Ti base Implant Crowns. Are they okay?

[Affinity]

Andrew, do you sandblast your tibases? and wax out the retention grooves?

Ive always thought about it, it is surely a better bond to be blasted, but I worry about altering the 'authenticity' if something happens to it.. Its a mechanical bond anyway but they are hard to get off even after a firing. Maybe the IFU says to blast it?

 

[grantoz]

im a custom guy because the customer is always right.

 

[Andrew Priddy]

Andrew, do you sandblast your tibases? and wax out the retention grooves?

Ive always thought about it, it is surely a better bond to be blasted, but I worry about altering the 'authenticity' if something happens to it.. Its a mechanical bond anyway but they are hard to get off even after a firing. Maybe the IFU says to blast it?

yep.. everything but the microgrooves.. some bases have microgrooves all the way up
never seen an ifu for base prep

debond on idle oven at 450c for 10 minutes.... let it cool... insert screw and driver.. hold the crown occlusion down and tap the butt of the driver on the table

 

[Brett Hansen CDT]

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

I am familiar with ZBLC. I design my custom abutments with margins much deeper than I would for a cementable restoration to take advantage of polished zirc's properties.

 

[AKDental]

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.

Mr Hansen i 100% agree with all your points. Just one question how much do you charge for a ti base implant crown and how much do you charge for a customabutment screwmentable implant crown?? i ask because the main reason i usually use a tibase is mainly due to cost and labor, with the tibase being much easier to produce. I feel like it sounds bad, but really the cost is an issue. I was actually thinking of trying to switch over to all custom abutments as ive seen other labs doing that with great results but personally im not there yet.

 

[AKDental]

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.

Hi lab guy, i think you have very valid points...and i have a question which i feel like you might be able to answer. So i was under the impression that the diameter of the tibases should always fit into the gum area and as long as the zirconia that is going around the chimney as long as it is not made wider that it should fit into the space. Now I am not so sure. I think that for most tibases its okay but with the smaller platforms like, for ie., Nobel Biocare, the Narrow Platform NP, other implant systems as well, the tibase is wider than the implant itself. and this makes it not go in easily. What is your opinion of this??
Seems like i cannot get a good understanding of gingiva when referring to implant crowns. Gives me such a headache...But thanks if you have some input on this.

 

[AKDental]

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.

hmm interesting, yes that is what i had learned initially. But i read some article somewhere that had said that it was polished zirc, then titanium, and so on.
Also, spoke to brother in law dentist that said in his study group it was the same. Im gonna ask him again about that again. Heres probably a better question though, does it really even make a real difference though, hehe. So do you finish your zirconia on an implant crown?>??
Do you polish it? glaze? polish the whole crown? just the lower gingival area? Also if it is polished then what about flourescence?>

 

[AKDental]

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

hey andrew how you doing? what is a micro ridge? oh and also, you are saying that the cells attach to polished zir easier than what?

 

[Brett Hansen CDT]

Mr Hansen i 100% agree with all your points. Just one question how much do you charge for a ti base implant crown and how much do you charge for a customabutment screwmentable implant crown?? i ask because the main reason i usually use a tibase is mainly due to cost and labor, with the tibase being much easier to produce. I feel like it sounds bad, but really the cost is an issue. I was actually thinking of trying to switch over to all custom abutments as ive seen other labs doing that with great results but personally im not there yet.

We charge appropriately for our work. We have one set price that includes everything for a screw retained monolithic zirconia restoration. It doesn't matter if we use a ti base or a custom abutment. The knowledge and expertise involved in working on implant cases is valuable outside of the cost of the abutment. We do charge about $50 over that price for Straumann cases. This is because we can get an Atlantis Custom Base for less than a Straumann custom abutment and we don't have to spend the time designing the straumann abutment and trying to get it to pass validation in 3shape. Some of the milling companies we get custom abutments from are cheaper, but we don't alter a price because of that. The fees we pay every year for 3shape and the salaries of the experienced people involved in handling these cases is more of a factor in how we price our screw retained restorations.

 

[Affinity]

https://www.researchgate.net/publication/330917544_Epithelial_sealing_effectiveness_against_titanium_or_zirconia_implants_surface

https://tomaslinkevicius.com/wp-content/uploads/2019/01/Zrvs-Ti.pdf

"An animal study 107, in which titanium implants with a titanium plasma-sprayed coating were examined, showed accumulation of titanium particles in regional lymph nodes and other organs, notably the lungs and bones, after implant placement in the jaws"

Never know what youll find from these Dr Frankensteins.