BEYOND  HEROIC  DETISTRY Alex Shvartsman, DDS, FAGD And  Dr. Edward Brant
Third most common dental emergency
 
 
 
Cause of failure?
NO FERRULE! <ul><li>What’s a ferrule? </li></ul><ul><li>Ferrule guidelines. </li></ul><ul><li>A post is meant to retain th...
What to do?
Restorative options <ul><li>Post and crown no ferrule </li></ul><ul><li>Post and crown, 2mm ferrule </li></ul><ul><li>Crow...
Post and crown without a 2mm ferrule on sound tooth structure <ul><li>DOOMED TO FAIL!!!!!!!!!!!!!!!!!!!!! </li></ul><ul><l...
Post, crown with 2mm ferrule! <ul><li>Biologic width infringement </li></ul><ul><li>Crown margin has to be 2.5mm from the ...
Crown lengthening dilemmas <ul><li>Esthetics </li></ul><ul><li>Crown to root ratio consideration </li></ul><ul><li>Decreas...
 
 
 
Super-eruption dilemmas <ul><li>Appropriate case selection – length of root </li></ul><ul><li>Patient willingness to wear ...
 
 
5 weeks later,  3 months stabilization
 
 
PARADIGM SHIFT
EXTRACTION <ul><li>RPD </li></ul><ul><li>Maryland bridge </li></ul><ul><li>Bridge </li></ul><ul><li>Implant supported crow...
Total tooth replacement DENTAL IMPLANT <ul><li>Better long term prognosis </li></ul><ul><li>Predictable </li></ul><ul><li>...
Implant time line options <ul><li>Extract, place implant, immediate implant borne temporary, integrate, restore. </li></ul...
Immediate implant temporization options <ul><li>Implant must be torque tested to 35Ncm </li></ul><ul><li>Cement on to the ...
Cement vs. screw retained
Advantages of screw retained temp. <ul><li>No additional micro-gap </li></ul><ul><li>No chance for leaving cement under he...
Steps for  screw retained  temp.
Vaccuformed stent, temporary abutment, a little improv.
Rough temp
Fill in the gaps
Polish and seal
Screw in, seal access with wax and Fermit/composite
Can’t temporize implant? <ul><li>Need to graft </li></ul><ul><li>Implant moving at 45Ncm. </li></ul><ul><li>Don’t want to....
Non-implant borne temporaries.
Transitional RPD “The  Flipper” <ul><li>Loose </li></ul><ul><li>Difficulty speaking </li></ul><ul><li>Possible tissue comp...
Removable Transitional RPD Essix with tooth <ul><li>No tissue compression </li></ul><ul><li>Non-bulky </li></ul><ul><li>Di...
 
 
Fixed Transitional  The   modified winged pontic <ul><li>Non-bulky </li></ul><ul><li>No tissue compression </li></ul><ul><...
Design <ul><li>Non-precious frame </li></ul><ul><li>Acrylic pontic  </li></ul><ul><li>Thin wings preferably with holes </l...
 
Ability to modify pontic and support soft tissue profile
 
 
 
What would you do?
What will you do?
What will you do?
Steel & Sunshine  for the tooth Titanium and piece of mind for you and the patient
Single  tooth  Implant Restoration options <ul><li>Screw retained crown to implant </li></ul><ul><li>Screw retained crown ...
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Town and Country Simpl abutment system
Simpl Steps: <ul><li>Unscrew healing abutment </li></ul><ul><li>Place Impression abutment – verify fit with x-ray </li></u...
 
Thank you  Questions?
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Long Island Implant Dentist presents "The Benefits of Dental Implants"

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Periodontist who does his best when he provides Long Island with treatment for tooth and gum disease. Dentist, dental implants, laser gum treatment for periodontal disease, bone graft, gum surgery

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  • Third most commo
  • Long Island Implant Dentist presents "The Benefits of Dental Implants"

    1. 1. BEYOND HEROIC DETISTRY Alex Shvartsman, DDS, FAGD And Dr. Edward Brant
    2. 2. Third most common dental emergency
    3. 6. Cause of failure?
    4. 7. NO FERRULE! <ul><li>What’s a ferrule? </li></ul><ul><li>Ferrule guidelines. </li></ul><ul><li>A post is meant to retain the core not support a crown </li></ul><ul><li>Ceramic crowns </li></ul>
    5. 8. What to do?
    6. 9. Restorative options <ul><li>Post and crown no ferrule </li></ul><ul><li>Post and crown, 2mm ferrule </li></ul><ul><li>Crown lengthening, post, crown </li></ul><ul><li>Super eruption, crown lengthening, post, crown </li></ul><ul><li>Extract and restore missing space </li></ul>
    7. 10. Post and crown without a 2mm ferrule on sound tooth structure <ul><li>DOOMED TO FAIL!!!!!!!!!!!!!!!!!!!!! </li></ul><ul><li>1. Crown and post will fall out </li></ul><ul><li>2. Root fracture </li></ul><ul><li>3. Patient loses confidence. </li></ul>
    8. 11. Post, crown with 2mm ferrule! <ul><li>Biologic width infringement </li></ul><ul><li>Crown margin has to be 2.5mm from the osseous crest to avoid chronic inflammation or recession </li></ul><ul><li>Must sound the bone! </li></ul>
    9. 12. Crown lengthening dilemmas <ul><li>Esthetics </li></ul><ul><li>Crown to root ratio consideration </li></ul><ul><li>Decreased bone support for tooth </li></ul><ul><li>Decreased bone support of adjacent tooth </li></ul><ul><li>Possible furcation involvement of adjacent teeth </li></ul><ul><li>Total cost of treatment? </li></ul>
    10. 16. Super-eruption dilemmas <ul><li>Appropriate case selection – length of root </li></ul><ul><li>Patient willingness to wear braces </li></ul><ul><li>Time </li></ul><ul><li>Need crown lengthening after </li></ul><ul><li>Crown/root ratio </li></ul><ul><li>Total cost of treatment? </li></ul>
    11. 19. 5 weeks later, 3 months stabilization
    12. 22. PARADIGM SHIFT
    13. 23. EXTRACTION <ul><li>RPD </li></ul><ul><li>Maryland bridge </li></ul><ul><li>Bridge </li></ul><ul><li>Implant supported crown </li></ul>
    14. 24. Total tooth replacement DENTAL IMPLANT <ul><li>Better long term prognosis </li></ul><ul><li>Predictable </li></ul><ul><li>Patients will not loose confidence due to failed dentistry </li></ul><ul><li>It is fast becoming, if not already, the standard of care for tooth replacement. </li></ul>
    15. 25. Implant time line options <ul><li>Extract, place implant, immediate implant borne temporary, integrate, restore. </li></ul><ul><li>Extract, place implant, non-implant borne temporary, integrate, restore. </li></ul><ul><li>Extract, Graft, Temporize, place implant, integrate, restore. </li></ul>
    16. 26. Immediate implant temporization options <ul><li>Implant must be torque tested to 35Ncm </li></ul><ul><li>Cement on to the temporary abutment </li></ul><ul><li>Screw retained temporary </li></ul>
    17. 27. Cement vs. screw retained
    18. 28. Advantages of screw retained temp. <ul><li>No additional micro-gap </li></ul><ul><li>No chance for leaving cement under healing tissue. </li></ul><ul><li>Easier to tissue-mold </li></ul><ul><li>No twisting implant on removal. </li></ul><ul><li>Temps don’t fall off. </li></ul>
    19. 29. Steps for screw retained temp.
    20. 30. Vaccuformed stent, temporary abutment, a little improv.
    21. 31. Rough temp
    22. 32. Fill in the gaps
    23. 33. Polish and seal
    24. 34. Screw in, seal access with wax and Fermit/composite
    25. 35. Can’t temporize implant? <ul><li>Need to graft </li></ul><ul><li>Implant moving at 45Ncm. </li></ul><ul><li>Don’t want to. </li></ul>
    26. 36. Non-implant borne temporaries.
    27. 37. Transitional RPD “The Flipper” <ul><li>Loose </li></ul><ul><li>Difficulty speaking </li></ul><ul><li>Possible tissue compression </li></ul><ul><li>Possible compromised surgical result. </li></ul><ul><li>Poor at tissue support </li></ul><ul><li>I HATE THEM!!!!! </li></ul>
    28. 38. Removable Transitional RPD Essix with tooth <ul><li>No tissue compression </li></ul><ul><li>Non-bulky </li></ul><ul><li>Difficult to eat with </li></ul><ul><li>Cheap and quick – make them yourself! </li></ul><ul><li>Patients do not like it for long term use </li></ul><ul><li>Poor at tisue support </li></ul>
    29. 41. Fixed Transitional The modified winged pontic <ul><li>Non-bulky </li></ul><ul><li>No tissue compression </li></ul><ul><li>Easily removed and re-cemented </li></ul><ul><li>Lasts a long time </li></ul><ul><li>Modifiable after multiple surgical procedures </li></ul><ul><li>Tissue support possible </li></ul><ul><li>Relatively inexpensive </li></ul>
    30. 42. Design <ul><li>Non-precious frame </li></ul><ul><li>Acrylic pontic </li></ul><ul><li>Thin wings preferably with holes </li></ul><ul><li>No prep of linguals of adjacent teeth </li></ul><ul><li>Same fee as for a flipper </li></ul>
    31. 44. Ability to modify pontic and support soft tissue profile
    32. 48. What would you do?
    33. 49. What will you do?
    34. 50. What will you do?
    35. 51. Steel & Sunshine for the tooth Titanium and piece of mind for you and the patient
    36. 52. Single tooth Implant Restoration options <ul><li>Screw retained crown to implant </li></ul><ul><li>Screw retained crown to abutment </li></ul><ul><li>Cemented crown to Prefabricated abutment. (stock abutment) </li></ul><ul><li>Cement retained crown to custom abutment, (UCLA abutment) </li></ul><ul><li>CAD/CAM abutment </li></ul>
    37. 72. Town and Country Simpl abutment system
    38. 73. Simpl Steps: <ul><li>Unscrew healing abutment </li></ul><ul><li>Place Impression abutment – verify fit with x-ray </li></ul><ul><li>Take fixture level impression with heavy body, bite, counter, shade. </li></ul><ul><li>Define margin placement </li></ul><ul><li>Lab default: B=1.5mm, I=.75mm, L=.25 </li></ul><ul><li>2 weeks for titanium abutment & PFM </li></ul><ul><li>3 weeks for titanium abutment & Zircad crown </li></ul><ul><li>4 weeks for zirconium abutment & Zircad crown </li></ul><ul><li>Approve design via e-mail – if you want </li></ul><ul><li>Take verification x-ray </li></ul><ul><li>Seat crown, adjust as needed </li></ul><ul><li>Cement crown </li></ul>
    39. 75. Thank you Questions?

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