Managing Problems in the Restorative Phase of Dental Treatment

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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
  • 1. Slideshare To 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
  • 2. IRSC 2013 Final Meeting for 2013 November 14: Dental Laboratory Showcase
  • 3. Implant Restorative Study Club Problem Solving in the Restorative Phase of Treatment sponsored by Prosthodontics of Central Indiana August 29, 2013 The Monon Center, Carmel
  • 4. Goals for this evening Assuming everything has been done to prepare for success to this point! Managing problems at try in/place When to return to the lab, or not Managing “emergencies” and later problems
  • 5. Problems Fixed Removable
  • 6. Problems: Fixed At try in/placement: 1. Proximal contacts 2.Seating 3. Occlusion: missing.....where should it be anyway? 4. Buccal emergence profile/proximal contour 5. Excess cement At follow up and emergencies: 1. Porcelain fracture 2. Loosening: crown abutment implant implant
  • 7. Problems: Fixed At try in/placement: 1. Proximal contacts 2.Seating 3. Occlusion: missing.....where should it be anyway? 4. Buccal emergence profile/proximal contour 5. Excess cement At follow up and emergencies: 1. Porcelain fracture 2. Loosening: crown abutment implant implant
  • 8. proximal contacts: not usually perfect from the lab...why?
  • 9. Sequence: Check both proximal contacts (floss test) which contact is tightest?(floss test) Disclose Adjust Check seating (explorer) Check BOTH contacts again(floss test) Which contact is tightest? Disclose Adjust Check seating(explorer/bite cotton roll hard 5min/10min) Check BOTH contacts again(floss test) Which contact is tightest? Disclose Adjust Check seating (seems down) Check contacts again. If 1or 2 open contacts, If perfect, Make BWX (quite often has to be vertical)
  • 10. Problems: Fixed At try in/placement: 1. Proximal contacts 2.Seating 3. Occlusion: missing.....where should it be anyway? 4. Buccal emergence profile/proximal contour 5. Excess cement At follow up and emergencies: 1. Porcelain fracture 2. Loosening: crown abutment implant
  • 11. Where should it be? Discuss: A.out of occlusion B. occlusion in clench. (What about non-clenchers)? C. normal, tooth-to-tooth type contact
  • 12. 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 abutment 3. Check adjacent teeth with shim 4. If out of contact, mark with Accufilm 5. 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)
  • 13. How about excursive movements?
  • 14. Problems: Fixed At try in/placement: 1. Proximal contacts 2.Seating 3. Occlusion: missing.....where should it be anyway? 4. Buccal emergence profile/contour 5. Excess cement At follow up and emergencies: 1. Porcelain fracture 2. Loosening: crown abutment implant implant
  • 15. Problems: Fixed At try in/placement: 1. Proximal contacts 2.Seating 3. Occlusion: missing.....where should it be anyway? 4. Buccal emergence profile/proximal contour 5. Excess cement At follow up and emergencies: 1. Porcelain fracture 2. Loosening: crown abutment implant implant
  • 16. Problems: Fixed At try in/placement: 1. Proximal contacts 2.Seating 3. Occlusion: missing.....where should it be anyway? 4. Buccal emergence profile/proximal contour 5. Excess cement At follow up and emergencies: 1. Materials fracture: porcelain/acrylic resin 2. Loosening: crown abutment implant implant
  • 17. Problems: Fixed At try in/placement: 1. Proximal contacts 2.Seating 3. Occlusion: missing.....where should it be anyway? 4. Buccal emergence profile/proximal contour 5. Excess cement At follow up and emergencies: 1. Materials fracture: porcelain/acrylic resin 2. Loosening: crown abutment implant implant
  • 18. Problems:Removable At try in/placement: which inserts to use? locator height At follow up and emergencies: soft tissue problems unstable/non-retentive fractured base
  • 19. At try in/placement: locator height - tissue height - restorative space - position of implants - ability of patient to seat
  • 20. Problems:Removable At try in/placement: which inserts to use? locator height At follow up and emergencies: soft tissue problems unstable/non-retentive fractured base
  • 21. Problems:Removable At try in/placement: which inserts to use? locator height At follow up and emergencies: soft tissue problems unstable/non-retentive fractured base
  • 22. Problems:Removable At try in/placement: which inserts to use? locator height At follow up and emergencies: soft tissue problems unstable/non-retentive fractured base
  • 23. IRSC Finally: Please complete your survey online: http://www.surveymonkey.com/s/68TMNG9 November 14: Dental Laboratory Showcase
  • 24. 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.
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