Dr.Nailesh Gandhi Dental Implantologist

02/10/2018

Use of A-PRF in Sinus augmentation is explained in details.Please read.

Coming next month to Inside Dentistry (November 2018) a CE article on " Simultaneous Sinus Augmentation and Implant Placement" with Delia Tuttle and Gregori M. Kurtzman (link will be posted when it goes live next month)

26/08/2018

The Dirty Denture

From Dr. Tiny Nair, Cardiologist, TVM

I had finished my MBBS and was pursuing MD in internal medicine in one of the best govt. colleges in kerala; clearing the tough MD entrance by merit gave an aura and self pride, that comes along with the name tag and the white coat of a fresh graduate.

I was posted in a ward at the back of the main building. A middle aged man, admitted with some innocuous illness suddenly collapsed, his breathing was heavy, an obvious sign of cardiac arrest. I quickly started cardias massage with chest compression and basic CPR (cardio pulmonary resuscitation. Other residents and the duty registrar quickly joined me. Initially we got back pulse, put him on a trolley and rushed him to the cardiac ICU, which was little far away, continuing intermittent chest compression and oxygen. Despite our heroic measures the patient was continuing to be bad and struggling to breathe, with feeble pulse.

Every staff in the ICU was running; the senior-most nurse in the ICU (almost on the verge of her retirement) was watching all our efforts.

She suddenly stepped in and said, ‘can you just hold on for a moment’?

She opened the patients mouth, extended his neck, and in one swift movement introduced a Macgills Forceps (a large holding / catching device) into the patient’s mouth. She pulled out the ‘denture’ that the patient had swallowed; that was the reason for his choking.

Pic - MacGills Forceps

It was not a cardiac arrest, just that he had chocked on his loose denture.

The man became quiet; the heroic doctors silent, and everyone heaved a sigh of relief. After mumbling some kind of apology and ‘thank you sister’ I left ; the weight of my degree suddenly felt like a burden, the white coat too uncomfortable.

What they didn’t tell me in medical school was that degree cannot match experience.

Today, as a senior consultant, during our ICU rounds, if I feel the patient is fine and can be shifted out, I ask the duty nurse whether it is OK to shift out the patient or not. After all I see the patient for 10 minutes twice a day, while the nurse spends the entire day with the patient. I may know more intricate biochemistry and pathology, but she has better intuitions about the patient.

Take her judgement into confidence too; believe me, it is good to believe her.

(sharing fr
om a friend Dr.Gururaj Rao)

02/05/2018

Treat for the dentist treating the pt..

30/03/2018

We are very happy to announce this June 2018 we will be completing 31 years of implant practice.

01/03/2018

Editor: Morton L. Perel

05/02/2018

Sharing from a friend. Very important to give your feedback on this information.

Posting a little on the ongoing MRI safety discussion based on my recent clinical experience. I had a patient who had epilepsy in the childhood and who gets an MRI scan every year to ensure everything is all right. He had come to me with a request to change all of his ‘metallic’ restorations done by a previous dentist to ceramic ones. He said that his previous MRI scan was ‘unreadable.’

I were reluctant to believe him and hence searched for literature on dental restorations and MRI/CT. There is surprisingly little research that can be found. I’ll post a paper or two that I referred to sometime later. Later, I visited a radiologist with the query about MRI/CT safety of dental restorations. Here’s a summary of what he said to me and what I read in the papers:
1. The problem with metals and MRI is not much about the metal getting pulled out of body due to the magnetic field. Cardiac arterial stents are metallic and are completely embedded in soft tissues. Nothing untoward happens, since the amount of metal is small. The problem is that the brain MRI scan images get distortions when ferromagnetic metals are present near the head, and these distortions are huge ones. The radiologist showed me scan after scan after scan wherein the distortion had tendered the MRI unreadable, just like in my patient. Except most MRIs are not planned but are required as emergency investigations, typically after a stroke. Not much can be done about pulling out the dental restorations when a patient comes in on a gurney, having suffered a massive life threatening accident. Also, due to the close proximity of oral cavity to the base of cranium, a lot of vital arteries cannot be studied, a potentially fatal flaw in the scans in elderly stroke patients, which can mean the difference between life and death.
2. Titanium is MRI safe. The problem is that most of the devices contain titanium alloys, which may have traces of ferromagnetic metals, which can interfere with the image on scan. Even so, most of the titanium devices will not render the scan unreadable.
3. The worst offenders are porcelain-fused-to-metal crowns and orthodontic brackets. But a lot of things including metal posts, zirconium restorations and some brands of composites cause unreadable scans.
4. Amalgam— surprisingly — does not cause very much distortion. Ditto with e-Max.
5. CT scans also suffer from image distortion. But with CT scans, you can simply remove the slice that contains the dental restorations and read the cranium.

So what do I do now that I know these things? Firstly, I was shocked that such a significant matter is not even remotely referred to when we study restorative dentistry. I became aware of it only when I had a patient visiting me who suffered from the ill effects of dental metals. After this episode, I checked the restorative materials I use in my clinic to ensure their MRI safety. Also, nowadays I always inform the patient about the MRI safety of whatever restoration they are getting, with a mention of alternative materials that perform better on MRI. That way, my conscience is clear. It isn’t very easy for a patient to understand the significance of readability of MRI scan that may be needed in future in case of an accident. But I think it’s our duty to at least mention this point. Who knows, it may turn out to be the difference between life and death in some.

The radiologist I visited expressed that this topic must be taken seriously by dentists, specially since the potentially life threatening consequences are not borne by us.

And the next scan my patient underwent turned out to be readable.

15/12/2017

BMC Oral Health. 2017 Dec 12;17(1):149. doi: 10.1186/s12903-017-0442-x.

14/12/2017

The i-Brush is a debridement instrument for dental implants subjected to peri-implantitis.

16/10/2017

Highly recommend

Fast Track Clinical Education in Implant Overdenture Diagnosis, Treatment Planning, Surgical Placement of Implants, Restorative Procedures, and Hygiene

22/09/2017

wow

20/09/2017

Saw yet one more patient at the clinic today, with uncontrolled diabetes and heart disease since decades.. a quick diet history revealed the usual suspects.. bountiful cow's milk, loads of ghee, buttermilk and paneer.. taking 10-12 different tablets a day! 😐 People become wary and hesitant if we suggest them to replace those toxic dairy products with life elixirs like fresh fruits and tender coconut water.. please make note, those fruit sugars are the good healthy ones, will NEVER cause your blood sugar levels to rise! Infact focus more on plant-based food and see your health improving like never before.. Ditch meat and dairy for a couple of months and see the results for yourself! Dont pay heed to your doctors if they ask you to avoid any fruits to control your diabetes levels.. nature can never go wrong.. eat all the bananas, grapes, mangoes you want, guilt-free, you'll just repair the damage.. added bonus if you can incorporate an hour of daily exercise as well!

( very well written, sharing from a friend Shivanand Shetty. )