Be known for your patient care. In this piece, we’ll review a procedure featuring an 85-year-old patient who is having an implant uncovered.
Watch this video to learn how the Isolite System helps you:
- Drastically reduce the chance of infection
- Eliminate the prospect of patient aspiration
- Full access within the mouth. No cotton rolls or dry angles.
Rolando Mia: Good day everybody. Welcome to Dr. Tom’s Tips Case of the Week on Tuesdays at 10AM. Today, the focus is using Isolite® in taking an impression specifically for implant placement. Good morning, Dr. Hirsch.
Procedure Background and Overview
Dr. Tom Hirsch, DDS: Good morning. So, I just took a video last week of me uncovering an implant. I’m just going to show you a couple of different ways to do this. Bring up that the x-ray please, Rolando.
So here, what I did, I placed this implant about a year ago and time got away from us.
The implant placement was pretty good and I’m slightly off maybe two or three degrees on my angle of placement, but I buried this thing. This is an 85-year-old gentleman.
So, we placed this, and I just wanted to make sure it closed and healed in the sterile environment rather than having any possibility of infection. There’s going to be a lot of different ways that we can uncover an implant. I could lay a flap and I could flap into the back of the lingual. I could place my surgical guide back in there and make a little tissue punch with my surgical guide.
The way that I’m going to show you today it’s just another way of doing it. We’re going to expose the top of the hand piece with a flat nose diamond.
Digital Scanning with Isolite®
So, we place the Isolite® and then just started scanning the upper arch. Here’s my first takeaway, make sure you have all of your parts in your scan bodies. I got to that point right there. When I scan the top and I went to scan the lower arch and all of a sudden, I didn’t have a scan body for that particular implant. Darn. It’s my bad. I could have exposed this and put a healing cap on and got a scan body, but it’s going to take me 15-20 minutes to get my impression.
What we ended up doing here, is I have the sound where the implant was, trying to find the hole, the cover screw. I didn’t bother to get my surgical guide. So, I anesthetize with a local anesthetic there and I just picked up this diamond. I didn’t use any water initially with this because the diamond will actually cauterize the tissue it’s going around and there isn’t any bleeding.
Uncovering the Dental Implant
We’ve got a lot of good, attached gingiva. Therefore, we can it this way rather than laying a flap. I went down until I hit the top of the healing abutment and top of the cover screw. Then, I went around and circumscribed until I got the whole thing exposed. One of the things to notice is when I do start utilizing water, the patient can actually utilize his tongue to get the water out.
A takeaway point is when we’re uncovering an implant the nice thing is I don’t have an extra set of hands in the mouth. I don’t have any cotton rolls. I don’t have any dry angles. Water is continuously evacuated through the Isolite. I’m just to do this procedure in a really nice, relaxed situation without stress.
No Stress: Cotton Rolls, Dry Angles, Aspiration
So we found the cover screw, we removed it and I dropped it. I was lucky it didn’t go down the hash, but even though it had gone somewhere, not a big deal. We can see the top of the implant. There’s very little bleeding. So, I did not have a scan body to use, and I took a conventional impression coping. We just decided to take this to finish anyway. Screw the impression coping back in, put some red wax in there.
We don’t have any impression material that goes down into the access hole. Something important, here, the Isolite was in my way but all I had to do is just move it back one more tooth. It just makes it really easy where the patient can rest through the whole thing and be nice and relaxed.
Dry it off take my light body and pressure material and inject it around. My assistant is filling up the tray. Then we put it in there. Let it set for a few minutes. Come back, remove it, take it out. Take your cover screw out. You can see the tongue just totally out of the way. Then, I get my healing abutment and put it back in there. Screw it into place, torque it down and we’re done.
This whole thing took me about 20 minutes to start the finish. It’s an alternative way to go ahead and do something if you don’t have a scanner and you’re doing things physically. I could have also at the same time, taking the upper impression with alginate at the same time, because of Isolite, if you really wanted to maximize your time. So, you can get them both going at the same time. That was just another way to do something.
Rolando Mia: That is fantastic. I noticed too, from a patient perspective, this does not really seem like the most comfortable procedure on earth, right?
Patient Felt Relaxed With Bite-Block
Dr. Tom Hirsch, DDS: No, it was very comfortable for him as a matter of fact. He was relaxed. I mean, he was just resting on the bite block. He was relaxed. He didn’t have to deal with me going in and out of his mouth or the assistant retracting and stuff. Everything was done in a nice, relaxed environment.
So look, nobody wants to go to the dentist. Nobody wants to have an implant. Nobody wants to have an implant uncovered. But actually, he was relaxed, and he wasn’t uncomfortable at all.
Rolando Mia: That is fantastic. People told us it’s difficult to take impressions with Isolite. Here, it doesn’t look like it.
Dr. Tom Hirsch, DDS: It’s not. It can be in certain situations. For example, I extracted a tooth this morning and it was number two and it was an easy extraction. But the access there was horrible and it was a tough situation just in cleaning up all the granulation tissue. So what was started off as easy, was really tough. Procedures can be tough or easy. You know, you never really know until you get in there but, Isolite just helps make everything a little bit easier for my hands.
Rolando Mia: I loved seeing how easy, stress free, and comfortable this was.