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    Help with Anterior hybrid case

    Discussion in 'Implants' started by kmart, Jul 12, 2017.

    1. kmart

      kmart Member Full Member

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      I have a case that's coming in soon for an anterior hybrid case. Implants will be placed at #6,9,11 sites. Doc hasn't decided if he wants a titanium framework or zirconia framework. The dr and I have never done a case like this before, but I would prefer zirconia. I guess my question is where is a good place to outsource the framework? I have a 3 shape scanner but don't have the implant module, and frankly I think designing something like this is over my head for doing it my first time! Suggestions please!!
       
    2. JMN
      Curious

      JMN Christian Member Donator Full Member

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      Check with Bernard at Panthera. They are one of the sponsors here and in Canada. Nobody has ever said that I'm aware of that it was anything but a good experience working with them.
       
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    3. CoolHandLuke
      Fiendish

      CoolHandLuke Well-Known Member Full Member

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      you say hybrid, so i am under the impression you are looking for a screw retained chunk of zirconia. just remember you may want to use non engaging interfaces if this is the case, because its likely you dont want individual abutments to glue a frame to.

      this will slightly change who you seek to get items from, but theres several sponsors of DLN you should see before i continue about who is better than whom.
       
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    4. kmart

      kmart Member Full Member

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      Yes it will be screw retained, I should have mentioned that before! I've heard a lot of talk on DLN about panthera and it seems like everybody has nothing but good things to say about them. I will talk to the doc and see what he wants to do for sure. If he wants to go the titanium route I would have to order a complete porcelain kit for titanium which I'm trying to avoid.

      He has been nudging me pretty hard about what to charge the patient for a case like this, he was thinking $8,000 or so. Does that seem reasonable? The lab side of things I don't think I would charge anything less than 1,750 bare minimum. I know these cases can be a huge stress load.
       
    5. CoolHandLuke
      Fiendish

      CoolHandLuke Well-Known Member Full Member

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      on implant cases many docs do it by line item. ive seen 1400/abut, 1000/u for frame, and this is 3a, 4 units so...
       
    6. CoolHandLuke
      Fiendish

      CoolHandLuke Well-Known Member Full Member

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      btw, for this kind of case seeing you are in the states maybe Alien milling would be a better help to you. but i don't know your digital situation so i cant say for sure. have you got a scanner?
       
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    7. kmart

      kmart Member Full Member

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      Yes I do have a scanner. I have a 3 shape d850. Also a Roland 51d
       
    8. kmart

      kmart Member Full Member

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      Wouldn't that be 6 units instead of 4?
       
    9. CoolHandLuke
      Fiendish

      CoolHandLuke Well-Known Member Full Member

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      you said 6-11 right?

      [​IMG]

      [​IMG]
       
    10. CreDes
      No Mood

      CreDes Active Member Donator Full Member

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      You have the right setup for the case so you can do it it in-house as a hybrid zirconium with titanium interface.
       
    11. kmart

      kmart Member Full Member

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      6,7,8,9,10,11. Sorry I come up with six lol!
       
    12. kmart

      kmart Member Full Member

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      Could you elaborate a little more on this? Do I need the implant module for something like this?
       
    13. rkm rdt
      Artistic

      rkm rdt Well-Known Member Donator Full Member

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      That case will pay for the module.
       
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    14. omsk

      omsk New Member Full Member

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      I think you have the right tools to make this in-house. Use what you would pay other lab to mill this as an investment for that implant module.

      That being said, you'll have to determine if it screw retained is the right choice once you have the case with you. You might get a case where the screw holes will go right through the facial of one of the teeth; especially since there's an abutment on #9. In which case you might have to go with a cement retained bridge with custom abutments. Otherwise the esthetics of the case may be compromised.

      Once you have picked one, the rest is pretty easy IMO as long as you plan ahead on the steps you'll take.
       
    15. user name
      Question

      user name Well-Known Member Donator Full Member

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      I don't live in an expensive area by any means. From my Drs, this would be around 15k.
       
    16. Affinity
      Question

      Affinity Well-Known Member Full Member

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      Of course you can do it without a implant module and the tools you have, if its over your head, send it off. PM me if you want it designed.
       
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    17. CreDes
      No Mood

      CreDes Active Member Donator Full Member

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      You could even buy cad points to use for this bridge no matter which route that you take.
       
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    18. Labwa
      Breezy

      Labwa Active Member Full Member

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      I wouldn't go down the path of layering on titanium. unless he gives you 4 weeks to iron out the issues. It is quite technique sensitive.
      Go the Zirc path. If they are aestheticly focused layer the front 6 or 8 and the tissue.
      If not do mono with layered tissue. Either way buy the module and design it yourself. It might eat the profit but at least you have the module for future cases.
       
    19. JMN
      Curious

      JMN Christian Member Donator Full Member

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      @kmart, there's something I just realized hasn't been suggested yet, don't know why we didn't think about it.

      Call the rep for the implant company he uses or plans to use. Loop through the field rep. That's what they're there for, to help their stuff get sold, sure, but to make their brand look gooooood. If the most local guy is not up to speed, there is always someone who is because these guys help train the OMFS docs into their systems and protocols.

      If you're not sure which system he's planning on using, let him in on the idea and see if he'd like to meet with the rep, after you do, or the three of you together. If you solo-meet, get radiographs, pictures, measurments, all the details you can get.

      Edit: If you haven't, read this thread to try and minimize the problems you could have. There's other siilar ones too, but the big things always seem to be slooow temp chages, and certainty of your foundation with one screw test jig verification.
      http://dentallabnetwork.com/forums/...ed-bridges-problem-with-breaking.26277/unread
       
      Last edited: Jul 14, 2017
    20. Affinity
      Question

      Affinity Well-Known Member Full Member

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      Everyone always wants to do screw retained on cases like this, but most times on anteriors its not possible. Of course you will no more when you have the models, but if it were me, I would make custom zr hybrid abutments with a zr bridge over the abutments.
       

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