managing problems in the restorative phase of dental treatment
DESCRIPTION
Slides from the Indianapolis Implant Restorative Study Club (IRSC) on August 29, 2013 by Christine Bishop, DDS, MSD and Savi Abey, DDS, MSD featuring common problems associated with implant therapy in both fixed and removable prosthodontics.TRANSCRIPT
SlideshareTo IRSC Members: some slides have been removed from the slideshare. If you need more information about any of the topics mentioned in the headings, feel free to contact Dr. Bishop or Dr. Abey by email.
Bishop(at)teethin.com
Abey(at)teethin.com
IRSC2013 IRSC2013
Final Meeting for 2013
November 14: Dental Laboratory Showcase
Implant Restorative Study Club
Problem Solving in the Restorative Phase of
Treatment
sponsored by Prosthodontics of Central Indiana
Implant Restorative Study Club
Problem Solving in the Restorative Phase of
Treatment
sponsored by Prosthodontics of Central Indiana
August 29, 2013The Monon Center, Carmel
Goals for this eveningGoals for this eveningAssuming everything has been done to prepare for success to this point!
Managing problems at try in/placeWhen to return to the lab, or not
Managing “emergencies” and later problems
ProblemsProblemsFixed
Removable
Problems: FixedProblems: FixedAt try in/placement:
1. Proximal contacts2.Seating
3. Occlusion: missing.....where should it be anyway?
4. Buccal emergence profile/proximal contour5. Excess cement
At follow up and emergencies:1. Porcelain fracture
2. Loosening:crown
abutmentimplant
implant
Problems: FixedProblems: FixedAt try in/placement:
1. Proximal contacts2.Seating
3. Occlusion: missing.....where should it be anyway?
4. Buccal emergence profile/proximal contour5. Excess cement
At follow up and emergencies:1. Porcelain fracture
2. Loosening:crown
abutmentimplant
implant
proximal contacts:
not usually perfect from the lab...why?
proximal contacts:
not usually perfect from the lab...why?
Sequence:Check both proximal contacts (floss
test)which contact is tightest?(floss test)
DiscloseAdjust
Check seating (explorer)Check BOTH contacts again(floss
test)Which contact is tightest?
DiscloseAdjust
Check seating(explorer/bite cotton roll hard 5min/10min)
Check BOTH contacts again(floss test)
Which contact is tightest?DiscloseAdjust
Check seating (seems down) Check contacts again. If 1or 2 open
contacts, If perfect, Make BWX (quite often has to be
vertical)
Problems: FixedProblems: FixedAt try in/placement:
1. Proximal contacts2.Seating
3. Occlusion: missing.....where should it be anyway?
4. Buccal emergence profile/proximal contour5. Excess cement
At follow up and emergencies:1. Porcelain fracture
2. Loosening:crown
abutmentimplant
implant
Where should it be?
Where should it be?
Discuss:A.out of occlusion
B. occlusion in clench. (What about non-clenchers)?
C. normal, tooth-to-tooth type contact
Suggested Sequence for
centric:Assumptions:
2 proximal contacts are present.Full seating confirmed with VBWX
1. (Implant crown out): confirm contact of adjacent teeth with shim
2. Place crown onto abutment3. Check adjacent teeth with shim
4. If out of contact, mark with Accufilm5. Adjust
Repeat steps 3.-5. until shim contact present adjacent teeth.
6. Check implant crown with shim. If out of contact,
7. If in contact, adjust a tiny bit more. (always get pt feedback on
occlusion; and metal occlusal more forgiving)
How about excursive movements?
How about excursive movements?
Problems: FixedProblems: FixedAt try in/placement:
1. Proximal contacts2.Seating
3. Occlusion: missing.....where should it be anyway?
4. Buccal emergence profile/contour5. Excess cement
At follow up and emergencies:1. Porcelain fracture
2. Loosening:crown
abutmentimplant
implant
Problems: FixedProblems: FixedAt try in/placement:
1. Proximal contacts2.Seating
3. Occlusion: missing.....where should it be anyway?
4. Buccal emergence profile/proximal contour
5. Excess cementAt follow up and emergencies:
1. Porcelain fracture2. Loosening:
crownabutmentimplant
implant
Problems: FixedProblems: FixedAt try in/placement:
1. Proximal contacts2.Seating
3. Occlusion: missing.....where should it be anyway?
4. Buccal emergence profile/proximal contour5. Excess cement
At follow up and emergencies:1. Materials fracture: porcelain/acrylic resin
2. Loosening:crown
abutmentimplant
implant
Problems: FixedProblems: FixedAt try in/placement:
1. Proximal contacts2.Seating
3. Occlusion: missing.....where should it be anyway?
4. Buccal emergence profile/proximal contour5. Excess cement
At follow up and emergencies:1. Materials fracture: porcelain/acrylic resin
2. Loosening:crown
abutmentimplant
implant
Problems:RemovableProblems:RemovableAt try in/placement:which inserts to use?
locator heightAt follow up and emergencies:
soft tissue problemsunstable/non-retentive
fractured base
At try in/placement:locator height- tissue height
- restorative space- position of implants
- ability of patient to seat
Problems:RemovableProblems:RemovableAt try in/placement:which inserts to use?
locator heightAt follow up and emergencies:
soft tissue problemsunstable/non-retentive
fractured base
Problems:RemovableProblems:RemovableAt try in/placement:which inserts to use?
locator heightAt follow up and emergencies:
soft tissue problemsunstable/non-retentive
fractured base
Problems:RemovableProblems:RemovableAt try in/placement:which inserts to use?
locator heightAt follow up and emergencies:
soft tissue problemsunstable/non-retentive
fractured base
IRSC IRSC
Finally:
Please complete your survey online:
http://www.surveymonkey.com/s/68TMNG9
November 14: Dental Laboratory Showcase
This is the information that I mentioned about a course for the Prettau Bridge: the full arch zirconia bridge. Dr. Weir feels that Dr. Tischler is a highly appropriate authority on the subject. Check out the website below, or contact Dr. Weir.
This is the information that I mentioned about a course for the Prettau Bridge: the full arch zirconia bridge. Dr. Weir feels that Dr. Tischler is a highly appropriate authority on the subject. Check out the website below, or contact Dr. Weir.
From: "C. Douglas Weir" <dweir1(at)netsurfusa.net>Subject: Date: August 27, 2013 4:44:01 PM EDT
To: Bishop Doctor Christine <chrisbishop88(at)gmail.com>
http://www.tischlerdental.com/
There is a great amount of info if you click on the "for dentists" tab.
The next course is Nov 8-9.