7 parallel abutments from trios/imes450

[prestige.dental]

The abutments were placed in the mouth and regular crown bridge impression taken without paying attention to margins as we would get the margins from D900 scanner by individual abutments scanning as a die. But the stone abutments broke as we removed the cast from PVS impression....poured the cast 3 times and abutments broke every time all though the abutments are perfectly parallel.

I gave up.

The cast u are seeing with the abutments on is closed tray impression with right hex orientation but close trays are never accurate and the open tray impressions although accurate do not carry hex position.

The PVS impression of the abutments in the mouth is accurate but it I can't remove the damn cast out of the impression intact

.

 

[Toothman19]

Have you tried placing a pin in the stone while it's still wet. The will give extra support and the stone won't break. Just put a pin or paper clip into the impression before you pour the model

 

[adl]

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The abutments were placed in the mouth and regular crown bridge impression taken without paying attention to margins as we would get the margins from D900 scanner by individual abutments scanning as a die. But the stone abutments broke as we removed the cast from PVS impression....poured the cast 3 times and abutments broke every time all though the abutments are perfectly parallel.

I gave up.

The cast u are seeing with the abutments on is closed tray impression with right hex orientation but close trays are never accurate and the open tray impressions although accurate do not carry hex position.

The PVS impression of the abutments in the mouth is accurate but it I can't remove the damn cast out of the impression intact

. View attachment 21241 View attachment 21237

View attachment 21246 View attachment 21240 View attachment 21239

View attachment 21234 View attachment 21235 View attachment 21236

The abutments were placed in the mouth and regular crown bridge impression taken without paying attention to margins as we would get the margins from D900 scanner by individual abutments scanning as a die. But the stone abutments broke as we removed the cast from PVS impression....poured the cast 3 times and abutments broke every time all though the abutments are perfectly parallel.

I gave up.

The cast u are seeing with the abutments on is closed tray impression with right hex orientation but close trays are never accurate and the open tray impressions although accurate do not carry hex position.

The PVS impression of the abutments in the mouth is accurate but it I can't remove the damn cast out of the impression intact
Pour it and let it sit overnight . Next morning soak the whole thing for 5-10 min. Start separating the model from the impression slowly . It works 9 out of 10 times
. View attachment 21241 View attachment 21237

 

[prestige.dental]

Have you tried placing a pin in the stone while it's still wet. The will give extra support and the stone won't break. Just put a pin or paper clip into the impression before you pour the model

Thanks toothman, thank u for your tip

 

[adl]

View attachment 21246 View attachment 21240 View attachment 21239

View attachment 21234 View attachment 21235 View attachment 21236

The abutments were placed in the mouth and regular crown bridge impression taken without paying attention to margins as we would get the margins from D900 scanner by individual abutments scanning as a die. But the stone abutments broke as we removed the cast from PVS impression....poured the cast 3 times and abutments broke every time all though the abutments are perfectly parallel.

I gave up.

The cast u are seeing with the abutments on is closed tray impression with right hex orientation but close trays are never accurate and the open tray impressions although accurate do not carry hex position.

The PVS impression of the abutments in the mouth is accurate but it I can't remove the damn cast out of the impression intact

. View attachment 21241 View attachment 21237

Whoops I messed up . Let's try it again . Pour it and let it sit overnight . In the morning soak the whole thing for 5-10 min . Start releasing the model slowly . It works 9 pit of 10 times.

 

[JohnWilson]

I am a bit of a loss on how this case got to the point of producing abutments with out knowing the design on top of it? I see a bunch of supra gingival margins in the maxilla that make me wonder how the emergence was generated???

IF you had set up the order form to do a simple round house temp bridge over the top of the abutments, milled it in plastic you could use this as.


1) Cross arch verification of the TRIOS scan.

2) Emergence profile verification

3) Bite/esthetic/midline and high/low lipline confirmation.


I think you are planning a cemented restoration, so knowing where your restoration is going to be before you finish abutments/margins/emergence is how we design in my lab.

If you went this route I outlined you could skip this impression step, do a standard copy of your abutment design, append the design to the copy, print the model of your abutment design and remount with the Temp bridge after bite equilibration/modifications. All of this is assuming you made a bite rim and scanned that into the trios scan as a preop. This path allows you to segmented this bridge if the scan is off, and have the ability to do an altered cast if necessary. From the design picture it appears an opposing was scanned in but how???


I am happy to share so please if your uncomfortable in open forum asking specific questions just PM me. This is a big case and you have the tools to do great work if you know how to use them wisely.

 

[prestige.dental]

I am a bit of a loss on how this case got to the point of producing abutments with out knowing the design on top of it? I see a bunch of supra gingival margins in the maxilla that make me wonder how the emergence was generated???

IF you had set up the order form to do a simple round house temp bridge over the top of the abutments, milled it in plastic you could use this as.


1) Cross arch verification of the TRIOS scan.

2) Emergence profile verification

3) Bite/esthetic/midline and high/low lipline confirmation.


I think you are planning a cemented restoration, so knowing where your restoration is going to be before you finish abutments/margins/emergence is how we design in my lab.

If you went this route I outlined you could skip this impression step, do a standard copy of your abutment design, append the design to the copy, print the model of your abutment design and remount with the Temp bridge after bite equilibration/modifications. All of this is assuming you made a bite rim and scanned that into the trios scan as a preop. This path allows you to segmented this bridge if the scan is off, and have the ability to do an altered cast if necessary. From the design picture it appears an opposing was scanned in but how???


I am happy to share so please if your uncomfortable in open forum asking specific questions just PM me. This is a big case and you have the tools to do great work if you know how to use them wisely.

Thanks John

Patient has a temp bridge in his mouth made in a analog way over these implants. So

first a trios scan was made with the temp bridge

Then temp removed, seven scan bodies screwed in and trios scan taken

The two files were stitched using the marks/dots made on the palate. This is how we designed the abutments with in the envolope of the bridge.

We are trying to make it a cement retained FCZ bridge but we need a accurate cast with the hex. And we do not know a way of doing this.

Dead on accurate imp can be taken by splinted non eng imp copings.

the trios scan is even inferior to closed tray PVS impression

 

[prestige.dental]

So here is what I understand , the printed model you are taking about, would come from the trios-scan body scan. And we would be sticking in the digital implant analogs.

By altered cast u mean you would replace the faulty analogs in the printed model

 

[JohnWilson]

I think I understand your path,

The analog model that you originally had shown mounted and is being shown is not what the abutments were designed from

You made a trios scan designed abutments and used the old implant bridge to reference the bite and aid you in your design.

SO

Now you want to do a cemented Zirc bridge, you torqued the abutments into place and now took an analog impression???? Did they remove all the abutments again and deliver the old bridge back?

Lastly what I was outlining is that since you have the abutments designed you can take that design file and have a model printed of the abutments you designed. (same as what you were trying to do with the pvs impression) You do this by making a standard copy appending the design, then make a new order for a model and import the dcm file of your design. Then send it to be printed. It will be much more durable than any stone model.

In any event if you milled your own abutments and then hand polished then your model will not be super accurate. In theory what I suggested would work and I have done it many many times.

Since I have done at least 50 MISCH style FCZ CEMENTED ROUNDHOUSE bridges in the last 2 years I can tell you that using stone for this type of appliance is asking for trouble I have done it both ways and I recommend this product.

http://www.xpdent.com/catalogs/bredent/liquids/exaktoform-liquid.aspx?sm=f_b

 

[prestige.dental]

I think I understand your path,

The analog model that you originally had shown mounted and is being shown is not what the abutments were designed from

You made a trios scan designed abutments and used the old implant bridge to reference the bite and aid you in your design.

SO

Now you want to do a cemented Zirc bridge, you torqued the abutments into place and now took an analog impression???? Did they remove all the abutments again and deliver the old bridge back?

Lastly what I was outlining is that since you have the abutments designed you can take that design file and have a model printed of the abutments you designed. (same as what you were trying to do with the pvs impression) You do this by making a standard copy appending the design, then make a new order for a model and import the dcm file of your design. Then send it to be printed. It will be much more durable than any stone model.

In any event if you milled your own abutments and then hand polished then your model will not be super accurate. In theory what I suggested would work and I have done it many many times.

Since I have done at least 50 MISCH style FCZ CEMENTED ROUNDHOUSE bridges in the last 2 years I can tell you that using stone for this type of appliance is asking for trouble I have done it both ways and I recommend this product.

http://www.xpdent.com/catalogs/bredent/liquids/exaktoform-liquid.aspx?sm=f_b

Thanks John for taking the time. I will call you to share our experiences with the trios scan body model less work flow. Lot of money was spent buying the trios but the implant transfer has not been accurate from the mouth to the screen and we kept bugging CAP, but at this point we have gone back to analog methods. But I have not given up.

I need to study the trios machine deeply to exploit its true potential.

 

[prestige.dental]

I want to thank toothman, I got the model right the fifth time with all the 7 analogs intact using the metal pins.
Lots of respect for this unbiased forum.

 

[rkm rdt]

Thanks John for taking the time. I will call you to share our experiences with the trios scan body model less work flow. Lot of money was spent buying the trios but the implant transfer has not been accurate from the mouth to the screen and we kept bugging CAP, but at this point we have gone back to analog methods. But I have not given up.

I need to study the trios machine deeply to exploit its true potential.

come visit the Trios Study Club on Facebook.

 

[rkm rdt]

Why not just scan the abutments with the Trios and print a model?

 

[2thm8kr]

Why not just scan the abutments with the Trios and print a model?

How will you verify the model?

 

[Toothman19]

View attachment 21271 View attachment 21271 I want to thank toothman, I got the model right the fifth time with all the 7 analogs intact using the metal pins.
Lots of respect for this unbiased forum.

Thats what we are all here for. Ive had that happen many times to me and I know how big of a pain in the a$$ it is

 

[prestige.dental]

How will you verify the model?

I feel that the stitching of the thousands of pictures taken by trios would not produce a accurate model. Desktop scanner (d900) does not do all that stitching and is therefore accurate.

I just wanted to finish the case with the existing knowledge and experience. Having been rejected by trios, I did not want to try it.

Also there would not be a model unless I printed one. Don't have printer yet, ( planning to buy the juell 3d printer this week).

But now it seems like, for the next case, I should have the abutments scanned in the mouth and do designing from there and the print model to just check the fit.

 

[prestige.dental]

How will you verify the model?

I feel that the stitching of the thousands of pictures taken by trios would not produce a accurate model. Desktop scanner (d900) does not do all that stitching and is therefore accurate.

I just wanted to finish the case with the existing knowledge and experience. Having been rejected by trios, I did not want to try it.

Also there would not be a model unless I printed one. Don't have printer yet, ( planning to buy the juell 3d printer this week).

But now it seems like, for the next case, I should have the abutments scanned in the mouth and do designing from there and the print model to just check the fit.

 

[2thm8kr]

Not trying to be combative about this. I have been playing with IO scanners for a long time and they are just not predictable enough for this. Experiment and learn, but rely on traditional techniques for now. IO scanning has come a long way, but adding in the variable of printed models from IO scans will make your head spin.

 

[PDC]

View attachment 21246 View attachment 21240 View attachment 21239

View attachment 21234 View attachment 21235 View attachment 21236

The abutments were placed in the mouth and regular crown bridge impression taken without paying attention to margins as we would get the margins from D900 scanner by individual abutments scanning as a die. But the stone abutments broke as we removed the cast from PVS impression....poured the cast 3 times and abutments broke every time all though the abutments are perfectly parallel.

I gave up.

The cast u are seeing with the abutments on is closed tray impression with right hex orientation but close trays are never accurate and the open tray impressions although accurate do not carry hex position.

The PVS impression of the abutments in the mouth is accurate but it I can't remove the damn cast out of the impression intact

. View attachment 21241 View attachment 21237

Mill an extra set of abutments and place them with analogs into impression. Dr will need to bag and label each abutment so it that it will make repositioning easier for you after he removes them. These abutments shouldn't be difficult to reseat in the impression considering their length. Pour it up...it ain't gonna break. And you have accurate margins.

Scan this model and mill a temp for verification purposes. Send it to doc for try-in. If it fits, then you have an accurate model to work with and a temp scan to use for the final bridge.

 

[rkm rdt]

Not trying to be combative about this. I have been playing with IO scanners for a long time and they are just not predictable enough for this. Experiment and learn, but rely on traditional techniques for now. IO scanning has come a long way, but adding in the variable of printed models from IO scans will make your head spin.

I doubt a closed tray impression will be much better and this is not screw retained .