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Implants
Ti based implant crowns
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<blockquote data-quote="drguzman" data-source="post: 339995" data-attributes="member: 25351"><p>Yes, these articles are not on Ti Base Vs Custom Abutment, they are more on Peri-implantitis, which by the time it happens, it is not on the lab. Now how many young clinicians ask you all, "what do you think?". You have the opportunity to further educate a lot of clinicians and improve patient's lives.</p><p></p><p>Having that margin at tissue level statistically makes a difference for the health of the implant (at least according to Derks).</p><p></p><p><a href="https://drive.google.com/file/d/11Mkwav9vR3sxc1pEwYAXJwncN5d3Pz9u/view?usp=sharing" target="_blank">Restorative Margin to Bone distance</a> (made an illustration but it's too tricky to just drop the image)</p><p></p><p>Now there are many height of Ti Bases, so 1.5mm of taller would protect more the bone levels, with the drawback of complicating the chance of having a restoration that emerges in a Non-Pumpkin shape (think of a 4.8mm implant going to a 10-12mm Molar, in just 2-3mm of height. If the Ti Base is 2mm in height you know have 1mm to go from 4.8mm to 12mm (the Pumpkin restoration). </p><p></p><p><a href="https://drive.google.com/file/d/1ixMORHgEjysTQsYtHj2e1J1Xr7zLmTMQ/view?usp=sharing" target="_blank">Second Illustration</a></p><p></p><p>There is advantages and disadvantages the different treatments, and plenty of literature to support both. </p><p></p><p><Opinion below></p><p></p><p><strong>On a Ti Base:</strong> </p><ul> <li data-xf-list-type="ul">there is definitely less risk of cement being a problem (assuming it's done right, at the lab, cemented, cleaned, polished, steamed etc),compared to clinically cementing intra orally. This point cannot be emphasized enough as excess cement is in the race for the biggest implant killer factor (up there with heavy smoking and uncontrolled diabetes). Now it is not always possible to do a Ti Base, for example, the path of insertion, and the path of the implant do not allow the seating of the restoration (which for a single restoration, it is not crossing anyone's mind to use a non engaging ti base). </li> <li data-xf-list-type="ul">The restoration is less expensive to make, but requires more clinical precision (no cement to provide passivity, so seating the restoration might require more skill at adjusting contacts. Less experienced clinician might loose the proximal contact, and now what would happen to the cement if you have to add porcelain to a contact? </li> <li data-xf-list-type="ul">If there is gingival recession, there is reduced risk of metal ever showing. Also, reduced chance the average clinician will notice things are migrating south</li> </ul><p><strong>On a Custom Abutment:</strong></p><ul> <li data-xf-list-type="ul">There is less risk of having cement compromise the implant in comparison with a stock abutment (which i hope your docs are not using),but more risk of having excess cement compared to a Ti Base.</li> <li data-xf-list-type="ul">The restoration is more expensive</li> <li data-xf-list-type="ul">You could detect early changes/recession if the lingual margins are at gingival level.</li> <li data-xf-list-type="ul">It is easier to probe the restoration when compared to a Pumpkin type emergence.</li> <li data-xf-list-type="ul">The emergence is fully customizable, which close to the platform having a narrower emergence provides more space for connective tissue thickening (which would minimize risks of gingiva looking gray)</li> </ul><p>On the Scary side, thinking of screw retained restorations on multiple implants, the less precise the impression/cast, the more likely there will be misfit clinically, and your restoration will be under stress and break earlier, making you look bad, or making you wonder if there is anything wrong with your processes at the lab... did you fire the restoration too many times? was it the material? is there something wrong with your sintering? or is it the clinician impression? is the clinician grinding and inducing cracks? If your prosthesis survives, some implants will fail, and you might get ask to discount a second restoration or worse. I'm just thinking scenarios here since I don't have a lab people send stuff to, but I do talk to technicians in my area who educate dentists in the area more than I do because they have worked for years together and have a longer relationship, etc. I am sure you all might be familiar with doctors' egos, and those egos might not trust younger doctors even if they are specialists. </p><p></p><p>Just food for thought <img src="data:image/gif;base64,R0lGODlhAQABAIAAAAAAAP///yH5BAEAAAAALAAAAAABAAEAAAIBRAA7" class="smilie smilie--sprite smilie--sprite1" alt=":)" title="Smile :)" loading="lazy" data-shortname=":)" /></p><p></p><p><strong></strong></p><p><strong></strong></p></blockquote><p></p>
[QUOTE="drguzman, post: 339995, member: 25351"] Yes, these articles are not on Ti Base Vs Custom Abutment, they are more on Peri-implantitis, which by the time it happens, it is not on the lab. Now how many young clinicians ask you all, "what do you think?". You have the opportunity to further educate a lot of clinicians and improve patient's lives. Having that margin at tissue level statistically makes a difference for the health of the implant (at least according to Derks). [URL='https://drive.google.com/file/d/11Mkwav9vR3sxc1pEwYAXJwncN5d3Pz9u/view?usp=sharing']Restorative Margin to Bone distance[/URL] (made an illustration but it's too tricky to just drop the image) Now there are many height of Ti Bases, so 1.5mm of taller would protect more the bone levels, with the drawback of complicating the chance of having a restoration that emerges in a Non-Pumpkin shape (think of a 4.8mm implant going to a 10-12mm Molar, in just 2-3mm of height. If the Ti Base is 2mm in height you know have 1mm to go from 4.8mm to 12mm (the Pumpkin restoration). [URL='https://drive.google.com/file/d/1ixMORHgEjysTQsYtHj2e1J1Xr7zLmTMQ/view?usp=sharing']Second Illustration[/URL] There is advantages and disadvantages the different treatments, and plenty of literature to support both. <Opinion below> [B]On a Ti Base:[/B] [LIST] [*]there is definitely less risk of cement being a problem (assuming it's done right, at the lab, cemented, cleaned, polished, steamed etc),compared to clinically cementing intra orally. This point cannot be emphasized enough as excess cement is in the race for the biggest implant killer factor (up there with heavy smoking and uncontrolled diabetes). Now it is not always possible to do a Ti Base, for example, the path of insertion, and the path of the implant do not allow the seating of the restoration (which for a single restoration, it is not crossing anyone's mind to use a non engaging ti base). [*]The restoration is less expensive to make, but requires more clinical precision (no cement to provide passivity, so seating the restoration might require more skill at adjusting contacts. Less experienced clinician might loose the proximal contact, and now what would happen to the cement if you have to add porcelain to a contact? [*]If there is gingival recession, there is reduced risk of metal ever showing. Also, reduced chance the average clinician will notice things are migrating south [/LIST] [B]On a Custom Abutment:[/B] [LIST] [*]There is less risk of having cement compromise the implant in comparison with a stock abutment (which i hope your docs are not using),but more risk of having excess cement compared to a Ti Base. [*]The restoration is more expensive [*]You could detect early changes/recession if the lingual margins are at gingival level. [*]It is easier to probe the restoration when compared to a Pumpkin type emergence. [*]The emergence is fully customizable, which close to the platform having a narrower emergence provides more space for connective tissue thickening (which would minimize risks of gingiva looking gray) [/LIST] On the Scary side, thinking of screw retained restorations on multiple implants, the less precise the impression/cast, the more likely there will be misfit clinically, and your restoration will be under stress and break earlier, making you look bad, or making you wonder if there is anything wrong with your processes at the lab... did you fire the restoration too many times? was it the material? is there something wrong with your sintering? or is it the clinician impression? is the clinician grinding and inducing cracks? If your prosthesis survives, some implants will fail, and you might get ask to discount a second restoration or worse. I'm just thinking scenarios here since I don't have a lab people send stuff to, but I do talk to technicians in my area who educate dentists in the area more than I do because they have worked for years together and have a longer relationship, etc. I am sure you all might be familiar with doctors' egos, and those egos might not trust younger doctors even if they are specialists. Just food for thought :) [B] [/B] [/QUOTE]
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