I think if you look initially, the key is to have a good plan. So if you have not planned exactly where the teeth go, in the neutral zone and in the mouth, then they are doomed to fail in some way, some shape, some form.
When patients come to us with existing maxillary dentures and want to transition to afixed implant supported prosthesis, sometimes the treatment planning process can be a little confusing and a little challenging.
And we tend to maybe let the patient drive that decision and we end up doing a fixed prosthesis. But really the question is, is that the best prosthesis for them?
When looking at implants versus teeth, it is very important to consider the differences between them. There are many differences.
One difference that's very important for us as Dawson Dentists to consider is that a tooth has a periodontal ligament, the PDL. An implant does not.
An implant is essentially an ankylosed unit.
So recently, there's been a lot of debate as to whether we should be using screw-retained restorations on our implants or cement-retained restorations. I think the trend lately toward screw-retained restorations has been driven by research that shows retained cement in that delicate sulcus around the implant is the leading cause of peri-implantitis.
So my quick tip is about immediate non-occlusal load temporaries for implant restorations.
I love doing INOL temporaries.
I just think it's a great value for patients, but what I found was that there's a lot of chair time involved in doing these. I've done many of them in my office and the patient would come over from the surgeon's office, implant was placed that morning. They come to me. I have my stent ready. I fabricate the INOL temporary and it looked great, but it took me an hour or an hour and a half to do it. And there's a lot of bleeding involved, and tissue involvement that just becomes very frustrating to work with when you are trying to deal with a temporary material.
Cement-retained implant crowns are very, very popular and have been for the past 10 or 15 years.
But one of the challenges we see with cement-retained implant crowns is the lack of retrievability, especially since most of these have been put on with permanent cement.
Even the temporary cement sometimes is very difficult to remove.
Transcript continued below...
Welcome to Quick Tips. Today I want to give you some guidance when you are planning an esthetic restoration in the front of the mouth that's going to involve an implant.
What to look at first
When we look at these type of cases, the first thing we've got to be considering is the precision of that maxillary incisal edge. The second thing we have to think about is once we get that maxillary incisal edge figured out, where that gingival plane is going to be because that is going to be determining the optimum length of the tooth.
And then from there we have to think about how far that free gingival margin has to be from the head of the implant. Remember the incisal edge to free gingival margin really determines the length of the tooth.
Now we can plan the precise placement of the implant. We have our incisal edge position and we have our free gingival margin. We also know from the biology of implants that if the head of that implant can be about 3 millimeters from our free gingival margin, that gives us the room to be able to shape the tissue, support those papillas and have a great result.
So at the Dawson Academy, if you have an implant we still do everything the same way.
Transcript continued below...
Hi everybody, welcome to Quick Tips. In this edition, I want to talk about dental implants from an occlusal perspective. And first, let's begin with some key points about how implants are different than teeth.
Implant dentistry has become extremely predictable. However, we must pay attention to some very non-forgiving principles if we hope to create stable, long lasting results for our implant patients. I call these the “Seven Deadly Sins”. Each one, on it’s own, can jeopardize even the best implant surgery.
Implant Dentistry has been a huge topic, especially as of recent. You can't pick up a dental publication without seeing multiple articles surrounding the topic.
Statistics show that Implant Dentistry can actually be the highest production per hour procedure and have the greatest lifetime financial opportunity for your practice.
So why leave that opportunity to just Oral Surgeons? The general dentist can (and should) play a major role in any case involving dental implants too.