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Robert J. Miller, MA, DDS / Warren C. Edwards, DDS / Carlos Boudet, DDS / Jonathan H. Cohen, DDS (This article originally appeared in a 2009 issue of Titanium) Abstract: Placement of dental implants in the anterior mandible is considered by many clinicians to be a relatively low risk procedure. However, hemorrhagic episodes following implant placement in the mandibular symphysis are regularly reported and can have serious consequences. The use of high resolution focused cone beam scanners has given us the ability to visualize the intricate neurovascular network of the intraforaminal region without distortion and in greater detail. Knowledge of the arterial supply, and navigated implant placement in the mandibular symphysis, can help to avoid these potentially life-threatening emergencies. TITANIUM 2009 1(2): 0-0 Key words: incisive canal, lingual artery, mylohyoid artery, submental artery, superior genial foramen. INTRODUCTION Preoperative assessment of bone density and volume is a critical compo- nent of dental implant surgery. For most of the history of this discipline, periapical or panaoramic X-rays have been used to evaluate implant sites. Limitations of these radiographic modalities are distortion, magnification, and a missing third dimension of bone volume. The introduction of computed axial tomog- raphy (CT) revolutionized our ability to virtually dissect maxillofacial structures and to determine osseous architecture without distortion. However, CT imag- ing has 3 major drawbacks. First, is the relatively high radiation dose during the scanning procedure. Second, is the high degree of background scatter around metallic restorations and implants. Third, is the significant burnout of medullary bone that is directly propor tional to the radiation dose. These parameters often obscure fine osseous structures and eliminate soft tissue profile. Our lack of appreciation for the complex anatomy of the mandibular symphysis occasionally leads to unintended consequences or even life-threatening emergencies. There are many case reports in the literature describing hemorrhagic episodes fol- lowing surgical implant placement that resulted in near-fatal airway obstruc- tion. Some authors have even sug- gested that a CT scan should be routinely performed prior to the placement of implants in the intraforaminal region. (To read more download the article  ) |
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(This interview originally appeared in OsseoNews) Introduction Dr. Robert J. Miller is a graduate of the New York University College of Dentistry and completed a general practice residency at Flushing Hospital and Medical Center. Prior to attending dental school, Dr. Miller earned Bachelor of Arts and Master of Arts degrees in biology. He is a board certified Diplomate of the American Board of Oral Implantology/Implant Dentistry and is in private practice in Delray Beach at The Center for Advanced Aesthetic and Implant Dentistry. Dr. Miller serves as chairman of the Department of Oral Implantology at the Atlantic Coast Dental Research Clinic in Palm Beach, Florida. You can find out more about Dr. Miller at: http://www.robertmillerdds.com/ Interview Osseonews: Dr. Miller, do you believe that lasers have a place in implant dentistry? Dr. Miller: If we compare the use of lasers to the traditional surgical approach using “cold surgical steel”, lasers clearly are the better choice. Using a laser to perform implant surgery enables us to prepare the implant site with minimal trauma to the hard and soft tissue. In fact, I would more properly characterize this approach to surgery as atraumatic. |
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By Dr. Robert J Miller (This article originally appeared in the September/October 2006 issue of Dental Practice) [Download PDF] Instrumentation for dental implant procedures has not changed significantly over the last few decades. Most of these procedures share one parameter in common; they are primarily resective in nature. When tissue is traumatized, it goes through an inflammatory cascade which results in edema, erythema and discomfort for the patient. A period of tissue remodelling then occurs in which the production of matrix metallo-proteinases (collagenases, elastases, and gelatinases) occurs. These enzymes are the primary inducers of both soft and hard tissue remodelling. Crestal bone remodelling around implants is one result of the action of these compounds. The loss of peri-implant osseous support may cause the collapse of the interdental papilla, resulting in compromised gingival display in the aesthetic zone. |
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Probably one of the questions we are asked the most often, is what is the best solution for a missing tooth or a badly broken tooth? The answer normally is: A Dental Implant! A dental implant is the long lasting solution, and one that will put a smile on your face! An implant is the most predictable way to replace a missing tooth. Unlike tradtional bridges that require preperation of the adjacent teeth, an implant restored area does no damage to surrounding teeth! The implant is a root shaped titanium fixture that is placed in the bone. Titanium is highly biocompatible, so that the natural bone grows in intimate contact with the impllant. (Osseo-integratio) When this happens, the implant becomes rock solid, which is what you want, and we want to occur! There are many options for how a dental implant is used, and we invite you to contact the office and you can even talk to Dr. Miller, be sure to send us an e-mail as well. |
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A smile. Is it beautiful? Of course, and a smile is contagous! And it is true we at times are insecure about our smile because of the condition of our teeth. Dr. Miller and his staff want to meet you and work with you to restore a big beautiful smile on you! This is more then just adding a veneer, but requires understanding the condition of your mouth, so that the best cosmetic treatment plan is designed for you. Using computerized technology and the experience of Dr. Miller, you will have that big beautiful smile. Smile Delray Beach! . |
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