
thereafter
211. Learning Objectives Review
• Can you select appropriate candidates for Mini Implant
placement?
• Do you comprehend the technical application and use of the
Mini Implant System?
• Can you appreciate the clinical efficacy of Mini Implants?
• Do you understand the learning curve involved with Mini
Implant placement?
Have we met these objectives?
212. POP QUIZ Question #9
How frequently should the patient be seen
during the first year of follow-up after MDL
placement?
213. POP QUIZ Question #9
How frequently should the patient be seen
during the first year of follow-up after MDL
placement?
Answer: Every 3 months
214. What Do I Need To Get Started?
ONE
Essentials Kit
-(12) MDL 2.0 & 2.5
-(2) Blossom One Piece 2.5
-(2) Milo 3.0
-Upper, Lower, C&B Patient Models
Deluxe surgical kit with all
Instrumentation
215. What Do I Need To Get Started? (cont.)
TWO
Aseptico Motor and Hand piece
Aseptico Powered Trolley
*Removable Head for Thorough Cleaning
Mont Blanc AHP-85-MB-X
Aseptico AEU-7000SF1-70V………………$4895
Powered Trolley ATC12V2…………………$695
216. ONE + TWO = SUCCESS
Our dentists’ who use our surgical
motor and instruments have better
success than by hand.
(I have never broken an implant using the
surgical motor)
220. POP QUIZ Question #10
When should the ratchet wrench be
used?
Answer: For the final few turns of an implant
when extremely dense bone is encountered.
221. How will MDLs change my practice
and my life?
• Emotional Satisfaction
• Patient Relationships and
Referrals
• Personal and Family time
• Financial Freedom
224. Using the MDL in your practice
A No-Brainer!
• Patient Satisfaction
• Doctor Satisfaction
• Staff Involvement
• Financially Accepted
• Financially Rewarding
• Minimal Up Front Costs for Office
225. POP QUIZ Bonus Question
How much additional yearly gross income
would your practice enjoy if you completed
two MDL cases (8 implants) per week?
226. POP QUIZ Bonus Question
How much additional yearly gross income
would your practice enjoy if you completed
two MDL cases (8 implants) per week?
Answer: $400,000
