Ti base Implant Crowns. Are they okay?

[AKDental]

Hi I was just wondering about ti-base crowns. Someone recently told me that the lab they worked at
had stopped making ti-base crowns because they thought that they were garbage. (I think they were
only making screwmentable and custom abutment cementables. Or manufacturer stock abutment type
screwmentable crowns..i guess not 100% sure)
Ive been making mostly ti-base crowns for a couple years now and they seem to work okay. Ive had only one
come back due to debonding of cement. Ive seen a couple others where the crown debonded or even
cracked near the base but it looked like cad technician "design flaw" due to a chimney height that was much too short.

Anyway i still use them and think they are great but mainly due to ease of use and cost being the main reasons.
On the other hand i do believe that a custom abutment screwmentable crown is probably a better overall crown
due to the added support and probably is better when they bite as far as the bite forces that are happening.
But that is really too technical for me so im really just guessing...

One last thing this is a totally different subject but i use a nonshaded zirconia and dipping liquid which i think looks great
due to my great artistic coloring skills... I tried multilayer and never comes out looking good enough. Almost there
but just a little too opaque and hard to get incisal looking natural. How about you guys?
Just throwing that out there. If nobody responds to this, no prob. Not that important. Just bored and had a minute.

 

[doug]

Never had a failure with the interface using RelyX Unicem resin cement. Follow the instruction and everything is good. I like the idea of the zirconia being in contact with the tissue. There are studies that indicate less irritation, more bio-compatibility with zirconia. Did they express to you their reasons for not liking Ti-Bases?

 

[RileyS]

We do lots of tibase implant crowns and never any problems that we’ve heard of.

With zirconia:
the brand of multi you’re using isn’t very good
Your oven needs calibration
You entered the program parameters
incorrectly

Or

You’re truly just too good at pre sinter coloring

 

[AaronW12321]

With multi you may have to nest your units incisal edge some fixed distance from the top of the puck, like 2-3mm. Puck size matters too depending on how your zirc is layered, I use 18mm and 25mm primarily. Play around with puck heights and nesting heights and then lock it in, should get better results. We still dip Vita 3D-M shades with the B&D stuff and it works great tbh.

Agree with Riley, we've done 1000s of tibase implant crowns and very few issues. Of those, maybe 3 fractures at the emergence with the undersized authentic biohorizon and implant direct tibases. Occasionally we have an issue with tissue height not being communicated or accounted for have to remake on a different tibase, or convert to custom abutment. Currently trying to convert everyone to custom abutments though for the better tissue health, but still do around 30% on tibases. 99% of our implant work goes out screw retained, bonded in the lab on a printed model.

 

[AKDental]

Never had a failure with the interface using RelyX Unicem resin cement. Follow the instruction and everything is good. I like the idea of the zirconia being in contact with the tissue. There are studies that indicate less irritation, more bio-compatibility with zirconia. Did they express to you their reasons for not liking Ti-Bases?

Yes the person said that "ti-bases" were not structurally ideal therefore should not be used for implant crowns that are molars or have a heavy bite force.
Didn't really sound correct to me but apparently the person worked for a medium sized lab where they did away with ti-bases completely and he was very
convinced that ti-bases were "bad". I didn't really get into detail though as to how he was so sure about this. But anyways so far they seem to work very well for me. And the cement that i use is rely x luting cement.

 

[AKDental]

We do lots of tibase implant crowns and never any problems that we’ve heard of.

With zirconia:
the brand of multi you’re using isn’t very good
Your oven needs calibration
You entered the program parameters
incorrectly

Or

You’re truly just too good at pre sinter coloring

haha. i doubt that about that last part. But i use origin zirconia. For some reason seems like they have there translucency on point. especially for the presinter dipping method. What brand zirconia do use if you don't mind me asking? Oh and just a FYI i havent tried
so many different zirconia brands but i have tried katana(ok),aidite(always had color issue , like very orange tinted),zirlux, nacera, and a few others. And to be fair, they are all good zirconia brands and probably anything that i didn't like was due to improperly following instructions.(I say this because every single company that sent me a sample crown of their zirconia always look "GREAT".)

 

[AKDental]

With multi you may have to nest your units incisal edge some fixed distance from the top of the puck, like 2-3mm. Puck size matters too depending on how your zirc is layered, I use 18mm and 25mm primarily. Play around with puck heights and nesting heights and then lock it in, should get better results. We still dip Vita 3D-M shades with the B&D stuff and it works great tbh.

Agree with Riley, we've done 1000s of tibase implant crowns and very few issues. Of those, maybe 3 fractures at the emergence with the undersized authentic biohorizon and implant direct tibases. Occasionally we have an issue with tissue height not being communicated or accounted for have to remake on a different tibase, or convert to custom abutment. Currently trying to convert everyone to custom abutments though for the better tissue health, but still do around 30% on tibases. 99% of our implant work goes out screw retained, bonded in the lab on a printed model.

yes i noticed that when using ML with the puck thickness making difference in translucency and sometimes shade. Yeah i used to think that multilayer makes it much easier because you don't have to keep track of shades and have all these dipping liquids and itll save time. but actually after trying it, and im sure its different for other labs, i think the dipping method is a more efficient workflow especially timewise. Oh and i have a dwx51d so no multidisc changer and all that here. but i like it because i can nest everything on one or 2 pucks. so nest, mill, cut out, and dip. and i mark the shade onto each crown using millbox. and i don't have to worry about positioning of crown in puck. i don't know, seems to make my life easier.
oh also, with the tissue health thing, i heard that gum tissue responds better to "polished" zirconia better than to titanium. Read it somewhere and also a dentist said same thing. Possibly i misunderstood though. But interesting.

 

[RileyS]

I've been using Whitepeaks Hyperion for the last two years and loved it but the D and C shades suddenly turned super grey. So I've tried Nacera pearl but didn't get the results I liked. Now I'm trying Aidite 3d prozir and I like the reults so far.

 

[Brett Hansen CDT]

The biggest issue with using Ti bases is that they can get too thick too deep under the gingiva. If they aren't planned for properly, or the correct marginal height of a ti base isn't used for a specific case, the ti base can hit the bone surrounding the implant which will not allow the doctor to seat the restoration or the patient's gingiva won't tolerate the emergence of the ti base. This is why we use custom abutments in most of our screw retained cases.

We also design our custom abutments to take advantage of the biological properties of zirconia, as Doug mentioned, by placing the margins of our abutments deeper than we would if it was a cementable crown.

The last issue I have with ti bases is companies like Straumann not offering an angled screw channel custom abutment for their own implants. They try and force us to use a ti base that only has ONE collar height and many times these ti bases barely peek out above the crest of the tissue on anterior cases when they are most needed.

Custom abutments will add more surface area to bond to a crown which will decrease the chances of a crown debonding. We rarely see this, but we do see it more often on ti base cases over custom abutment cases.

 

[TheLabGuy]

I'll be the devils advocate here and clearly say Ti-Bases are garbage and have for awhile now. They don't follow the emergence profile, don't provide the same retention as a custom abutments. They are prone to peri-implantitis because the cement line is at the implant platform versus margin line in a custom abutment. Pretty common sense from an engineering standpoint, you have a this little cylindrical tube called a ti-base with a big ole fat lady (your zirconia) sitting on it and we sit back saying that this is just as good?...not this guy. I get the economics, and in some rare cases a Ti-Base could be suitable, but to save a few extra bucks when the patient is paying 4K/implant w/restoration. Not the way I want to run my lab, it's halfass in my opinion and I know you guys will give me shlt for it, that's okay, i deserve it but I've made a pretty hard stance on this years ago.

 

[Brett Hansen CDT]

I'll be the devils advocate here and clearly say Ti-Bases are garbage and have for awhile now. They don't follow the emergence profile, don't provide the same retention as a custom abutments. They are prone to peri-implantitis because the cement line is at the implant platform versus margin line in a custom abutment. Pretty common sense from an engineering standpoint, you have a this little cylindrical tube called a ti-base with a big ole fat lady (your zirconia) sitting on it and we sit back saying that this is just as good?...not this guy. I get the economics, and in some rare cases a Ti-Base could be suitable, but to save a few extra bucks when the patient is paying 4K/implant w/restoration. Not the way I want to run my lab, it's halfass in my opinion and I know you guys will give me shlt for it, that's okay, i deserve it but I've made a pretty hard stance on this years ago.

Just had a doc text me....neodent screw retained crown won't seat. We used ti base. No longer.

 

[TheLabGuy]

Just had a doc text me....neodent screw retained crown won't seat. We used ti base. No longer.

Sounds about right...and hey, i get the economics and have I lost accounts because all they want to do is Ti-Bases, of course I have but to be honest, I really don't want halfass Docs as my clients in the first place because a halfass Doc is already halfway away from paying his bill on time which is the worst type of Doc out there in my opinion because that's the biggest fk you to your lab when you don't pay on time.

 

[Affinity]

riley stop using that crap and get some sagemax. The multilayer T is pretty nice, I use it on all my molars now. The multi + is pretty good on the shades and real translucent. If that still doesnt do it for you, they have a new +2.0 , its pricey so it must be good, but I havent tried it. Also the GC UHT is great for anterior but like $200 a puck!

As far as ti bases, I dont have many issues although Ive seen multiple biohorizons snap at the hex. The surgeons tell the Drs to use 'authentic' abutments and send nobel universals with every case. Now I mill 'authentic' nobel custom abutments from preforms.. Sure they are made in Spain by the same company that makes the 'aftermarket' Dess preforms, and they are the same exact abutment with a NB lasered on, but if they come with a nobel sticker its 'authentic' Even worse, have you seen the nobel 'adapter for zirconia abutment' that tightens into the zirconia with prongs as you tighten the screw? My wax toilet seal has more retention.

 

[Affinity]

oh also, with the tissue health thing, i heard that gum tissue responds better to "polished" zirconia better than to titanium. Read it somewhere and also a dentist said same thing. Possibly i misunderstood though. But interesting.

I went to implant symposium and a research Dr there had SEM images of epitheleal cells on implants and said that the best material to promote growth of tissue is polished titanium, followed by polished zirconia, followed by glazed zirconia. Just what I heard.

 

[RileyS]

But your mom gives me a discount

 

[RileyS]

(hope your mom is alive and well)

 

[Affinity]

She feels sorry for you. (oh and shes on this forum so Id watch it)

 

[RileyS]

 

[Andrew Priddy]

I'll be the devils advocate here and clearly say Ti-Bases are garbage and have for awhile now. They don't follow the emergence profile, don't provide the same retention as a custom abutments. They are prone to peri-implantitis because the cement line is at the implant platform versus margin line in a custom abutment. Pretty common sense from an engineering standpoint, you have a this little cylindrical tube called a ti-base with a big ole fat lady (your zirconia) sitting on it and we sit back saying that this is just as good?...not this guy. I get the economics, and in some rare cases a Ti-Base could be suitable, but to save a few extra bucks when the patient is paying 4K/implant w/restoration. Not the way I want to run my lab, it's halfass in my opinion and I know you guys will give me shlt for it, that's okay, i deserve it but I've made a pretty hard stance on this years ago.

ive had that stance for years as well

and agree with you "now" in a few points only

i would encourage you to check out ZBLC or zero bone loss concepts.. ive been working with an OS that is also an educator for quite some time now and have done quite a few cases...

another Dr has an "in office" plan, and ZBLC restorations fit some but certainly not the bulk of restoration made... from there, we don't manufacture OEM and inflate "costs" by including 3izimmer OEM for example (higher cost manufacturing). it gets done at TRU, and the patient gets a lower cost that has now become more affordable. a ZBLC case is also much easier to manufacture including "design" with 1/2 the return time.

the cement junction is minimal compared to a CA/hybrid, meaning less overall risk... epithelial attach to polished (all sub-g is polished) Zir easier and seal the path to the base junction. bacterial buildup is the problem with the cement junction, but you get a much more intimate sealing fit with a tibase.

always the concern is the "bondable surface area", i've seen many failures of improper use in the past on tibases, and this is where the "stability judgement" lies... also, "micro ridges" on bases need to be "waxed out" b4 blasting

i also ask you to consider "patient age" in your formula.. does the patient have 2 Christmas dinners left or 60

 

[Andrew Priddy]

Just had a doc text me....neodent screw retained crown won't seat. We used ti base. No longer.

the CM and GM scan body top geometry are damn near identical and the correlation won't throw a red flag. just had one but caught it bc i knew the dr probably wasn't placing CM's
CM is the first in the Drs dropdown and GM didn't exist. (2 months ago)
also verify with a report