Implants It Will Also Talk A Little Bit

implants it will also talk a little bit

about their limitation as a preview I

really don’t use them for single tooth

restoration however they do work great

for hybrids the internal connection or

bone level implant I think that

uniformly most people use an internal

connection implant we place our implant

at or below bone level there’s nothing

that comes out of the gingiva or travels

through the bone and we attach our

abutment or whatever Connection we may

be using now

one-piece implants are interesting they

certainly wax and wane in popularity

with a one piece implant you have an

abutment or an attachment that is

permanently welded to the implant they

may ask yourself why would I want that


the discussion that we’re going to have

today is really centered about abutments

and micro movements so if we were to

want to emulate anything with our

abutments we would want to emulate the

one-piece emblem the one-piece implant

the abutment does not move although the

image them showing you me look kind of

like there’s a screw hole in there there

is no screw hole because there’s no

screw certainly one-piece implants have

their use in dentistry I have only used

them in lower anterior and lateral

incisors an area of course another

discussion is tie bases but if you want

to use any sort of a ceramic abutment

you have something inside the ceramic

called a titanium base the amount

ceramics surrounding the titanium base

has to be at least 600 microns thick and

if you can’t get that you’re really

going to prep through the ceramic into

your tie base so in areas of limited bzo

difficult space a one-piece implants

kind of cool because there’s no screw

hole so you can really prep these things

fairly thin and not worry about things

breaking so one thing that’s really kind

of cool if you want to have a good pulse

on what’s going on in implantology and

transit implantology is to really look

at labs and labs have noticed some

interesting trends going on one thing

that’s gone up way up is the use of

conical connections so we’ll describe

exactly what a conical connection is but

the use of conical tractions have gone

up two hundred and sixty eight percent

over the last four years and that’s

quite a bit and what is it about a

conical connection that’s so cool well

we’ll figure this out but before we get

into talking about connections I just

want to throw down a little bit

more terminology and talk about engaging

versus non engaging connectors or

abutments or attachments so we know that

if we have a single toot

we want to stick an abutment in that

gray and black hive printed textile

single tooth we don’t want that a button

to rotate we want to duplicate what’s in

the mouth and either take an impression

or a digital image and have that sort of

reference and not move around so for

most single units we use an engaging

connectors something goes inside the

internal connection and prevents this

rotation when we’re using healing

abutments or if we’re using multi unit

abundance we do want it to spin around

we do want to have the freedom of not

having to have internal connections draw

now look a little bit about the

all-on-four technique on certain aspects

of the all-on-four technique you do want

engaging and sometimes you don’t want a

check well the let’s cut to the chase so

really if you look at all the different

implant connections the name of the game

in let’s back up a little bit the name

of the game in placing implants as a

surgeon is to put your implants into the

bone and not have the bone go away so

there’s certain things that we do during

surgery of not overheat the bone not

over torque it make sure we have enough

bone to keep it on around the implant

now when it comes to restoring we can

introduce a lot of variables that can

cause bone loss later on we can put it

into too much occlusion and have the

patient buy on it with non-working

interferences and cause it we can leave

cement around it

and that tube can cause

some bone loss around the implant but

really this discussion is to talk about

something called a micro gap now doctors

if rich in Germany did a really really

cool study and I invite anyone to look

up differences studies on different

types of implants and what he did was he

looked at various implant connection

types under function and figure out how

they moved around now if any of you have

dealt with a that call we don’t want to

get from the patient where they say hey

Doc I think my implant is loose the

first thing you think about is okay I’m

freaking out my implant is going to fall

out but then you see the patient and

turns out that the implant itself is not

loose however the abutment and/or crown

is if you look at the tissue around the

very loose abutment it looks really

really bad and the reason why is that

we’re pumping all sorts of saliva

bacteria into that implant abutment

connection and causing the infection

so he looked at that distance that micro

gap between the abutment and the implant

itself and what factors related to that

one other thing if you read zipper

exposure if you go on YouTube just go

ahead and type as if rich and you’ll get

to watch his really really good lecture

and I got to tell you I’m used to

watching very techy lectures and stuff

about all sorts of stuff it is a great

lecture in its simplicity because it

really gets down to the bottom of it

about why we have bone loss around

implants and a lot of it is related to

screwing and causing the micro gap

zippers had a really really good analogy

earlier a kid and I grew up in

Washington state and basically arraigned

all the

time and one thing that was always fun

to do as a kid was I would go out I

would put on my rain boots and jump

around man

dr. zip bridge had a really good analogy

you’re jumping around you’re splashing

the water everything is cool and then

you hit a really deep puddle and what

happens well your rain boots fill up

with water and then you’re sloshing

around it’s very uncomfortable

one thing that he looked at besides the

lateral movement of implants was

aerial photography of river between cliffs

something that he termed the micro pump

and the micro pump was related to the

amount of space and a vacuum that space

caused on an implant and so if we have a

lot of space inside our implant that the

parts don’t fit right and there’s just a

lot of gap when you chew back and forth

that lateral movement will open up a

micro gap and then micro pump or vacuum

will force fluid saliva bacteria into

your implant and have a nice little home

for that implant – or within that

implant for that bacteria so when

designing the ideal implant we want an

implant that does not have much of a

micro gap and certainly does not have a

lot of space in between the implant

components I apologize my last

presentation had a really cool video so

you’ll have to use your imagination here

which is really not something you want

to do in a lecture but on the left-hand

side we have a very platform switched

implant that has a conical connection

and when chewing laterally on this

implant there’s really little micro

movement at all on the right hand side

we have an old-school implant that

certainly has a lot of space underneath

it and has sort of an external bevel and

that one had quite a bit of space

so why screw loosing bad so this is not

my patient on the image below but I tell

you that kind of presentation that very

puffy and very angry looking gingiva

around a loosened abutment screw is very

common and very scary I’ve placed

implants and done immediate

temporization only to have my temporary

loosen up and I’ll see something like

that and immediately think oh my god I

lost the and when we look at screw

loosening in general as long as we

torque our abutment screws down to the

proper amount of torque with the implant

system I use that’s 30 Newton

centimeters of torque I like to use a

multi torque wrench that you see above

the average amount of screw loosening in

modern implants is about six percent

that’s not a really big amount however

an external hex implants that we use

before they can be up to 57 percent of

screw rule fitting but hey what happens

when you have a screw loosen and this is

a bigger discussion it’s certainly a

topic for another webinar or a class

I’ve really moved from doing a lot of

cemented restorations to retain

restorations and so if you have in a

button that happens to loosen up the

first little game you’re going to play

is find the abutment screw if you’re

really really good and always put your

implant in the center of the attention

of space it should be easy to find and

if it’s not you can always look at your

x-ray and see where that is but in

essence what you do is you cut a hole

through the crown into the abutment and

make yourself a quote unquote screw

mental restoration so go ahead and pop

that out play some teflon tape of I use

a combination of two types of composites

I really like flow at ALC from premiere

as my flowable composite you can see how

opaque that is

a taste composite over the top this is

24 biker which I have the opaque version

the name of the game in filling access

fees on to routine crowns or if you’re

doing a screw mental restoration is you

know making sure that you pack enough

teflon tape to will pick that out we

talked about screw loosening a lot but

my Vain’s existence as a restorative

dentist is group breakage and lucky I’m

lucky in that I haven’t seen a lot of

broken screws in my day but when you do

have a broken screw it’s certainly

something you want to avoid and again

the topic today is the abutment

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