Full Arch Splint On Custom Abutments

[Al.]

Intresting Case

7 Abutments, Dr wants custom abutments, cast in type 4 Gold and a one peice PFM bridge on top.

4 of the implants are partialy above the gum line and the angulations are challanging.











Off for tryin.

 

[user name]

From what Ive been seeing, the Doctor sent it to the right guy. Im curious, what is your education/background in this business. How did you get started, etc. (whens the book coming out?).

 

[Gdentallab]

hey Al, we've been waiting to see something exciting !

did you make the full wax up before proceeding ?

I've seen similar cases where the bridge will seat in place without cemention , (retention by friction),are we in a similar situation here.
Waiting to see the end
good luck.

 

[JohnWilson]

I am sure your going to do a wonderful job on this,

Not sure why this guy has to have gold abutments Al, if you were to do these abutments via cad cam it would literally be less than 20 min of design time to get them perfectly parallel, with a 2* taper with consistent .75mm shoulder margins on these abutments. It would also cost about a 1/3 of the cost compared to the cost of gold+the UCLA cyl. Not to mention the hours of time savings as well.

The problem as you know when you have abutments that are as tapered as these getting the bridge to seat perfectly passively is next to impossible.

Have you asked this client as to why he only wants TYPE 3 gold??

Did you finish up the other case or is this it?

Good to see you again.

 

[Al.]

I dont know why he wants gold abutments.
This is a different case.

These type cases can be stressfull.

Theres alot that can go wrong and you have alot of money fronted in components and metal and labor.

Here's the frame after tryin and ready for opaque.

27.5 dwt, Noble. Calisto 75 PD. Its got 2% Gold 75% Palladium

 

[JohnWilson]

He didn't want a cant off the right side? The AP spread is pleanty to add a unit or two there.

Looks like the frame seats GREAT!

Looking forward to the glass pictures.

 

[TECHARTISAN]

I am sure your going to do a wonderful job on this,

Not sure why this guy has to have gold abutments Al, if you were to do these abutments via cad cam it would literally be less than 20 min of design time to get them perfectly parallel, with a 2* taper with consistent .75mm shoulder margins on these abutments. It would also cost about a 1/3 of the cost compared to the cost of gold+the UCLA cyl. Not to mention the hours of time savings as well.

The problem as you know when you have abutments that are as tapered as these getting the bridge to seat perfectly passively is next to impossible.

Have you asked this client as to why he only wants TYPE 3 gold??

Did you finish up the other case or is this it?

Good to see you again.

Assuming in house scanning, design, and milling capabilities....and a Doctor who wants Gold.....

Is there any reason you couldnt....

Use a good quality machinable wax, look for a prototype specific jewelers wax...they burn out clean where most of the other machinable waxes may not...

Kindt collins makes Master Protowax which is brownish gold in color and resold by a dozen different names within the jewelry industry. They also make most of the bright blue machinable wax youll find while looking....'

Personally, Id avoid the blue...good for jewelry master patterns...not good for direct investment.

Sorry if that is too off topic....didnt mean to threadjack....

Great work Al..your pictorials never fail to impress me.

 

[Al.]

Assuming in house scanning, design, and milling capabilities....and a Doctor who wants Gold.....

Is there any reason you couldnt....

Use a good quality machinable wax, look for a prototype specific jewelers wax...they burn out clean where most of the other machinable waxes may not...

Kindt collins makes Master Protowax which is brownish gold in color and resold by a dozen different names within the jewelry industry. They also make most of the bright blue machinable wax youll find while looking....'

Personally, Id avoid the blue...good for jewelry master patterns...not good for direct investment.

Sorry if that is too off topic....didnt mean to threadjack....

Great work Al..your pictorials never fail to impress me.

Im still in the stone age but I dont know any other way to make a gold custom abutment unless I bought a wax milling machine or a glorified surveyer with a handpeice attached.


Survey and hand wax. Then finish it up in the metal.

It takes the same amount of time as a full cast crown so I charge about the same labor.

 

[Al.]

From what Ive been seeing, the Doctor sent it to the right guy. Im curious, what is your education/background in this business. How did you get started, etc. (whens the book coming out?).

My Dad was a dentist I went to a 2 year lab school. Southern College in Orlando. 78, Its closed now. But in the day, alot of the lab owners in Orlando came from that school.
Thats it for education, but I go to courses every year, mostly Drs courses but they are expensive.

 

[Al.]

hey Al, we've been waiting to see something exciting !

did you make the full wax up before proceeding ?

I've seen similar cases where the bridge will seat in place without cemention , (retention by friction),are we in a similar situation here.
Waiting to see the end
good luck.

No full contour wax that would take forever and a day.

He sent the model of the temps with a suck down and I put that on the model to use as a guide.

Also he wanted the incisal edge position the same as the temps so I made a putty matrix on the lower to help with the frame.

 

[JohnWilson]

Assuming in house scanning, design, and milling capabilities....and a Doctor who wants Gold.....

Is there any reason you couldnt....

Use a good quality machinable wax, look for a prototype specific jewelers wax...they burn out clean where most of the other machinable waxes may not...

Kindt collins makes Master Protowax which is brownish gold in color and resold by a dozen different names within the jewelry industry. They also make most of the bright blue machinable wax youll find while looking....'

Personally, Id avoid the blue...good for jewelry master patterns...not good for direct investment.

Sorry if that is too off topic....didnt mean to threadjack....

Great work Al..your pictorials never fail to impress me.

I am sure it can be done but the majority of abutments today are not being done in gold. It makes so little sense when Ti has so many advantages.

I am searching Pub-med for articles right now that give some sort of reasoning why gold is a more preferred material and have not found anything concrete.

Like I said I think the old timers are just set in their ways.

When we did these types of cases before we invested in cad/cam the units were waxed in milling wax, put on the milling machine and shaped, casted then re milled. It was a very labor intensive way of doing it. I can't tell you how many late late nights I had in the lab doing milled 2 degree abutments with galvano copes cemented into a substructure to support a denture.

These were and are sweet appliances.

 

[Bedrock]

Nice work, and great photos

 

[rkm rdt]

"I am searching Pub-med for articles right now that give some sort of reasoning why gold is a more preferred material and have not found anything concrete."

The blue tinge on the analogs is a clue

 

[TheLabGuy]

What was the reasoning for all the different implants? Pretty, thanks for sharing.

 

[doug]

What was the reasoning for all the different implants? Pretty, thanks for sharing.

I would guess it was what the surgeon had on the shelf, but I could be wrong.

 

[Al.]

I dont know but there are 3 different types and the patient has bone loss around some of them. My guess this is a salvage case and some of them were replaced. He wants everyting around the implants off the tissue to prevent any more loss.

I think contours and ridge laps around the abutments cause tissue and bone loss plus food packing.

 

[Al.]

Final shade requested is A2.

Opaqued and dusted with shoulder powder.
Thank Goodness nothing moved. Degass and first opaque with my fingers crossed.

I fired my wash bake higher for a better bond. About 100 F higher.
Tips are with the incisal opaque, interprox with A4 to help with interproximal depth and seperation.
Cervical opaqued in the D range to help keep the value down in the thin areas.

I inspect the opaqued frame for any little pits that may cause bubbles later. See the 1 on the lingual pic on the bicuspid.
I scrubb some opaque in it before my first dentin build.

 

[Mark Jackson]

Al, was this case done using computer planning and a surgical guide?

 

[paulg100]

"was this case done using computer planning and a surgical guide? "

Oh no here we go

looking good so far Al. Picked yp a new account thats still big on using metal, so i gotta brush up on me metal techniques.

You find using the incsial opaque on the tips helps much with the transition?

 

[Al.]

Al, was this case done using computer planning and a surgical guide?

Dont know the history, but these guys do alot of salvage work and have to work with what the patient comes in the door with and what their finances allow to fix previous work.