Dental Tribune U.S. Edition

Dental Tribune U.S. Edition | April 2012A18 Clinical benefits of the ‘Inclusive Tooth Replacement Solution’ By Darrin W. Wiederhold, DMD, MS, and Bradley C. Bockhorst, DMD A hallmark of the most successful modern clinicians is the ability to strike a balance between a daily load of 12 to 16 patients and maintaining the same high standard of care. No easy task when it comes to implant cases. Currently, the manufacturer is re- sponsible for the components, the labo- ratory for the restoration — after receiv- ing the impressions. Restoratively, that’s like erecting a house on an existing foundation, limiting the builder. Proper esthetics requires soft-tissue contour- ing that begins at implant placement, making stock components less than ideal. With the new Inclusive® Tooth Re- placement Solution from Glidewell Lab- oratories, custom-designed temporary components allow for immediate pro- visionalization specific to each patient, and a matching custom impression coping communicates the final gingi- val architecture to the laboratory. Add the implant, surgical drills, prosthetic guide, final custom abutment and fi- nal BruxZir® Solid Zirconia restoration (Glidewell), and the clinician receives all the components necessary to place, provisionalize and restore the implant. The Inclusive Tooth Replacement So- lution supports a streamlined workflow that ensures predictability and long- term success. Armed with the endgame in mind and the tools and road map to get there, experienced and novice clini- cians alike can place and restore dental implants with greater confidence than ever before. Implant treatment workflow • Consultation and data collection • Day of surgery protocol • Healing phase • Restorative phase: final impressions • Delivery of final prosthesis Consultation and data collection For single-tooth replacement or full- mouth rehabilitation, comprehensive treatment planning is paramount. You’ll need: • Full-arch upper/lower impressions (PVS) • Bite registration • Full-mouth radiographs (panoramic and CBCT scan, as needed. Note: If you do not have a CBCT scanner, refer pa- tient to an imaging center.) • Shade match of existing dentition • Preoperative photos Once you’ve selected a diameter and length of implant, forward the diag- nostic materials (impressions, models, bite registration, shade, implant size) to Glidewell for fabrication of the custom components. The laboratory will pour and articulate the models and assemble the components, delivered to you in an all-inclusive box (Fig. 1): • Prosthetic guide (Fig. 2a) • Custom temporary abutment (Fig.2a) • BioTemps® provisional crown (Glide- well) (Fig. 2a) • Custom healing abutment (Fig.2a) • Custom impression coping (Fig. 2a) • Surgical drills (Fig.2b) • Inclusive Tapered Implant (Glide- well) (Fig.2b) Day of surgery protocol Place the box contents alongside your usual surgical armamentarium. Con- firm the prosthetic guide fits snugly around the teeth. Visually confirm the proposed location of the implant oste- otomy correlates with your planned lo- cation. After placing the implant, decide based on the level of primary stability whether to place the custom healing abutment or the custom temporary abutment and accompanying BioTemps crown. Either option will begin sculpt- ing the soft-tissue architecture around the implant to develop the future emer- gence profile. If there is adequate attached tissue, use a tissue punch to remove the soft tissue over the osteotomy site; other- wise, reflect a flap. Note that the margin of the custom temporary abutment is set at approximately 2 mm. Depending on the thickness of the soft tissue, the abutment can be ad- justed and BioTemps crown relined. The custom healing abutment or BioTemps crown must be 1 mm to 1.5 mm out of occlusion to avoid occlusal stress. Store custom impression coping with patient chart for the restorative phase. Healing phase Schedule monthly follow-up appoint- ments to ensure osseointegration is pro- gressing and to adjust the provisional restoration. Restorative phase: final impressions Upon successful osseointegration, the restorative phase begins. Contours of the custom impression coping match those of the custom healing abutment or custom temporary abutment, so it’s simple to remove the custom abutment, seat the impression coping and take an accurate full-arch final impression us- ing a closed-tray or open-tray. Complete a simple prescription form included with the original box, select your final custom abutment and final shade for your BruxZir or IPS e.max® (Ivoclar Vivadent; Amherst, N.Y.) resto- ration, and simply forward these items to Glidewell. There are no additional laboratory fees. Delivery of final prosthesis On the day of delivery, remove the cus- tom temporary abutment and clean all debris from inside and around the im- plant. Try in the final Inclusive® Custom Abutment (Glidewell) and BruxZir or IPS e.max crown (Fig. 3). Check the contours, contacts and occlusion and adjust as needed. The final occlusion should be light on the implant-retained crown, with forces directed along the long axis to mini- mize lateral forces. The abutment screw is tightened to 35 Ncm, head of the abutment screw cov- ered and crown cemented. All excess cement must be removed. Instruct your patient about home care, and set a recall schedule. Fig. 1: Inclusive Tooth Replacement Solution Photos/Provided by Glidewell Laboratories Fig. 3: Final Inclusive custom abutment and final BruxZir or IPS e.max crown.Fig. 2b: Inclusive Tapered Implant and disposable surgical drills. Fig. 2a: Prosthetic guide, custom temporary abutment, BioTemps provisional crown, custom healing abutment and custom impression coping. iNdustry NEWs CDA BOOTH NO. 1444