Go Back   Team-BHP > Around the Corner > Shifting gears


Reply
 
Thread Tools Search this Thread
Old 7th November 2012, 02:15   #1336
BHPian
 
dgupta's Avatar
 
Join Date: Jul 2012
Location: Coventry, UK
Posts: 69
Thanked: 64 Times
Default re: Calling doctors/dentists/specialists on Team-BHP to provide free consultations

I need some advice on a knee injury my mother in law is suffering from. She took a fall on her right knee around 3 weeks back in her building compound. She slipped and hit her right knee bang on the ground. She treated the knee with an ice pack and it got better in 2-3 days. A simple X-ray revealed no damage to the bones and the general practitioner advised some rest and cold therapy. However she could continuously experience pain in her knee, it would not prevent her from moving around and going to the office, but could not fold her leg and sit on the floor.

A MRI scan has revealed the following

1. Grade 3 tear of the ACL and PCL
2. Joint effusion with synovitis
3. Focal bone edema/ bruise posterior aspect of medial femoral condyle
4. Small posterior popliteal cyst - Baker's cyst

From whatever I could gather on the internet, this is a major injury and she would require a ligament reconstruction surgery. Any Orthopaedics out here who can advise on this based on the above information ?

What I am puzzled about is the mismatch in symptoms for a grade 3 ACL and PCL tear that I read about on the net. She complains of only a very slight pain in her knee and is hardly having any trouble going about her daily chores. She travels to office catching a train in Mumbai travelling 2 hrs each way. I am sure there is more to this than what I read on the internet. Any help and advise will be much appreciated. We are visiting the orthopaedic surgeon tomorrow for an opinion as well.
dgupta is online now   Reply With Quote
Old 7th November 2012, 08:14   #1337
BHPian
 
BoneCollector's Avatar
 
Join Date: Apr 2011
Location: -----****-----
Posts: 923
Thanked: 1,278 Times
Default

Quote:
Originally Posted by dgupta
I need some advice on a knee injury my mother in law is suffering from. She took a fall on her right knee around 3 weeks back in her building compound.

A MRI scan has revealed the following

1. Grade 3 tear of the ACL and PCL
2. Joint effusion with synovitis
3. Focal bone edema/ bruise posterior aspect of medial femoral condyle
4. Small posterior popliteal cyst - Baker's cyst

From whatever I could gather on the internet, this is a major injury and she would require a ligament reconstruction surgery. Any Orthopaedics out here who can advise on this based on the above information ?
Consult Dr Anant Joshi,a pioneer in arthroscopy and sports related injuries,he is from Mumbai.MRI can give vague results if there is inflammation in the knee.However the injuries mentioned are severe.A physical examination will be much helpful than correspondence. Hope this helps.
BoneCollector is online now   Reply With Quote
Old 7th November 2012, 12:27   #1338
BHPian
 
arjyamaj's Avatar
 
Join Date: Apr 2008
Location: NCT
Posts: 69
Thanked: 23 Times
Default re: Calling doctors/dentists/specialists on Team-BHP to provide free consultations

Question: are lawyers included in this forum under the 'specialists' tag? Or are we still regarded as bloodsucking parasites?

If we are included, then I'd be happy to provide some free consultation (we call it pro bono) provided its not too complicated.
arjyamaj is offline   Reply With Quote
Old 7th November 2012, 13:09   #1339
Distinguished - BHPian
 
Thad E Ginathom's Avatar
 
Join Date: Jun 2007
Location: Chennai
Posts: 7,694
Thanked: 6,869 Times
Default re: Calling doctors/dentists/specialists on Team-BHP to provide free consultations

I'm sure your generosity is appreciated; indeed I might impose on it one day!

I think this thread has such a medical nature now that we ought to have a new one for legal enquiries.
Thad E Ginathom is offline   Reply With Quote
Old 7th November 2012, 13:16   #1340
Distinguished - BHPian
 
Tejas@perioimpl's Avatar
 
Join Date: Sep 2008
Location: Bombay
Posts: 3,956
Thanked: 4,825 Times
Default re: Calling doctors/dentists/specialists on Team-BHP to provide free consultations

Quote:
Originally Posted by arjyamaj View Post
Question: are lawyers included in this forum under the 'specialists' tag? Or are we still regarded as bloodsucking parasites?
If we are included, then I'd be happy to provide some free consultation (we call it pro bono) provided its not too complicated.
Why don't you start a new thread? It'll be a great help to all.

Quote:
Originally Posted by Thad E Ginathom View Post
Dentists, implantologists please...

I have a three-tooth crown, upper front teeth, on two implants. The crown has become quite loose. My dentist's response was he thinks the screw has come loose in the implant, rather then the crown cement failing, and that removing the crown could cause much more trouble. There is no suspicion that the implant has come loose in the bone, but he did not x-ray it.

What kind of scenarios could be involved here? If the implants are still secure, but the threads have failed or deformed, is there any practical cure? Could it be simply glued back into place?

I imagine that removing an implant that is still set in the bone must be a horrible task
OK. Screw loosening on an integrated implant is a full day lecture. Let's try to simplify it as much as possible.

Let's first see the different parts of an implant. The implant basically has two parts. The implant body that goes into the bone and where one needs to wait for 3 months for it to integrate (fuse) with the bone. Once integrated, an abutment is screwed onto the implant with the help of an internal screw and a crown is cemented on the abutment. Ofcourse there are many more combinations and other options to the above, but this is the most common.

Here's a representative image:

Name:  Screen Shot 20121107 at 1.10.21 PM.png
Views: 302
Size:  83.1 KB

Identify the cause of the loosening.
1. It wasn't tightened properly. Ideally the screw should be tightened according to the manufacturer's recommendation using a torque ratchet. Usually 25 newtons. Most screws have a slight elasticity and once tightened, they tend to spring back. Thus, recommended protocol is to tighten, wait for 10 seconds and re-tighten.

2. Lateral excursive movements. Implants traditionally can withstand a lot of vertical forces but not lateral forces. If you are constantly hitting the implant crown during lateral excursive movements of the jaw (first point of contact here being the implant crown and not other teeth), then two things can happen. Either the screw becomes loose or you start loosing marginal bone.

A loose screw eventually will break and to retrieve the broken screw is extremely difficult from the implant body and many times will necessitate the removal of the implant.

Now, coming to your problem:

Let's assume the abutment screw is loose and not the implant itself. The cement bond is also fine. Thus, the only thing that needs to be done is to tighten the screw. This is done my removing the crown and accessing the abutment to tighten the screw.

Most dentists to remove a cemented crown use a crown remover which is a spring loaded hook which the dentist puts into a slot under the crown and activates and tries to remove the crown with brute shock force. If your dentist ever picks up such an instrument, RUN!

So what to do?

Two options. One is recommended, and one is jugad.

The recommended option is to cut the crown through and through. Use a diamond bur for the ceramic part of the crown and a metal cutting bur for the metal part. Always use brand new burs with lots of irrigation and a good high vac suction to suck out the metal filings. Then, the dentist simply accesses the abutment and can tighten the screws. However, a new crown now needs to be made for the implant. Screws whose threads if damaged (rarely) can't be used. However, the implant company can replace the screw at a minimal cost. If the internal threads of the implant are damaged (rare), all good implant companies will provide the doctor with a thread former that he can use to make new threads in the implant body.

Jugad technique: Make a hole from the top of the crown lingually assuming where the abutment opening is and then through this hole tighten the screw and seal the hole with a composite.

In either case, the dentist needs to figure out why the loosening happened.

I won't get into the scenario for removing an implant as yet.

Hope this helps.
Tejas@perioimpl is offline   Reply With Quote
Old 7th November 2012, 13:53   #1341
BHPian
 
arjyamaj's Avatar
 
Join Date: Apr 2008
Location: NCT
Posts: 69
Thanked: 23 Times
Default re: Calling doctors/dentists/specialists on Team-BHP to provide free consultations

Quote:
Originally Posted by Tejas@perioimpl View Post
Why don't you start a new thread? It'll be a great help to all.
Good idea!
arjyamaj is offline   Reply With Quote
Old 7th November 2012, 14:35   #1342
BHPian
 
dgupta's Avatar
 
Join Date: Jul 2012
Location: Coventry, UK
Posts: 69
Thanked: 64 Times
Default re: Calling doctors/dentists/specialists on Team-BHP to provide free consultations

Quote:
Originally Posted by BoneCollector View Post
Consult Dr Anant Joshi,a pioneer in arthroscopy and sports related injuries,he is from Mumbai.MRI can give vague results if there is inflammation in the knee.However the injuries mentioned are severe.A physical examination will be much helpful than correspondence. Hope this helps.
Thanks for the reply bonecollector. We are consulting an orthopaedic today, lets see what he says.
dgupta is online now   Reply With Quote
Old 7th November 2012, 18:38   #1343
BHPian
 
Join Date: Oct 2007
Location: dombivili,mumbai
Posts: 68
Thanked: 2 Times
Default

Your dentist ll cut away the crown, tighten the abutment and will take an impression and call you back after 3-4 days to put in new crowns/ bridge.
Such problems can occur in implant related prosthesis .
khadoos baby is offline   Reply With Quote
Old 7th November 2012, 22:21   #1344
Distinguished - BHPian
 
Thad E Ginathom's Avatar
 
Join Date: Jun 2007
Location: Chennai
Posts: 7,694
Thanked: 6,869 Times
Default re: Calling doctors/dentists/specialists on Team-BHP to provide free consultations

Tejas, khadoos, thank you.
Quote:
Originally Posted by Tejas@perioimpl View Post
2. Lateral excursive movements. Implants traditionally can withstand a lot of vertical forces but not lateral forces. If you are constantly hitting the implant crown during lateral excursive movements of the jaw (first point of contact here being the implant crown and not other teeth), then two things can happen. Either the screw becomes loose or you start loosing marginal bone.
That'll be me. Front lower teeth hitting back of top teeth. They always have done, despite bite correction. That's is probably the major cause for the loss of my real incisors.

This dentist didn't insert the implants, but he did make the current crown, and the fit has always been a bit too tight.

Quote:
A loose screw eventually will break and to retrieve the broken screw is extremely difficult from the implant body and many times will necessitate the removal of the implant.
I guess it had better get sorted, then, sooner rather than later.

Quote:
Let's assume the abutment screw is loose and not the implant itself. The cement bond is also fine. Thus, the only thing that needs to be done is to tighten the screw. This is done my removing the crown and accessing the abutment to tighten the screw.
There is quite a lot of forward/back play, and now some up/down play too: I haven't actually tried pulling down hard!
Quote:
Most dentists to remove a cemented crown use a crown remover which is a spring loaded hook which the dentist puts into a slot under the crown and activates and tries to remove the crown with brute shock force. If your dentist ever picks up such an instrument, RUN!
Hah! Well, my man does use stuff like that (like a hook with a moving block on it, but very cautiously, and I know he doesn't want to do that near the implants

Quote:
Two options. One is recommended, and one is jugad.

The recommended option is to cut the crown through and through. Use a diamond bur for the ceramic part of the crown and a metal cutting bur for the metal part. Always use brand new burs with lots of irrigation and a good high vac suction to suck out the metal filings. Then, the dentist simply accesses the abutment and can tighten the screws. However, a new crown now needs to be made for the implant. Screws whose threads if damaged (rarely) can't be used. However, the implant company can replace the screw at a minimal cost. If the internal threads of the implant are damaged (rare), all good implant companies will provide the doctor with a thread former that he can use to make new threads in the implant body.
Very interesting*, and very useful. Many thanks. I think the crown has to go. I think it has to go so as to address the cause of the problem, whatever else has to be done. Possibly the lower incisors should be "made smaller" (ie crowned) too.

Quote:
I won't get into the scenario for removing an implant as yet.
And I really, really hope I don't have to ask!


*Of course, it would be more interesting if it wasn't happening to me
Thad E Ginathom is offline   Reply With Quote
Old 7th November 2012, 22:27   #1345
Distinguished - BHPian
 
Tejas@perioimpl's Avatar
 
Join Date: Sep 2008
Location: Bombay
Posts: 3,956
Thanked: 4,825 Times
Default re: Calling doctors/dentists/specialists on Team-BHP to provide free consultations

Have you thought that maybe your posterior teeth have ground off due to bruxism thereby causing the front teeth to clash? Treat the cause not the problem. Think over that. Shall elaborate more if you want.
Tejas@perioimpl is offline   Reply With Quote
Old 7th November 2012, 23:57   #1346
Distinguished - BHPian
 
Thad E Ginathom's Avatar
 
Join Date: Jun 2007
Location: Chennai
Posts: 7,694
Thanked: 6,869 Times
Default re: Calling doctors/dentists/specialists on Team-BHP to provide free consultations

Yes, it is very possible. Back in 2004 or 2005 this dentist corrected my bite by appropriately crowning all those teeth. Yes, I have a tooth grinding habit, and yes, those crowns are worn. Thanks for reminding me. Will certainly bring that into the conversation if he doesn't.
Thad E Ginathom is offline   Reply With Quote
Old 8th November 2012, 07:32   #1347
Distinguished - BHPian
 
Tejas@perioimpl's Avatar
 
Join Date: Sep 2008
Location: Bombay
Posts: 3,956
Thanked: 4,825 Times
Default re: Calling doctors/dentists/specialists on Team-BHP to provide free consultations

Lastly, get a night guard made if you haven't already got one. Check for signs of wear every six months and replace if required.
Tejas@perioimpl is offline   Reply With Quote
Old 8th November 2012, 11:22   #1348
BHPian
 
car-dent's Avatar
 
Join Date: Jan 2010
Location: NOIDA
Posts: 130
Thanked: 21 Times
Infractions: 0/1 (5)
Default re: Calling doctors/dentists/specialists on Team-BHP to provide free consultations

Quote:
Originally Posted by Thad E Ginathom View Post
Yes, it is very possible. Back in 2004 or 2005 this dentist corrected my bite by appropriately crowning all those teeth. Yes, I have a tooth grinding habit, and yes, those crowns are worn. Thanks for reminding me. Will certainly bring that into the conversation if he doesn't.

Hi i am a prosthodontist and i have been going through your post. i 100% agree to what tejas@perioimplant has advised you.
screw loosening is a rather common problem with two piece implants but then it must have some underlying cause as he suggested such as the bite and lateral forces.
car-dent is offline   Reply With Quote
Old 8th November 2012, 11:50   #1349
Team-BHP Support
 
Samurai's Avatar
 
Join Date: Jan 2005
Location: B'lore-Manipal
Posts: 22,144
Thanked: 13,725 Times
Default

I am trying to get HBOT or Hyperbaric Oxygen Treatment for my autistic son. Bangalore would be the first choice, but I am not aware of any such facility in Bangalore.

But I hear Mumbai has lot of options. Looking for a package deal for 40 sessions with accommodations. Appreciate some info in this regards.

Last edited by Samurai : 9th November 2012 at 11:10. Reason: typo
Samurai is offline   Reply With Quote
Old 8th November 2012, 13:21   #1350
Distinguished - BHPian
 
Thad E Ginathom's Avatar
 
Join Date: Jun 2007
Location: Chennai
Posts: 7,694
Thanked: 6,869 Times
Default re: Calling doctors/dentists/specialists on Team-BHP to provide free consultations

Quote:
Originally Posted by Tejas@perioimpl View Post
Lastly, get a night guard made if you haven't already got one. Check for signs of wear every six months and replace if required.
Quote:
Originally Posted by car-dent View Post
Hi i am a prosthodontist and i have been going through your post. i 100% agree to what tejas@perioimplant has advised you.
screw loosening is a rather common problem with two piece implants but then it must have some underlying cause as he suggested such as the bite and lateral forces.
Thanks both. I'll be back at the dentist one day next week.

Sheesh, getting old sucks... teeth problems, hearing aids on the horizon, a few other bits to be checked out next week too . Hey ho, at least I'm still alive!
Thad E Ginathom is offline   Reply With Quote
Reply


Thread Tools Search this Thread
Search this Thread:

Advanced Search


Similar Threads
Thread Thread Starter Forum Replies Last Post
Calling Lawyers & CAs on this forum to provide free consultations arjyamaj Shifting gears 239 16th September 2017 14:08
Calling Networking and Server specialists! Red Liner Gadgets, Computers & Software 29 24th October 2015 12:47
Why do doctors make us wait for Hours? Daewood Shifting gears 22 23rd September 2011 21:36
Benign or malign cancers - doctors or 'been there' patients pls advice... gbpscars Shifting gears 16 29th July 2009 16:38
Any Veterinary Doctors on TBHP? - please help MillionSwords Shifting gears 13 18th March 2009 12:56


All times are GMT +5.5. The time now is 19:14.

Copyright 2000 - 2017, Team-BHP.com
Proudly powered by E2E Networks