DESS Ti Base Geometry for Nobel Active Implants

[Brett Hansen CDT]

I am restoring 12-15 with a PFM screw retained bridge. There are two Nobel Active 5.5 implants in 14 and 15 and one Nobel active 4.3 implant in 13. I ordered a non-engaging ti base from Dess for 13 and two engaging Ti bases for 14 and 15 since DESS doesn't make non-engaging ti bases for the 5.5 implant. I cut the engaging part off the 5.5 ti bases and then we fabricated the metal framework for a try in. The picture you see is from the try in. The doctor is wondering why 14 and 15 look like a "platform switch" where 13 does not have that same look. Does it matter? Is there a reason for this? This is my first time restoring a screw retained bridge with these parts. The patient in this case has a very high dental IQ and we want to make sure we can answer any questions if they arise. I would also just like to know for my own personal education. Thanks!

 

[DESS-USA]

All of the Nobel Active platforms are platform switched. I would assume if the dentist had a digital xray he could enlarge #13 and see the platform switch on the 4.3 platform.

The geometries of both the engaging and non engaging ti bases will be the same above the implant.

DESS does have non engaging 5.5 Nobel Active ti bases also - https://www.dess-usa.com/ti-base-engaging-5-5-wp-16-069-nobel-active-compatible/

 

[DanM]

Does cutting the hex off concern anybody? I know we've all done it when we have had to but with now so many options for components it seems like its less necessary. I have a dr that sends me stock abutments and wants me to cut the hex off for screw retained bridges. So for now I just note it on the invoice that dr requested hex removed.

 

[DESS-USA]

You did the right thing by protecting yourself. I am responding to you from the perspective of a manufacturer of implant components that designs abutments and screws for specific applications and tests these parts based on industry specifications (ISO, FDA, CE) to ensure that they can hold up in the mouth for "infinite life". This means passing static and compression testing per ISO 14801 and this is a requirement for FDA. What concerns me is the stock abutment is not tested or designed for non engaging usage and for screw retained. If it was then it would have gone through the same testing that the ti bases have to go through to obtain FDA. Labs use them because the doctor possibly wants to save a dollar or has extra inventory or believes that the taller tapered wall abutment will be stronger than a shorter vertical wall ti base...and this is not the case. You would save time using the right part and the doctor would have less risk of failure if he did so as well. If you need any assistance let me know. Always willing to help.

 

[Brett Hansen CDT]

Thanks for your help Keith!

 

[lcmlabforum]

I am restoring 12-15 with a PFM screw retained bridge. There are two Nobel Active 5.5 implants in 14 and 15 and one Nobel active 4.3 implant in 13. I ordered a non-engaging ti base from Dess for 13 and two engaging Ti bases for 14 and 15 since DESS doesn't View attachment 31681 make non-engaging ti bases for the 5.5 implant. I cut the engaging part off the 5.5 ti bases and then we fabricated the metal framework for a try in. The picture you see is from the try in. The doctor is wondering why 14 and 15 look like a "platform switch" where 13 does not have that same look. Does it matter? Is there a reason for this? This is my first time restoring a screw retained bridge with these parts. The patient in this case has a very high dental IQ and we want to make sure we can answer any questions if they arise. I would also just like to know for my own personal education. Thanks!

Just FYI in the FWIW dept: I would be concerned with the radiograph being sent to me showing bone loss around #13 implant, and not sure if the other bone
density around the other 2 implants look alike, better, or worse.
I am not sure I would say anything and really this is not your area since the restoring DDS is the one who is responsible for
the clinical decisions, maybe that was why the decision was made to 'splint' or connect the implants. Then again, if it makes
it harder for the patient to clean and end up with more bone loss, having this picture is good for you to keep to say this
was how it looked like at the time you provided the prosthesis.
Also, if you used original Nobel Parts for Conical Connections, they all have that 'platform switch appearance'. #13 might be just angled
differently.
My 2 cents
LCM

 

[Brett Hansen CDT]

Thanks for your input LCM. Sounds like this patient doesn't take care of his dental work which may be the cause of the bone loss. We are in the process of redoing old work. I guess he has lots of money.