Inclusive.... or exclusive? GW rant!

[Affinity]

So unfortunately, a Dr sent me a custom zr abutment on an GW inclusive implant. They will not sell me the single scan abutment and digital file, only the complete kit. Since I really really dont like using this lab, I am forced to talk the Dr out of placing these implants .. I have no choice but to send to them or an affiliate. Anyone out there want to email me an inclusive .dme?? Ill be your best friend!

Where are the companies other than NT trading that are going to bust this monopoly?!?

 

[JohnWilson]

which fixture?

 

[Affinity]

its the 4.5 internal hex, its an inclusive implant I guess..

btw im sending you a big box today john!

 

[JohnWilson]

That internal hex is probably keyed to the Zimmer fixture, do you have any scan locators for that fixture? If not send me the model I will scan it for you if you want and supply a base that will work.

There are several clones associated with that internal hex.

What's in the box?

 

[Affinity]

your new polishing unit! be there thursday.

So you think the inclusive implant is the same as a zimmer? I tried to order the scan abutment today but they wont give me the digital file unless I buy the whole set, so the locator is worthless.. thats why Im ranting.

 

[JohnWilson]

LOL good deal, thanks my old fashion car battery charger system is ready for retirement and this was the unit I was looking to purchase so YOU are the man! Thanks

Send me the case I will take care of it for you,or order the NT trading base once you know for sure and your home free

 

[Affinity]

I think I will order the base and try it out.. Ill PM you about having it milled. thanks

 

[prosthotech]

Just use the 4.5 zimmer scanning abutment. Use zirconia to titanium sleeve, 6 mm if available. All zirconia abutments are prone to fracture, especially in the posterior.

btw, my in house lab is an "Inclusive" partner lab.

 

[rkm rdt]

All zirconia abutments are prone to fracture, especially in the posterior.

 

[lcmlabforum]

Looks yummy. There some truth to that though, will try to find some images of those
one of these days to post. Not all will fail in a short time, depends on what your
definition of success or longevity is.
Had not seen titanium abutment fracture though.
LCM

 

[Marcusthegladiator CDT]

All zirconia abutments are prone to fracture, especially in the posterior.

Now Im hungry.

 

[prosthotech]

@rkm rdt

Evidence? Where have you been? I have fabricated, milled, and delivered enough all zirconia abutments to my patients that we will no longer deliver them, with exceptions made in the esthetic zone, and even then, with great caution when restoring morse tapered connection. I've been to enough symposia and meetings to know I'm not the only one experiencing issues with all zirconia abutments.


The Journal of Prosthetic Dentistry
Volume 95, Issue 2, February 2006, Pages 111–11

Wael, et al

Fracture resistance of single-tooth implant-supported all-ceramic restorations: An in vitro study

Forty-eight standardized maxillary central incisor alumina crowns (Procera) were fabricated for each of the 3 test groups (n=16) (Control group Ti, titanium abutments; Group Al, alumina abutments; Group Zr, zirconia abutments) for the Replace implant system. The crowns were adhesively luted using a resin luting agent (Panavia 21) and artificially aged through dynamic loading and thermal cycling. Afterwards, all specimens were tested for fracture resistance using compressive load on the palatal surfaces of the crowns. Kruskal-Wallis analysis of variance and post hoc Wilcoxon rank sum tests were performed to test for differences in fracture resistance values (α=.05).

Results
All test specimens survived the artificial aging process using simulated oral conditions. No screw loosening was recorded. The median fracture resistance was 1454 N, 422.5 N, and 443.6 N for groups Ti, Al, and Zr, respectively. Significant differences were found for the fracture resistance comparisons of group Ti with groups Al and Zr (Kruskal-Wallis test, P<.001). The test results for the comparison of groups Al and Zr were not significant.

Conclusion
All 3 implant-supported restorations have the potential to withstand physiologic occlusal forces applied in the anterior region.







Int J Oral Maxillofac Implants. 2009 Sep-Oct;24(5):850-8.
In vitro study of the influence of the type of connection on the fracture load of zirconia abutments with internal and external implant-abutment connections.
Sailer I, Sailer T, Stawarczyk B, Jung RE, Hämmerle CH.
Source
Clinic for Fixed and Removable Prosthodontics and Dental Material Science, Center for Dental and Oral Medicine, University of Zurich, Switzerland. [email protected]

Abstract
PURPOSE:
To determine whether zirconia abutments with an internal connection exhibit similar fracture load as zirconia abutments with an external connection.

MATERIALS AND METHODS:
The following zirconia abutments were divided into four groups of 20 each: StraumannCARES abutments on Straumann implants (group A),Procera abutments on Branemark implants (group B),Procera abutments on NobelReplace implants (group C),and Zirabut SynOcta prototype abutments on Straumann implants (group D). The abutments were fixed on their respective implants either internally via a secondary abutment (A) or a metallic coupling (C) (two-piece) or directly externally (B) and internally (D) (one-piece). In each group, 10 abutments were left unrestored (A1 to D1). Ten received glass-ceramic crowns (A2 to D2). Static loading was performed according to the ISO norm 14801 until failure. The bending moment was calculated for comparison of the groups and subjected to statistical analysis (Student t test).

RESULTS:
The mean bending moments of the unrestored abutments were 371.5 +/- 142.3 Ncm (A1),276.5 +/- 47.6 Ncm (B1),434.9 +/- 124.8 Ncm (C1),and 182.5 +/- 136.5 Ncm (D1). Two-piece internally connected abutments exhibited higher bending moments than one-piece internally (C1 versus D1 P = .003, A1 versus D1 P = .03) or externally (C1 versus B1 P = .004) connected abutments. The groups with restorations did not show different bending moments than those without restorations. The mean bending moments of the restored abutments were 283.3 +/- 44.8 Ncm (A2),291.5 +/- 31.7 Ncm (B2),351.5 +/- 58 Ncm (C2),and 184.3 +/- 77.7 Ncm (D2). Group C2 exhibited the highest bending moment (P < .05). Internally connected one-piece abutments (D2) were weaker than all other groups (D2 versus A2 P = .002; D2 versus B2 P = .001; D2 versus C2 P = .0003).

CONCLUSIONS:
The type of connection significantly influenced the strength of zirconia abutments. Superior strength was achieved by means of internal connection via a
secondary metallic component.

 

[Marcusthegladiator CDT]

@rkm rdt

Evidence? Where have you been? I have fabricated, milled, and delivered enough all zirconia abutments to my patients that we will no longer deliver them, with exceptions made in the esthetic zone, and even then, with great caution when restoring morse tapered connection. I've been to enough symposia and meetings to know I'm not the only one experiencing issues with all zirconia abutments.


The Journal of Prosthetic Dentistry
Volume 95, Issue 2, February 2006, Pages 111–11

Wael, et al

Fracture resistance of single-tooth implant-supported all-ceramic restorations: An in vitro study

Forty-eight standardized maxillary central incisor alumina crowns (Procera) were fabricated for each of the 3 test groups (n=16) (Control group Ti, titanium abutments; Group Al, alumina abutments; Group Zr, zirconia abutments) for the Replace implant system. The crowns were adhesively luted using a resin luting agent (Panavia 21) and artificially aged through dynamic loading and thermal cycling. Afterwards, all specimens were tested for fracture resistance using compressive load on the palatal surfaces of the crowns. Kruskal-Wallis analysis of variance and post hoc Wilcoxon rank sum tests were performed to test for differences in fracture resistance values (α=.05).

Results
All test specimens survived the artificial aging process using simulated oral conditions. No screw loosening was recorded. The median fracture resistance was 1454 N, 422.5 N, and 443.6 N for groups Ti, Al, and Zr, respectively. Significant differences were found for the fracture resistance comparisons of group Ti with groups Al and Zr (Kruskal-Wallis test, P<.001). The test results for the comparison of groups Al and Zr were not significant.

Conclusion
All 3 implant-supported restorations have the potential to withstand physiologic occlusal forces applied in the anterior region.







Int J Oral Maxillofac Implants. 2009 Sep-Oct;24(5):850-8.
In vitro study of the influence of the type of connection on the fracture load of zirconia abutments with internal and external implant-abutment connections.
Sailer I, Sailer T, Stawarczyk B, Jung RE, Hämmerle CH.
Source
Clinic for Fixed and Removable Prosthodontics and Dental Material Science, Center for Dental and Oral Medicine, University of Zurich, Switzerland. [email protected]

Abstract
PURPOSE:
To determine whether zirconia abutments with an internal connection exhibit similar fracture load as zirconia abutments with an external connection.

MATERIALS AND METHODS:
The following zirconia abutments were divided into four groups of 20 each: StraumannCARES abutments on Straumann implants (group A),Procera abutments on Branemark implants (group B),Procera abutments on NobelReplace implants (group C),and Zirabut SynOcta prototype abutments on Straumann implants (group D). The abutments were fixed on their respective implants either internally via a secondary abutment (A) or a metallic coupling (C) (two-piece) or directly externally (B) and internally (D) (one-piece). In each group, 10 abutments were left unrestored (A1 to D1). Ten received glass-ceramic crowns (A2 to D2). Static loading was performed according to the ISO norm 14801 until failure. The bending moment was calculated for comparison of the groups and subjected to statistical analysis (Student t test).

RESULTS:
The mean bending moments of the unrestored abutments were 371.5 +/- 142.3 Ncm (A1),276.5 +/- 47.6 Ncm (B1),434.9 +/- 124.8 Ncm (C1),and 182.5 +/- 136.5 Ncm (D1). Two-piece internally connected abutments exhibited higher bending moments than one-piece internally (C1 versus D1 P = .003, A1 versus D1 P = .03) or externally (C1 versus B1 P = .004) connected abutments. The groups with restorations did not show different bending moments than those without restorations. The mean bending moments of the restored abutments were 283.3 +/- 44.8 Ncm (A2),291.5 +/- 31.7 Ncm (B2),351.5 +/- 58 Ncm (C2),and 184.3 +/- 77.7 Ncm (D2). Group C2 exhibited the highest bending moment (P < .05). Internally connected one-piece abutments (D2) were weaker than all other groups (D2 versus A2 P = .002; D2 versus B2 P = .001; D2 versus C2 P = .0003).

CONCLUSIONS:
The type of connection significantly influenced the strength of zirconia abutments. Superior strength was achieved by means of internal connection via a
secondary metallic component.

You don't like bologna?

In 12 years I've only heard of a single Zirc abut fail. So it's possible. But I am sure there were other conditions that came into play when it failed. Meaning, somebody did some thing wrong.

 

[Tom Moore]

There is already a recall for this reason.

 

[rkm rdt]

Where have I been?

In the lab making successful abutments while you are eating kale sandwiches on Fridays.

Maybe you picked the wrong lab!

 

[prosthotech]

Where have I been?

In the lab making successful abutments while you are eating kale sandwiches on Fridays.

Maybe you picked the wrong lab!

I own my own lab. We fabricate implant prosthetics for doctors around the country. Our specialty is full mouth implant reconstruction. Try using all-zirconia abutments opposing one another in the second molar region and tell me how it goes for you. Also, the all-zirconia abutments we have used are either prefabricated by the manufacturer or milled by Glidewell, as we have an agreement with them. We no longer use these outside of the esthetic zone.

How many of your cases have you personally delivered and followed for over 5 years? I may have an advantage in this regard, since I place the implant and take the records, then my lab fabricates the prosthetics to my precise specifications. I have been involved in placing and restoring thousands of implants, and lecture with material support from HiOssen, Implant Direct, Zest Anchors, GC America, and Bisco. I am the director of Modern Implant Institute and of the HiOssen Basic and Intermediate Implant courses and have seen enough problems with abutment design and inappropriate material selection to form an opinion that most dental technicians are not current with the literature. While I trust that your abutments are functional in vitro, it is often an entirely different world once the prosthetics are in full function for several years.

We have found that the all-zirconia abutments fail due to stress concentration at the angled areas of the connection, even snapping off in Morse tapered connections. Try to remove a cold welded piece of zirconia from inside of a Morse tapered connection, and I'm sure you will never use all-zirconia abutments in the molar region again. I really wanted these abutments to work, since we could use Nobel Rondo or ZirPress direct to a prefab zirconia abutment and make them with amazing shades that were very translucent. Moral of the story: support your posterior and angled zirconia abutments with titanium.

For dentists and patients who want to have zirconia for esthetic reasons, we will design the abutment in 3Shape, mill it on our BruxZir mill or Amann Girrbach Motion 2, and bond in the appropriate prefabricated titanium sleeve using Panavia. My short response to the original question was to use the longest possible sleeve, 6 mm, assuming it fits within the design envelope. The longer sleeve is difficult to debond, and transmits the bending forces deeper into the zirconia portion. Whenever possible, our screw retained zirconia or zirpress to zirconia crowns use a 6 mm sleeve.

I think you misunderstood my "all zirconia abutments" to mean that any zirconia abutment will break. Replace that with "all-zirconia abutments" or "full zirconia abutments," and I think you will have less of a problem disagreeing with my statement and the scientific literature.

My only problem with zirconia to titanium abutments, is that it adds extra labor and cost for minimal esthetic gain. If you are worried about titanium showing through a thin area, just bond composite opaquer with an appropriate metal primer to the mesio-facial aspects of the abutment you are trying to mask. If you want to get fancy, grind in a little relief in those surfaces, and the opaque will be flush with the rest of the abutment walls. Shofu makes an excellent, super opaque material that works well in these circumstances, keyed to the Vita Classic shades.

By the way, although I'm a vegetarian, I'm not fond of kale, especially on Fridays.

 

[Affinity]

Wasnt considering an all-zirconia abutment. just the hybrid style. Found a solution thanks!