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

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

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