Case Study Review with Dillon Caines, DDS

Hi, I’m Dr. Todd Shatkin and good morning and welcome to this Monday morning minute. For the next three weeks, we’re going to be highlighting case studies that have been prepared by our three dental residents in our NYU Langone AEGD program. They have all placed over 50 mini dental implants since starting the program in July. It is my pleasure to introduce Dr. Dillon Caines as our first program this week. Good morning, Dillon.

Yeah, good morning, Dr. Shatkin thanks for having me on. Great to have you on the program, and great to have you as one of our amazing residents this year. Thank you. Thank you for the opportunity. It’s been amazing. What will your case focus on today?

So this case was a young individual who came in with a few missing teeth, and it was a great application for our mono dental implants. We use a lot of minis here for our dentist stabilizations, our roundhouses, but those mono implants, they’re great for immediate extractions and also just really nice in that maxillary premolar to premolar zone.

So what teeth did you do on the case? So in this case, we did number twelve and 13. Okay. It was a nice twelve and 13 premolar case. Patient was very happy with the results. It was a nice, efficient process, and, yeah, we got some good results there.

So, in general, Dillon, what do you think of this program here in Buffalo? I think this program is the greatest program in the country. When I discovered it and started reading about it in D Two and everything you’re doing up here, it seemed to be revolutionary. And since I’ve been here, it’s been way beyond that in every way.

You started looking into our program when you were in your second year at dental school. Well, yeah, because once I started reading about the minis and what you were doing shortly thereafter, I heard that you were starting a residency, and last year’s class was the first inaugural class, and it’s been incredible. I didn’t even know you did that.

One thing I do remember about you, Dillon, when I interviewed you, which stuck in my head, was the fact that you went to NYU Dental School and you shared a tiny apartment with an entire family. Yes. There’s a family of five down in Chinatown there, and they moved to the States to pursue the American dream. And I’m from Canada and I was doing the same thing, so we meshed together and it was a really good experience.

Well, we all know how expensive it is to live in New York. So you were on a college dental school budget, and you rented one small room that had a curtain between you and the parents of the family. Had to be very unique and interesting. It was. Yeah. They actually didn’t speak English, so there was a lot of cultural learning and cultural exchanges and it was great. Yeah.

Well, you got a little more space in your apartment here in Buffalo, right? Oh, yeah. No, Buffalo is the best. And if you’re interested in the residency, definitely it’s life changing, so it’s career changing, so definitely look into it.

I’ll be honest with you, that was one of the things that really stood out when Mr. Splecki and I interviewed you and made us decide we wanted this guy in our programs. Great. Yeah. We’re really happy to have you here. Thank you so much. Great job.

Actually, I know you’ve placed more than 50 minutes. He’s probably close to 100. Yeah, we’re about the 120 mark now. Yeah, that was back in October. We were about 50, and so now it’s just ramped up and we’re increasing in 2020. How many teeth do you think you’ve extracted? At least 400. At least.

Going better for what, five months? Yeah, we’re doing a lot of full mouth cases, so you end up doing 20 teeth in a case. Unbelievable. So it’s been great. Thank you. That’s fantastic. Well, we’re glad to have you here with the program, and I’m really excited for you to share this study that you did for that patient. Sounds good. Thanks, Dillon. Great. And we’ll see you next week on the Monday Morning Minute.

All right. So, yeah, today I just wanted to talk about the monos. The minis are just incredible for so many applications, but the mono is this one piece of our toolkit that really rounds out what we do. It’s great for fixed applications. You can see here, just a quick review of it has that nice clinical abutment head and that bendable collar. And it has a lot of similarities to the mini. It’s self tapping, it’s a one piece and flapless surgical placement really excels in the premolar to premolar region. And the maxillary can also be used in the mandibular posterior as well. Really great for immediate placements due to the unique thread design. This is the advanced course. I’m sure you guys know this really well, but some treatment planning considerations with the mono is that that four millimeter collar here, just that polished collar has to be considered when you’re treatment planning, when you’re doing your measurements. My patient today was a 45 year old female, a very classic patient. She came in with some pain in the lower right, had a few missing teeth, and she wanted to replace them. She had a history of some extractions and a few composites.

Her oral hygiene was quite good overall. Her medical history, you know, she had a benign breast tumor removed in 2001, but other than that, she was quite healthy. A few allergies. Her extra oral and intra oral exams really revealed no substantial, you know, issues. So she presented just like this. Again, pain in the lower right, the dentalist region up here in 1314. That she twelve and 13 rather. That she really wanted to address overall with her period and periodontal diagnosis, she had chronic generalized gingivitis, a bit of calculus and heavy plaque. Overall, we did our endodontic diagnostics on 28. We found it to be irreversible pulpitis. Other than that we had number 19 and 28 and 29 were quite broken down. So our overall treatment plan that we came up with was some monos in twelve and 13 crowns at 19 and 29 and a mano at 28. This was the treatment plan she ended up going with. Alternatives were root canals for number 28. She really didn’t want to do any root canals. She wanted to avoid that at all costs. Just the history that she’s heard from her family members. Traditional bridges were an option, but the patient agreed that cutting down the adjacent teeth wasn’t ideal and she didn’t want anything removable.

So fixed was the way to go. This is just some CT planning for sites twelve and 13. So you can see we’re just measuring our palatal bone, getting our length. In this case, we chose the 30 by eleven monos at twelve and 13. Our clinical rationale is that we had the bendable prosthetic head, we had that increased clinical crown height of that abutment, which is nice, and we had plenty of bone to work with. This was from surgery day. We did the placement of twelve and 13, marked our sites, placed them. This is just some analytics of the placement after the procedure. So this was number twelve. And one of the greatest learning experiences here has been really looking at the implants after you placed them on the CT and seeing how you did versus what it looked like in the mouth. So here number twelve was a bit buckle, not as ideal, but it torqued at 60 Newtons and so that was great. In the case of number 13, that was a bit better. It was nice and centered, what we’re looking for. So that was good. This is an image of the final impression visit.

So everything healed up really well. Really nice to percussion. This was from crown delivery day. So we had really nice PFC crowns, number twelve and 13. This is what the final delivery looked like. Patient was very happy with the results. He was feeling really good in these videos here. They’re not working, but I was just showing you the percussion tests at the one month follow up. Due to finances, we had to wait a little bit longer to do the lower right. Ever since we’ve done the lower right, we delivered her other crowns and she’s doing great. We’re just waiting on this. Crown is coming back in about a week and we’ll cement that and everything’s looking really good. So yeah, thank you very much, appreciate it.