I am going to give you a very quick course. I am going to show you very quickly how to add another step when you are doing your socket preservation that will enable you to always place accurate implants without the risks of nerve or bone perforation. Very few of you may be doing implants because of the risks, technology and cost. Before I start here are some quick pointers to reduce most of the risks. Don’t place implants above the mental foramen, in the upper and lower 2nd molar areas, and try always use short implants with platform switching (The abutment is narrower than the implant. But as I said this is not an implant course. This is just to show you another step that you should do be doing when you do socket preservation.
So the easiest time to accurately place an implant is when you take out the tooth and the reason for that is that you are able to see inside the socket.It’s not always convenient to place the implant at the time of extraction. There may be infection, a socket wall defect or the patient does not want the implant on that day. Regardless every time you pull out a tooth you should be recording and preserving the socket. Let me show you why.
When the inside of a socket is visible you can center the implant in the socket, or into the septal plate, or to offset it lingually if there is deficient facial bone; there are a variety of Safegide pegs that will allow you to preselect any position in relation to the open socket. Before you position the bone replacement material into the socket, record or “pick up” the socket dimensions and relationship with a disposable Safegide socket insert and bite registration material.
So at the time of extraction you pull out the tooth and you insert a little plastic insert that looks like a peg into the socket. These plastic pegs are made out of a special proprietary type of plastic that is antibacterial and shows up in 3D on a regular x-ray. If the peg is too long it can be snapped to size with your fingers. The peg has 3mm markings like a perio probe that show up on an x-ray. This allows you to measure bone height easily so that you canselect the right length implant. The metal ring on top that sticks out the socket becomes a drill guide.
So you pretty much take a piece of plastic, snap it so that the bottom of the metal part is level with the bone crest, and take your bite registration with a very rigid material.Your pick up gives a very accurate representation of where the socket is, the angle of the socket, the depth of the socket, all the information that you need to do the implant at a later date. Then you remove the plastic peg which will leave the metal ring attached to bite registration material. On the day you want to place the implant simply place the bite registration in the mouth and drill to your desired length. The guide will also show you where to remove gingiva if you do not want to raise a flap.Another reason to use this technique is you may want a guide to use on the day of extraction simply to stabilize your drill. It will take a week or two plus many hundreds of dollars to have a laboratory fabricate a guide that you can easily do in a few seconds for less than the cost of a pizza. Your cost and time are low enough that I suggest that you make a guide with every extraction for free. This gives you another wayto put a ring on your patients finger so that they come back to you for the implants. If you are not taking out the tooth on the day you make your diagnosis then you can simply take impressions for a working cast model. Then make a plastic jig out of triad on the model with a hole in the Triad above the tooth to be extracted. Or make a jig in the mouth using Triad and your curing light. Complete the guide on the day the patient comes in for the extraction.
There are many reasons why you should have a guide if you want to place an implant, that’s because it makes things very safe and very easy. The alternatives for the patient are a CT scan and a lab fabricated guide. This may be inconvenient and adds an extra $1000 on an implant which may make the procedure unaffordable.
State laws vary so dramatically regarding Botox and dermal fillers that it is hard to know whether you are allowed to perform these procedures as a dentist, and if you are, under what circumstances. Here is a partial summary of what the law is regarding the use of Botox by dentists in 27 states.
In the states of Mississippi and Virginia, the use of Botox in dentistry is restricted to oral and maxillofacial surgeons who have completed a specific residency.
In many states, use of Botox by dentists is permitted, but restricts its use to dental treatments only and only by dentists who have completed a course of study by a program that is accredited by the American Dental Association and/or the dental board of that state. These states include: Alaska, Connecticut, Florida, Idaho, Iowa, Kansas, Maryland, Nevada, New Hampshire, New York (see our New York Botox training program), North Carolina, Texas, Washington, West Virginia and Wisconsin. The wording of these laws varies by state and a few of them do not address Botox specifically, but do contain verbiage that restricts dental practice to procedures involving the mouth, its contents and associates structures and tissues.
In other states, use of Botox by dentists is not restricted beyond a requirement that the dentist completes a course of study by a program that is accredited by the American Dental Association and/or the dental board of that state. These states include Arkansas and Louisiana. These two states in particular further set forth that the training course must cover certain topics to include consulting with and assessing patients, uses and contraindications of Botox, potential risks and side effects associated with Botox and related treatments and how to manage them, preparation and administration of the injections, therapeutic uses of the drugs, hands on training with actual patients. These states further restrict use of Botox by dentists to their dental office and forbid administration from support staff, such as dental nurses and hygienists.
Some states currently have no regulations regarding use of Botox by dentists. These states include: Massachusetts, New Mexico, Pennsylvania, South Carolina, South Dakota, and Wyoming. It should be noted that many malpractice insurance carriers still require that anyone administering Botox or dermal fillers complete an appropriate course of training (see our Online Botox Training Program). A few of these states, while they do not currently have any restrictions, are considering or may soon consider regulations in this area.
Finally, Delaware has taken rather a unique stance on use of Botox by dentists. The Board of Dentistry and Dental Hygiene in Delaware has responded to inquiries regarding Botox by refusing to take a position. At the current time, Delaware treats possible violations regarding dentists administering Botox on a case by case basis.
It is important to note that these regulations are politically motivated, not a reflection of the ability of Dentists to perform Botox – in fact, Dr. Katz is a dentist, and pioneered the use of Botox for the face.
For a full list of state regulations, visit: http://dentox.com/state-by-state-dental-botox-regulations/