December 14, 2018

View from the dentists chair – Guest Blog

About me

My name is Dr Jonathan Cochrane, I am 29 years old and live in Bristol, England. For my undergraduate BDS degree I trained at the University of Bristol, where I loved the city so much, I decided to settle here! I have always had a keen interest in Oral Surgery and so dental implants seemed like a natural area for me to continue with my postgraduate dental education; I have been placing implants for 4 years and in 2018 placed 110 dental implants. What sets me apart is that in September 2017 I was the youngest dentist to graduate from the University of Bristol with a master’s degree in Dental Implantology. In addition, in September 2018 I was also the first British dentist to be awarded a Certificate in Implant Dentistry by the German Board of Oral Implantology (DGZI).

My implants

Day to day, I mostly use the Astra Tech EV implant system (which I love!), however, when certain clinical situations require a different approach, I can also use Straumann and/or Ankylos implants. Indeed, I believe it is important to be versatile and understand the strengths of different products available on the market, whether this applies to implant systems, or bone regeneration materials.  

Guided Bone Regeneration

When I first started to place dental implants, as with most other clinicians, I first gained experience with Guided Bone Regeneration techniques by using a bovine sourced  xenograft. However, as many will have experienced, these products can be fiddly to use and once you have factored in the porcine collagen membrane it can also be very technique sensitive and time consuming to apply. Alongside this, I have personally found that many patients did not like the fact that we were using animal products. Indeed, during my implant consultations I regularly encountered resistance from patients with dietary, religious and ethical concerns. This led me to ponder, surely there must be a better, more socially acceptable solution available for our discerning implant patients?

Introduction to EthOss

I must admit, I only first became aware of EthOss through a Facebook advert; Swallow Dental were presenting this new ‘wonder’ material via an introductory event in Bristol held at the SS Great Britain. After following the link and reviewing various case studies showcasing the seemingly incredible regenerative potential of this new synthetic bone regeneration material my interest was suitably piqued. I realised that I had nothing to lose by going along to hear all about it; I am of course very glad that I attended!

Learning curve with EthOss

As with starting to use all new clinical products, I was very careful with my initial case selections. I started using EthOss with small, predictable guided bone regeneration procedures i.e. buccal fenestrations. However, I was very pleased with the clinical outcomes produced. With confidence I started to apply it to larger defects and in more varied sites i.e. sinus lifts and the tunnel technique (to avoid block bone grafts). However, I must admit, I did learn the hard way… You need to achieve good tension-free primary closure of the wound, otherwise the EthOss material may work its way loose during the first two weeks of soft tissue healing/before your mucosal wound edges have approximated shut. This of course means that there may be less graft material to turn into bone, thereby giving you a less than desirable guided bone regeneration outcome.

The perfect clinician

Now, I am by no means a perfect clinician, however I now do feel very confident when using EthOss day to day in assisting with my implant placement procedures. It is a lovely material to use and provides me with very predictable outcomes. However, I would recommend those users new to EthOss to take things slowly (i.e. the conventional way) by burying your implants and to ‘expose’ them later instead of rushing ahead and using healing abutments at the time of placement. That is not to say I don’t use healing caps via 1-stage surgeries, I do, but only when I can achieve good tension-free primary closure as previously explained.

My treatment aims

Undeniably, I am a big fan of trying to reduce treatment times for my implant patients as some complex treatment plans can take ~1 year to complete. Therefore, I do favour immediate implant placements (when clinically suitable), however this may not always be the case. In those situations where immediate placements are contraindicated, I have become a big advocate of using EthOss to perform socket preservation. Indeed, this is where I believe EthOss really comes into its own!

Socket Preservation to the max!

After atraumatically removing a tooth/root and careful curettage of the residual extraction socket of all granulation tissue, you now have the perfect site in which to use EthOss. By following the manufacturers guidelines i.e. mixing the EthOss powder 50:50 with sterile saline, good shaking/mixing, expressing this ‘claggy’ mixture into the recipient site and then drying lightly with sterile gauze for 3 minutes, you can achieve a stable bone regeneration matrix which will have a consistency like chalk. In those cases where you cannot then achieve good primary wound closure over the recent extraction socket, I have found using Sinoss collagen fleece to be both an economical and efficient way to retain EthOss in the socket thereby allowing decent soft tissue overgrowth within a couple of weeks. By the time of surgical re-entry (I only wait 10 weeks!) I consistently see vascularised, cancellous type 2/3 bone in which I can then place my dental implants in the restoratively perfect position and achieve very good primary stability. Indeed, I could never hope to achieve results even similar to this when using alternative bone substitution materials.

Conclusion

In short, I am a big fan of EthOss as a true bone regeneration material; it works wonders for both my patients and me. Truly, it has allowed me to shorten my overall implant treatment times and provide me with the confidence to consistently deliver great surgical and aesthetic outcomes. When I can, I like to post my own case studies on the EthOss Facebook group (EthOss Case Studies), I therefore invite you to join me on this educational platform and to also post your experiences with using EthOss; you won’t be disappointed!

Dr Jonathan Cochrane
BDS, MFGDP(UK), MFDS RCS, CertConSed,
MSc (Dental Implantology), CertImpDent (DGZI)