Impressing an implant case

[millennium]

Hi all.

I have a case coming up where the patient wants impressions to be taken on #3, 5, 12, 14, 19, 29 implant sites the same day as the surgeon uncovers them because the patient has "that day off from work".
All to be single screw retained implant crowns.
What is the minimum time between uncovering implants and taking impression?
The restorative dentist sais a week is ok, the surgeon sais same day is ok.
I say the tissue should heal first. I don't want to add porcelain to fill in food traps!

Thanks in advance.

 

[2thm8kr]

How long has the tissue had time to heal?
Immediate placement in extraction sites?

 

[millennium]

How long has the tissue had time to heal?
Immediate placement in extraction sites?

The implants were placed a while ago, I don't know exactly when.
As far as I know the tissue should heal and go through the dimensional changes (shrink) before impressing.

 

[CatamountRob]

The implants were placed a while ago, I don't know exactly when.
As far as I know the tissue should heal and go through the dimensional changes (shrink) before impressing.

What's "a while ago"? Days, weeks, months?

 

[millennium]

What's "a while ago"? Days, weeks, months?

I don't know.
The surgeon will "uncover" the implants, so I think months.

 

[CatamountRob]

I guess I don't understand the question. Have healing abutments been placed yet?

 

[millennium]

I guess I don't understand the question. Have healing abutments been placed yet?

No healing abutments yet. Patient is going to the surgeon to uncover the implants and for the healing abutments to be placed at that time.
The restorative dentist wanted to wait two weeks before impressing. The patient wants to impress that same day because he took off from work already.
The restorative dentist called the surgeon who said same day impression is fine" do an encode so the stiches don't come out with the impression material" he said.

 

[user name]

Wait.

Patient doesn't know whats going on, so their opinion is invalid.

 

[millennium]

Wait.

Patient doesn't know whats going on, so their opinion is invalid.

Dentist should be running the show.

 

[DESS-USA]

Granted I am not a dentist, just an ex implant sales rep. I was taught the healing abutment should be in the mouth for a few months so that the tissue heals and is managed correctly. So when it comes time to take implant level impressions you have healthy, properly formed tissue and can take accurate impressions.

Maybe with the current all on 4 protocols / immediate load it has changed where the "tissue is no longer the issue."

I assume the surgeon is suggesting encode healing abutments for several reasons (just a hunch)-

1. supposedly eliminates the need to take implant level impressions, which some restorative dentist don't know how to etc and the surgeon does not want to provide the parts or show them how, etc. However with encode healing abutments the restorative dentist is taking a "encode healing abutment impression". Six of one 1/2 dozen of another.
2. the tissue management is still an issue with this solution because it needs time to heal and form correctly so encode healing abutments don't save any time.
3. the surgeon gets favorable treatment in using encode healing abutments since to the novice general dentist think they have to go to a 3i approved lab to fabricate the restoration and will pay a small fortune for this.

If you need normal parts for the this case such as 3i healing abutments, impression copings etc let me know since I have them. No encode here though.

 

[millennium]

Granted I am not a dentist, just an ex implant sales rep. I was taught the healing abutment should be in the mouth for a few months so that the tissue heals and is managed correctly. So when it comes time to take implant level impressions you have healthy, properly formed tissue and can take accurate impressions.

Maybe with the current all on 4 protocols / immediate load it has changed where the "tissue is no longer the issue."

I assume the surgeon is suggesting encode healing abutments for several reasons (just a hunch)-

1. supposedly eliminates the need to take implant level impressions, which some restorative dentist don't know how to etc and the surgeon does not want to provide the parts or show them how, etc. However with encode healing abutments the restorative dentist is taking a "encode healing abutment impression". Six of one 1/2 dozen of another.
2. the tissue management is still an issue with this solution because it needs time to heal and form correctly so encode healing abutments don't save any time.
3. the surgeon gets favorable treatment in using encode healing abutments since to the novice general dentist think they have to go to a 3i approved lab to fabricate the restoration and will pay a small fortune for this.

If you need normal parts for the this case such as 3i healing abutments, impression copings etc let me know since I have them. No encode here though.

I just wanted to know what the average time span was between placing the healing abutment and taking the impression.

The dentist called me to let me know that this case is coming up.

He called me again to tell me that the impression appointment was on the same day as was uncovering the implants and placing the healing collars. I don't understand how this was coordinated between the dentist and the surgeon.

I told the dentist its too soon and the tissue needs time to heal properly. This is not a novice dentist and he knows tissue needs to heal.

The dentist called the surgeon and surgeon said that its ok to impress the same day as uncovering the implants. The surgeon also said that in order not to remove the healing abutments encode was an option. (I don't do encode)

Apparently the patient is insisting on the same day uncovering and impressing.
The last call from the dentist was to tell me that he will get a week between appointments which I think is way too soon.

 

[Sda36]

Big check mark user! [emoji4]

Sent from my LG-H812 using Tapatalk

 

[JMN]

I just wanted to know what the average time span was between placing the healing abutment and taking the impression.

The dentist called me to let me know that this case is coming up.

He called me again to tell me that the impression appointment was on the same day as was uncovering the implants and placing the healing collars. I don't understand how this was coordinated between the dentist and the surgeon.

I told the dentist its too soon and the tissue needs time to heal properly. This is not a novice dentist and he knows tissue needs to heal.

The dentist called the surgeon and surgeon said that its ok to impress the same day as uncovering the implants. The surgeon also said that in order not to remove the healing abutments encode was an option. (I don't do encode)

Apparently the patient is insisting on the same day uncovering and impressing.
The last call from the dentist was to tell me that he will get a week between appointments which I think is way too soon.

Impressions with sutures, never a good idea if avoidable. How long? The Shadow Knows, but he's not telling. It can vary with pt health and age is all I can honestly advise there.

Were it my mess, I'd suggest an immed rpd for however long you'd like. And then you'll pick up the bill for any re-contouring issues from further resprption or tissue changes in the first year.

If they let the patient drive instead, notify them and get signed paper that the patient has heen told and understands the risks will pay for any re-contouring that will be needed when they start spitting under the bridge in 2-3 weeks..

Seeks like it wasn't coordinated between OS and GP, but that the OS doesn't want to be the bad guy and tell them, and the GP doesn't either, so once again, it's all the techs fault.

My general prwctice is never to say "no", but get them to say it for me.

 

[slotboom.f]

Best to protect this patient against his wants since the result may have permanent outcome.
Just wait two week and let the patient do his/her homework by brushing the implant site with a soft brush in the mean while. It is really crazy that with such major investment in surgery and also financially everyone seems to settle for an outcome which is dictated by just a day off.



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[millennium]

I think where there is one week between appointments there will be two or more. I think the Doc is afraid the patient is going to walk if timeframe doesn't go patients way.

 

[millennium]

Found out today I got one month of tissue healing time between uncovering the implants and placing healing collars and taking the final impression for this case

 

[slotboom.f]

There you go sanity rules after all[emoji39]


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