Venting titanium implants

[skdawl]

Is anyone providing vent holes on mesial and distal areas of titanium abutments to counteract the cement displacement upon seating cement retained crowns? Sorry if this has been covered in a different post.

 

[Marcusthegladiator CDT]

I've had Docs request this on stock abuts, so I looked up the specs on the holes and their placement and had at it...

 

[skdawl]

Why just stock abutment s? Did they explain why they wanted them?

 

[2thm8kr]

Why just stock abutment s? Did they explain why they wanted them?

Stock abutments usually have a deep sub gingival margin especially on the buccal. Cement gets forced deep into the sulcus around the implant and it's nearly impossible to get every bit of it out. This is one of the leading causes of post integration failure of implants. This is also the reason why screw retained are becoming popular again.
Custom or patient specific abutments have the margin placement optimized, making it much easier to remove the adhesive.

 

[skdawl]

That's why I was asking. I just seen Dr. Alfonso Pineryo's lecture that was Restoratively Driven Implant Failure, and you hit everyone of those reasons on the head. Even as far as Premier implant cement being the most popular and probably the worst cement to use. He had a cool slide representation using Starbucks cups and shaving cream to show cement displacement. 90% of cement comes out of a closed abutment compared to 36% on an IVA abutment. Alongside that only 17% of Drs in an international study are using the rim loading technique. He also had some impressive studies on compatible components vs original, but nobody wants to hear about that.

 

[eyeloveteeth]

Is anyone providing vent holes on mesial and distal areas of titanium abutments to counteract the cement displacement upon seating cement retained crowns? Sorry if this has been covered in a different post.

can you provide a pic? i'm not sure what you mean by vent holes

 

[skdawl]

if you watch about the last 5 minutes of this video you will see Alfonsos Starbucks experiment. Only this presentation was in 2012 before his IVA slides. The IVA is only recommended for titanium abutments. The Holes are placed in the medial and distal interproximals 1/3 down from the occlusion. The hole is .75mm in diameter using a carbide bur no high speed. I'll try to find a pic but in the slide he showed most of the excess cement flowed into the open abutment which reduced excess cement and had better retentive properties.

 

[skdawl]

can you provide a pic? i'm not sure what you mean by vent holes

This pic looks a little low.

 

[eyeloveteeth]

oh wow, i've never heard of this before....interesting concept. something worth charging extra for too.

 

[skdawl]

oh wow, i've never heard of this before....interesting concept. something worth charging extra for too.

I think it is a very valid concept seeing as how thin the cement has become and we are now seeing failed implants with the cement on the threads which also has to absorb into the bone. The best part will be showing your dentist how to do a proper rim job.[emoji12]

 

[doug]

I've been know to provide a little tool to the docs that is basically this: I will extrude bite registration material into the finished crown and let it set. I then clean it of excess material and put it on a q-tip stick. the doc can then put cement into the crown and push the bite registration into the crown to express the excess cement before final cementation. I didn't think of this, it was suggested to me and it comes with a fee to the doc.

 

[JohnWilson]

We have surgeons we work for that we provide custom abutments temp crowns and MASTER dies, its a die stone replica of the abutment. This is sent to the referral gp that will send it to the restoring lab to use a number of different way either analog or digital.

This die essentially does the same things as what Doug is outlining and helps spread the proper amount of cement in the crown. The 3% needed verses a 100% full crown of cement is very telling. The tolerances are so much tighter today with the precision of cad and the quality of resin cement on the market.

The vent hole to me I do not understand, to me it appears to allow cement to flow down the inside of the abutment and if the screw is not blocked out appropriately it could cause issues. Maybe I am not understanding it but it appears its just away to distribute the hydraulic load???

 

[skdawl]

They still block out the screw from what I gathered just not making it a completely closed abutment to allow for cement flow. In the video I posted above the speaker before Alfonso showed the study on cement loading techniques. Please fill me in to the issues that can occur? If the screw is still protected by Teflon tape or cotton and cement fills the rest what are your main concerns? I do think full loading needs to stop especially with premier because it is pink, odorless, and tasteless and harder to detect excess. But He did also say all margins should be supragingival to counteract all these problems. Which would make life easier but drs and patients probably would not be on board with. Now I realize I have been rambling and probably didn't even answer your original question. And if not please tell me more about your concerns so I can look into them myself.

 

[JohnWilson]

Here is my basic thought process as I have witnessed over my 20+years of doing implants.

We protect the screw so that in the event of screw loosening we can retrieve the crown and re-torque the restoration. Sounds easy...

In a perfect world we have perfectly placed implants that accept the load properly with no off axis issues to deal with. Screws are torqued properly and we would NEVER have to retrieve a cemented crown. Yeah right....

Of course this is not the case and this is why we do anything we can to protect the head of the screw from cement.

The reason why implant companies started to "suggest" using "Implant cement" was because Dr's were constantly having to retrieve restorations so they could re-torque these problem cases. This wondrous new overpriced temp cement started to cause more problems, they were more soluble than the "real" varieties and caused many a stinky mouth when the materials started to break down and invite buggies in-between abutments and crowns. So now it becomes necessary to scrap this brand of cement and the clients start to use the "good stuff" again and load the crowns just like they do with tooth born restorations and we start to have tons of issues cleaning cement.

Many may have seen this but when the good stuff (cement) gets down the abutment channel and you need to retrieve a crown because of screw loosening you now add an additional step to try and clean this area of the abutment with out damaging it to allow the driver to reach the protected head of the screw. If you have every tried to do this I can tell you its not easy OUTSIDE the mouth let alone when its back on a second molar. Anything the client can do to protect this sacred channel they would be very prudent to do so.

SO this lends me to the question at what point do we have diminishing returns on our actions? We are trying to do all we can to share knowledge with out clients to help save the possibilities of cement caused perio-implantitis but at the same time we are locking on crowns to abutments with no way to retrieve them (easily) if and when they need attention.

This is one of the reason why 85% or more of the implants I restore today are screw retained

 

[skdawl]

85% wow that is impressive and please other techs comment if you are doing the same volume. Alfonso the speaker I seen said that was the most hygienic way to go but there are still a lot of cement retained. I think the aim of the presentation was to prevent the retrieval of these restorations by applying better techniques like mentioned before with the 3% ratio. He actually spends a fair amount if time on implant retrieval and I can promise that fcz is going to be a major problem. As technicians we need to be aware of all of These issues more in depth while advising our drs on what is available and these techniques. As for cement retained we should make a duplicate die that they can load cement place it on the dummy die and remove excess cement before placing using the rim technique. I'm not disagreeing with you at all John. This comes down to risk management and not compromising the treatment plan that our lab has been given. Thanks for your input now my wheel are turning even faster. [emoji70]

 

[skdawl]

And again no one wants to hear this but 'compatible' vs original components actually has merit in studies. It will only take 3-9 years to see our failures so save your pennies now I guess.

 

[skdawl]

Plus as a lab you can charge for a dummy die of an implant.

 

[skdawl]

Here was one day this last week for us

Can you send this a different way? I can't load this. Says file not supported

 

[JohnWilson]

I have tried to share the production we did on Wednesday last week.

http://vid215.photobucket.com/albums/cc285/Ziconia/IMG_0355 2_zpsmrep9l6z.mp4

 

[JohnWilson]

I am not sure why we can not embed from different hosts @Travis

This host is terribly slow