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Ask Dr. Roberts
Q 1. Dr. Roberts, I have avoided using blade implants because I've heard about them settling into the bone after a few years, is this true? Answer: No, Settling is not, and never has been, a problem with the Ramus Blade implant designs. Even Ramus Blades made of 316-L stainless steel in 1967 did not experience settling! However, the Ramus Frame did experience settling. The problem was corrected in 1976 by designing an anti settling tab. Also, since changing to Titanium the problem was rectified and tabs are no long necessary. Now you can confidently place these implants with the knowledge that they will not settle over time. Q 2. Dr. Roberts, I have had good success with the Ramus Blade and Ramus Frame implants, yet I'm always nervous about causing paresthesia in my patient, what can I do? Answer: Let's take each implant design separately. For the Ramus blade, periapical x-rays are the best and most accurate imaging choice. When there is a marginal bone height, use a measuring device such us a dental burr. (The flutes of a 557burr are 5mm.) After the initial penetration through the cortex, place the burr into the hole and press it down until it stops. Next, take a periapical x-ray. Mortise with care in the deep portions of the osteotomy. When seating the blade do not attempt to force the implant deeper than the prepared sight. Where there is minimal bone, a relieved implant will allow space for the nerve canal to pass under it. For the Ramus Frame, the first step is case selection. If one selects cases having mandibular region of 12mm or greater in the mid -body region, then paresthesia should be easily avoided. The Ramus Frame serves best in atrophic mandibles so to begin with be selective with cases. The majority of my cases are 12mm or less, for these are the patients who really need relief from atrophy. However, there is a price to pay which is partial paresthesia. Most paresthesia cases receive partial or complete recovery within 3-5 years. Several modifications of the RA3 were made to alleviate paresthesia. For instance, the anterior foot has been shortened requiring a shorter anterior osteotomy. Also, the posterior foot projects forward and backward by 10mm. Thus positioning it higher on the ramus, alleviating nerve approximation. In addition, here are some procedural tips used to avoid paresthesia. Before starting your procedure locate the mental foramina and avoid injury to the nerve bundles. When reflecting the soft tissue, locate both nerve sites and be protective of the site. before beginning the osteotomy use the anterior template to center and locate its position on the bone. If you have any question about our implants, ask Dr. Roberts at: |
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