Monday, February 25, 2013

Identify Implant Parts On-Line

When you have an impression post, analog, screw, implant, etc., and are uncertain of the brand or system, use our new web site to conduct a search. You will find high-resolution images and descriptions of all the major implant companies, and even a few unfamiliar ones. You can even use an x-ray of an implant to determine its manufacturer. Once you’ve found the brand, use the site to choose from the many restorative options available from ROE. 


Valplast Adjustment

Customers are continually requesting Valplast adjustment techniques. For years we’ve recommended using hobby torches, or very hot water, to adjust the clasps to the desired position. Although we do not have a more scientific method of positioning the clasp, we do suggest a particular instrument called the Flexite Electric Heat Gun ($199), that promises not to blister or burn clasps. It may be purchased from The Flexite Co. by calling 866-353-9483.


CBCT Update - Simplant Master Site

Last year ROE became a FastTrack, SimPlant Master Site. This means we now offer a fast conversion service. We also provide quicker turnaround on SimPlant guides. Rather than mail models to Europe, we now scan the models and e-mail the .stl file.

Zimmer Trabecular Implants

“Trabecular MetalTM implants are fabricated of elemental tantalum metal using a vapor deposition technique to create a metallic strut configuration that is similar to trabecular bone. The resulting crystalline nano-texture permits direct bone apposition” – Zimmer Dental.

That’s a mouthful, and in essence means Zimmer’s new implant looks and acts like bone. The new design presumably results in quicker and stronger integration. The designed voids are much larger than natural bone, allowing more, and faster, ‘ingrowth’ (natural bone growing into the implant). This design provides more flexibility, and exhibits mechanical properties closer to cancellous bone than any other material.

Splints - Who sets the vertical?

Setting the vertical opening for splints is usually accomplished by the laboratory. When an office sends a bite registration that clearly exhibits MI (maximum intercuspation), casts are hand-held, articulated, and opened 3 millimeters using the Flexible Clearance Guide. Vertical distance is determined by placing the FCG between the 1st molars.

Many of our clients use another effective technique to set the vertical with the use of cotton rolls. This method helps them deliver trouble-free splints. During the first appointment, instruct the patient to bite into centric, in order to verify the midline and bite position. Then, place cotton rolls behind the cuspids, as shown, and instruct the patient to bite until feeling resistance. With the patient holding this position, express bite registration material di
stal to the cotton rolls. Remove the cotton rolls (optional), keep the posterior bite in place, and express material in the anterior. This tripodal bite will allow you to confirm the correct opening. On our work authorization, instruct us to “mount and restore” the case to your bite. View a step-by-step procedure on the splint-page of our website.

Transmucosal Abutments What are they and how do they help?

Transmucosal or multi-unit abutments are permanent abutments used to bring the restorative platform of an implant from the bone level to the tissue level. Rather than struggle with ‘sluffing’ tissue around the implant during restorative and maintenance procedures, these abutments support and protect the tissue. They are very effective when multiple implants are placed in deep, thin biotype tissue. With these abutments, implant frameworks can be removed without the need to temporarily reinsert tissue-supporting healing-cuffs. Implant companies sell special multi-unit healing-cover-caps to protect the screw holes during the various procedures. In fact, these caps must be used
Transmucosal Abutments
during the framework construction phase to protect the exposed portion of the abutment. Other benefits of transmucosal include redirecting the trajectory of the prosthetic screws to more esthetic or functional direction, correcting angles of divergently placed implants to allow easier case-seating, and assisting with determining framework passivity.

Capturing impressions with multi-unit abutment transfer-copings is simpler than implant-level impressions, and prevents many time-consuming challenges inherent in complex cases. When ordering transmucosal abutments, be sure to include the special impression-transfers and healing-cover-caps. If you need assistance, or have questions about ordering, please call us.

Expanded Uses of Zirconia

Due to its immense popularity and changing modalities, zirconia has been a frequent topic of discussion in our newsletters during the past few years. Another is progressive implant solutions. The first part of this section on zirconia will integrate the two topics, and the second will offer an alternative to metal-free bridges.

Part 1: Hybrid dentures have significantly increased in popularity. Although a wonderful option for the patient, they do present challenges, primarily with regard to strength and longevity. Fortunately, the technology with which they are produced continues to improve. Updates include virtually-designed milled bars, the use of special teeth, and required minimum vertical openings.

This year we are offering an exciting option to the traditional hybrid, a full-arch,


screw-retained, 100% zirconia bridge. This milled, monolithic bridge, which we call TLZ-IB, provides esthetics and durability with very little maintenance. The restoration is available for most implant systems and is attached to the implants via titanium interfaces that fit precisely into the bridge. As with all our implant-supported restorations, screws only contact titanium, and never zirconia.

Fabricating these cases differs slightly from traditional hybrids. The implant-level impression and bite registration are the same, but the try-in is unique. Once a set-up has been approved intra-orally, it is digitized and reproduced into a screw-retained, milled, acrylic prototype. This monochromatic appliance will be tried-in to confirm esthetics and function. The adjusted, patient-approved try-in is our blueprint for the final prosthesis that will require little-to-no adjustment.

Part 2: Monothltic zirconia, TLZ, is a great restorative option, and due to its superior strength has become many doctors’ “go-to material” for posterior crowns and bridges. In esthetically critical areas, PFZ restorations (porcelain-fused-to-zirconia) incorporate layered, veneering ceramics for a more vital appearance. Sometimes a case requires both the strength of monolithic zirconia and high esthetics. We can accomplish this with a hybrid restoration we call TLZ-cutback. We virtually design the monolithic material in functional areas, and digitally cut back labial material to make room for stacked porcelain to improve the vitality
of the case. If you have a patient that requires this combination, ask for a TLZ-cutback.