fabricating an "all on four" diem.

[McTeeth]

Hey Everybody

I have a few conversions under my belt some questions:

1) What is the best way to figure out which MUA to use, we are currently "eyeballing" them by getting the patient to close jaw and see if the screw hole lines up with lingual cusp tip/cingulum (lower conversion)?

The few dentist I have worked with simply are not interested in surgical guides, one says "How can you trust if its seated correctly" We currently have a slick procedure for converting, but always looking for better ways. We pick up the 2 anteriors, take a bite, unscrew, mount on articulator, break-away the 2 anteriors.(denturist hates Triad) secure denture in CO to opposing, pick-up all 4 on model...bite was bang-on in the mouth.

2) How do these surgical guides work if you need to remove bone?

Thanks

 

[Smilestyler]

The guides are clear so its pretty easy to see when they are all the way in. Unless you are obliterating an entire ridge there will be enough bone in the buccal/palate to maintain its position. That being said, most truly dont use them because of their cost.
As for the abutments the surgeon usually puts straight ones in the front, and the Multis in the posterior and we eyeball together the correct angle based on where we want the screw to come out.
The method you describe is very similar to the way I do it.
Where in Canada are you from?

 

[McTeeth]

Im in BC. Ya I was just wondering if anybody had any tips on "eyeballing" lol, We are sometimes eyeballing 17's on the front only to later change them to straights on final.

 

[Soniq]

Hybrid conversion re-articulation

Hi Gary,

Sorry I'm rather late on this topic, but may I ask how you re-articulate the new implant level model with out a new bite registration?

Thanks,

Darwin

 

[Tom Moore]

Whats the going price for the tech to be at the conversion? A few years ago it was $800 around here but I think that has fallen.

A local lab owner took a nine month sabbatical from his lab a few years ago and let his employees run it while he worked at the place they do these every day. His calender now stays full doing this sort or work. It was a great investment for him and they paid him well to learn.

 

[Smilestyler]

Hi Gary,

Sorry I'm rather late on this topic, but may I ask how you re-articulate the new implant level model with out a new bite registration?

Thanks,

Darwin

You must attach the denture to the anterior implants intraoral, then just screw it back on the model to pick up the remaining implants. No bite registration required.

 

[Smilestyler]

Whats the going price for the tech to be at the conversion? A few years ago it was $800 around here but I think that has fallen.

A local lab owner took a nine month sabbatical from his lab a few years ago and let his employees run it while he worked at the place they do these every day. His calender now stays full doing this sort or work. It was a great investment for him and they paid him well to learn.

Way more than $800 (way more) in Canada. Did I mention way more?

 

[Thedentureman]

What do you guys think about that 3M hard pick up stuff?

 

[premierlab]

Ill be honest, I have done immediate conversions with almost every material on the market. Self cure or light cured materials make me nervous. I have seen a large portion of the conversions done with these materials experince some kind of falure during the provisional healing stage. The bond between these materials and lab processed acrylics are just to weak to stand up to the stresses of a fixed provisional resoration. I have worked with several laboratories, dentists, and surgions across the country and seen alot of the bad and ugly. I use GC patteren resin for pick-up of temporary cylinds into the denture then indirectly do the rest of the conversion out of the mouth with very hot water, a curepot and lucitone fast pour acrylic. With this modality it may take just a little longer but I am currently running with zero failures of anykind. The 5-6 month healing period has been completely stress free to the patient, doctor and lab and this altimately builds a great reputation. Not temporazing a case 30 minutes faster. I have worked with numerous doctors and labs that had been temporizing cases for quite some time and after training them on my way of temporizing they have all switched to it and will consider nothing else. Not bragging, it just flat works!! if there is any way I can be of assistance just let me know, I would be glad to help!

 

[BobCDT]

I am with Mark, I have about 20 chair side conversions under my belt, every time I do one I get faster and learn a new trick.

If this is a single arch case you will be fine, just bring some 30 sec blu moose or rigid bite reg material to help you stabilize the denture. Also if you make some occ indexing putty matrix's you will have an easier time locating centric as you stabilize the denture. Once you have this accomplished then you can tack your cylinders in place and back fill outside of the mouth. Retry things in, check bite and then cut down all your flanges and convex the base.

Just know its going to take way longer than you expect your first time and the surgeon is going to be impatient and the patient will not be very compliant the longer it takes.

If your lab is not in the same building make a checklist of items you will need to bring to accomplish the task, run through a mock case virtually in your lab reaching for the items you will need and write them down. Sometimes its the simplest item that you forgot to bring that either makes or breaks the transition.

I have 2 big boxes set up as my "GO BOXES" that has a mini lab in them, and I add something I think of after just about every surgery.

Hi John,
Or anyone else . What do you charge for this service?
Thanks

 

[Thedentureman]

100 an hour

 

[Thedentureman]

Do you have any pictures of the case?

 

[Jose]

after you guys are done, send me a duplicate of those screwretain inmediate loads and i will convert them into prettau bridges, check out my profile pictures, curently doing alot of this cases, they come out nice.

Cad Cam Prettau zirconia at Tischler Dental Laboratory - YouTube

 

[Jose]

we have done some inmediate loads in the office also. speeds up the protocol for prettau.

 

[CPLZ]

Do you vets of All-On-4 have a recommended training course for conversion?

 

[Smilestyler]

Chrysalis is where I learned how. Its in Canada