Implant tips

JohnWilson

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Here is another tip on saving your gp's/ or potential clients loads of head aches.

One of the biggest oral surgeons in my area has contracted with me to handle all of his custom abutments. He takes a fixture level impression and we do custom cad/cam abutments with a temp crown that he will deliver. Prior to sending the case. We do 2 things:

1) If the case is an anterior we digitize the abutment in our procera software and save it for potential future use. This take about 3 minutes and we save it to a Flash Drive. Since we do not work with all of the OS's referral base there is a good chance we will never see this unit for the definitive restoration but with the help of some subtle marketing and the OS office managers marketing efforts for us its been a very big growth for us.

2) We make a PVS impression and make a master die of the abutment that the OS will send to the restoring DR in a nice shiny Box with my labs name on it. This allows some subtle marketing to clients I want to work for, and also allows that GP to not be stressed when he takes the final C&B impression. Since most feel its a big no no to pack cord on implants, the soft tissue may lay over on the abutment margin. Since we have a master die to seal margins to thee is no concern if this happens.

Have a great week,
 
JohnWilson

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Another thing we do for our clients is make abutment seating jigs. I know many of you are aware of this for multiple unit restorations but even for singles we have started making them for molar restorations.

We make them out of light cure baseplate material extending to the adjacent dentition to stabilize the jig. We make certain the material adapts very well to the abutment so that it has retention in the jig and drill a hole through the top of the jig to allow a driver to access the screw. Its amazing how difficult it can be to orient a molar abutment free hand with out a jig.

This technique can save your clients a ton of time over the time it takes to make the jig. Make your next implant crown a surprise for your clients and send them a jig like this as a promo. When we originally started this it was to just help our clients, now its an extra $15 for every fixture we restore.
 
CatamountRob

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John,
I like the idea of an abutment seating jig, I have certainly heard enough times how difficult it can be to get them oriented in the mouth. Perhaps you could post some photos when you have a chance. Thanks Rob
 
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mike123

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well your tips are really great .. i want to know that can the broken teeth can be again good.
:D
 
kcdt

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I will attest to the fact that using an abutment jig is a must for trouble free delivery. The risks in having something out of orientation is too great.
 
wwcanoer

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Re: abutment indexes or jigs

John, I read your write up regarding the jigs, and thought what a neat idea!

I don't feel like I'm getting the hang of it though. I'm using Triad custom tray light cured material, making sure that I can index the abutment and then get everything reoriented back onto the model. That seems to be going fine in my opinion. Admittedly, I don't have to deal with cheeks and tongues. Feedback from the assistance is about a 50-50% rate of success. According to the doctor it's more like 25%. I'm providing an access hole for the screw at the top of the jig. Could this be part of a problem regarding lack of retention? Dr. recommended securing the abutment to the jig with flowable composite. The assistance thought that was a silly idea.

Any thoughts, or ideas to go about this

thanks in advance,

Carol

picture.php
 
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thewhitelab

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I make these jigs for all my implant work and find pattern resin a great material for such a job. no problem with retention

hope this helps?
 
JohnWilson

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Re: abutment indexes or jigs

John, I read your write up regarding the jigs, and thought what a neat idea!

I don't feel like I'm getting the hang of it though. I'm using Triad custom tray light cured material, making sure that I can index the abutment and then get everything reoriented back onto the model. That seems to be going fine in my opinion. Admittedly, I don't have to deal with cheeks and tongues. Feedback from the assistance is about a 50-50% rate of success. According to the doctor it's more like 25%. I'm providing an access hole for the screw at the top of the jig. Could this be part of a problem regarding lack of retention? Dr. recommended securing the abutment to the jig with flowable composite. The assistance thought that was a silly idea.

Any thoughts, or ideas to go about this

thanks in advance,

Carol

picture.php

In the picture you provided is the second unit a screw retained gold crown?? Going over a screw retained crown is a bit more difficult because of contours. When we do those types of jigs we use Acrylic lined with Versacryl (resilient material i.e. flexes) Often times when doing multiple units when engaging parts are used the Dr will have to load the jig up with one unit, screw it down, remove the jig, re seat additional unit/s and repeat.

Light cure material works perfectly on most single units, but I choose to use baseplate material over the flowible type. Seems it adapts a bit better to the abutment. Retention of the abutment in the jig is based on many things but most importantly is abutment design (How parallel the walls of the abutment are and having at least one flat side so the abutment does not rotate in the jig) Adding friction to the polished surface (sandblast)will help as well. A dab of Vaseline works wonders in the operatory as well.

The screw hole is the most important part this is what allows the Dr to tighten the abutment where it belongs. Just make sure when the jig is made that the screw has the ability to go through the top of the jig with out binding.


Let me know if you need any further details.
 
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Yes i agree with john, abutment design is very important i.e. a flat side or retention groove, however, pattern resin i believe is more accurate. i often use this material as a substitute for wax when constructing a coping with great results.
 
JeffT

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hi John, If you have two abutments in line.ie premolar and molar as singles will you make a jig for each or do one for both? Im thinking one for both but i thought i would ask.

thanks, jeff
 
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TheLabGuy

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John, 'Versacryl'...............as I bang my head on the bench, why didn't I think of that.........That stuff is pretty neat (TomZ gave me a sample while I was in Chicago). I've heard Brian and Tom talking about it awhile but never thought to try it as a 'light body' material in the implant jigs. Makes a ton of sense.

Carol, you need to get a better adaptation of the light cured material around your abutment, or use some Versacryl........ As implants become more and more involved, implant jigs will become the norm. It's crazy to think if you did a poll right now, I would say less than 10% of labs actually make a jig.....
 
JohnWilson

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hi John, If you have two abutments in line.ie premolar and molar as singles will you make a jig for each or do one for both? Im thinking one for both but i thought i would ask.

thanks, jeff

We always try and get away with making one jig. For singles, if there is a distal and an mesial abutment tooth we will make it in one unit and see if the abutments will draw. If it doesn't the Dr has to seat one unit remove the abutment seat other abutment and so on.

The longest internal connection fixtures out there make this a common practice for us.
 
JeffT

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Understand and thanks
Jeff

Hi Rob, I have never made a jig, I have known about them but never done it. But I will give it a go now using all the tips from you guys.

Jeff
 
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wwcanoer

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John, regarding your first response back to me. The gold crown was a "screw in" restoration. I called and requested a sample of the Versacryl material to try that out. In the meantime, I'll try pattern resin.

I think one of my big fears about getting too close of an adaptation, is of some sort of contamination from the jig (residual oxygen layer, I think it's called, on the triad?),to the abutment that well compromise the cementation phase. I know that once the abutment are torqued in, you can't just easily remove it to clean surfaces again.

Keep you all posted regarding my experimentations with your suggestions!

Thanks so much for all the comments.

Carol
 
JohnWilson

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John, regarding your first response back to me. The gold crown was a "screw in" restoration. I called and requested a sample of the Versacryl material to try that out. In the meantime, I'll try pattern resin.

I think one of my big fears about getting too close of an adaptation, is of some sort of contamination from the jig (residual oxygen layer, I think it's called, on the triad?),to the abutment that well compromise the cementation phase. I know that once the abutment are torqued in, you can't just easily remove it to clean surfaces again.

Keep you all posted regarding my experimentations with your suggestions!

Thanks so much for all the comments.

Carol

Carol the O.I.L that all composite material have can easily be removed from the jigs before you send them out. Truth is it will most likely not effect the cementaion anyhow but... A couple of tips for removal.

The easiest way is to use a paint on gloss varnish this solves all the problems. Another way is with denatured alcohol and a good stiff denture brush.

Did you get the lab self cure Versacyl kit where you can adjust the hardener/softener to the desired flex? The premeasured self cure soft reline kit is too soft for this application.

The cool thing is that even though this material is PMMA we still make the jig out of light cured baseplate material for speed and accuracy then hog it out, put mechanical retention in the jig and then reline with the versacryl. You have to remember we only do this technique for full screw retained crowns so it will snap over the H.O.C. of the crown to hold it in the jig. Abutments have just straight composite no versacryl interface.
 
JeffT

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Hi John, reference to your jig for screw retained crowns. Would a lab putty work for the reline or for the whole jig itself or is it too flexible?

thanks
jeff
 
TheLabGuy

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What about Blu-moose and use some polyvinyl as a light body? Simple, fast, and no light cure?
 
JohnWilson

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Hi John, reference to your jig for screw retained crowns. Would a lab putty work for the reline or for the whole jig itself or is it too flexible?

thanks
jeff

The jig has to be rigid, any flex and it defeats the purpose. Most times when a custom abutment is made it flairs the soft tissue which means there is some force needed to seat it. Even when we line the jigs with versacryl its just the sides of the jig holding the unit and the occ stop is in hard composite. This maintains a rigid form.

Keep thinking outside the box its how I came up with many of my techniques.
 
Wyolab

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I also use triad material for my jigs. As was stated earlier having a groove or flat side to prevent rotation is important. I also heard back from a dentist after he struggled with a couple of my jigs, and realized his screwdriver was much shorter then mine. This prevented him from being able to use the jig after the first few turns, very embarrassing. I have marked my lab screwdriver and everything is going fine now.
 
kcdt

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Carol the O.I.L that all composite material have can easily be removed from the jigs before you send them out. Truth is it will most likely not effect the cementaion anyhow but... A couple of tips for removal.

The easiest way is to use a paint on gloss varnish this solves all the problems. Another way is with denatured alcohol and a good stiff denture brush.

Did you get the lab self cure Versacyl kit where you can adjust the hardener/softener to the desired flex? The premeasured self cure soft reline kit is too soft for this application.

The cool thing is that even though this material is PMMA we still make the jig out of light cured baseplate material for speed and accuracy then hog it out, put mechanical retention in the jig and then reline with the versacryl. You have to remember we only do this technique for full screw retained crowns so it will snap over the H.O.C. of the crown to hold it in the jig. Abutments have just straight composite no versacryl interface.

I will vouch for the alcohol- I use the same technique to gt the stickiness off LC baseplates.
 

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