Implants

Implant brands & connections

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

Straumann

Implants with a CrossFit connection (SC, NC, RC) are preferred for all applications. Bone level, TorcFit connection (BLX, BLC) implants are suitable for overdenture cases, this platform is not ideal for fixed cases at this time.

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 stock impression components for SP implants.

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.

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.

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 . In some cases, we may avoid this at the patient's direction to decrease expenses.

Restorative space

Specific prostheses

Single tooth implants (STIs)

• We always plan to use a custom abutment.
• We always plan to use screw retained prostheses.
• We can angle correct up to 30° with modern custom abutments and hexalobular screws.

Implant retained FDPs

• 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.

Implant-retained overdentures

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

• 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 or Novaloc).
  • We can manage divergence up to 40°. Divergence between 20-40° is possible, but only with the Locator ER system.
  • Divergence up to 60° management is possible with Locator RTx systems. We do not routinely stock or use this system.
  • Even when divergence can be managed at the prosthetic level, increased divergence is associated with increased insert wear.
  • Anecdotally, implant divergence is related with decreased patient satisfaction due to a perceived rock.
• As much A-P spread as possible.
• As much inter-implant distance as possible.
• A minimum of 10mm restorative space.

FP1/FP2 fixed, full arch prostheses

• 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 they can be left out of centric and excursive function.

FP3 fixed, full arch prostheses

• 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.
• 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 releasing 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 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.