This In The First Place But This Real

connections we’ll talk about avoiding

this in the first place but this real

quick let’s talk about what happened so

this patient came in I had done a

titanium base with a ceramic screw

retain restoration on top I use this

type of tool there’s different names for


implant direct calls it the X s XP and

no that’s not something that teenagers

do with their phones the FX T stands or

screw extraction tool it’s fun clockwise

and as its goes in clockwise it backs

out the screw and as a side note I like

to always use the abutment screws that

come with my implants the native

abutment screw and implant direct we get

a free screw that comes with it however

if you’re using a different company you

may want to buy the abutment screw that

is native to the implant that you’re

using rather than abutment screws that

may be provided by your lab or the

company that makes the titanium base I

find them to be a little bit soft and I

think that’s why this broke one of the

great things about lecturing is I get to

meet dentists and chitchat and talk shop

with them one dentist told me a really

really good

a trick and I’ve yet to try it but if

you have an electric handpiece and you

can run your electric handpiece in

Reverse he suggests if you have a broken

screw to use a sharp new inverted cone

burr running counterclockwise on your

your high speed handpiece you’ll engage

the screw and spin it out also Pisa

domes are a great way to go ultrasonics

or another great way to go to remove

broken screws and I was managed to get

it out here to the final okay so let’s

get back to the topic at hand so really

if you look at popular connections the

three most popular connections out there

are the trial oh the trial of our based

on the Nobel replaced implants and

there’s certainly a lot of companies

that have tri lobe implants trial of

implants or how I got started in

planetology so the surgeon who is

placing implants and I was restoring

them used a tri low type implant and I

thought hey when I started placing

implants I kind of liked it I’m going to

go ahead and start I moved on later on

to an internal hex type implant and

later to the conical connection one

thing that’s great about tri lobe type

implants is they’re very very easy to

restore because the abutment only goes

in three ways hex type implants do have

variations and how you can restore it

especially if you have multiple implants

and multiple abutments that can become a

little problematic

um so more is not necessarily better to

take it one step further a lot of

conical connection type implants do have

hexes within them so there is an anti

rotational feature it’s just deeper into

the implant itself but for the sake of

this discussion in sort of my personal

experience will be discussing the

implants I have used the legacy and

from implant erectus one that I have one

variation on some internal axis is that

it has what’s called a 45-degree lead in

bevel and what that means is it’s kind

of a conical connection in that is sunk

into the implant and there is some

degree of angulation in that area that

is inside the inlet now a conical

connection implant has a very large

amount of ferrule or internal service

and that angulation is quite a bit

steeper than 45 degrees if you look at

sort of implant companies and implant

research one thing that’s nice is that

implant companies kind of I don’t want

to say copy off of each other but

there’s certainly dominant trends that

we see in implantology flap or external

hex pipe implants don’t have a lot of

internal ferrule or internal contact

between the sort of male portion of the

abutment and the internal connection

before you five-degree lead in bevel

internal x implants as you can see in

the size of the abutment the gold

portion on that zirconia is we got a

little bit more

however we go to a conical connection

type implant there is just quite a bit

of internal barrel or internal surface

area between the abutments and um there

is some disagreement on how you measure

the degree of internal connection that

we have some people measure it from the

outside so you might hear a conical

connection having a 10 degree or a 15

degree some measure from the inside so

for the sake of this discussion I’ll be

measuring it from the inside

so a butt joint type implant

photo of thunderstorm

um really has no degree of internal

ferrule there’s sort of a portion the

guys to screw but we don’t really have

much of an emulation between the flat

surface and the inside so some may even

say that’s a 90 degree butt joint but

for the sake of this discussion let’s

just say that it is the internal hex

implant has a 45 degree lead in bevel

the conical connection type implant that

would we’ll be discussing today the

interactive from implant direct as

almost an 80 degree internal bevel and

there’s internal octagon type implants

that are compatible with Stralman that

is more of a more paper or a much deeper

internal connection which is 82 degrees

so why do we here why do we care what

type of internal connection that we’re

placing well again as mentioned earlier

surgically your restorative lis the name

of the game is to place an implant

that’s going to stay there forever we

want to minimize the amount of bone loss

that we have around our implant and it

stayed before and we know this in pareo

that if the patient comes in with tartar

all over their teeth and pleural hygiene

we’ll see inflammation of the gingiva or

gingivitis that sustained inflammation

will lead to periodontitis so if we have

an implant obviously we don’t have a

periodontal we can’t use the same

terminology but if we have localized

inflammation around the top of our

implant or implant platform that

sustained inflammation will lead to bone

loss over time so let’s talk about how

abutments connect with the rest of the

implant so the external Hecker implant

or the internal Trollope are described

as flat on flat connections and if you

look at the image to the right you can

see that external hacks is really a butt

joint with the connection inside the

implant and if you look the image

left you can see – there’s really no

degree of paper between that sort of

mail portion of the abutment and the

internal connection as a result you

really got to sort of open up the inside

of the implant to allow these to clear

imagine having a crown press and your

crown prep has a zero degree of table

any casting problem or problem with the

lab will prevent that crown from seating

so as a result you’re going to need more

die spacer and implants with a flat on

flat connection they typically have a

large amount of space inside the implant

and that turns into a micro pump as the

tooth people – laterally more and more

saliva and bacteria will be pumped into

the inside of the implant and this is

just sort of shows you the difference

between the two now one thing that’s

very interesting and we’ll talk a little

bit about tactile feel when using a a

conical connection because there’s such

a large amount of the abutment that sits

inside as you torque the abutment down

there is a sort of spreading effect

between that conical can or the conical

connection and the internal part of the

abutment and the abutment will actually

spread the implant laterally that gives

us quite a bit of cold welding and

further prevents any sort of micro

movements on the impact one side note

which is an interesting thing that

certainly has happened to me which is no

fun at all but when you’re using and a

tri lobe type implant sometimes those

points of the hex

the high pain can get very thin around

those areas and implant direct is

certainly has taken

measures to bolster or thicken the

amount of implant material around these

try loads but I’m sure there’s a lot of

people out there who have had to deal

with implant flowering and again that’s

certainly not a fun thing to do

interesting enough reading the zipper

study I remember some of the first trial

of type implants I would take off the

abutment screw or maybe if I put on a

temporary abutment it was ready to

restore he would take them off and you

know dang it would be really really

smelly in there and so back to dr.

zebras analogy of the galoshes and being

in water you’re just getting all sorts

of yucky has basically pumped into your

implant internal connection and this is

just an example of taking off an

abutment and seeing that the results of

that micro pump one other interesting

aspect doctor exhibits were looked at

was the amount of micro gap between a

platform shifted implant and a non

platform shifted in and this makes a lot

of sense a platform shifted implant will

display much less of a micro gap then

something that does not and I think that

purple green and orange abstract painting

really just plays hand-in-hand with the

diameter of the implant the amount of

movement you get obviously as you get to

the edges or fringes of a very large

abutment that is going to move just

another image showing the difference

between flat on flat and conical the

take-home message really is that by

minimizing the amount of space inside

the internal connection and also having

this bolstering effect of the implant

pushing laterally onto the internal

connection and sealing things up and

getting cold welding we can minimize


as days before this area marked in

orange is the area where the implant

will spread laterally one thing that’s

nice if we have a lot of good bone is

that bone is also going to be pushing

back so as that spreads laterally the

bone will push back and further squeeze

that and decrease with the amount of

micro movement so as an aside people

often ask me hey implant direct is an

awesome company they have 16 18

different types of implants not so cool

and then other nipples say hey wait a

minute there is 16 or 18 different

implants out there why should I choose

one or the other well I have evolved

from utilizing a trial of implant to

utilizing an internal hex implant to now

using a conical connection type implant

and so there’s certain aspects of the

implant that I personally use the

interactive that I really like I like

the taper of the implant it has very

aggressive threads I like the concept of

micro threads as we approach the crustal

bone these micro threads get smaller and

smaller exerting less force on cortical

bone we know that medullary bone has a

much greater blood supply and is less

prone to bone loss versus cortical bone

which has less vascularity so I don’t

want to over torque that area one other

cool thing about the interactive is the

way that this little snappy portion

attaches to the abutment that portion is

captured within the implant or within

the impression as we take an impression

and we’re able then to place our

analogues with a metal-on-metal

connection as stated before the having

that conical connection coupled with a

very nice platform switch it really kind

of decreases the amount of micro

movement and bone loss that we have the

micro threads as we approach the

cortical portion of the bone is

described for are also a beneficial to

decrease people often I’m asked to what

are some other factors in the factor in

to my choice of using an implant or not

using an implant and you really have to

ask yourself how do you restore are you

a custom above unscrewed screw tain type

of girl or guy or do you like just using

a stock abutment and you know gluing

stuff on and just being done with it

some people feel very comfortable

placing their implant and placing the

abutment and managing the tissue under

will rather just have their specialist

go ahead and put an abutment on and give

you some sort of a snappy cap or some

sort of easy way of taking an impression

one concept that’s near and dear to my

heart is guiding a plan surgery and I’ll

discuss a little bit the difference

between fully guided and freehand

placement of implants after utilizing

the surgical guide and there’s certainly

implants that cater more to that one

thing I do like about the implants that

I currently place or all-in-one

packaging I remember back in the day

when I started placing implants I didn’t

know what to order and as a result I

forgot to order

healing about men’s above and screws

impression copings so I do like the fact

that we have various types of packaging

that allow me to have all those things

in one and it really the only thing I

have to purchase lab analogs if I do a


and out to a lab just a quick talk about

fix your mouth I use implants um that if

I’m not doing guided implant surgery

have mounts on them and fix your mounts

that are available and implant direct

have different sort of ways we have

fixed amounts like the purple one you

see in the far left whose only job is

really to take the implant into the

mouth and serve as a clothes tray

impression coping

we have fixture mounts which can be

utilized to retro-fitted enter into a

temporary hybrid like this this is a

replant amount that you see next to the

purple one or a legacy to mount is very

similar these screw tame mounts could

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