| Tips for Dentists
As experienced prosthodontists, we like
to share our many years of experience with referring dentists
and other prosthodontists. We hope our tips and suggestions
are helpful. If you have any questions or comments about this information,
we would be happy to speak with you by phone
or email.
Please check back regularly as new tips will continue to
be added.
Implant Restorations:
Screw Retained or Cemented?
Large restorations are best managed with screw retention.
Small restorations and single teeth can be readily managed
with either screw retention or cementing. In all cases, maintenance
and retrievability are important.
The advantages of screw retention include ease of repair,
ease of access to disengaged abutments or failed implants,
ease of addition to the existing prosthesis and complete,
reliable control of the retention. There is also nothing like
screw retention to prevent multiple inadvertent washouts.
In many cases, especially where there are short abutments,
hard cement may be needed, which often becomes permanent.
The advantage of cemented restorations is their ease of technique
and lower cost of components. When it comes to large porcelain
restorations, especially those going around the arch, the
distortion that occurs when firing the case ruins the fit.
The less precise fit of a cemented case can compensate for
this distortion.
Some believe that a lack of screw access opening in a cemented
restoration is an advantage. In some cases it is, but overall
we don't find this to be very important when balanced against
the retrievability provided by screw retained restorations.
Our preference is screw retained restorations whenever we
can do them.
Implant Restoration Technique:
Attention to detail is extremely important in all aspects
of dentistry but with implant restorations it can be the difference
between success and failure.
Always take a radiograph of the transfer copings before making
impressions. You cannot always see the interface all around.
At try in, make radiographs of the framework, especially with
multiple splinted units. It is very embarrassing to be checking
the completed case some time later when there is some trouble
to find the framework not seated.
 Despite
the high quality of impression materials, we still like to
lute our transfer copings together with resin before making
the impressions.The obvious additional stability improves
accuracy throughout the subsequent impression-making procedures
and model fabrication.
Screw access openings can be finished with porcelain around
the circumference in the lower arch when aesthetics are important.
In the upper arch, gold can be brought right up to the occlusal
surface. The resultant gold channel can be used as a means
for managing a check bite record as well. These cylinders
of gold help maintain the porcelain strength.
Although implant companies, in recent years, have been focusing
on simplicity and ease of technique, there is no easy answer.
Detailed diagnosis and treatment planning, and perfect execution
of clinical and laboratory technique, is what it takes to
get the job done.
Caveat:
"Tips for Dentists" is primarily for discussion
purposes and to share our techniques and philosophies. We
would be happy to hear from you and we do not expect you to
follow our methods. Different techniques work better in some
hands than others. There are many ways to do the same procedures.
Forest Hill Prosthodontists will not be responsible for techniques
you acquire from
this site.
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