What do you recommend?

[Brett Hansen CDT]

I am treatment planning a case: 6 implants...completely edentulous on the mandibular...fixed bridge. Zirconium or metal framework over the abutments? Esthetics obviously favor the zir, but I am sacrificing strength? Assume the implants are in ideal positions.

 

[JohnWilson]

Few things to think about

VD how much ya got? Inter arch space

Are you replacing a defect in the ridge? Using pink porc?

Are you going to ridge lap or emerge the bridge from the margin of the abutment?

Screw retained?

Lots of questions to make an informed opinion.

 

[Brett Hansen CDT]

I haven't seen the patient at all. Right now I am just providing an estimate for the doc. Assuming the VD isn't compromised, she has a full denture on the maxillary, is there any reason not to do a zir bridge? the doc is fine with doing zir abutments...he says this patient is a real "bitch" so he wants to make sure this is as esthetic as possible. Preferrably, I would like to do a screw retained zir bridge over top of those abutments, but I am not sure how to do that.

My plan is to waxup the case, get 6 Atlantis abutments made. Use the waxup to have Diadem mill out a Zir framework that I have cut back on the facial. I am going to assume pink porcelain for the estimate.

In a perfect world, I would like for this bridge to be screw-retained. Atlantis abutments aren't set up for that. Would you recommend I try a different approach to the abutments? The reason I want it screw-retained is because I am worried about porcelain chipping and having it screw-retained would make it easy to fix. Maybe I am over-thinking this and cement-retained is the way to go?

Some of these implants have been in for 12+ years. I am assuming that we will be ridge-lapping.

 

[droberts]

I haven't seen the patient at all. Right now I am just providing an estimate for the doc. Assuming the VD isn't compromised, she has a full denture on the maxillary, is there any reason not to do a zir bridge? the doc is fine with doing zir abutments...he says this patient is a real "bitch" so he wants to make sure this is as esthetic as possible. Preferrably, I would like to do a screw retained zir bridge over top of those abutments, but I am not sure how to do that.

My plan is to waxup the case, get 6 Atlantis abutments made. Use the waxup to have Diadem mill out a Zir framework that I have cut back on the facial. I am going to assume pink porcelain for the estimate.

In a perfect world, I would like for this bridge to be screw-retained. Atlantis abutments aren't set up for that. Would you recommend I try a different approach to the abutments? The reason I want it screw-retained is because I am worried about porcelain chipping and having it screw-retained would make it easy to fix. Maybe I am over-thinking this and cement-retained is the way to go?

Some of these implants have been in for 12+ years. I am assuming that we will be ridge-lapping.

Brett,

You have your hands full. Patient is a"bitch"? Wants esthetics, but has a max. denture? First of all, get the case in your hands mounted before giving any estimates or design. With a max. denture, you may be able to do a screw retained ( denture) hybrid on the mand. with great esthetics. It will look as good if not as better as her max. denture for sure. Just a thought...

 

[Brett Hansen CDT]

Patient wants a fixed prosthesis. The oral surgeon and dentist are meeting this friday and they need an estimate from me today. They know it won't be the exact amount, they just need a ballpark.

 

[Jo Chen]

It is possible to make a screw retained zirconia substructure and bake porcelain right to it. Just be careful of distal cantilevers. Need to make a verification index/jig to make sure your model is the same as the patient before you mill anything.
Angulation of the implants is critical, you don't want them to go through the labial/buccal of the finished bridge.
Start with a teeth in wax set up first for diagnostic purposes. Maybe incorporate radiographic beads (Attachments International) in the base plate so the Dr. can take at least a pano and get an idea of spacing, bone height and any vital structures. Duplicate the teeth in wax in clear acrylic as a surgical guide.
Be involved, don't be shy telling the surgeon where you would like to have the implants placed. The restoration drives the implant placement and position, not the other way around.

 

[Brett Hansen CDT]

Jo, 5 of the implants have been in for some time. They are gonna pull the remaining dentition and put in one more implant.

I just faxed the doc an estimate for $5200...that includes 6 Zir Atlantis abuts, 12 unit Zir bridge, 12 unit wax-up, and gingival porcelain. This is assuming a cementable bridge.

 

[Jo Chen]

$5200 seems a little low

 

[k2 Ceramic Studio]

Can you not design your framework around links, then you will have your screw retained bridge, then get the surgeon to bond everything in at the fit stage, that way you can have a very cheap provisional pmma bridge done for the try in and any bite problems can be rectified and the pmma bridge can be double scanned by your milling centre if it has been adjusted or by you and then milled in Zr.

NeoLink | Cement or Screw Retained Implants | Fabrication |Neoss

 

[droberts]

$5200 seems a little low

Especially cement retained with a patient that could be a problem.

 

[JohnWilson]

I agree this is an 8k case doing it as you suggested.

Its funny that the Neoss implants were brought up we just received 6 singles in based on this fixture. I thought I had worked with most this one is new to me.

 

[Brett Hansen CDT]

Here is a breakdown of how I can up with the $5200:

12 unit Zirconia framework @ $197 per unit(this is the same price we would charge for a single zirconia layered anterior)
6 Atlantis Zir abutments @$371 ea.
12 gingival porc. added @ $38 per unit
in-lab diagnostic wax-up not sent to doc $120
$20 for soft tissue model
$15 for shipping and infectious control

We serve the indianapolis/central IN area. According to LMT's yearly numbers, the midwest is cheaper than the east and the west.

 

[Jo Chen]

More complexity means more ways to fail.
The risk of something going wrong with an implant case is greater than with a "normal" case. Since we have to eat it in case of failure regardless whose fault it is just to keep the customer, it would be prudent to charge accordingly. A gold plated titanium screw from Biomet 3i is about $50 alone. How many times do we get calls and the Dr. claims there was no final screw with the case?
popcorn

 

[doug]

More complexity means more ways to fail.
The risk of something going wrong with an implant case is greater than with a "normal" case. Since we have to eat it in case of failure regardless whose fault it is just to keep the customer, it would be prudent to charge accordingly. A gold plated titanium screw from Biomet 3i is about $50 alone. How many times do we get calls and the Dr. claims there was no final screw with the case?
popcorn

How many times have you found out that the doc used the lab processing screws to seat a Biomet case? The abutment WILL
come loose and you are gonna have to eat that case. All they get from me is the gold screws. If they're not with the case, it's not my doing.

 

[Jo Chen]

Yes it does happen, the doctor using the lab screw. If the Dr. used the lab screw, tough love, full charge remake unless she is cute and sweet.

I attach a bright colored tag to the blank comment card indicating the torque value and not to use the lab screw but the virgin final screw in the original packaging. This way I sell an extra item (lab screw) and the abutment arrives at the Dr.'s office on the model in the correct orientation.

 

[samii]

hi, i am a graduated technician, i need ur help, where can i find directions about full cerams like procera without use cad/cam?

 

[amadent]

hi, i am a graduated technician, i need ur help, where can i find directions about full cerams like procera without use cad/cam?

?