Safer Installation Presentation
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The document discusses the complexities of intra-oral cementation in dental implants, highlighting factors such as misfits, residual cement, and voids that can lead to complications like peri-implant diseases. It compares screw-in versus cement-in techniques, concluding that both methods carry risks but that improving cementation techniques can reduce negative outcomes. The paper emphasizes the importance of managing excess cement and employing optimal fitting techniques to enhance patient safety and treatment efficacy.
Safer Installation Presentation
- 1. 1 Can We Make Intra-oral Cementation Safer? Emil L.A. Svoboda PhD, DDS Web Version April 11, 2017
- 2. 2 Milan Jovanovic RDT Digital Workflows 1(888)337-5223 www.DiamondDentalStudio.com Acknowledgements Vladimir Agranat PhD Fluid Mechanics 1(416)708-7153 www.acfda.org Helping Deepen my Knowledge of Laboratory Technology and Making Custom Prosthetics Helping Deepen my Knowledge of Fluid Dynamics and Modeling Technology
- 3. 1. Patient Related • Inherent Biology and Host Resistance • Environmental Challenges and Presence of Specific Pathogens • Lifestyle and Maintenance 2. Industry Related • Technology and Its Limitations at a Practical Cost – Accuracy Costs Money • Dentist - Technique Related Treatment Complications Have Many Contributing Factors that Interact 3 Complications are Bad for Business
- 4. Presentation Sequence 1. Adverse Conditions Created by the Dentist • Screw-in and Cement-in Techniques 2. Safer Cement-in System • Correcting Margin Design • Preventing the Gingival Effects • Preventing Cement Voids • Reducing Cementation Pressure 3. Understanding Retrievability 4. Safer Screw-in System Preventing Technique Related Complications 4 Providing Safer Implant Treatment
- 5. Which is Better for the Patient? Which Reduces Complications? What is the Perceived Implant Dilemma? 5 Should We Install Implant Prosthetics by Screw or Cement?
- 6. 4 Significant Reviews 2013-2015 Mucositis 30% of Implants Peri-implantitis 15% of Implants *Peri-implant Disease 45% of Implants Failure Rate of implants 4% 5 years, 8% 10 years No Difference Between Cement or Screw Installation 6 Atieh MA et al. The Frequency of Peri-implant diseases: A systemic review and meta-analyses. J Periodontol 2013:84(11):1586-1598 Whittneben et al. Clinical Performance of Screw- Versus Cement Retained Fixed Implant-Supported Reconstructions: A Systemic Review. The Int J Oral Maxillofac Implants; 2014:29(Suppl):84-98. Sherif S et al. A Systematic Review of Screw- versus Cement-Retained Implant Supported Fixed Restorations. J of Prosthodontics 2014 (23)1-9 Daubert DM et al. Prevalence and predictive factors for peri-implant disease and implant failure: a cross- sectional analyses. J Periodontol 2015:86(3): 337-347
- 7. No Difference in Complications Between Cement or Screw Installation 7Can We Do Better By Incorporating New Knowledge? Let’s Find Out How
- 8. Why do We Need to Adjust the Prosthesis to Make it Fit in the Mouth? Contacts, Occlusion, Margin Fit 8 Fits on the Model BUT Not in the Mouth! Whether Created from Physical or Digital Impressions
- 9. The BIG Problem with Screwed-in Prosthetics 9 Inaccurate Model The Abutment-Prosthesis Complex is Combined on an Inaccurate Model Fits on the Model BUT Not in the Mouth
- 10. *Acceptable Levels Model Error of 100 to 150 microns Passive Fit could not be achieved with Screwed-in Prosthetics! *Review: Passive Fit in Screw Retained Multi-unit Implant Prosthesis Understanding and Achieving: A Review of the Literature. M.M.Buzaya and N.B. Yunus. J Indian Prosthodont Soc. 2014, Mar;14(1):16-23 Comparison of the Accuracy of Different Transfer Impression Techniques for Osseointegrated Implants. Zen BM et al. JOI Vol 41 No 6 2015: 662-667 Branemark PI, Zarb GA, Albrektsson T. Tissue -integrated prostheses. Chicago: Quintessence; 1985. p. 253 10 Figure of implants above from “Dental Implant Prosthetics, Carl E. Misch, Elseier Mosby, 2005 & 2015 Even the theoretical suggestion of “not more than 10 microns error” by PI Branemark in 1985, could be considered sloppy as periodontal pathogens are around 1 micron in diameter and less Mechanical and Biological Instability
- 11. 11 Abutment-Prosthesis Complex is Made to Fit the Model and Joined Together Built on Inaccurate Model (±100 µm) *Optimized Laboratory Technician makes Abutments and Prosthesis fit Inaccurate Model and Joins them Together Implant 2 Analogue Built on Inaccurate Model (±100 µm) *Optimized *Optimized for Implant Analogue Abutment- Prosthesis Complex *Optimized to Fit Inaccurate Model and Joined Implant 1 Analogue Prosthesis Abutment Abutments Joined to Inaccurate Prosthesis have Inaccurate Relative Position And Alignment Abutment Abutment Prosthesis Abutment Dentist removes the Screw-Abutment-Prosthesis Complex from an Inaccurate Model to Install into the Mouth
- 12. 12 The Screw-in Technique Creates Misfits and Stress at the Implant-Abutment Connection Built on Inaccurate Model (±100 µm) *Optimized *Optimized to Fit Inaccurate Model Screw-in Installation Creates Misfits at the Deep Tissue Level Misfits are Difficult to Fix Mechanical and Biological Problems *Misfits create STRESS and VOIDS at the Deep Tissue Level Implant 1 In Mouth Optimized *Misfit Implant 2 In Mouth Abutment Abutments are joined to Prosthesis Abutments are joined to Prosthesis Dentist removes the Screw-Abutment-Prosthesis Complex from an Inaccurate Model to Install into the Mouth Abutment
- 13. Multiple Unit Screwed-in Prosthetics AMPLIFY the Implant-Abutment Misfit Problem! 13 Figure of implants from “Dental Implant Prosthetics, Carl E. Misch, Elseier Mosby, 2015 Pg 740 Dental Implant Prosthetics. Carl Misch, 2nd Edition, Elsevier-Mosby, 2015,Ch 28. Passive Fit in Screw Retained Multi-unit Implant Prosthesis Understanding and Achieving: A Review of the Literature. M.M.Buzaya and N.B. Yunus. J Indian Prosthodont Soc. 2014, Mar;14(1):16-23 – an elusive goal! Bacterial leakage of different internal implant/abutment connections. Nasar HI and Abdalla M. Future Dental Journal 2015 Why Do We Need a Specific Screw Tightening Sequence for Multiple Implants?
- 14. Derks et al. Effectiveness of Implant Therapy Analyzed in a Swedish Population: Prevalence of Peri-implantitis J Dental Research, 2016 Vol 95(1)pp43-49 (588 patients with 2,277 implants ) Patients with 4 or more implants were 15X more likely to have Peri-implantitis 14 Effectiveness of Implant Therapy Analyzed in a Swedish Population: Prevalence of Peri-implantitis. Editorial by Emil L.A. Svoboda PhD, DDS. www.ReverseMargin.com. Aug 8, 2016. 79% of these prosthetics were installed by the screw-in technique
- 15. This is a World-Wide Problem that May Reduce Demand for Implant Treatment Derks J, Tomasi C. Peri-implant health and disease. A systematic review of current epidemiology. J Clin Periodontol 2015; 42 (Suppl. 16): S158–S171. Department of Periodontology, Institute of Odontology, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden Meta-analyses weighed mean prevalence /Implant Peri-implant mucositis 43% Peri-implantitis 22% Peri-implant Disease 65% 1. Peri-implant Diseases are common complications 2. Clinicians should inform their patients prior to treatment 3. Clinical strategies should include preventative measures 15
- 16. “Primary Prevention is of Key Importance” “Preventing peri-implantitis by managing peri-implant mucositis” Is that primary prevention??? 16 How do you correct an implant-abutment misfit? This Misfit PROBLEM Can be Prevented by Intra-oral Cementation! Jepsen S et al. Primary Prevention of peri-implantitis: Managing of peri-implant mucositis. J Clin Periodontol 2015;42 (Suppl. 16) S152-S157 S Sahin and MC Cehreli. The Significance of Passive Framework Fit In Implant Prosthodontics: Current Status. Implant Dent 2001;10 85-92
- 17. 17 Parts are Assembled in the Mouth • Abutments are Individually Attached to dental implants • Implant-Abutment fit is not dependant on the model accuracy • No tight contacts to keep the abutments from seating Implant-Abutment Connections are Optimized! Intra-oral Cementation Technique The Big PROBLEM is Residual Subgingival Cement!
- 18. 18 The Current Cement-in Technique Abutments are Individually installed onto implants already in the Mouth Implant 2 In Mouth *Optimized Fit Implant 1 In Mouth Individual Abutments Installed First Abutments are NOT joined to Prosthesis Abutment Prosthesis is NOT Joined to Abutments Abutment
- 19. 19 The Current Cement-in Technique Abutments are Individually installed onto implants already in the Mouth Implant 2 In Mouth *Optimized Fit Implant 1 In Mouth Cement-in Prosthesis Optimizes the Implant-Abutment Fit Cement Space Allows for a Passive Fit of the Prosthesis Implant 2 In Mouth Built on Inaccurate Model (±100 µm) Misfit/Cement Filled *Optimized Fit Excess Cement Is a Problem! Excess Cement Can be Removed, BUT Can it be Prevented? Implant 1 In Mouth Abutment 1 Abutment 2 Abutments are Independent Abutments are Joined by the Prosthesis After they have achieved optimal fits with their Implants Prosthesis
- 20. Excess cement can go deep into the peri- implant tissues where it is difficult to see on x-rays and where it can be very hard to remove from the surfaces of the prosthesis, abutments and implants. 20 Cementation in Dental Implantology. An Evidence Based Guide. Edited by Chandur P.K. Wadhwani. Published by Springer 2015. Many “Screwers” Focus ONLY on this Problem! And Deny/Choose to Forget the Serious Misfit Problem! Many “Cementers” Deny having this Serious Problem! What is the Actual Implant Dilemma?
- 21. Nissan et al. Long-Term Outcome of Cemented Versus Screw-Retained Implant-Supported Partial Restorations. Int J Maxillofac Implants 2011;26:1102-1107 Split Mouth Design, 38 patients, 221 Implants, mean follow up 5 years, up to 15 years 21
- 22. Residual Excess Cement & Peri-implant Disease cemented single unit implant crowns 39 consecutive patients with 42 implants with peri-implant disease 12 of the same patients had 20 implants without disease and without detectable subgingival cement 34 of 42 the test implants had Residual Subgingival Cement ( 81%) After Cement Removal 25 of the 33 (74%) no longer has signs of peri-implant disease (74% of the 81% = 60%) 22 Thomas G Wilson Jr. The Positive Relationship Between Excess Cement and Peri- implant Disease: A Prospective Clinical Endoscopic Study. J. Periodont 2009;1388
- 23. Peri-implant Disease is Reduced by Subgingival Cement Removal! 60% of the Peri-implant Disease Cases got better when Residual Subgingival Cement was Removed 23 Single Tooth Cemented Restorations Thomas G Wilson Jr. The Positive Relationship Between Excess Cement and Peri-implant Disease: A Prospective Clinical Endoscopic Study. J. Periodont 2009;1388-1392
- 24. Preventing Residual Subgingival Cement could reduce peri-implant disease by 60%! 24 Albert Einstein “Intellectuals Solve Problems, Geniuses Prevent them.” Treatment of Complications can be Very Expensive!
- 25. What Determined the Margin Design for Replacement Teeth? The design of margins reflected available technology to create prosthetics Feather margin – soft gold at the thin margins were burnished towards the tooth retainers to form a seal. Chamfer & Butt – responded to the needs of porcelain and the availability of the high speed. The older cements also required high pressure installation to reduce film thickness and compensate for their low compressive strength and solubility at the margins. 19
- 26. Excess cement - 1. can be difficult to control** 2. can go deep into the subgingival spaces*,** 3. can be difficult to detect and remove** 4. is a risk factor for periodontitis and peri-implant disease*** 5. can be removed by endoscopic means or after surgical access*** *Cementation in Dental Implantology. An Evidence Based Guide. Edited by Chandur P.K. Wadhwani. Published by Springer 2015. **The Influence of the cementation margin position on the amount of undetected cement. A prospective clinical study. Tomas Linkevicius et al. Clinical Oral Implants Research. Vol 24,Issue 1, 71-76, Jan 2013. ***Thomas G Wilson Jr. The Positive Relationship Between Excess Cement and Peri-implant Disease: A Prospective Clinical Endoscopic Study. J. Periodont 2009;1388-1392 What do we understand about intra-oral cementation today? It is a hydraulic event.* 26
- 27. Margin Design Effects the Direction of Cement Flow! Why would you ever choose to use Margin Designs that direct excess cement into the tissues again??* 27
- 28. Gingival Effects Discovered! 28 When “Gingiva” was present on the model – Excess Cement was still projected under the Gingiva, regardless of Margin Design!
- 29. Controlling Excess Cement During The Process of Intra-oral Prosthesis Cementation: Overcoming the Gingival Effects. ELA Svoboda, OralHealth Oct 2015;52-66 and at www.ReverseMargin.com. The Gingival Effects on Cement Flow can be HUGE 29 They include the Deflection Effect, Eddy Effect, Plunger Effect and Bellows Effect. All Our Patients have Gingiva We Should All Understand The Gingival Effects on Cement Flow
- 30. Venting and *Retainer Replica Technique To Reduce the amount of cement ejected from the margins into the subgingival environment* 30 Effect of implant abutment modification on the extrusion of excess cement at the crown-abutment margin for cement-retained implant restorations. C. Wadhwani et al. The International journal of oral & maxillofacial implants 11/2011; 26(6):1241-6. Cementing an Implant Crown: A Novel Measurement System Using Computational Fluid Dynamic Approach. C Wadhwani, S Goodwin, K Chung. Clinical Implant Dentistry and Related Research, 2014. *Cemented implant restoration: A technique for minimizing adverse biologic consequences. G Galvan, J Kois, Y Chaiyabutr and D Kois. J Prosthet Dent 2015;114:482-485 *Technique for controlling the cement for an implant crown. C Wadhwani, A Pineyro, Journal of Prosthetic Dentistry. 2009:102;V1; 57 Effects of a Cementing Technique in Addition to Luting Agent on the Uniaxial Retention Force of a Single-Tooth Implant-Supported Restoration: An In Vitro Study. International Journal of Oral & Maxillofacial Implants . Santosa RE, Martin W and Morton D. 2010, Vol. 25 Issue 6, p1145-1152.
- 31. How much volume reduction do you need, to avoid both overfilling and underfilling the prosthesis? 31 Cement voids under a prosthesis can be very difficult to detect and correct Loose Control over Cement Volume and Cement Distribution using these techniques
- 32. Why do we cement restorations? 1) Retention 2) Fill Space to Prevent VOIDS 32 Are VOIDS Dangerous? a) Breading grounds for oral pathogens – top 3 reasons prosthetics on natural teeth fail and can cause peri-implant-disease b) Very difficult to detect and treat c) Reduce retention d) Discoloration e) Stink and taste bad Can VOIDS be Prevented?
- 33. 1) OVERFILL the prosthesis with cement and extrude excess cement from around the entire margin to prevent voids 2) Apply cement in such a way as to prevent air entrapment 3) Firmly hold the Prosthesis down while the cement sets 33 VOIDS can be very difficult to detect and correct VOIDS can be PREVENTED by Technique! Safer Intra-oral Cementation: Prevention of Cement Voids under the Prosthesis. ELA Svoboda, www.ReverseMargin.com Jan 3, 2017
- 34. Low Prosthesis Installation Pressure 34 Reduce Speed of cementation to 1) reduce pressure of the excess cement exiting the margins and 2) reduce pressure buildup under the prosthesis. Use a wider 80-100 micron cement space will reduce resistance to cement flow. Enhances Control of the Flow of Excess Cement How far do you want to project cement?
- 35. Cement Control System design features and techniques that make Intra-oral Cementation Safer 35 Prevents Peri-implant Disease related to: 1) Implant-Abutment Misfits 2) Residual Subgingival Cement 3) Cement Voids Safer Intra-oral Cementation: Prevention of Cement Voids under the Prosthesis. ELA Svoboda, www.ReverseMargin.com Jan 3, 2017 Controlling Excess Cement During the Process of Intra-oral Prosthesis Cementation: Overcoming the Gingival Effects. ELA Svoboda, OralHealth Oct 2015;52-66 and at www.ReverseMargin.com. I have already restored 560+ implants over 3+ years Prosthesis Installation Technique using the Reverse MarginTM Design and Technique. ELA Svoboda, www.ReverseMargin.com June 16, 2015.
- 36. 36 The Clinical Experiment 1 AD 14
- 37. 37 The Clinical Experiment 2 HA 14
- 38. 38 The Clinical Experiment 2 HA 14
- 39. The Clinical Experiment 3 HL 14
- 40. HL 14 The Clinical Experiment 3
- 41. 41 IJ 14 The Clinical Experiment 4
- 42. 42 IJ 14 The Clinical Experiment 4
- 43. 43 MJ 14 The Clinical Experiment 5
- 44. 44 RL 14 The Clinical Experiment 6
- 45. 45 RM 14 The Clinical Experiment 7
- 46. 46 WF 14 The Clinical Experiment 8
- 47. 47 WJ 14 The Clinical Experiment 9
- 48. 48Clinical Experiment 10 – Take Prosthesis Out PE 16 Experiment Experiment Experiment
- 49. 49 PE 16 The Process Experiment Treatment
- 50. 50 PE 16 Treatment and X-rays
- 51. 51Experiment and Results 10 PE 16 Experiment No Cement Beyond Margins
- 53. 53 KL 15-16 Experiment 11 Experiment No Visible Residual Cement beyond Margin
- 54. 54 WM 16 New Version Experiment 12 Not Remove Expressed Cement No Visible Residual Cement Experiment
- 55. 55 MC 16 Distal-LingualBuccalMesial Experiment 13 with Stock Abutment Creating Residual Subgingival Cement!
- 56. 56 MC 16 Install Case 13
- 57. Summary: Install Abutment*, Torque2X, Teflon, Lubricate, Cement Prosthesis*, Remove Excess, Maintain … Safer Installation! 57 *Use Cement Control System Concepts
- 58. 58Why do some clinicians choose to use the Screw-in Installation Technique? 1. Retrievability ***** 2. Because We Can! Is it Free? 3. Cannot Control Cement and Gave Up Trying Dental Implant Prosthetics: Achieving Retrievability and Reducing Treatment Complications by using a Modified Installation Technique. ELA Svoboda, Oral Health October 2016, pgs 8-20. also www.ReverseMargin.com
- 59. Is Retrievability Specific to the Screw-in Technique? a.Yes b.No 59
- 60. Retrievability is NOT Specific to the Screw-in Technique! 60 It is a Result of “Retrievability Features” of the Implant-Abutment- Prosthesis Complex
- 61. Allow the Abutment-Prosthesis Complex to be removed from the mouth and re-installed without any critical damage. “You can take it out and put it back again and it still works” 61 Retrievability Features for Screw-in Prosthetics
- 62. Retrievability Feature 1 62 Working Path of insertion parallel alignment of implants and sensitive to alignment remaining teeth ………. Can we really make implants and prosthetics parallel to adjacent teeth and each other in 3 Dimensional Space? a. Yes b. No
- 63. 63 Do they make it easier to fool ourselves about fit? Are they stable? Multiple units may require the use of multi-unit abutments to build a little tolerance to off-angle implants for the part that telescopes into the implant (internal hex, taper fit) or abutment (external hex). Retrievability Feature 2
- 64. 64 Use of special Angled Screw Channel (ASC) Abutment and special screw heads to help make more favorable access hole locations and reduce treatment related cantilevers. Retrievability Feature 3 Sadly …. None of these Features Solve the Implant-Abutment Misfit Problem if …
- 65. 65 …. the abutment-prosthesis complex is assembled on the inaccurate lab model first. Too bad! Screw-in Installation Creates Misfits at the Deep Tissue Level Misfits are Difficult to Fix Mechanical and Biological Problems *Misfits create Stress and VOIDS at the Deep Tissue Level Implant 1 In Mouth Optimized *Misfit Implant 2 In Mouth Abutments are joined to Prosthesis
- 66. Retrievability – Because We Can! 1. Repair and rejuvenate hybrid prosthetics*** - Prevent by use of more durable materials 2. Control Excess Cement Prevent - Use the Cement Control System 3. Replace and tighten loose abutment screws Prevent - Use Genuine parts and proper torque values (2X), optimize the implant-abutment connection, reduce or avoid cantilevers, use night guards … do not need retrievability to tighten screws – just need access to screw 4. Gain access to soft tissue under prosthesis Prevent complications, avoid cantilevers, work around prosthesis 66 It is Free? Is it worth it?
- 67. site development procedures $$$$ use of guided implant surgery $$ expensive additional parts and lab work dealing with screw access holes and their maintenance $$$ may create cantilevers that are difficult to maintain, are mechanically unstable and create space for oral pathogens $$$$ Current techniques cause an implant-abutment misfit $$$$$ 67Retrievability Features can Add Risk and Cost Retrievability features can be expensive! The Dentist must weigh the cost and benefit for each case.
- 68. 68 Retrievability Features can Add Risk and Cost Perio-endo issues, smoker, some medical issues TP16
- 69. 69 Retrievability Features can Add Risk and Cost No sinus graft advisable TP16
- 70. 70 Retrievability Features – Require a lateral sinus graft Immediate implants – used bone spreading graft TP16 Failed
- 72. 72Retrievability Features can Add Risk and Cost Some Parts are Non-RetrievableTP16
- 73. 73 Poor Dental IQ Can Add Risk and Cost Refuses – stop smoking, night guard, 3 month scaling TP16
- 74. 74 Poor Dental IQ Can Add Risk and Cost Refuses – stop smoking, night guard, 3 month scaling TP16 Tight Contact
- 75. 75Retrievability Features can Add Risk and Cost Can We Tighten Loose Abutment Screws? YesKC16
- 76. 76Retrievability Features can Add Risk and Cost This is not my work! What is next Upper Left?MA16
- 77. 77Retrievability Features can Add Risk and Cost This is my solution – Not Retrievable MA16
- 78. 78 Retrievability Features can Add Risk and Cost KS16 How about reducing the need to retrieve a prosthesis?
- 79. 79 Retrievability Features can Add Risk and Cost KS16 Not Mine Not Mine
- 80. You have convinced Your Patient to buy a Retrievable Screw-in Fixed Restoration. 80 Can you prevent the implant-abutment misfit?
- 81. Retrievability Features are in Place 81 Assembled on Model Implant-Abutment Misfit Iatrogenic Complications Current Screw-in Installation Can We Make the Screw-in Prosthesis Retrievable and Prevent the Implant-Abutment Misfit? YES
- 82. Retrievability Features in Place 82 Assembled in Mouth Optimized Implant-Abutment Connection Excess Cement Removal Confirmed This does not need Cement Control Design Features, but they might be helpful for fully seating the prosthesis in place. Screw access holes are available for easy access on a needs basis. Svoboda Modification 1 1. Lab delivers abutments and prosthesis separately with … 2. …access holes sealed with acrylic plugs 3. Dentist installs abutments to optimize their fit 4. Access channels are filled with Teflon plugs 5. The prosthesis is cemented into the mouth 6. Excess cement is removed, as well as possible 7. The access holes are drilled out 8. Prosthesis is taken out of the mouth 9. Excess cement removed 10.Assembled Prosthesis is screwed into place 11. Teflon plugs are reinstalled 12.Acrylic plugs are remade 13.Occlusion is adjusted Svoboda Modification – Option 1
- 83. Retrievability Features in Place 83 Assembled in Mouth Optimized Implant-Abutment Connection Prosthesis Seating and Excess Cement Removal Facilitated by use of the Cement Control System. Screw access holes are available for easy access on a needs basis. Svoboda Modification 2 1. Lab delivers abutments and prosthesis separately with … 2. …access holes sealed with acrylic plugs 3. Dentist installs abutments to optimize their fit 4. Access channels are filled with Teflon plugs 5. The prosthesis is cemented into the mouth 6. Excess cement is removed 7. The access holes are drilled out 8. Prosthesis is taken out of the mouth 9. Excess cement removed and voids are filled 10.Assembled Prosthesis is screwed into place 11. Teflon plugs are reinstalled 12.Acrylic plugs are remade 13.Occlusion is adjusted Svoboda Modification – Option 2
- 84. Retrievability Features in Place 84 Assembled in Mouth Optimized Implant-Abutment Connection Excess Cement Removed Effectively Needs Cement Control System Abutment Screw access hole can be made on a needs basis Simplified Svoboda Modification Least Steps, Reduces Service of Acrylic Screw Access Hole Cover. 1. Lab delivers abutments and prosthesis separately with … 2. …access holes sealed with acrylic plugs 3. Dentist installs abutments to optimize their fit 4. Access channels are filled with Teflon plugs 5. The prosthesis is cemented into the mouth 6. Excess cement is removed 7. The access holes are drilled out 8. Prosthesis is taken out of the mouth 9. Excess cement removed and voids are filled 10.Assembled Prosthesis is screwed into place 11. Teflon plugs are reinstalled 12.Acrylic plugs are remade 13.Occlusion is adjusted Simplified Svoboda Modification
- 85. Retrievability Features in Place 85 We can retrieve either prosthesis by accessing the abutment screw on a needs bases. Svoboda Modification 1&2Simplified Svoboda Modification NoDo we need to remove a prosthesis to tighten a screw?
- 86. … Now we can Prevent Implant-Abutment Misfits for Retrievable Prosthetics Too? 86 Albert Einstein “Intellectuals Solve problems, Geniuses Prevent them.” This has the potential to reduce peri-implant disease by 60% Svoboda E. Dental Implant Prosthetics: Achieving Retrievability and Reducing Treatment Complications by Using a Modified Installation Technique. OralHealth October 2016, pp 8-18
- 87. Why Reduce Complications? 87 This Can be Very Costly 1. Loss of Productive Time 2. Working in a hostile environment 3. Loss of patients and negative referrals 4. Cost of retreatment 5. Possible college and legal action Because Now We Can!
- 88. The Reality is that We Need to Change our Installation Systems to Make them Safer 88 Safer Installation is Key to Making Implant Treatment Safer by 60% Because Now We Can and It is Our Responsibility
- 89. 1 Dilemma Resolved: Safer Cementation makes Implant Treatment Safer Whether You Choose to Cement-in or Screw-in Your Implant Prosthetics
- 90. 90 Thank you for Your Attention! drsvoboda@rogers.com www.ReverseMargin.com
- 91. Additional Information: If you are viewing a PDF Format version of my Powerpoint Presentation, you will not be able to watch the Videos V1 to V5. I feel that these videos are crucial to your understanding of the characteristics of cement flow during the intra-oral cementation process. I invite you to study these videos on my website www.ReverseMargin.com There are nuances to the my prosthesis installation system. Once I have my custom abutment seated, the prosthesis installation is much easier and better controlled than most current techniques. The Cement Control System promises to reduce treatment complications related to implant-abutment misfits and residual subgingival cement by 60% (extrapolated from the study by Wilson 2009). In addition it will help you understand and prevent complications related to cement voids that can be caused by some proposed installation techniques. This work is also relevant to prosthetics cemented onto natural teeth. The fluid dynamics are the same. I look forward to your comments and to your feedback regarding your experience with the my system. My above website has information regarding Laboratory support. I also look forward to opportunities to present my work to your Study Clubs and Academic Institutions. Its all about reducing complications. 91