UCLA and 3Shape

[Andrew Priddy]

well, I wanted to try and design frames, mill in acrylic, and bond to cast-to's
I set this up over tibases (vario)
i'm thinking Glidewell bases (setup) will work best for most platforms

don't worry about trying to design the cuff.. we will wax it in:

make sure the frame is very passive on multiple units.. don't be afraid to hog out the frame access holes.. you will need room the get acrylic to flow in
shave off some of the base of the frame and taper in the acrylic

cut the access tubes so you can adjust the frame to the occlusion.. also, I ran a wax bead around the UCLA at the cuff

seal the junction between frame and access tube at the bottom
fill the void between access tubes and frame with pattern resin/ picu-plast etc... notice that the access tubes are kept long to allow you to fill the void and not the screw access tube

after the frame is stable, remove it.. sculpt the tissue, insert the frame, wax the cuff

clean up the access tubes, smooth the surface with wax, make any final adjustments

the frame is extremely stable
also, still using white-out without fail!

 

[Andrew Priddy]

more:

Bredent.. cast with white-out on the threads

shiny interfaces (acid only)

 

[rkm rdt]

The surgical course I attended last night advised against uclas. The gold adapts are wearing out!
This is a perfect example of what not to do any more!

 

[Andrew Priddy]

yea, I can disagree with that.. I have at least 15 units on by bench to do, and they come in from all over the country. so, how exactly are they wearing out?
technically, we could say that about every single restoration placed in the mouth

we have a track record and extremely low return rate for any reason with our cast-to abutments.. also, the Dr's that request them are the best we have and work with.. I guess they didn't get the memo either?

so with that said, maybe you could expand our knowledge base a little more than just stating "The surgical course I attended last night advised against uclas. The gold adapts are wearing out!
This is a perfect example of what not to do any more!"

oh wait! do you mainly work in CAD?

 

[rkm rdt]

This is a surgeons perspective so they don't give a rats patoot about you when the patient comes back with a loose implant and a lawyer.

 

[Andrew Priddy]

oh, do explain to me how a cast too effects whether or not an implant loosens, compared to ti/pfm bonded in the mouth.. or bacteria buildup from poor design... or cement left at the crown/abutment junction
hell, how come so many techs don't sculpt tissue (or more importantly, know how too).. the list goes on

now, if you are going to offer no more than "hey a guy said".. with no additional information, then i'm pretty comfortable doing what I know how to do.
there are 4 of us in the implant department, and we put out a crapload/ wide variety of implant work.... in a lab well respected for it's implant work.,, we also have several "study groups" and tons of training

 

[rkm rdt]

Good for you ,you're a rockstar.
I'll respect the observations and experience of any "guy" that is an accredited doctor and surgeon.

Nice pics though.

 

[JohnWilson]

The surgical course I attended last night advised against uclas. The gold adapts are wearing out!
This is a perfect example of what not to do any more!

Maybe poor quality 3rd party parts or full cast interfaces from plastic patterns then there may be some truth to it

A machined part regardless of material with the right tolerances will last. I would love to hear their rational on this along with any scientific evidence. If the interface is wearing I would bet screw loosening and our poor surgical/prosthetic planning had more to do with the reason rather than a manufacturer specific component.

As for using two engaging UCLA's on a bridge, you are hard pressed to get this to draw most of the times with out altering something somewhere but thats another thread for sure.

 

[rkm rdt]

Gold adapt

 

[JohnWilson]

So was this a Nobel Biocare hating group

I have cases in the mouth more than 25 years based on cast to techniques that have not "wore out"

Its it easier today to use a Ti base? Hell yeah, is it better? Thats a subjective term that has so many variables that comparing apples to apples is near impossible.

Would like to hear more but for some reason you are being very vague with your reply, also I didn't think it was like you to take something for gospel at a study club with out REAL evidence rather than conjecture and thats all it seems as if you are reporting. Enlighten us all,

Who was the speaker, was it evidence based or anecdotal

 

[rkm rdt]

The evidence was presented with images of the worn interfaces and the bone loss and ****.
I found irony in the fact it was an original component. It didn't come from my lab so I can't comment on the fabrication protocol only the perspective of the surgeon.

 

[Andrew Priddy]

As for using two engaging UCLA's on a bridge, you are hard pressed to get this to draw most of the times with out altering something somewhere but thats another thread for sure.

John, I was kind of expecting you to "chime in" on draw and non-engaging parts... one aspect i'm not a fan of for sure, or one restoration we "do" that I am not fully in agreement with. Yes, it would certainly be a debate, but not one I could back or justify

I would appreciate any opinion on the idea/ study/ or theory behind using 1 non-engaging and 1 engaging in a 3 unit restoration

 

[Andrew Priddy]

Good for you ,you're a rockstar.
I'll respect the observations and experience of any "guy" that is an accredited doctor and surgeon.

Nice pics though.

this really isn't a conversation, or even close to being an argument with any supported facts..
I was just sitting here trying to figure out wtf I did to piss you off.. but just realized I don't care

 

[CoolHandLuke]

so why did you bother computer designing it at all ? you probably spent more time on the waxing, reaming, and placing sleeves than making the digital design and wax milling. it looks like the wax doesnt even fit the things its uspposted to fit on.

so call me confused, what am i missing? why not spend the time in cad? to add extra hole diameter, and get the right implant alignment so the dern thing fits.

 

[Affinity]

I thought about doing this too, but after seeing those steps I think ill stick to hand waxing..

 

[Andrew Priddy]

actually, it went pretty fast.. especially for the first one. reaming it out doesn't take any time, and designing it takes a lot less time than it does build a supported structure in acrylic of light cure/ grind it back/ build and contour in wax.

so, the idea behind it is to have the CAD department be able to do the design, mill the acrylic, give it to another worker to pre-prep it, and hand it off to me to complete.
I posted the process to get it more streamlined.. you can't spend the time on the cuff in CAD because we are designing over a variobase, not a cast-to.. it won't be accurate. if there was a dme. for the idea, it could be a lot better.

also, I am sure it can be streamlined further. a lot further
I find it interesting that my coworkers (watching the process) had some positive input, while nothing seems positive here at all, which honestly leaves me wondering why the hell I posted it in the first place

 

[Affinity]

Dont get me wrong, I appreciate you posting. For a bridge I would definitely do it this way.. For singles, they take less than a minute to wax.. I like the idea of a .dme for the interface to the gold adapt, then you could cut the hole.. That would be the money.. but thats out of my scope or worth the time.

 

[CoolHandLuke]

actually, it went pretty fast.. especially for the first one. reaming it out doesn't take any time, and designing it takes a lot less time than it does build a supported structure in acrylic of light cure/ grind it back/ build and contour in wax.

so, the idea behind it is to have the CAD department be able to do the design, mill the acrylic, give it to another worker to pre-prep it, and hand it off to me to complete.
I posted the process to get it more streamlined.. you can't spend the time on the cuff in CAD because we are designing over a variobase, not a cast-to.. it won't be accurate. if there was a dme. for the idea, it could be a lot better.

also, I am sure it can be streamlined further. a lot further
I find it interesting that my coworkers (watching the process) had some positive input, while nothing seems positive here at all, which honestly leaves me wondering why the hell I posted it in the first place

that explains a lot actually.

 

[JohnWilson]

John, I was kind of expecting you to "chime in" on draw and non-engaging parts... one aspect i'm not a fan of for sure, or one restoration we "do" that I am not fully in agreement with. Yes, it would certainly be a debate, but not one I could back or justify

I would appreciate any opinion on the idea/ study/ or theory behind using 1 non-engaging and 1 engaging in a 3 unit restoration

My thoughts are to make the restoration so it has the highest chance of success with the least frustration to deliver with the most advantageous path to retrieve it in the future.

That may mean two non eng bases it may mean one non one eng.

It also has a lot to do with the fixture being restored as well. On some fixtures when we use non eng bases rely tremendously on the screw which will be the weak link, On these we will use eng interfaces. I also have a few clients that mandates both eng parts which will force us often to soften a hex from time to time to accommodate for draw.

As you can see there is no ONE path. Every client I work for has some ideas on what they feel is best. I do not try and convince them to change unless it goes against my restorative protocol. With proper verification all of the above can work effectively.

 

[lcmlabforum]

Jack Hahn was at a lecture that told audience the soft tissues formed a better seal with Titanium than
GoldAdapt, and he was representing the Nobel group on that day.
While that may be the case, I have seen good old external hex implant and restorations from 20 years
doing just fine with gold cast prosthetics.
Now, as to this:
The evidence was presented with images of the worn interfaces and the bone loss and ****.
I found irony in the fact it was an original component. It didn't come from my lab so I can't comment on the fabrication protocol only the perspective of the surgeon.

I think that is considered anecdotal because only 1 case presented. and if interfaces are worn,
the causes can be multifactorial. Was it adjusted at the time of seating?
Was it passive when in was seated the first time around.
What was the restorative dentist's explanation?
Even evidence from journals do not support mis-fit causing bone loss, some even
'proved' the opposite, if that is a sentence that can be used to interpret outcomes of
research articles.
However, I would be surprised if mis-fit did not cause mechanical complications like
uneven wear.
As for bone loss, I would ask how much bone loss has occurred, over what period of
time, and that means what did the pre-op X-ray look like when impression was made.
Then I would ask how well was the patient cleaning and returning to the DDS for maintenance.
After all that, then I would consider the material of the restoration itself being cause of
the bone loss.
But, hey, what do I know, I am not a 'board certified surgeon' . . .
LCM