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davidJ

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Hello.

I was thinking of a great idea to help patients to have a healing temporary crown immediately after an implant placement.

1- place the implant at higher ncm to receive a temp/healing crown.

2- scan and design (in house lab)

3- mill a single body, zirconia abutment and a temp crown. This "temp" is actually one body zirconia milled in one piece that has the zirconia abutment, like straumann cares abutment on the bottom and a temp crown on the top with a hole for access for a temp screw.

Pt wears it for 2 months (out of occlusion),the "temp" will mold the gum, and I could use this design to fabricate the final one better.

Question:

If full zirconia abutment is available, why couldn't we mill full zirconia final crown that is one piece with zirconia abutment? (given that technique is accurate enough to repeat every time). Or is it already there?

Self critique:
Does this idea need FDA approval? I'm pretty sure. Any inputs?
Why not just make a final immediate one? for molding gum for better perio control.

Could you guys review my idea please? Thank you
 
Brett Hansen CDT

Brett Hansen CDT

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I almost never use zirconia interfaces into implants anymore. Au hued Ti works great in the anterior and is much more reliable long term.
 
greeny

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With just a few small changes to your material choices (and components) this will be easily achievable without additional scrutiny from the FDA:

1) Switch from zirconia to PMMA: Zirconia has a long sintering cycle. PMMA will be ready for placement right out of the machine (after you knock off a few sprues, of course). I also have first-hand experience with producing single/locking zirconia interface geometries that were intended for direct-to-implant use. Long story short, they fail at an unacceptable rate. There are other benefits to use PMMA for a temp, but these are the most noteworthy.

2) Switch to using a ti-base for a 2-piece screw retained crown: In most cases, these components are FDA registered, and the part you're required to mill in-house much easier to produce - it's essentially a PMMA crown over a mini-abutment with a screw access hole. As a bonus, this doesn't require milling equipment that's quite as accurate or robust - or unique milling tools and strategies for producing interface geometries.

Here's the part you'd be milling in-house if a ti base was being used; any of the machines/distributors we work with could deliver this solution to you, and you'll be making these parts on day 1 of training, before you even break for lunch 😉

pmma_ti_base_hyperDENT_2.png pmma_ti_base_hyperDENT_1.png

Notice inside the pink abutment base boundary line above, there are only large radius corners - all of which can be achieved with a standard ballnose tool. And here's the same view, but translucent:

pmma_ti_base_hyperDENT_3.png

Plus a nice side-view, just for good measure!

pmma_ti_base_hyperDENT_4.png

And I'm about to open a whole new can of worms, but a 1-piece PMMA screw retained crown incl. the interface geometry is technically possible. Although I'd still suggest using a ti base.
 
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Tyjhart9

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Hello.

I was thinking of a great idea to help patients to have a healing temporary crown immediately after an implant placement.

1- place the implant at higher ncm to receive a temp/healing crown.

2- scan and design (in house lab)

3- mill a single body, zirconia abutment and a temp crown. This "temp" is actually one body zirconia milled in one piece that has the zirconia abutment, like straumann cares abutment on the bottom and a temp crown on the top with a hole for access for a temp screw.

Pt wears it for 2 months (out of occlusion),the "temp" will mold the gum, and I could use this design to fabricate the final one better.

Question:

If full zirconia abutment is available, why couldn't we mill full zirconia final crown that is one piece with zirconia abutment? (given that technique is accurate enough to repeat every time). Or is it already there?

Self critique:
Does this idea need FDA approval? I'm pretty sure. Any inputs?
Why not just make a final immediate one? for molding gum for better perio control.

Could you guys review my idea please? Thank you
Have you looked at Zero Bone Loss Concept(ZBLC)? Dr. Linkevičius as written an entire book on this concept and it seems to be the way to go.
 
TheLabGuy

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A higher torque at implant placement?
 
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davidJ

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Thank you guys for replies. I wrote this late last night and I did more research after posting and Greeny you are right, zirconia abutments do break more than Ti abutments. If zirconia breaks, i'm sure PMMA will break as well.

Thank you Greeny for detailed description of PMMA and a ti base. I think that is a great idea. So, Ti base can be used for permanent crown.

I saw a video on youtube that a dentist bond Tibase to cadcam zirconia and use it as a permanent crown.

My question is then, do we bill Ti base as a ti abutment? If we can, we don't have to have FDA approval for milling own abutment?

I mean the crown is basically the abutment and the crown together luted to the Tibase.

I could see this has some advantages: Ti base is cheaper, more predictable tissue displacement, faster crown fabrication.
 
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FASTFNGR

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Hello.

I was thinking of a great idea to help patients to have a healing temporary crown immediately after an implant placement.

1- place the implant at higher ncm to receive a temp/healing crown.

2- scan and design (in house lab)

3- mill a single body, zirconia abutment and a temp crown. This "temp" is actually one body zirconia milled in one piece that has the zirconia abutment, like straumann cares abutment on the bottom and a temp crown on the top with a hole for access for a temp screw.

Pt wears it for 2 months (out of occlusion),the "temp" will mold the gum, and I could use this design to fabricate the final one better.

Question:

If full zirconia abutment is available, why couldn't we mill full zirconia final crown that is one piece with zirconia abutment? (given that technique is accurate enough to repeat every time). Or is it already there?

Self critique:
Does this idea need FDA approval? I'm pretty sure. Any inputs?
Why not just make a final immediate one? for molding gum for better perio control.

Could you guys review my idea please? Thank you
Because the internal ring where the screw sits is breaking under pressure when torquing. Same as when we use to use zirconia abutment alone.
 
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Diastema

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I' ve done 2 ZrO2 Abutments and one failed. That's one too many. I stopped offering ZrO2 Abut and now just offering TI abutments.
I also think that implants are not ready for occlusal stress right away.
If you make them out of occlusion, you will witness opposing tooth eruption, giving you less space for your final...
There is no reason to burn the steps....
We are (proud I assume) craftsman. : )
 
greeny

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Thank you guys for replies. I wrote this late last night and I did more research after posting and Greeny you are right, zirconia abutments do break more than Ti abutments. If zirconia breaks, i'm sure PMMA will break as well.

Thank you Greeny for detailed description of PMMA and a ti base. I think that is a great idea. So, Ti base can be used for permanent crown.

I saw a video on youtube that a dentist bond Tibase to cadcam zirconia and use it as a permanent crown.

My question is then, do we bill Ti base as a ti abutment? If we can, we don't have to have FDA approval for milling own abutment?

I mean the crown is basically the abutment and the crown together luted to the Tibase.

I could see this has some advantages: Ti base is cheaper, more predictable tissue displacement, faster crown fabrication.

Yup! Ti bases can be used for the final.

I try my best to stay away from advising labs/clinics on the regulatory side, but someone like @Tim Torbenson at EVO820 (https://www.evo820.com/) would be able to give you some clarity regarding the expectations of the FDA in this situation. But from my understanding, they're only looking at the ti base and not the structure you're milling on top of it.
 

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