What to charge?

[ParkwayDental]

I am doing an all on 4 case upper and lower. I was wondering what to charge since this is my first one we are doing? Also do you guys put a metal bar on the inside to reinforce the denture acrylic?

 

[PCDL]

Ok, is this all on 4 being delivered at the time of surgery or after the placement and healing?? If its an immediate, then no bar, just acrylic and maybe some ribbon wire or comparable. I charge around $750 for a temporary like that.

If its a final, a metal bar is preferable, as it will increase the life of the restoration. On a case like that, with 4 implants as a hybrid, my fee would be around $2700-$3100 for the finished restoration (IPN teeth, eclipse or 199 base, cad/cam bar, misc. parts, labor) You can charge less doing UCLA cylinders and some other sort of reinforcement, but it may not be up to your standards.

 

[ParkwayDental]

I am sorry, it is for the final restoration that is a hybrid! It has four implants with nobels multi unit abutments to correct the angle. I was thinking around 3500 so I am in the ball park.

Next question is I have a 3shape where can I get the scan bodies and library for the multi unit abutments???

 

[PCDL]

ahhh... that one is tougher... I deal with 3i, and they require the model sent to them for scanning. I don't know many people fabricating bars from optical scanners, most are still using the more accurate touch scanners.

 

[ParkwayDental]

I have done some bars on 3shape before but not with these type of abutments.

 

[JohnWilson]

I have Nobel's optical scanner which allows me to scan and design these bars to be milled in New Jersey. $3500 is about the National average, my lab is north of that.

Remember one thing with fixed hybrid cases, you are married to them. Every single one of these cases can be a loss for both you and your client if not fabricated with knowledge and the understanding of what a implant retained and supported appliance needs to be successful.

Good luck

 

[droberts]

As John mentioned above, there is knowledge needed to fabricate such appliances. This was a doctors first hybrid case. Not sure if it was the labs first, but you be the judge. This case was seated about a month ago. Doctor called me and ask me if i would take a look at it. Enclosed are photos of the max. hybrid with open anterior space allowing food/salivia to run wild. Not only that, the bar had a severe convex arch in the design? The acrylic work that is shown totally is not acceptable. In processing, press pack. They tweaked the max. bar slightly and had a defect in the mand. causing the occlusion to be off. Case is a Class II set in lingualized? The patient will wear down the lingual cusp so fast and then work on the anterior teeth. Just a mess. I remounted using the Stratos giving me references. Then burned off the max. arch to get to the bar. Guess what? The bar then seated down passively Cut back on the bar to make it a wrap around style. The mand. arch, cut the teeth off thinning the base. Reset both arches with mutliple contacts of the posterior teeth equilbrating in bilateral and forward excursive movements. Case is out for try-in. As for fees on the hybrids? More than the national average...

 

[saltydoc]

droberts, could you expand on the problem of the Mx acrylic?
From what I see in the photo, the convex metal areas (ling./ging.) need to be trimmed back (away from the ging) allowing the bucc/fac acrylic ridge to be extended while still maintaining a flat to convex surface bucc-lingually (modified-ovate) for cleaning. It looks like the convex metal area was designed to prevent open areas on the lingual, but this is counterintuitive because it creates concave areas just bucc to it which will be a food/plaque/tarter trap.
Other than the warping from processing, which should have been verified in the lab, I think the acrylic is functionally acceptable. As for asthetics (on the orig),the interprox 8-9 could be trimmed back a little giving the teeth more depth and the secondary anatomy of the teeth has been removed from over-polishing. I don't stipple the tissue as per request of my prosthodontist. Also, stippling in nature only occurs within the first 5mm of the gingival margin.
I like the new teeth. Are those Physiodens? they have a lot more character.

 

[timbangley]

3,900 for name brand bar and 2,900 for off brand such as inclusive