Implants

Implant brands & connections

We maintain the armamentarium to work with all modern platforms for Straumann, Nobel, Astra, & Zimmer implants.

For a reference on these implant specifics, visit implantcharts.com.

One mouth, one brand

If a patient already has existing implants, our recommendation is to always keep the same brand as they have existing, so long as it is a reputable brand. Having multiple implant brands and platforms will complicate restoration should they every need to be used together in the future.

Tissue level versus bone level

We always prefer bone level implants. If there are systemic or local factors that indicate a tissue level implant for a single tooth implant or overdenture case, we are willing discuss. We ask that we are part of this conversation as early as possible as we no longer routinely stock impression components for Straumann bone level implants.

Straumann

Implants with a CrossFit connection (SC, NC, RC) are preferred for all applications. Implant with TorcFit connections (BLX, BLC, TLX, TLC) implants are suitable for overdenture cases, this platform is not ideal for fixed cases due to the undersized nature and over-emphasis of clearance fit geometry of TorcFit connections. Standard Plus (tissue level) are not preferred because of their increased prosthetic complication rate, but may be preferred in specific applications.

Nobel-Biocare

When using Nobel implants, we prefer the Conical Connection platform. We purposely avoid the Nobel 3.0 implant & platform because of its low prosthetic screw torque value.

Denstsply-Sirona Astra

In the Dentsply-Sirona world, EV implants are preferred.

Planning

Our expectation is that all implant cases will be CT guided and placed using a surgical guide and we set our patient's expectations accordingly. With the modern systems incorporating crown down planning into their softwares, we have moved away from providing a wax-up as we have in the past.

If you need anything from us, whether it is a wax-up or surgical guide, let us know and we will be happy to provide what you need.

For edentulous cases, we aim to provide a conventional denture for use as a scan appliance and for use as in interim during the healing phases of treatment. In some cases, we may avoid this at the patient's direction to decrease expenses, we always prepare the patient that their preference may need to be overridden by the need for a scan appliance.

Restorative space

Angle correction

Specific prostheses

Single tooth implants (STIs)

• We always plan to use a custom abutment.
• We always plan to use a screw retained prosthesis.
• Our primary custom abutment is the Dentsply-Sirona Atlantis gold-shaded custom abutment.
  • We can angle correct up to 30° with modern custom abutments and hexalobular screws on most modern implant platforms.
  • If possible we will use a straight screw access channel as there is some evidence that hexalobular screws provide inaccurately low torque values using standard instrumentation.

Implant retained FDPs (irFDPs)

• Implant retained FDPs are an anomoly in that they are the one class of prostheses where we consistently to use feldpathic porcelain stacked on a custom chromium cobalt framework. This is the weakest of all prostheses, occlusion should be given extra consideration.
• We can angle correct up to 30° with modern custom frameworks and hexalobular screws on most modern platforms.

Implant-retained overdentures (OVDs)

In planning placement in preparation for implants, please give us:

• A minimum of 10mm restorative space.

• As much A-P spread as possible.

• As much inter-implant distance as possible.

• As much parallelism of implants as possible.

  • Implant divergence is ideal below 20°. With less than 20° of divergence, any retention system can be used (Locator Standard Range (SR) or Novaloc).
  • We can manage divergence up to 40°. Divergence between 20-40° is possible, but only with the Locator Extended Range (ER) system.
  • Divergence up to 60° management is possible with Locator RTx systems. We do not routinely stock or use this system

  Expect increased wear even with angulation within tolerance

  Even when divergence can be managed at the prosthetic level, increased divergence is associated with increased insert wear.

  Divergence & patient satisfaction

  Anecdotally, implant divergence is related with decreased patient satisfaction due to a perceived rock, especially if combined with poor A-P spread.

• We generally avoid overdentures on bars because of the increased space requirements and the increased associated prosthetic complications.

  • The primary reason we would consider this is to improve A-P spread.
  • Research has not shown cross-arch splinting to improve implant survival.

FP1/FP2 fixed, full arch prostheses (FP1/2 FFP)

• Number of implants at surgeon's discretion, textbook ideal is:
  • Maxillary implants at sites #3, 5, 6, 8, 9, 11, & 14 to support FDPs #3-5, 6-8, 9-11, & 12-14.
  • Mandibular implants at sites #19, 21, 22, 27, 28, & 30 to support FDPs #19-21, 22-27, & 28-30.
• Second molars are not appropriate on these prostheses.
• No distally cantilevered pontics.
• Mesially cantilevered pontics may be selectively considered if necessary, so long as the occlusion can be designed to have the pontic left out of both centric and excursive function.

FP3 fixed, full arch prostheses (FP3 FFP)

• Number of implants is at surgeon's discretion, we need 4 to restore.
• 14mm of vertical restorative space is ideal.
  • It is possible to restore down to 12mm, but specific implant brands, platforms, and protocols must be used with distinct divergence requirements as these prosthesis are direct-to-fixture, without a multi-unit abutment.
• We will always plan to restore with monolithic 3-Y zirconia.
• Pursuing both arches simultaneously improves esthetic and occlusal outcomes.
• Second molars are not appropriate on these prostheses.
• Distal extension should be less than 1 whole tooth.

Healing abutments

Generally, the largest healing abutment that you can give us is best, but at the end of the day, all healing abutments are one-size fits all and round.

We generally optimize the custom abutment/framework design for cleansability taking the local anatomy into account. This is typically highly anatomic. We are not scared of blanching or pressure during delivery and will anesthetize and create a small crestal incision if necessary.

Clearing implants for the restorative phase

We really appreciate it when you do a final healing check, including a torque test, of your implants prior to sending them back to us for the restorative phase of treatment. When an implant spins during delivery the patient is upset and we are out the cost of the abutment or prosthesis. It happens, but we want to minimize this.

Our team is trained to not schedule patient's for final impressions until we have received definitive proof that you have cleared the implant for restoration. This ideally comes in the form of a letter.

Final impression thoughts of surgical concern

Whenever possible, we prefer the Dentsply-Sirona Atlantis custom abutments and frameworks/suprastructures. One of the reasons for this is their scanbodies have a metal platform that roughly approximates the fixed platform of the custom abutment. This basal portion, usually around 1mm, comprises part of the platform and is not customizable. This allows us to confirm definitive seating as well as assess if there is going to be any bony impediment to seating the definitive prosthesis.

Straumann CARES custom abutments and frameworks are avoided in our office unless required by the implant platform.