Minimal implant experience

[Denture Dude]

My lack of experience regarding implant work is showing. Or maybe not? Ive got a new, young doc. We completed a conventional FLD, then he brings me the denture and a new impression with implant parts picked up and asked me if I could incorporate the two. I just kinda looked at it and said 'I dont know if this is possible, I dont have a ton of experience but I dont think this is how to do this, I think we shouldve built the denture over the implants to begin with.' Unfortunately I was visibly slighty shaking my head while answering. Is this something that can be done? My confidence is down today.

 

[CoolHandLuke]

same as fitting an old denture to a new cast. it'll be rough going and would have been better if the doc had handpieced some pockets out, jammed impression material inside and picked the parts up in a reline type object you could just pour and reline.

what you have is the harder way. do it but don't bake acrylic, just cut pockets, fill with wax, let the hot wax pick up the implant parts from the model, send it back for try in at which point we hope (s)he will remove your wax and do the reline thing.

don't guarantee a bite until they do the reline thing.

 

[Denture Dude]

Thanks cool hand.

My mentor that was slowly teaching me all this up and died on me. Since then I’ve been a little lost and so I just use honesty, ‘doc I’m not confident I can do this for you.’ I regret the head shaking part. Really need to hone my interpersonal skills.

 

[CoolHandLuke]

sorry to hear that, but try not to lose heart. slowly most processes are being transcribed on digital pages like this so it wont die out completely, even after the paradigm to digital processing changes the field.

 

[Doris A]

My lack of experience regarding implant work is showing. Or maybe not? Ive got a new, young doc. We completed a conventional FLD, then he brings me the denture and a new impression with implant parts picked up and asked me if I could incorporate the two. I just kinda looked at it and said 'I dont know if this is possible, I dont have a ton of experience but I dont think this is how to do this, I think we shouldve built the denture over the implants to begin with.' Unfortunately I was visibly slighty shaking my head while answering. Is this something that can be done? My confidence is down today.

All the Dr had to do was ream out the denture over where they're going to be placed and pick them up in the mouth.

 

[Denture Dude]

All the Dr had to do was ream out the denture over where they're going to be placed and pick them up in the mouth.

Ya this is where I dropped the ball. He’s inexperienced and so wants to have the lab do as much as possible. Which is an opening for me to lead and teach. I did neither.

 

[Doris A]

Ya this is where I dropped the ball. He’s inexperienced and so wants to have the lab do as much as possible. Which is an opening for me to lead and teach. I did neither.

Don't beat yourself up. It's a learning experience for you both. The day I stop learning in this business, is the day I lock the door for the last time!

 

[Brett Hansen CDT]

We have all had failures. I hated not being sure and confident in how to handle different implant cases. I was always honest with my doctors about what I knew and hoped they would be patient with me as I figured things out. This website helped a lot in learning how to handle implant cases.

 

[TheLabGuy]

Yep, would of had Doc pick them up chairside and if they don't know...I would go out to the office and show them (charge accordingly) while patient is in the chair. A lot of research on how picking them up chairside is even more accurate than what we can do in the lab when it comes to this specific procedure.
I teach - only pickup one at a time, prepping the undercuts, use the right pickup material (sterngold and preat are my favorite),how to use the locator tool (this always confuses the shlt out of the Docs for some reason),what colors are what poundage, and BLACK is never given to the patient for the love of anything holy!!! Seriously, I can't tell you how many times i've received a reline locator denture and the damn black processing insert is still in there...black is for lab processing only. If you look at the black inserts, the black has no internal, therefore no internal retention. I won't even let a black insert ever leave the lab because it irks me so much. A pet peeve per say.

 

[Denture Dude]

My attitude and how I handled the situation is what’s bugging me.


Appreciate all the info. Can anyone steer me towards learning resources concerning overdenture implant techniques? I barely know the basics, maybe not even that. I know what I’ve been shown which is little.

 

[Affinity]

The fact that youre here learning from the experience, from people who have done the same thing, shows that you care, which is all a Dr can hope for. The Drs learn the same way, and the beauty of this business is working together as a team, and thats being able to admit you dont know, learn and move on.
Ive gotten into trouble saying, "No problem I can do that!" and try to figure it out later.. If dentists are famous for anything, its referrals, it means they are at the limit of their expertise, and the cookie platters that show up this time of year are plenty. Drs refer theyre crap to us all the time, but we dont get the cookies...

 

[TheLabGuy]

My attitude and how I handled the situation is what’s bugging me.


Appreciate all the info. Can anyone steer me towards learning resources concerning overdenture implant techniques? I barely know the basics, maybe not even that. I know what I’ve been shown which is little.

As Affinity stated, don't beat yourself up. We all learned in different ways and the most important thing is you care to learn. I know Dr. Misch books are great, especially the yellow one (i think it's volume 2). Also, prescribe to some of the removable guru's Facebook and instagram pages...Eugene Royzengurt has a shlt ton of videos. So does Tom Zaleske and Robert Kreyer as well. Plenty of great implant removable techs out there. I'll name a few more, Bob Hicks (this guy is brilliant and my first call when i need to run a case by someone),Bart Hyde (amazing work),Brian Carson, Dan Elfring, Karl Sampson. Damn, I know I'm missing a bunch of folks (sorry) but add them as friends on FB or find their Instagrams, those folks really do care as well and are always willing to help another caring tech out. Also, their is a few of us here as well. It's a journey, and with implants, can be an expensive one if you don't know what you are doing.

 

[Andrew Priddy]

My attitude and how I handled the situation is what’s bugging me.


Appreciate all the info. Can anyone steer me towards learning resources concerning overdenture implant techniques? I barely know the basics, maybe not even that. I know what I’ve been shown which is little.

2 things...

i can't count the number of time i could have "handled" a situation (usually the most challenging) differently. i learn what i can and try not to do it again... this is what makes a "good tech" a "great tech".

looking for the info... makes all the difference
give yourself the credit

 

[JKraver]

My attitude and how I handled the situation is what’s bugging me.


Appreciate all the info. Can anyone steer me towards learning resources concerning overdenture implant techniques? I barely know the basics, maybe not even that. I know what I’ve been shown which is little.

Get the answers and go back promptly to the Dr with the answers he needed.
What kind of overdenture? Just locators? Bar?

 

[Smilestyler]

I am going to chime in to give another perspective (not trying to offend)
While chairside pickup is generally quite accurate the materials used are usually inferior. Self cure acrylic that is usually the wrong colour and definitely not colour stable. It often has smaller bubbles and unhygienic. Many of the chairside acrylics deliberately do not use bonding agents (I assume in case something goes wrong) and can fail down the road because of this. Attaching the housing in heat cure acrylic gives far superior results as long as all of the steps are done accurately.
Sometimes and implant is a bit too tall for any number of reasons and despite the best blockout attempts, can allow acrylic to lock around the implant creating a disaster in the mouth. Much better for it to happen on the bench.
I heat cure all locator style housings and have done it this way for over 15 years. And only occasionally have to remove and pickup chairside. I just don’t think it should be discouraged is all that I want to say.
Also as far as the black processing inserts intra orally. I am not positive but I think a new trend with locators is immediate loading and my limited understanding is that the black is to be used during the initial osseointegration.

 

[Brett Hansen CDT]

As Affinity stated, don't beat yourself up. We all learned in different ways and the most important thing is you care to learn. I know Dr. Misch books are great, especially the yellow one (i think it's volume 2). Also, prescribe to some of the removable guru's Facebook and instagram pages...Eugene Royzengurt has a shlt ton of videos. So does Tom Zaleske and Robert Kreyer as well. Plenty of great implant removable techs out there. I'll name a few more, Bob Hicks (this guy is brilliant and my first call when i need to run a case by someone),Bart Hyde (amazing work),Brian Carson, Dan Elfring, Karl Sampson. Damn, I know I'm missing a bunch of folks (sorry) but add them as friends on FB or find their Instagrams, those folks really do care as well and are always willing to help another caring tech out. Also, their is a few of us here as well. It's a journey, and with implants, can be an expensive one if you don't know what you are doing.

Completely forgot I read Mish's implantology text book when I was thrown the implant department 5 years into my career as a dental tech.

 

[Affinity]

As Affinity stated, don't beat yourself up. We all learned in different ways and the most important thing is you care to learn. I know Dr. Misch books are great, especially the yellow one (i think it's volume 2). Also, prescribe to some of the removable guru's Facebook and instagram pages...Eugene Royzengurt has a shlt ton of videos. So does Tom Zaleske and Robert Kreyer as well. Plenty of great implant removable techs out there. I'll name a few more, Bob Hicks (this guy is brilliant and my first call when i need to run a case by someone),Bart Hyde (amazing work),Brian Carson, Dan Elfring, Karl Sampson. Damn, I know I'm missing a bunch of folks (sorry) but add them as friends on FB or find their Instagrams, those folks really do care as well and are always willing to help another caring tech out. Also, their is a few of us here as well. It's a journey, and with implants, can be an expensive one if you don't know what you are doing.

I basically taught myself to do dentures with help from TomZ and Brian when they were still around here.

I had a Dr that knew up front I was an amateur at removables and worked with me for years to refine a denture for him based on his experience. Since then Ive tried to stop doing them but this Dr is basically begging me and offered to pay me double to keep doing them. I had to eat a lot of sh1t along the way, stay humble, and try try again, but that refinement and my own willingness to learn is now worth $650/arch and like I said, its only because I was willing to say 'I dont know how to do this' and always improve.

 

[Denture Dude]

Get the answers and go back promptly to the Dr with the answers he needed.
What kind of overdenture? Just locators? Bar?

The case that started this thread was a locator case. Funny enough I had to reject a bar case from the same doc as well. Patient with existing bar wanted new denture. I said very nicely ‘are you sure you want to take this case on?’ I suggested that he use a specific lab in our region that’s known for doing these complex cases in order to utilize their guidance and expertise, and that I’d like to see how they handled it. He went with the cheap lab, and ironically was asking me where to buy clips etc right before we discussed the new locator case that I also rejected after I was presented w a finished denture and a heavy body impression w implants picked up. I told him that I believe Preat was the best place to find hader parts, but why is the lab asking you for parts? I guess I could’ve worked my way through both cases, but I’m in house and really don’t want to party to something bad happening. Lol. I’ve heard horror stories of dentures getting stuck in the mouth etc. I’m kinda weird in that I don’t like surprises, especially those kind.

 

[Denture Dude]

So, here’s probably a dumb question but I’m going to keep asking. 1) Locator is a trademarked thing, but I see strauman, zest, preat, and others all claim to use ‘locator’ attachments. I’m confused. 2) I see some companies like dentis have their own that look like locators, I’m assuming they aren’t the same because they don’t use the locator name. 3) if a patient comes in and wants new inserts, how do you know which system to order from? Any indication on the metal housing?

 

[Smilestyler]

Zest makes the locator abutments for a variety of implant companies. There are several knock off brands that are mostly compatible. I think the locator RTX is the company’s answer with some changes that update whatever patents had expired.