Unfortunately for the elderly it is difficult to eat a healthy diet when poorly fit prosthetics hinder them from consuming certain food groups like fruits, vegetables or meat because of the discomfort and pain resulting from chewing. Properly designed prosthetics made of acrylic teeth are not only necessary for proper food intake but also important aesthetically at an advanced age. The design of artificial teeth is quite a challenge given the current state of knowledge. The challenge lies in matching them to their natural counterparts as closely as possible...
That today’s patients more than ever want fixed dental restorations is no secret. Especially in a toothless mandibular case, often the patient has problems to maintain a secure fitting prosthesis. As described in this article, with relatively little effort the problem can be helped using GALVANO telescopes on the Neoss implant system.
Again and again there are problems for patients wearing full dentures for it is not so easy to get along with the “third party”. The patients in question want to minimize efforts to find solutions that ensure a high level of security and regain the feeling that it is safe to smile and above all to be able to chew again without the danger that the appliance is moving uncontrollably.
The light cured wax system “Metacon” is based on the completely new and unique concept of converting wax into acrylic. The system includes “regular” modeling wax for crown and bridge techniques, implant and pressable ceramic cases (Metawax), as well as preformed wax patterns such as clasps, stipple sheets, retentions and bars (Metaform) for partial denture castings and combination cases without refractory model. The material is handled either just like conventional modelling wax (“hot” method), or it can be kneaded “cold”, as it offers perfect modelling consistency just slightly above room temperature. When the wax-up is finished, it is light cured in the one of the Metalight light curing units. This way the Metacon wax converts to acrylic, however maintaining the advantages of wax: it burns out cleanly and completely and does not expand in the ring.
As we step into the next decade of digital dentistry and CAD/CAM (Computer Assisted Design and Computer Assisted Milling) let’s reflect on the decade we left behind. For the last ten years labs and dentists have been assailed by new technologies full of exciting horizons and promises but realistically offering only limited products. Though it did not make sense, many companies asked dentists and technicians to invest thousands of dollars in systems before these products were even ready. Though many labs are interested in the cost saving aspect of dental CAD software, many are hesitant because they are not sure which system is worth investing in and are afraid of being limited to one brand or software that may have hidden limits or rules. Horror stories of complicated 130,000 dollar machines still being paid for and sitting unused on tables across labs frighten away investors.
Fortunately the good news is here for 2010
With the advent of impressionless custom abutments and well executed design and milling systems backing it up, dentistry can finally leave behind the never ending promises of the 2000’s. A number of exciting developments have created a very lucrative digital market and have finally opened it up to create buyers with more options.
Simplifying your dental life ... a wonderful idea in a world that seems to be getting more complicated all the time. Tight deadlines and financial constraints abound in the dental lab. Everyone seems to be discussing new materials (zirconia) and techniques (overpressing). And the new technologies (CAD/CAM) require unprecedented amounts of capital – while at the same time the dental lab is expected to be service-oriented and to make the most of its location advantage over providers of imported restorations. It must actively promote – sell! – its range of service and increase roductivity, defined as best quality of finished work at highest quantities per unit of time. The authors of this eport present the Metacon light-curing wax by Primotec, supposed to offer considerable time savings.
One tooth line instead of three: Same performance, lower inventory cost
Discussions about healthcare have a way of focusing almost exclusively on rising costs and associated problems. Yet, experiences have shown that restorations fabricated by pros in dental laboratories at a fair price generally continue to be in great demand. Most patients will opt for restorations in the upper-medium price range when presented with different options. Treatments commonly opted for as a result include combination restorations or telescoping bridges that include the use of denture teeth. The quality and economic aspects of a restoration will therefore greatly depend on the selection of an appropriate tooth line. This article discusses aspects to be considered in the selection process and reflects the experience by the author’s medium-sized laboratory with a staff of 12.
This article describes the manufacture of a screw retained implant prosthesis supported on a full passive implant composed of a cement retained chrome-cobalt alloy structure supported by screw retained implant stumps on the implant platform.
The IMPLA 3D Navigation System from SCHUTZ Dental Group, Inc is a tool for the production of high-class drilling templates with depth stop. The templates can be created using virtually any implant system on the market and can be produced in your own laboratory. The complete system consists of the IMPLA 3D planning software, laptop, IPS (Implant Positioning System) and consumables. The software can also be purchased individually.
Accurate 3D planning requires the production of an X-Ray template, CT or Cone Beam X-Ray with this template correctly in place, and a surgical guide produced from the information provided by the CT Scan and the planning done in the 3D software. Steps 1-4 discuss the creation of an X-Ray template.
This article discusses the use of a precision milled titanium substructure and individually cemented zirconia crowns to successfully rehabilitate an edentulous maxilla. The patient had extreme resorbtion that necessitated both hard and soft tissue simulation. The use of ceramic intended for titanium, as well as high strength zirconia allowed for a successful rehabilitation.
The zone comprised of the bone and soft tissues from the top of the implant through the soft tissues is not well understood by both dental technicians and dentists. Frequently, little or no consideration is given by the dentist as to the design of the abutment or implant restoration as it relates to this peri-implant tissue zone. For many dentists, the healing abutment is simply removed and a perfunctory mechanical impression is made by merely connecting a cylindrical fixture level impression coping to the implant and picking it up with impression material without regard to the anatomical contour (Fig. 1). The technician then pours up a cast with a fixture analogue often with no information or instructions conveyed by the dentist as to the abutment design parameters for the contiguous soft tissues. This results in the technician guessing as to the abutment emergence angle from the top of the implant, diameter and contour through the soft tissues. Impingement of the abutment on the bone or periosteum can have disastrous complications such as periimplantitis, loss of bone and gingival recession, or even implant failure. Improper abutment contour through thes soft tissues can also induce recession and peri-implantitis. A principal directive is to control all variables to avoid gingival recession around implant restorations.
As with all fixed prosthodontics the goal of the dentist-technician-surgeon team is to maximize clinical predictability in all aspects of implant dentistry in order to reduce the number of additional augmentive surgeries, avoid improper implant position which necessitates additional and more costly laboratory procedures, and avoid laboratory remakes due to improper restoration periimplant tissue contours. At every step of the implant prosthodontic process the team must endeavor to maximize the volume of peri-implant tissues. For an optimal clinical outcome the team can maximize predictability by paying meticulous attention to the key factors of:
• Treatment planning and site assessment
• Guidance for the implant surgeon to achieve correct implant placement
• Soft tissue site development with the provisional restoration
• Communication between dentist and technician in three dimensions
• Design and materials selection for abutment and crown
38 year old male, excellent general health with good supporting bone structure. The patient is a chronic mouth breather which accounts for some of the red areas in the anterior part of the mouth. His chief complaint was that the bridge “feels loose”.
Initial Treatment
After his initial visit with Dr. Cohen, a periodontist, the bridge was sectioned between teeth 9 and 10, tooth 8 was removed as was the retained root 9. Two Ankylos B 14 implants were placed with sulcus formers because of the deep placement of the implants and to facilitate the uncovering procedure. Three months later, the implants were uncovered by the periodontist and the sulcus formers were replaced with taller ones.
The patient was then referred to Dr. Goldenberg, a prosthodontist, to continue with the restorations. This was the patient’s first visit with the prosthodontist. Two weeks later the prosthodontist made a fixture level impression with two repositioning posts. The laboratory fabricated the soft tissue master cast with analogs of the Ankylos implants. Together with clinical images and the master cast, the prosthodontist and the author, a master dental technician, were able to tentatively fabricate a restorative treatment plan for the patient. Two problems were immediately apparent: the first was the discrepancy between the gingival level of the soft tissue on tooth 10 compared to tooth 7: the second was the extreme distance between the implant platform and opposing arch. In the laboratory, the abutment try-in kit was used to choose the appropriate abutment. These trial abutments are used to help estimate the angulation and soft tissue height for the Balance Abutment system. Our selection was a small 3.0/15° Balance Anterior abutment for both Ankylos implants. The problem we encountered was the lack of height of the abutment for proper retention of the future implant crown. Because of the compromised situation, the abutment had to be extended with a separate wax-up to “lengthen” the abutment which can be seen on the cast for this case.
Primary telescopes made of zirconium dioxide with electroplated secondary copings are the state-of-the-art of the telescopic crown technique (according to some publications). The esthetic advantage of the crown margin and the superb fit of the galvano copings are worth mentioning. But let’s remember the classic option! We are still able to manufacture precise telescopes made of premium gold alloy. The key advantage is the durability of the rugged margins.
Master Dental Technician Claus Küchler explains in this article that precious metal telescopes still fulfill all requirements of modern prosthetics.
Many dental technicians enjoy their work because of the challenges it brings, and that is the reason why we wrote this article. The initial situation was as follows: teeth 34 and 43 were prepared and 6 implants had been placed into regions 33, 35, 45 and 46. When we look at the model we can see the condition of the closed implants with the help of the defined healing caps. (Fig. 1).
All six posts should receive telescopes to support the tertiary structure. One look at the model and you can imagine the challenges the technician has to deal with to complete this work.
All technical reconstructions especially on implants have to be very precise. The dental technician has to have a medical understanding when it comes to implant restorations. He has to rethink the process!
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