As you’re well aware, there are not a few considering factors to make ideal implant restorations under various clinical situations. First, we must take an impression as accurate as possible to get “accurate master and opposing model”. That can be a fixture level and abutment level impression. I think the impression taking is like a first button in a shirt. So, if the first button is put wrong, then every button will be clearly wrong. This can create a stressful situation for both the patient and the doctor. The clinical importance of accurate impression taking cannot be overemphasized. Second, we should set-up the models on the articulator with the exact patient’s occlusal relationship. To achieve this, it’s also necessary to take a bite as corrective as we can. We can take a bite on the same day right after taking an impression or we can make an appointment to take a bite at the other day.
Furthermore, the quality of the bite registration can be affected by the kinds of bite materials. So, we should select proper bite materials such as paraffin wax, aluwax, silicone, pattern resin(Duralay®) and so on. I will talk about my clinical protocol when taking a bite in this implant prosthetic course. Third, we should decide the types of final restoration such as cement-retained, screw-retained and combination type restoration. They can be determined by the amount of vertical space and the path of implants.
Fourth, once the types of the final restoration are decided, we should consider which kinds of abutment is better to solve clinical problems. As for me, I often select a ready-made(stock) abutment if there is no distance problem and/or depth problem with fixtures. On the contrary, I select a customized abutment when there are various clinical problems with the distance between implants, the path of implants, the depth of implants and when I can predict a weak retentive force due to a limited vertical space. Even with the ready-made abutment, we should select “proper abutment height(H), abutment collar diameter(D), abutment collar height(GH)” considering the types of final restoration, the position of the gingival margin and emergence profile. For instance, when the vertical space is sufficient and when the position of implants is not off-center mesiodistally and buccolingually, I often make a combination type using ready-made abutments if the path of implants is parallel to each other and I make a cement-retained type if the path of implants is not parallel. On the other hand, after selecting customized abutments when the position of implants is not ideal and there is a depth problem with fixtures, I often make a combination type if the path of implants is parallel to each and I make a cement-retained type if the path of implants is not parallel.
Fifth, in a multiple implant restoration, we should decide whether the final restoration is splinted together or not. In some patients, it’s recommended to make a splinted implant restoration as follows: If a narrow diameter is involved, when the length of implant is less than 10mm, poor bone quality, when the patient has high occlusal force or para-functional habit. On the contrary, sometimes we can make a segmented implant restoration when the bone quality is very good, when the stability of implant-abutment connection is favorable, when the patient’s bite force is relatively weak and if a wide diameter implant more than 5mm is involved. In this session, I want to share my clinical protocol.
Sixth, we should select proper prosthetic material such as gold, porcelain and zirconia. Recently, the full contoured zirconia restoration takes up much in my clinic. This is for reducing or preventing “porcelain fracture or chipping during a maintenance period. Likewise, there are decision-makings at each prosthetic step to get the good quality of the final restoration. The proper prosthetic methods make your patients and you less stressed during prosthetic procedures, in addition, we can reduce the rate of maintenance works and we can come up with counterplans when they will happen. I sincerely hope this course will be of great help to your practice.
1. The reasons why I don’t make a single cement-retained or screw retained prosthesis when the vertical space is sucient
2. The eectiveness of single combination type(SCRP) restoration when the vertical space is sucient
3. Understanding the clinical workflow of single combination type(SCRP) restorations through videos
4. Selective guideline – What kind of abutment is better to get a good quality of the final restoration?
5. Implant prosthetic design for favorable response to peri-implant tissue – What type of the gingival cu design is good
for the long-term prosthetic survival rate?
6. We should evaluate a lateral movement to avoid premature contacts especially in a single implant restoration.
7. The reasons why we should have a temporization period on the posterior area
8. Considerations when making a splinted cement-retained prosthesis
9. Selection of proper temporary cement according to several factors related to the retentive force
10. Considering factors when making a splinted combination type
11. Understanding the clinical workflow of splinted combination type(SCRP) restorations through videos
1. The reason why I do make a splinted combination type even though the path of implants is not parallel to each other
2. How to take a bite correctly under various clinical situations?
3. How can we apply the concept of the combination type when the path of implants is not parallel in the internal connection system?
4. It’s recommended to separate the final restoration considering maintenance works like a contact point loosening
5. When do I select an abutment level impression after a temporization period on the posterior area?
6. Understanding of various splinted implant restoration through case presentations
7. What kind of impression method do you prefer to take on the anterior area?
8. Implant prosthetic design on the anterior area
9. The kinds of final abutment that can be selected on the anterior area
10. How to make an immediate provisional restoration right after placing the implant?
1. Decision-makings of each prosthetic step for fixed type full mouth implant rehabilitation
(1) Temporary restoration right after the implant placement
(2) Fixed type provisional restoration after successful osseointegration
(3) Impression taking method
(4) Bite registration
(5) How to record proper inter-arch jaw relationship
(6) How to apply the digital dentistry?
(7) Prosthetic materials
2. Clinical application of Locator abutment
November 15, 2019 9:00 AM
November 16, 2019 9:00 AM
November 17, 2019 9:00 AM
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