Scott Ganz - (2012/01/31 14:05)

Dear Anoosh - Great question! If there is an abundance of soft tissue to work with, and the denture is removed for modification and polish, you are correct that the tissue will collapse. You have two choices: (1) use screw-receiving abutments that extend above the tissue, or (2) when you remove the denture, immediately place healing collars to keep the tissue from collapsing, until the denture is ready to be re-inserted. Great question. Thanks!

Scott Ganz - (2012/01/31 14:02)

Hi George... Thanks for the comments. The bone reduction template requires additional software for its fabrication, and as I do not use Nobel Clinician in its latest version. SimPlant offers three different types of templates for implants - (1) bone borne, (2) tooth borne, and (3) soft tissue borne. In order to facilitate placement of implants into a newly reduced ridge, the software must be able to produce a bone borne template. I do not know if such a template can be fabricated with Nobel or any other software.

George Duello - (2012/01/30 20:25)

Scott, Very nice presentation. I know you are an expert on Simplant/Materialize technology. Do you have a protocol for NobelProcera/NobelGuide technology for which I use in my practice and lectures? George Duello

anoosh afifi - (2012/01/27 15:44)

Once the modified lower denture is seated over the implant abutments and acrylic is set and the restoration is unscrewed for the lab phase, how difficult is it to replace the restoration back onto the implants. Would the sutured mobile tissue over the top of implants not interfere with the seating of the abutments?

Scott Ganz - (2011/01/03 8:38)

Hi Sam - Thanks again for a great question! When evaluating each individual patient presentation, you should visualize how much tissue is present prior to the surgery. We know from the 3-D workup how much bone reduction will be required. The next issue would be the facial concavity, and placement of the implant in a facial-lingual dimension. Usually I will be grafting the facial concavity, not to support the implant(s) but to support the tissue. Therefore a vestibuloplasty will not be required. We may also add other soft tissue grafts if required, or us a product like Alloderm to add bulk and thickness to the facial aspect of the area to widen the ridge and support the new emergence profile. Hope this is helpful to you! Happy New Year!

Sam Busich - (2011/01/02 15:12)

Dr. Ganz; Thank you for your excellent presentation. Would you suggest a vestibuloplasty procedure as part of this Bone Reduction concept? Many thanks Sam

Scott Ganz - (2011/01/01 14:15)

Hi Dumitru - Good question! We always want to preserve the keratinized tissue! It is important to visualize the position of the keratinized tissue, and its thickness prior to opening the flap. You want to bisect the zone as best as possible. Then the flap is raised, the bone reduced, followed in this case by immediate implants. The tissue is then draped around the individual abutments, maintaining an increased zone of tissue once the area heals. You can also re-position the excess tissue by suturing to the underlying periostium to prevent it from riding up.

dumitru ovidiu - (2010/12/31 7:33)

After the bone reduction it will remain an exces of gingiva. You suture the initial flaps or trim the gingiva? If you reduce the flaps this means you will cut exactly the keratinized gingiva. what is the best way to do this? thank you!

Scott Ganz - (2010/07/15 9:47)

Hi Karyn - The bone reduction template is actually a method used in restorative dentistry - as in a reduction coping. I just took that concept and using SimPlant software was able to create a template to accurately remove bone. Using the 3-D reconstruction, you can estimate how much bone needs to be reduced to create adequate width for implant placement. I usually strive to place all implants at the same vertical position. Once the level of bone matches the ideal placement for implants (ideally with a barium sulfate scanning template used during the scan process), the bone can be "virtually" removed from the 3-D reconstruction. This can be checked and verified before sending it off to Materialise for template fabrication. This technique was first published in the Atlas of Oral and Maxillofacial Surgical Atlas in 2006. I can send you a PDF if you want to read further! Hope this helps!