Slides from the Indianapolis Implant Restorative Study Club (IRSC) on August 29, 2013 by Christine Bishop, DDS, MSD and Savi Abey, DDS, MSD featuring common problems associated with implant therapy in both fixed and removable prosthodontics.
Managing Problems in the Restorative Phase of Dental Treatment
1. Slideshare
To IRSC Members: some slides have
been removed from the slideshare. If
you need more information about any
of the topics mentioned in the
headings, feel free to contact Dr.
Bishop or Dr. Abey by email.
Bishop(at)teethin.com
Abey(at)teethin.com
3. Implant Restorative Study Club
Problem Solving in the
Restorative Phase of
Treatment
sponsored by
Prosthodontics of Central Indiana
August 29, 2013
The Monon Center, Carmel
4. Goals for this evening
Assuming everything has been done to prepare for
success to this point!
Managing problems at try in/place
When to return to the lab, or not
Managing “emergencies” and later
problems
13. Sequence:
Check both proximal contacts (floss test)
which contact is tightest?(floss test)
Disclose
Adjust
Check seating (explorer)
Check BOTH contacts again(floss test)
Which contact is tightest?
Disclose
Adjust
Check seating(explorer/bite cotton roll
hard 5min/10min)
Check BOTH contacts again(floss test)
Which contact is tightest?
Disclose
Adjust
Check seating (seems down)
Check contacts again. If 1or 2 open
contacts, If perfect,
Make BWX (quite often has to be
vertical)
14.
15.
16.
17.
18.
19.
20.
21.
22.
23. Problems: Fixed
At try in/placement:
1. Proximal contacts
2.Seating
3. Occlusion: missing.....where should it be anyway?
4. Buccal emergence profile/proximal contour
5. Excess cement
At follow up and emergencies:
1. Porcelain fracture
2. Loosening:
crown
abutment
implant
24. Where should it be?
Discuss:
A.out of occlusion
B. occlusion in clench. (What about non-clenchers)?
C. normal, tooth-to-tooth type contact
25. Suggested
Sequence for centric:
Assumptions:
2 proximal contacts are present.
Full seating confirmed with VBWX
1. (Implant crown out): confirm contact of
adjacent teeth with shim
2. Place crown onto abutment
3. Check adjacent teeth with shim
4. If out of contact, mark with Accufilm
5. Adjust
Repeat steps 3.-5. until shim contact
present adjacent teeth.
6. Check implant crown with shim. If out of
contact,
7. If in contact, adjust a tiny bit more.
(always get pt feedback on occlusion; and
metal occlusal more forgiving)
79. This is the information that I mentioned about a
course for the Prettau Bridge: the full arch zirconia
bridge. Dr. Weir feels that Dr. Tischler is a highly
appropriate authority on the subject. Check out the
website below, or contact Dr. Weir.
From: "C. Douglas Weir" <dweir1(at)netsurfusa.net>
Subject: Date: August 27, 2013 4:44:01 PM EDT
To: Bishop Doctor Christine <chrisbishop88(at)gmail.com>
http://www.tischlerdental.com/
There is a great amount of info if you click on the "for dentists" tab.
The next course is Nov 8-9.
Notes de l'éditeur
Details, details details and how to avoid the traps!
Focusing on problems unique to implant restorations. Most esthetic issues can be dealt with in the usual way. Color, shape translucency etc.Take the above in the correct order:contacts/seating/occlusion/buccal emergence/proximal contour
Focusing on problems unique to implant restorations. Most esthetic issues can be dealt with in the usual way. Color, shape translucency etc.Take the above in the correct order:contacts/seating/occlusion/buccal emergence/proximal contour
1.We demand larger area in contact. More chance for die abrasion as a larger has to be adjusted to perfect. 2.Roundish cross section of abutments..usually creates some rotation of crown
Beg: Every missing prox contact begins with a tight prox contact.
Challenge of poss soft tissue impingement, one tight prox contact might be one posing as 2 or just 1.
Can be very time consuming. When reach point of seating, often find one or both contacts is overadjusted. BACK TO LAB
Abtment failed to seat. Screw would not tighten. Mesial and distal bone grown over I platform.
Not fully seated. Discuss this abutment design and cement choice.
grey spots are water splashes on the mirror.
If missing, back to lab...why? See next case (Copeland)
Rather philosophical. Use of materials for occlusal. How is your ability to make this type of adjustment to a high level of accuracy?
Aft: More complex and difficult if the adjacent tooth or teeth lack occlusal contact.
grey spots are water splashes on the mirror.
Focusing on problems unique to implant restorations. Most esthetic issues can be dealt with in the usual way. Color, shape translucency etc.
Focusing on problems unique to implant restorations. Most esthetic issues can be dealt with in the usual way. Color, shape translucency etc.
Having a photo of position of abutment screw is very helpful. Photograph all custom abutments.
Solution to dissolve permanent cement. Has to be in ultrasonic 1-2 days.
zest locator parallel post / angle measurement guide