Marin Contemporary Perio and Implant Concepts

It was an honor lecturing last night to a bright and enthusiastic group of colleagues, on the topic of cutting edge techniques/trends in gingival plastic surgery. Thanks to Dr. Souyias, one of the most talented, and genuine humans I know, for hosting me. It’s a privilege to call you a friend

Root resorption is a common condition I see in my practice. Depending on the aggressiveness and depth of the lesion, I usually try to keep these teeth as long as possible. As long as the adjacent tissues are healthy and adjacent bone and periodontium are in tact. Even if we move to an implant later, its less years an implant has to remain in function. Here I raised a flap, debrided the lesion with a Piezosurgery 3 surgical unit, used Geristore restorative material to fill ...the lesion, and then augmented the soft tissue with an autogenous connective tissue graft. No pulpal exposure was noted during the debridement. Saving teeth is always my #1 priority, when it makes sense. #perio #periodontist #surgeon #oralsurgery #softissuegraft #dentist #dds #cosmetic #savingteeth #connectivetissuegraft #dentalspecialist #gumgrafting #gumrecession #piezosurgery #periodontology #odontologia #odonto #periodontista #oralsurgery #gumdisease #gumsurgery#perioproblems#periodontology_team #periodontics#softtissuesurgery #freegingivalgraft#plasticsurgery#resorption @ San Rafael, California

I present a sinus bump case in honor of Wednesday Hump Day :) There are many options for sequencing dental implant therapy in the posterior maxilla. There are many people that advocate extracting a tooth, elevating the floor of the sinus, and placing the implant fixture, all in one visit. In my hands, I am usually more comfortable extracting the the tooth, and getting soft tissue healing first. After 3-6 months of healing, if the bone volume allows, we can punch the tissue..., and do a flapless implant fixture placement, while at the same time, tenting the sinus floor through the osteotomy of the implant. This procedure is quick, efficient, and results in almost no pain post-operatively for the patient. It still amazes me to this day how little pain there can be with this type of minimally invasive approach. In this case above, I used a combination of twist drills and Piezosurgery to access the sinus, small particle size bovine xenograft (BioOss by Geistlich), and a Straumann Bone Level Tapered fixture. This method is my go to for cases where I have sufficient residual bone below the sinus to place the implant at the time of sinus floor elevation. The implant is restored 3 months after placement. I present a sinus bump case in honor of Wednesday Hump Day :) There are many options for sequencing dental implant therapy in the posterior maxilla. Many people advocate extracting a tooth, elevating the floor of the sinus, and placing the implant fixture, all in one visit. In my hands, I am usually more comfortable extracting the the tooth, and getting soft tissue healing first. After 3-6 months of healing, if the bone volume allows, we can punch the tissue, and do a flapless implant fixture placement, while at the same time, tenting the sinus floor through the osteotomy of the implant. This procedure is minimally invasive, quick, efficient, and results in almost no pain post-operatively for the patient. It still amazes me to this day how little pain there can be with this type of minimally invasive approach. In this case above, I used a combination of twist drills and Piezosurgery to access the sinus, small particle size bovine xenograft (BioOss by Geistli @ San Francisco Bay Area

Immediate implant placement and provisionalization is one of the most gratifying aspects of my surgical practice. I love being able help patients that that walk in with a hopeless tooth, and let have them walk out with a new tooth! Of course, not every implant case is done this way in my practice, but many of them are. The key to ideal outcomes is case selection. Factors we look at to help aid in the decision making for immediate placement - thick buccal bone, thick soft ...tissue, minimal damage to the bone, adjacent anatomical structures, available bone lateral or apical to the socket, and occlusal considerations. If we achieve sufficient primary stability at the time of implant placement, I can place a provisional that must be out of occlusion. The patient is instructed to NOT BITE with the tooth for 3 months, to allow for osseointegration (fusion with the bone). This also helps to maintain the soft tissue contours and papillae for the final restorative phase. I used a Straumann Bone Level implant for this case. I can’t wait for the wide release of the BLX implant, that should allow for higher torque values, especially in cases like this. After placement, I typically graft the residual gap with BioOss. #periodoncia #periodontia #periodontist #periodontics #periodontology #dentalphotography #odontologia #dentistica #dentistry #dentalsurgery #dentalimplants #immediatedentalplacement #immediateimplant #prosperdentist #oralsurgery #implant #straumann #implantologia #implantodontista #prosthodontics @ San Francisco Bay Area