Valmiki Sharma

Questions and Answers (9) View all

• Answer added in Implant Dentistry, Bone Grafts and Related Treatments
  18 Could an osseointegrated implant still slowly move in bone under a stable lateral stress? What about the relation between movement speed and stress?
  By Wei ma · Fourth Military Medical University
  Valmiki Sharma · University of Cambridge

  The situations you describe may lead to 'apparent' movement of the implant from a fixed point ie, the implant may seem to be in a different location e... [more]

  The situations you describe may lead to 'apparent' movement of the implant from a fixed point ie, the implant may seem to be in a different location eg, resorption of the labial plate will make the implant seem like it is more labial. The implant itself (if still integrated) will still be associated with the same bone as originally and will not have itself moved through that bone. IF it has actually moved ie, 'relative' movement from a stable fixed point then by defination it is no longer osseointegrated and this by defination is failure.
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• Answer added in Oral and Maxillofacial Surgery
  21 At second stage surgery there was an evidence of labial cortical bone loss without any mobility on an implant placed in max. central. How can one manage this?
  By Satyanarayana Raju · Vishnu Dental College
  Valmiki Sharma · University of Cambridge

  Thank you Wladimir. Fully agree with you Benjamin, I think if you've got 50% bone loss barely 6 months after placement not only do you need to replac... [more]

  Thank you Wladimir. Fully agree with you Benjamin, I think if you've got 50% bone loss barely 6 months after placement not only do you need to replace the implant, you really have to reassess what the devil is happening!- that would be truly worrying and in that situation 'patching up' with grafts, I fear, would only result in an extremely short term (false) result.
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• Answer added in Oral and Maxillofacial Surgery
  21 At second stage surgery there was an evidence of labial cortical bone loss without any mobility on an implant placed in max. central. How can one manage this?
  By Satyanarayana Raju · Vishnu Dental College
  Valmiki Sharma · University of Cambridge

  Wladimir also has a valid point, but in my experience, patients these days are really quite savvy (and rightly so) when it comes to the purported succ... [more]

  Wladimir also has a valid point, but in my experience, patients these days are really quite savvy (and rightly so) when it comes to the purported success rates - functional and aesthetic- of implant dentistry. Many would love to avoid any further surgery but the majority of my patients are pretty good at balancing longevity and acceptable cosmesis against the possible need for a little bit of further surgery and mildly protracted wait for all to be well. Certainly the majority of my patients would really rather not have the inconvenience of having to come in for numerous review appointments accompanied by radiographs if it can be circumvented with a little extra surgery. Again though it all depends on the patient and the situation- a couple of millimetres of recession even with a minimal 'black triangle' or even a small degree of 'shine through' will usually be tolerated by the majority of patients if it dosen't affect aesthetics. The same situation in someone with a high lip line OR someone particularly vain OR in certain social circles where 'you get what you pay for' would be unacceptable. Anyway whatever the case, oral hygiene, oral hygiene, oral hygiene and just when you think they've had enough oral hygiene, that's right, more oral hygiene!!!
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• Answer added in Oral and Maxillofacial Surgery
  21 At second stage surgery there was an evidence of labial cortical bone loss without any mobility on an implant placed in max. central. How can one manage this?
  By Satyanarayana Raju · Vishnu Dental College
  Valmiki Sharma · University of Cambridge

  I'd have to agree with the 2 comments above. How much bone is missing? If it is a minimal amount in a patient with a low smile line then possibly jus... [more]

  I'd have to agree with the 2 comments above. How much bone is missing? If it is a minimal amount in a patient with a low smile line then possibly just redistributing the occlusal loads will be OK +/- a bit of camouflarge with gingivally shaded porcelain. If however there is a significant degree of loss then I'm afraid grafting needs to be performed and, in my hands, this is best achieved with the implant completely out of function.
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• Answer added in Oral and Maxillofacial Surgery
  8 impacted lower wisdom tooth
  By yahya Qasim · specialized dental center
  Valmiki Sharma · University of Cambridge

  Lower wisdom teeth, oh how deviously innocent they can appear on radiographs! I agree in the most part with Shakeel. There are several factors to con... [more]

  Lower wisdom teeth, oh how deviously innocent they can appear on radiographs! I agree in the most part with Shakeel. There are several factors to consider even before looking at the ones previously mentioned. The actual patient, medical history, anxiety level, mouth opening etc... Most patients seem to 'have a friend' on whom (they would swear) the dentist had to put their knee on their chest to get the tooth out! There are any number of 'personal journey' websites from patients who had particularly bad experiences and somehow these are the ones many of the more highly anxious patient group seem to get onto. Personal experience is a most valuable assessment tool, unfortunately it isn't something you can read.......
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