3 unit screwed retained bridge with engaging abutments

[keydental]

Hey guys I’m new to doing screw retained bridges and I made the first one using engaging ti bases.
I got it to fit perfect on the model but after reading about having to use non engaging ti base for screw retained bridges I’m not sure if dr will be able to seat it. Any thoughts?

 

[CoolHandLuke]

if you can seat it, you got lucky. the implants were probably pretty parallel to begin with.

in the future if you can't seat a bridge it will be because of the interferences caused by undercutting the implant interface.

 

[keydental]

It seats fine on the model but I’m afraid it’s going to be slightly off in mouth that doc can’t seat it.
Would you recommend making any adjustments to hexes just to make sure they can make it fit?

 

[CoolHandLuke]

It seats fine on the model but I’m afraid it’s going to be slightly off in mouth that doc can’t seat it.
Would you recommend making any adjustments to hexes just to make sure they can make it fit?

ha never. if the implant fails and the patient sues, they'll be examining why. all they will see are ground off hexes and start blaming you.

never modify the engaging area.

if you can back your bridge up, to show you worked on non engaging parts to begin with, then you cover your a55.

 

[TheLabGuy]

I would send a Memo to the Doc stating that it has a passive fit on the model but with two engaging implants you can't confirm it will clinically. If there is an issue clinically, tell the doc to remove one of the engaging hexs or even part of it almost always works as well.

 

[keydental]

I would send a Memo to the Doc stating that it has a passive fit on the model but with two engaging implants you can't confirm it will clinically. If there is an issue clinically, tell the doc to remove one of the engaging hexs or even part of it almost always works as well.

Ok great this is what I needed. Thanks!

 

[Affinity]

Ive had bridges that fit perfect with the abutments engaging on the model, but Dr could not get it to seat. I would definitely remove some of the engaging aspect.

 

[JMN]

I wouldn't touch the interface. Liability concerns and if you do no insurance you or the doc has or can get will cover wilful mishandling, and that's exactly what it would be called.

You've been working this thing for a while and know exactly what way to put it so it drops in. Show the doctor the path of insertion when you take the case to him if it is a local account. If not local, send pictures or have a video chat.

Inform him of the best way to remove the engaging aspect, but inform that it will be a last resort, not the first thing done. First thing is for Doc to practice on the model for 5 minutes and again right before the appointment, right before it's sterilized for insertion.

Then remember in the future to always use non-engaging on bridges/splinted implants.

 

[user name]

I would most definitely rubber wheel down some of the engagement.

 

[TheLabGuy]

I wouldn't touch the interface. Liability concerns and if you do no insurance you or the doc has or can get will cover wilful mishandling, and that's exactly what it would be called.

You've been working this thing for a while and know exactly what way to put it so it drops in. Show the doctor the path of insertion when you take the case to him if it is a local account. If not local, send pictures or have a video chat.

Inform him of the best way to remove the engaging aspect, but inform that it will be a last resort, not the first thing done. First thing is for Doc to practice on the model for 5 minutes and again right before the appointment, right before it's sterilized for insertion.

Then remember in the future to always use non-engaging on bridges/splinted implants.

First thing that should of been done was a phone call...I actually have a identical case in my phone pile for Monday morning. Ask the Doc on how they want to proceed. I usually offer them three suggestions. 1. One abutment non-engaging 2. Both abutments enganging but cement retained 3. Both abutments enganging but will make holes for screw retained but will have Doc cement it in clinically. They almost always pick #3, but this avoids a remake when the Doc can't get it in and fubars that pretty hex.

 

[Contraluz]

It seats fine on the model but I’m afraid it’s going to be slightly off in mouth that doc can’t seat it.
Would you recommend making any adjustments to hexes just to make sure they can make it fit?

Great advice here, so far!!!

However, if you get ‘permission’ by your client, and him taking responsibility, certain implant brands it is rather easy to convert from engaging to non engaging. Like Nobel active and Straumann bone level. Zimmer, Nobel replace and many others are almost impossible. On them you really tamper with the abutments, while on the first two, you just cut off the engaging part.

Some brands don’t even offer non engaging abutments or Ti-bases. There you are left using either non-engaging temp cylinders, tamper with the hex or go non-OEM.

Some times there is no easy solution and you become a criminal rather quickly...

 

[keydental]

Great advice here, so far!!!

However, if you get ‘permission’ by your client, and him taking responsibility, certain implant brands it is rather easy to convert from engaging to non engaging. Like Nobel active and Straumann bone level. Zimmer, Nobel replace and many others are almost impossible. On them you really tamper with the abutments, while on the first two, you just cut off the engaging part.

Some brands don’t even offer non engaging abutments or Ti-bases. There you are left using either non-engaging temp cylinders, tamper with the hex or go non-OEM.

Some times there is no easy solution and you become a criminal rather quickly...

Do you know if Astra tech ev 4.2 and 4.8 are among those that’s not offered as non engaging?

 

[user name]

.

 

[Contraluz]

Do you know if Astra tech ev 4.2 and 4.8 are among those that’s not offered as non engaging?

This is a link to their Product catalogue: https://www.dentsply.com/content/da...TECH-Implant-System-EV-LR-a1axpr7-en-1507.pdf
If you dont find what you are looking for in the OEM catalogue, you will find non engaging parts here: https://www.dess-usa.com/astra-ev-compatible-straight-tibases/

 

[keydental]

F... I was hoping they didn’t have non engaging so I have an excuse...

 

[Contraluz]

F... I was hoping they didn’t have non engaging so I have an excuse...

Sorry...

 

[CatamountRob]

F... I was hoping they didn’t have non engaging so I have an excuse...

They were out of stock...

 

[keydental]

 

[DESS-USA]

DESS has Astra EV non engaging tibases- FDA approved with a lifetime replacement warranty on the Astra original implants and DESS components.

 

[Smilemaker1234]

First thing that should of been done was a phone call...I actually have a identical case in my phone pile for Monday morning. Ask the Doc on how they want to proceed. I usually offer them three suggestions. 1. One abutment non-engaging 2. Both abutments enganging but cement retained 3. Both abutments enganging but will make holes for screw retained but will have Doc cement it in clinically. They almost always pick #3, but this avoids a remake when the Doc can't get it in and fubars that pretty hex.

Have you had success with one engaging and one non engaging.? Seems like it would be stronger. I have never felt comfortable with non engaging bridges. (But I still make them.)It seems like only the screws are holding in in place.