use them routinely . There has been a sense in the dental community that the cost of the CT plus the implant is prohibitive , but that ’ s not been our experience . With few exceptions , with proper preauthorization by our top-notch staff , the custom implants , imaging and diagnostic studies we order are often covered by medical insurance .”
PRE-OP
TMJ Reconstruction
Total joint reconstruction has , in the past , been somewhat controversial due to alloplastic materials failures from decades past . Today we are able to reconstruct the joint using FDA-approved metallic-alloy and ultra-high molecular weight implants , successfully used in other loadbearing joints for years . While the indications are infrequent , total joint replacement has been shown to be far superior to autogenous tissues in terms of pain and restoration of function . With appropriate patient selection , even total joint replacement is also now an outpatient , office-based procedure .
POST-OP
Implant Site Development
As a Fellow of the International Team for Implantology ( ITI ), Dr . Bates works closely with restorative dentists , prosthodontists and periodontists in providing their patients with adequate bone and soft tissue for optimal functional and esthetic restorative-driven dental implant reconstruction . The facility ’ s capabilities allow for harvesting of autogenous bone from the iliac crest or the tibial plateau , in addition to common intraoral sites , providing a virtually unlimited volume of bone for alveolar ridge or sinus floor augmentation . “ We now routinely use platelet-rich plasma and guided bone regeneration to optimize the predictability of our grafts . We know that blood plasma rich in platelets contains a high concentration of bioactive proteins and growth-inducing hormones that improve bone quantity and quality and speed wound healing .”
3D cephalogram for obstructive sleep apnea patient illustrating the minimal cross-sectional area being significantly quadrupled from 100 mm ² in the preop airway analysis to 430 mm ² in the postop airway analysis . ( Photos courtesy of Dr . Jim Bates )
During graft site preparation , a nurse draws the patient ’ s blood and separates the platelet-rich plasma through centrifugation , which is then delivered to the operative field and mixed with harvested bone to form a composite graft , as well as sprayed onto the wound surface before and after membrane placement for its adhesive properties . “ Autogenous tissues are the gold-standard , and in bone grafts , predictability is what it ’ s all about .”
Zygomatic and Pterygoid Implants
However , in contemporary practice , Dr . Bates finds that many patients object to the multiple procedures and prolonged treatment times required by conventional bone graft augmentation and sinus lifts prior to dental implant reconstruction . For this reason , many patients who would normally require extensive grafting for full-arch dental implant reconstruction now undergo immediate reconstruction with zygomatic or pterygoid implants . “ Placing longer implants away from the atrophic dentoalveolar processes and the maxillary sinuses allows us to engage plenty of solid and healthy bone , avoiding alveolar bone grafts and sinus lifts altogether . Patients are thrilled to undergo a single surgical procedure and leave the operating room with functioning teeth that look great !”
FACIAL COSMETIC SURGERY Rhinoplasty
Often performed in conjunction with orthognathic surgery , reshaping of the nose is the most commonly requested cosmetic procedure in this group of patients . Dorsal humps , asymmetries or crooked
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