North Texas Dentistry Special Issue 2016 | Page 38

Are there any new options for edentulous patients?

George A. Nail, MD, DDS

CREDENTIALS
Board Certification: Diplomate
American Board of Oral and Maxillofacial Surgery

EDUCATION
Residency – Oral and Maxillofacial Surgery
UT Southwestern, Parkland Memorial and Affiliated
Internship in General Surgery
UT Southwestern Medical Center (1994)
MD – Graduate with Honors, University of Texas
Southwestern Medical Center at Dallas
DDS – Graduate with Honors, Baylor College of
Dentistry (1990)
BS in Chemistry – Graduated Magna Cum Laude
Southern Methodist University (1986)
PROFESSIONAL AFFILIATIONS
American Association of Oral and
Maxillofacial Surgery
Texas Society of Oral and Maxillofacial Surgeons
Diplomate, American Board of Oral
and Maxillofacial Surgeons

Jeffrey S. Dombrowski MD, DDS
CREDENTIALS
Board Certification: Diplomate
American Board of Oral and Maxillofacial Surgery

EDUCATION
Graduate, Oral and Maxillofacial Surgery Residency,
UT Southwestern, Parkland Memorial and Affiliated
Internship in General Surgery-UT Southwestern
Medical Center (1994)
Internship in Oral and Maxillofacial Surgery
Charity Hospital - LSU School of Dentistry (1990)
MD – Graduate, UT Southwestern Medical Center
at Dallas (1993)
DDS – Graduate with Honors
University of Iowa College of Dentistry (1989)
BS in Biology – Graduate with High Honor
Michigan State University (1985)

PROFESSIONAL AFFILIATIONS
American Association of Oral and Maxillofacial Surgeons
Texas Society of Oral and Maxillofacial Surgeons
Diplomate, American Board of Oral
and Maxillofacial Surgery

What are some of the practical
technologies that maximize patient
treatment outcomes in your
everyday practice?

Dr. Nail: Factors such as Bone Morphogenic Protein (BMP) can enhance
bone volume for dental implant placement, but is expensive and also can cause
a significant inflammatory response during the first weeks of healing. Over the
past several years I have taken full advantage of the patients’ own growth factors
by preparing Platelet Rich Plasma from
their own blood. By taking as little as 1½
tablespoons of their blood, 2 teaspoons
of platelet rich plasma (10 mL) can be
prepared in a process that takes 20 minutes. The resultant highly concentrated
platelet derived growth factors are activated into a gel by mixing the liquid PRP
with thrombin. Activated PRP can be
added to particulate bone to create a
bone putty for sinus floor grafts or guided
bone regeneration. Additionally, allogeneic bone blocks (specially sterilized
blocks of bone from human donors) can
be soaked in PRP prior to fitting them
to defects at proposed implant sites.
Platelet rich plasma is inexpensive, wellresearched, and is used in various applications across multiple surgical
specialties. By using PRP in this manner,
I have not had to harvest bone from a
patient for any kind of bone graft in the
past five years, and that includes some
full arch bone-grafted patients.

38 NORTH TEXAS DENTISTRY | www.northtexasdentistry.com

Dr. Nail: One widely advertised option
is a full arch implant hybrid prosthesis
known as All-on-4™, which is often
referred to as “teeth in a day”. While we
certainly provide this treatment, we have
found this phrase can be misleading because there are occasions where unanticipated grafting must be performed and
implant placement deferred or where all
of the implants are placed, but one or
more of them are not sufficiently stable to
be loaded immediately. In each case, the
patient wears conventional dentures until
stable implants can be placed and/or
loaded. For over two years now we have
been offering another rather innovative
option that avoids these surprises and is
several thousand dollars cheaper per arch
than All-on-4™. This, the CONUS prosthesis, is the same type of hybrid prosthesis,
still based on 4 implants, but secured with
four custom milled titanium telescoping
abutments friction fitting into four gold
housings within the prosthesis. While
this can be removed by the patient, it is
designed to be worn 24/7. Additionally,
there is no need for the restorative dentist
to be chairside during implant placement.
It is easier and less costly to repair than an
All-on-4™ and patients receive a back up
prosthesis that they can insert should the
original be damaged or lost.

Center for Facial
& Oral Surgery

1813 Golden Trail Court
Suite 100
Carrollton, Texas 75010
[phone]