Long Island Periodontist presents "Dental Implant Abutment Impression and Delivery Techniques"

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  • Didatic course if there is a demand we can go back to my office and do model work.
    Start out with what this looks like coming back from the surgeon.
  • Once you belong to the club you realize it is easier.
    Beg like learning a foreign lang, no frame of reference
    Kids learn faster
    Compare endo, p/c crown
    Disuse atrophy, no formal education it’s over, kids kidnapped or test you would learn the componenets. No dicom3, beta vhs, blu-ray and high def
    First class in dental school dental terminology anatomy make you learn mesial distal all the features of all the teeth
    All these names starts to make my mind glaze over
    Learn all this for 5-10 cases/year
    A lot of lecturers showing their commando cases.
    No nitty gritty lectures point a to point B
  • A lot of lecturers showing their commando cases.
    No nitty gritty lectures point a to point B
    First part will be on cemented restorations using custom abutments most popular way to restore
  • Nobel is the whole company. They have other implant configurations.
    Microsoft has different operating systems vista, xp, me,
    External hex, nobel active.
    Look at the photo or look at the report to find out what you need.
  • Purple is a little tough to see
  • No other driver will match
    Not a hex more like a star grip driver
  • No other driver will match
    Not a hex more like a star grip driver
  • Everybody is trying to make it easier on the restorative doctor
    The easier we make it the more inclined you will be to recommend
    prepackaged
  • Define
    Custom gets fired and metal is melted on to an post
    Easier and cheaper
    More accurate machined part that fits into machined part
    Need to be able to instrument the margin for removal of subg cement
    Have a stock of these and try in and see if it works I am ok
    But be prepared to take a fixture level impression
  • Look how close the cement margin is to the implant top
    Premachined tolerances are expected to be better
    Need to be able to instrument the margin for removal of subg cement
    Have a stock of these and try in and see if it works I am ok
    But be prepared to take a fixture level impression
  • Little short for retention purposes even though 5 mm should be enough
    Smoetimes prepping them becomes necessary
  • Little short for retention purposes even though 5 mm should be enough
    Smoetimes prepping them becomes necessary
  • Clinical pix?
    Adjacent teeth or second molar regions OOL
  • Comes prepackaged
  • Burnout coping = ?

  • Uni grip driver
  • Name of the screws
  • Coming back from the surgeon
    Take it from the top
    Everybody has unscrewd a healing abutm by now
    Imp coping given people problem
    Maybe getting a good impression
  • Trying to judge soft tissue height
    See 5 mm healing abutment
  • Use xrays and vision
    Sight down and examine path of insertion of crown
  • Papilla will not fill this in unlike after perio surgery or crown
    Make that proximal surface flat so the lab can fill the embrasure space more predictably
    I do not think they look at the soft tissue model as much as they should.
    T and C redid this without charge.
  • Papilla will not fill this in unlike after perio surgery or crown
    Make that proximal surface flat so the lab can fill the embrasure space more predictably
    I do not think they look at the soft tissue model as much as they should.
    T and C redid this without charge.
  • in
  • Especially for 3.5 mm impression coping
  • Especially in the mandible
    You do not have to look so use 2 hands
  • If you need help in the back parts of the mouth
    Just like working a socket wrench
    Hear and feel a click you know you are at the end
  • The purples and yellow have two different diameters
    Especially in the mandible
  • More than 3-4 mm of depth probably best
    Tissue collapse laser it away sometimes
  • By convention we put the lobe on the buccal
    Facilitates stock abutment placemnt
  • Bring it site with fingers or needle holder
    Especially helpful when tissue is tight and 3.5 mm purple
    Squeezes tissue and you can feel it drop in better
    Especially needed for nobelactive
    Nobelactive is a small step up in difficulty so these principles are needed
    Even if you are proficient with replace select and you do not need these principles for RS then you just may for nobel active
    Needle holder should have narrow beaks
  • So you don’t drop uni grip driver
  • Look down the implant sometimes lobe is not perfectly on the buccal
    Needleholder can generate more apical force for more positive feel
    Hands not in the way so you can see it drop
  • 3.5 mm in there already because restorative doc could not get 3.5 mm healing abutment home
    Look down the implant sometimes lobe is not perfectly on the buccal
    Needleholder can generate more apical force for more positive feel
    Hands not in the way so you can see it drop
    Pick the best path of insertion not to get voids
  • Define the difference
    Screw retained Misangeled implants, certain kinds of prosthetic abutments immediate implants if the interarch space is limited
  • Clear adhesive
  • Access hole as it relates to mesial and distal
    Pat burdi
    Line from astor
  • Access hole as it relates to mesial and distal
  • Sometimes tissue will really dampen
    If not sure it is home then take film
    Crestal release or laser
    Suspect gingival recession later
  • It is a releiving incision
  • Striving for a 0-2 mm subg margin
  • They are latch type sitting in wax
  • Needle holder being used to carry abutment to implant
    Kim o
  • Me doing the procedure
    Do not get to see me holding on to the abutment for dear life while I turn the abut screw
  • What I see
  • Misangled, anterior tooth have a problem
    But posterior well angled implant have a chance.
    Larger problem of bent or broken screw
    Do not hit screw head
  • Show me with composite
  • Pt don’t floss, other aidsFrank krepealapg 157
    Vestige from tooth tx planning
    Caries risk, harder to care for porc fractures
    Are the splinted crowns harder to seat
    Or is it a left over fear of tooth supported prosthetics
  • Frank krepeala
    Dazzling physics to prove this
    4mm single molars 14% body failure, multipl splinted 1%
  • Frank krepeala
  • Post-op Frank krepeala
    Convert to a pontic in one visit
  • Ann dreschler
    Damico
    Richter
    Joann cimminello
  • Impresion needle holder, LA,
  • Long Island Periodontist presents "Dental Implant Abutment Impression and Delivery Techniques"

    1. 1. Chair Time Saving andChair Time Saving and Confidence Raising TipsConfidence Raising Tips and Techniques for theand Techniques for the Abutment Phase ofAbutment Phase of Implant ProstheticsImplant Prosthetics
    2. 2. Why is implantWhy is implant dentistry harder?dentistry harder? dentistry harder?dentistry harder?Need to learn a different vocabularyNeed to learn a different vocabulary Different companies = different vocabulariesDifferent companies = different vocabularies Copings = transfer copings = impressionCopings = transfer copings = impression post = impression copingspost = impression copings Analogs = implant replicasAnalogs = implant replicas Lecturers skip over detailsLecturers skip over details Seat of the pants on the job training vs. FormalSeat of the pants on the job training vs. Formal trainingtraining
    3. 3. she coming overcoming over with?with? coming overcoming over with?with?
    4. 4. Why is implantWhy is implant dentistry harder?dentistry harder? dentistry harder?dentistry harder?Need to learn a different vocabularyNeed to learn a different vocabulary Different companies = different vocabulariesDifferent companies = different vocabularies Copings = transfer copings = impression postCopings = transfer copings = impression post = impression copings= impression copings Analogs = implant replicasAnalogs = implant replicas Seat of the pants on the job training vs. FormalSeat of the pants on the job training vs. Formal trainingtraining Lecturers skip over detailsLecturers skip over details
    5. 5. NobelNobel Biocare’sBiocare’s ReplaceReplace SelectSelect Components areComponents are color codedcolor coded
    6. 6. Even the fixture top is colorEven the fixture top is color codedcoded
    7. 7. ArmamentariumArmamentarium
    8. 8. Armamentarium 1st Visit:Armamentarium 1st Visit: Impression CopingsImpression Copings Impression CopingsImpression Copings
    9. 9. Implant ManufacturersImplant Manufacturers More User-FriendlyMore User-Friendly Look For My PhotosLook For My Photos
    10. 10. CustomCustom vs.vs. PremachinedPremachined (a.k.a., Stock, EZ)(a.k.a., Stock, EZ) AbutmentsAbutments AbutmentsAbutments AbutmentsAbutments AbutmentsAbutments AbutmentsAbutments CustomCustom EZ AbutmentEZ Abutment
    11. 11. CustomCustom vs.vs. PremachinedPremachined (a.k.a., Stock, EZ)(a.k.a., Stock, EZ) AbutmentsAbutments AbutmentsAbutments AbutmentsAbutments AbutmentsAbutments AbutmentsAbutments Watch gingival margin postion as it relates toWatch gingival margin postion as it relates to future restorative marginfuture restorative margin Too far apical can lead to subg inflammationToo far apical can lead to subg inflammation EZ abtutment impression procedure can beEZ abtutment impression procedure can be technically more sensitivetechnically more sensitive CustomCustom EZEZ AbutmentAbutment
    12. 12. Inspect Sulcus DepthInspect Sulcus Depth
    13. 13. Inspect Sulcus DepthInspect Sulcus Depth
    14. 14. Increased Height ofIncreased Height of Margin on the mesial ofMargin on the mesial of
    15. 15. Forced to switch fromForced to switch from premachined EZ abutment topremachined EZ abutment to custom abutmentcustom abutment
    16. 16. Key Components of theKey Components of the EZ AbutmentEZ Abutment EZ AbutmentEZ Abutment
    17. 17. EZ abutmentEZ abutment QuickTime™ and a DV/DVCPRO - NTSC decompressor are needed to see this picture.
    18. 18. ntnt ReplicaReplica
    19. 19. Healing Cap in PlaceHealing Cap in Place
    20. 20. wax addedwax added Gold will adapt to the GoldAdapt (customGold will adapt to the GoldAdapt (custom abutment)abutment) Invested and cast similar to normal crown andInvested and cast similar to normal crown and bridgebridge
    21. 21. Supply for 1st visit:Supply for 1st visit: ImpressionImpression Coping/Post(s)Coping/Post(s)
    22. 22. Video of soft tissueVideo of soft tissue QuickTime™ and a DV/DVCPRO - NTSC decompressor are needed to see this picture.
    23. 23. Pull the impression andPull the impression and the impression copingsthe impression copings
    24. 24. QuickTime™ and a decompressor are needed to see this picture.
    25. 25. QuickTime™ and a decompressor are needed to see this picture. Abutment DeliveryAbutment Delivery
    26. 26. First RestorativeFirst Restorative VisitVisit Pre-op EvaluationPre-op Evaluation Outcome films, photos, order impression copingOutcome films, photos, order impression coping Healing Abutment RemovalHealing Abutment Removal Impression Coping PlacementImpression Coping Placement Impression TakingImpression Taking
    27. 27. Look at Tissue Conditions and Height ofLook at Tissue Conditions and Height of Healing Abutment Before ImpressionHealing Abutment Before Impression Healing Abutment Before ImpressionHealing Abutment Before Impression
    28. 28. Inspect Heights ofInspect Heights of Contour BeforeContour Before ImpressioningImpressioning
    29. 29. Remove Heights of ContourRemove Heights of Contour Before ImpressioningBefore Impressioning
    30. 30. Papilla is not going to migratePapilla is not going to migrate
    31. 31. Papilla is not going to migratePapilla is not going to migrate
    32. 32. Open EmbrasureOpen Embrasure SpacesSpaces
    33. 33. Methods for impressionMethods for impression takingtaking
    34. 34. Set-up for FixtureSet-up for Fixture Level ImpressionsLevel Impressions Level ImpressionsLevel Impressions Color codedColor coded Have the impression copings “at the ready”Have the impression copings “at the ready” Tissue has a tendency to collapseTissue has a tendency to collapse Uni-grip driverUni-grip driver Short is often helpful in the posteriorShort is often helpful in the posterior Needle holder helpfulNeedle holder helpful Surgical SuctionSurgical Suction
    35. 35. Ready to Remove theReady to Remove the Healing AbutmentsHealing Abutments Start in the posterior parts of the mouth andStart in the posterior parts of the mouth and work towards the anteriorwork towards the anterior Double check surgical suction at the readyDouble check surgical suction at the ready
    36. 36. During Healing AbutmentDuring Healing Abutment RemovalRemoval Always maintain “healthy” inward force onAlways maintain “healthy” inward force on healing abutmenthealing abutment Strive for 2 handed technique to remove orStrive for 2 handed technique to remove or place any componentplace any component Use a needleholder when needed:Use a needleholder when needed: Healing abutment too tightHealing abutment too tight Safely manipulate drivers:Safely manipulate drivers: especially posterior maxillaespecially posterior maxilla sometimes in the posterior mandible Asst can retrieve healingsometimes in the posterior mandible Asst can retrieve healing abutmentabutment
    37. 37. QuickTime™ and a DV/DVCPRO - NTSC decompressor are needed to see this picture. Use Needle Holder To Hold Uni-Grip DriverUse Needle Holder To Hold Uni-Grip Driver
    38. 38. Gentle Handling ofGentle Handling of PatientPatientAim for the center of the mouthAim for the center of the mouth Don’t just grab the cornerDon’t just grab the corner Reach in then retractReach in then retract While Repositioning patient:While Repositioning patient: 2 points on the outside of face or jaw2 points on the outside of face or jaw Verbally tell them to lean one way or the otherVerbally tell them to lean one way or the other Turn the pts head toward the asst whenTurn the pts head toward the asst when requiredrequired Do not lean instruments against attachedDo not lean instruments against attached gingivagingiva It hurts and they won’t tell youIt hurts and they won’t tell you
    39. 39. Striving for Gentle Delivery ofStriving for Gentle Delivery of CareCare QuickTime™ and a DV/DVCPRO - NTSC decompressor are needed to see this picture.
    40. 40. During Healing AbutmentDuring Healing Abutment RemovalRemovalMake note of which healing abutment cameMake note of which healing abutment came out of which implant fixtureout of which implant fixture Heights and Widths can be differentHeights and Widths can be different Be prepared to place impression copingBe prepared to place impression coping immediately following the removal of theimmediately following the removal of the healing abutmenthealing abutment
    41. 41. Remove healing abutmentRemove healing abutment QuickTime™ and a DV/DVCPRO - NTSC decompressor are needed to see this picture.
    42. 42. Impression CopingImpression Coping PlacementPlacementPlacement with:Placement with: FingersFingers NeedleholderNeedleholder Anesthetize the tissue if neededAnesthetize the tissue if needed Especially for 3.5 mm implant fixtureEspecially for 3.5 mm implant fixture Pt comfortPt comfort Improves efficiencyImproves efficiency ““Extra” tissue will dampen your tactile senseExtra” tissue will dampen your tactile sense ““Is it tissue or bone?”Is it tissue or bone?” ““Do I have the right impression coping?”Do I have the right impression coping?”
    43. 43. Retention Screws Do NotRetention Screws Do Not Fall OutFall Out
    44. 44. Insert and Secure Impression CopingInsert and Secure Impression Coping QuickTime™ and a DV/DVCPRO - NTSC decompressor are needed to see this picture.
    45. 45. Impression CopingImpression Coping PlacementPlacement
    46. 46. Internal lobes ofInternal lobes of fixture matchfixture match indentations on theindentations on the impression copingimpression coping
    47. 47. QuickTime™ and a DV/DVCPRO - NTSC decompressor are needed to see this picture. Use Needle Holder To Hold Uni-GripUse Needle Holder To Hold Uni-Grip Driver While Securing ImpressionDriver While Securing Impression CopingCoping
    48. 48. Place Impression CopingsPlace Impression Copings QuickTime™ and a DV/DVCPRO - NTSC decompressor are needed to see this picture.
    49. 49. Place Impression CopingsPlace Impression Copings
    50. 50. Sample Lab RxSample Lab Rx Please pour up soft tissue model for customPlease pour up soft tissue model for custom abutmentabutment Provide ideal contours of the abutment to fillProvide ideal contours of the abutment to fill embrasure area and help prevent foodembrasure area and help prevent food impactionimpaction I will modify soft tissue as neededI will modify soft tissue as needed Other suggestionsOther suggestions
    51. 51. Closed Tray vs Open TrayClosed Tray vs Open Tray Impresssion TechniqueImpresssion Technique
    52. 52. Linking Open Tray Impression CopingsLinking Open Tray Impression Copings TogetherTogether
    53. 53. Open Tray ImpressionOpen Tray Impression QuickTime™ and a DV/DVCPRO - NTSC decompressor are needed to see this picture.
    54. 54. Better Look At TriadBetter Look At Triad BlueBlue QuickTime™ and a DV/DVCPRO - NTSC decompressor are needed to see this picture.
    55. 55. Abutment deliveryAbutment delivery Pre-opPre-op Tricks for getting the abutment toTricks for getting the abutment to the fixturethe fixture Technique to torque the abutmentTechnique to torque the abutment How I handle the access holeHow I handle the access hole
    56. 56. Inspect the Soft Tissue ModelInspect the Soft Tissue Model Look for Distinguishing mark on buccalLook for Distinguishing mark on buccal Line, dots, tooth numberLine, dots, tooth number
    57. 57. Inspect the Soft TissueInspect the Soft Tissue ModelModelLook for Distinguishing mark on buccalLook for Distinguishing mark on buccal Line, dots, tooth numberLine, dots, tooth number Look at the abutment carefully:Look at the abutment carefully: Note the orientation of the access holeNote the orientation of the access hole
    58. 58. Abutment DeliveryAbutment Delivery Rinse and dry the inside of the fixtureRinse and dry the inside of the fixture Finger delivery not often possibleFinger delivery not often possible Needleholder is used most oftenNeedleholder is used most often Generate more force to push tissue asideGenerate more force to push tissue aside
    59. 59. Back out + turn to help ensure fullBack out + turn to help ensure full seatingseating QuickTime™ and a DV/DVCPRO - NTSC decompressor are needed to see this picture.
    60. 60. Need the rightNeed the right needleholderneedleholder
    61. 61. Crestal ReleasingCrestal Releasing IncisionIncision
    62. 62. Abutments In Place,Abutments In Place, Laser GingivectomyLaser Gingivectomy Laser GingivectomyLaser Gingivectomy
    63. 63. To Apply The FinalTo Apply The Final TorqueTorque
    64. 64. Needle holder being used to carry abutment to implant carry abutment to implant
    65. 65. Restorative PhaseRestorative Phase Placement of AbutmentPlacement of Abutment Placement of AbutmentPlacement of Abutment
    66. 66. FermitFermit
    67. 67. Placing CustomPlacing Custom AbutmentAbutment
    68. 68. Choice of Cement forChoice of Cement for Final ProsthesisFinal Prosthesis Final ProsthesisFinal Prosthesis Temp-BondTemp-Bond With Vaseline ?With Vaseline ? Premier Implant CementPremier Implant Cement DurelonDurelon Final Cement of ChoiceFinal Cement of Choice
    69. 69. Technique to removeTechnique to remove crowncrown
    70. 70. If Crown Cannot BeIf Crown Cannot Be RemovedRemoved If possible, make occlusal accessIf possible, make occlusal access hole and find screw and tightenhole and find screw and tighten Correct reason for looseningCorrect reason for loosening Cut crown off, remake crownCut crown off, remake crown If both crown and abutment areIf both crown and abutment are mangled, remake bothmangled, remake both
    71. 71. Fill those holes tightlyFill those holes tightly with cottonwith cotton Gloria sessoGloria sesso Karen RowleyKaren Rowley
    72. 72. QuickTime™ and a DV/DVCPRO - NTSC decompressor are needed to see this picture.
    73. 73. Primary Benefit of independent crowns =Primary Benefit of independent crowns = Interproximal Hygeine, Pt Psyche, Easier toInterproximal Hygeine, Pt Psyche, Easier to repair porcelainrepair porcelain Is it easier to restore with single units?Is it easier to restore with single units? To Splint or Not toTo Splint or Not to Splint?Splint?
    74. 74. ““The Entire System Benefits From SplintingThe Entire System Benefits From Splinting Implants Together”Implants Together” Carl MischCarl Misch Splinted Implants:Splinted Implants: Increase functional surface area of bonyIncrease functional surface area of bony supportsupport Better resist lateral loadsBetter resist lateral loads Increase cement retentionIncrease cement retention Decrease the risk of:Decrease the risk of: screw looseningscrew loosening marginal bone lossmarginal bone loss To Splint or Not toTo Splint or Not to Splint?Splint?
    75. 75. Multiple Splinted CrownsMultiple Splinted Crowns Can Help Rescue ACan Help Rescue A CaseCase
    76. 76. Multiple Splinted CrownsMultiple Splinted Crowns Can Help Rescue ACan Help Rescue A CaseCase
    77. 77. Occlusal SchemesOcclusal SchemesIt must be emphasized that currently there is no evidence-based, implant- specific concept of occlusion. Future studies in this area are needed...” Clin Oral Implants Res. 2005 Feb;16(1):26-35 Kim YKim Y,, Oh TJOh TJ,, Misch CEMisch CE,, Wang HLWang HL.. occlusion strategy guidelines, clinical axioms and majority opinions ““Medium- or long-term failure of dental implants after osseointegrationMedium- or long-term failure of dental implants after osseointegration has been associated in the great majority of cases with occlusalhas been associated in the great majority of cases with occlusal overload....overload....Overload depends ultimately on the number and location of occlusal contacts, which to a great extent are under the clinician's control.”” Int Dent J. 2008 Jun;58(3):139-45.Int Dent J. 2008 Jun;58(3):139-45.Guidelines for occlusion strategy in implant-borne prostheses. A review.Guidelines for occlusion strategy in implant-borne prostheses. A review. Rilo BRilo B,, da Silva JLda Silva JL,, Mora MJMora MJ, Santana U., Santana U. Prevent Overload Cantilevers Parafunctions Premature Contacts Sufficient posterior support Improper occlusal design Strive for cuspid guided, group function and anterior disclusion
    78. 78. Concluding RemarksConcluding RemarksImplant manufacturers are attempting to makeImplant manufacturers are attempting to make prosthetics easierprosthetics easier Lab ProceduresLab Procedures Gentle handling of ptGentle handling of pt Impression Taking TipsImpression Taking Tips Evaluate tissue and adjacent teethEvaluate tissue and adjacent teeth Open tray impressionOpen tray impression Abutment Delivery and TorquingAbutment Delivery and Torquing Implant crown removalImplant crown removal Prevent trouble by splinting and occlusalPrevent trouble by splinting and occlusal considerationsconsiderations

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