Implant venting...

[sidesh0wb0b]

Wen can we start teaching surgeons to place healing caps for tissue management? Seriously!!

 

[shane williams]

When can we start teaching surgeons and dentists that surgical stents and guides are a better method than the traditional "oh this looks like a good spot" and "the angle doesn't really matter"
I love getting the case where the access hole comes out the facial, and the dr requests a screw-retained crown. Inform them of the situation and they still ok for screw-retained, only to get it back and they are pissed that the screw hole is facial and they can't match the shade with composite!!!

 

[Marcusthegladiator CDT]

When can we start teaching surgeons and dentists that surgical stents and guides are a better method than the traditional "oh this looks like a good spot" and "the angle doesn't really matter"
I love getting the case where the access hole comes out the facial, and the dr requests a screw-retained crown. Inform them of the situation and they still ok for screw-retained, only to get it back and they are pissed that the screw hole is facial and they can't match the shade with composite!!!

Seconds ago i shipped a case I finished yesterday. Temporary crowns 7,8, #8 pontic. #7 Implant. The screw channel came out the facial and the lingual, so naturally the incisal as well. So I built a custom abutment out of composite onto the temp abutment. In this way I was able to bulk the composite above the collar to adjust the tissue for a better emergence profile. And the temps are to be temp cemented over the abutment. It came out GREAT.

 

[Marcusthegladiator CDT]

Seconds ago i shipped a case I finished yesterday. Temporary crowns 7,8, #8 pontic. #7 Implant. The screw channel came out the facial and the lingual, so naturally the incisal as well. So I built a custom abutment out of composite onto the temp abutment. In this way I was able to bulk the composite above the collar to adjust the tissue for a better emergence profile. And the temps are to be temp cemented over the abutment. It came out GREAT.

I had already built this case once. I gave the doc a shell to be relined over his abutment. He had trouble even though I gave him a clear vacuum formed appliance to assist in proper alignment when religned. So then he didnt like the screw channel he made in it for some reason.... So I did things this way.

 

[rkm rdt]

When can we start teaching surgeons and dentists that surgical stents and guides are a better method than the traditional "oh this looks like a good spot" and "the angle doesn't really matter"
I love getting the case where the access hole comes out the facial, and the dr requests a screw-retained crown. Inform them of the situation and they still ok for screw-retained, only to get it back and they are pissed that the screw hole is facial and they can't match the shade with composite!!!

How many of those cases begin with study models and diagnostic wax ups?

 

[ParkwayDental]

Call me sometime I have a secret that we are doing with our surgeons here in town

 

[JohnWilson]

Call me sometime I have a secret that we are doing with our surgeons here in town

There are no secrets this is the interweb, spill it Mr Killer!

 

[ParkwayDental]

Alright here it goes, now since we are a huge Nobel lab and that's all we pretty much do this all might just be specific to Nobel Implants.

The OFS group and our lab came up with this idea and basically we are taking the Temporary Abutment and we have scanned and designed our own "healing cap" but it isn't really a healing cap. This will form the tissue properly and allow the patient to go home with a temporary that day.

We have several of these Jigs to fit a variety of scenarios. We have some for Centrals, Laterals, Bi's, and Molars but they are all different sizes and we have all the digital files saved so when the Surgeons need to restock we just mill what he needs. It is a pmma temporary jig that we created and they will form the tissue perfect. On the day of the surgery the patient leaves with a immediate temporary. We make the jigs and the surgeon will for a temporary over the jig which allows us to have perfect tissue and the patient is happy because they have a temporary in place when they leave.

 

[Marcusthegladiator CDT]

Alright here it goes, now since we are a huge Nobel lab and that's all we pretty much do this all might just be specific to Nobel Implants.

The OFS group and our lab came up with this idea and basically we are taking the Temporary Abutment and we have scanned and designed our own "healing cap" but it isn't really a healing cap. This will form the tissue properly and allow the patient to go home with a temporary that day.

We have several of these Jigs to fit a variety of scenarios. We have some for Centrals, Laterals, Bi's, and Molars but they are all different sizes and we have all the digital files saved so when the Surgeons need to restock we just mill what he needs. It is a pmma temporary jig that we created and they will form the tissue perfect. On the day of the surgery the patient leaves with a immediate temporary. We make the jigs and the surgeon will for a temporary over the jig which allows us to have perfect tissue and the patient is happy because they have a temporary in place when they leave.

ME LIKES!

 

[RileyS]

Alright here it goes, now since we are a huge Nobel lab and that's all we pretty much do this all might just be specific to Nobel Implants.

The OFS group and our lab came up with this idea and basically we are taking the Temporary Abutment and we have scanned and designed our own "healing cap" but it isn't really a healing cap. This will form the tissue properly and allow the patient to go home with a temporary that day.

We have several of these Jigs to fit a variety of scenarios. We have some for Centrals, Laterals, Bi's, and Molars but they are all different sizes and we have all the digital files saved so when the Surgeons need to restock we just mill what he needs. It is a pmma temporary jig that we created and they will form the tissue perfect. On the day of the surgery the patient leaves with a immediate temporary. We make the jigs and the surgeon will for a temporary over the jig which allows us to have perfect tissue and the patient is happy because they have a temporary in place when they leave.

so you supply doc with this and they trim the chimney as needed then make the temp tooth? do you supply them with an inventory or they call each time they have an appointment coming?
cool!

 

[ParkwayDental]

so you supply doc with this and they trim the chimney as needed then make the temp tooth? do you supply them with an inventory or they call each time they have an appointment coming?
cool!

Yep you got it, we supply the Surgeon with these and they will cut the top part off to the appropriate height to make the temp.

We supply them with an inventory, usually about ten of each one every month. That way they have them on hand and don't have to wait for us to get them one if they have a patient in the chair.

 

[JohnWilson]

So if the OS is making the temp over the top where is the savings for them? Not having to **** with the emergence? Plus they make a plastic sleeve that is essentially the same thing I believe, maybe not with the flair you have developed The nobel "quick temp abutment" shown is one of my least favorite as its thread timed. Your profile is not contoured to the sulcus its something the OS still has to do when he creates the temp right? I am trying to wrap my head on the time savings as one of the biggest benefit to forming the soft tissue early is the ability to transfer this information to the final impression via a custom impression comping fabricated from a jig based on the contours of the temp. Not knowing where the internal aspect of the fixture utilizing this technique makes it all but impossible to make the custom imp coping unless I am seeing this all wrong.

We also do not see as much immediate load cases, I would bet its maybe 5 percent. Getting primary stabilization and having a patient comply with proper measures to maximize SAFE osseointegration is really not a easy thing when you put a tooth on a temp abutment straight away.

Since we are sharing hopefully you are not thinking I am criticising as anything you can do to pound more OS to do something MORE its a great thing, I have shared our protocol with our surgeons and it absolutely works like a charm. We also have a line of contoured TI healing abutments with much more flair than the stock variety that are designed and contoured based on Nobels surgical protocol. These have been very popular with some of my surgeons.

thanks for sharing Tyler

 

[sidesh0wb0b]

How many of those cases begin with study models and diagnostic wax ups?

Almost none....

 

[sidesh0wb0b]

Alright here it goes, now since we are a huge Nobel lab and that's all we pretty much do this all might just be specific to Nobel Implants.

The OFS group and our lab came up with this idea and basically we are taking the Temporary Abutment and we have scanned and designed our own "healing cap" but it isn't really a healing cap. This will form the tissue properly and allow the patient to go home with a temporary that day.

We have several of these Jigs to fit a variety of scenarios. We have some for Centrals, Laterals, Bi's, and Molars but they are all different sizes and we have all the digital files saved so when the Surgeons need to restock we just mill what he needs. It is a pmma temporary jig that we created and they will form the tissue perfect. On the day of the surgery the patient leaves with a immediate temporary. We make the jigs and the surgeon will for a temporary over the jig which allows us to have perfect tissue and the patient is happy because they have a temporary in place when they leave.

Very nice, I've seen/done some similar to what you're doing. It does work fairly well.....if they take the time to do it. That's a bit IF. They don't like extra costs, and it's nearly impossible to push that onto the GP. At least has been for me lately.

 

[sidesh0wb0b]

So if the OS is making the temp over the top where is the savings for them? Not having to **** with the emergence? Plus they make a plastic sleeve that is essentially the same thing I believe, maybe not with the flair you have developed The nobel "quick temp abutment" shown is one of my least favorite as its thread timed. Your profile is not contoured to the sulcus its something the OS still has to do when he creates the temp right? I am trying to wrap my head on the time savings as one of the biggest benefit to forming the soft tissue early is the ability to transfer this information to the final impression via a custom impression comping fabricated from a jig based on the contours of the temp. Not knowing where the internal aspect of the fixture utilizing this technique makes it all but impossible to make the custom imp coping unless I am seeing this all wrong.

We also do not see as much immediate load cases, I would bet its maybe 5 percent. Getting primary stabilization and having a patient comply with proper measures to maximize SAFE osseointegration is really not a easy thing when you put a tooth on a temp abutment straight away.

Since we are sharing hopefully you are not thinking I am criticising as anything you can do to pound more OS to do something MORE its a great thing, I have shared our protocol with our surgeons and it absolutely works like a charm. We also have a line of contoured TI healing abutments with much more flair than the stock variety that are designed and contoured based on Nobels surgical protocol. These have been very popular with some of my surgeons.

thanks for sharing Tyler

Really only 5% immediate loading? It's about 15-20% in this area, with the clientele I'm working with thus far. Some are drastically opposed to immediate loading and will only progressively load the site....others won't load at all for 6-9mo, and some do it any way they feel its needed. Case by case basis. But I have yet to see a site ready to accept a final restoration that has had proper tissue management since the start.
Instead, I get the calls during seat that "it's really tight against the tissue"
Case in point....VERY small #6 pfm over Zimmer HLA 4/4 stock abutment. Not much room to begin with, vertically or to the adjacent teeth. Even using the 4mm straight instead of 4/5 flared abutment it left me with a snug fit on the soft tissue model....after prepping the abutment basically to toothpick size (ok maybe not quite that narrow). And since I always get the call from the Dr, I expect it here too. Prob next week.

He does listen though, and I know it's not the GPs fault, per say...he asked what could be done on the last case and I explained the challenges we have in restoring without gingival contouring done. The best option I could give him was to slice open the embrasure areas, flop the tissue back (holding with a single suture if needed),seating the crown, then flopping the tissue back and suturing it all back up. This is a practice Kois teaches (or taught) and has worked well for many Drs that used it. Needless to say, the last few have gone in better, though he still calls to see what can be done. He is a fairly new Dr so that lends to his willingness to suggestions.