Dental Implants
Calcitek, Sulzer, Centerpulse,
Zimmer, Nobel Biocare, etc.
Hex, Internal Spline,Tapered Screw Vent
And now Triangular Telescoping
Technology
With Nobel Biocare
3-27-13 UPDATE ..... It has been many years since I have visited let alone updated this site .... ALL OUR IMPLANTS ARE DOING
FANTASTIC ... No failures so far ... (knock on wood) I still use only custom hand waxed and cast HIGH NOBLE GOLD on both our abutment
crown that screws down into the analog that has had plenty of time to heal down inside the bone. And the finished crown that is cemented
over the abutment crown that has
the screw torqued into place thru the top of the abutment crown. The word Noble in metal means the least reactive ... the least
allergenic material there is period! And coming up out of the bone and tissue I think this is VERY IMPORTANT! It does cost more ...
But we have never done a case without it! I also have all our abutment crowns (and finished crowns) custom hand waxed and cast to fit
exactly each individual case the best way possible. We do more and more implants all the time ... I know I require a long healing time, but
refuse to change what works! ... I never EVER change a procedure because it's faster or less costly to do ... You only change a procedure because
it's BETTER!
We haven't used these old spline implants pictured here above for years now ... All Noble Biocare for now ... But all our old splines implants are doing fine
too. ... But I am still using those photos as they still shows the basic idea ...
2001 ... The age of the implant is really here for sure now. The latest implants have the superstructure screwed in and the crowns
cemented
over them. The screw head is not going through the outside of the crown and being pounded on by the opposing dentition and loosened.
The newer implants also have a 1.5mm internal hex, triangle, splines, etc for the superstructure to sit on or inside instead of the old 1/2 mm
raised hex . If the implant crown loosened even a little bit it could easily round off the corners ruining the implant in the bone, necessitating
surgical removal. And now these new internal tapered screw vents support even better ... and lock in kind of like how a fishing pole goes
together ... one telescoping into the other .. even more support that the splines.
I am going to show a case we just placed yesterday (2001) further down on this page. We used David at Sun Labs in Eureka, CA.
530 246-7600. Sun labs specializes in only implant lab work. They ship nation wide. David will rent all the instruments, torque wrenches,
etc. and sell any brand implant one might like to try out so you don't have to buy a different set up each time. They also use binocular
microscopes for that great fit.
We use high noble Gold on everything where cast metal is required but I think it is most important when used below tissue.
The case shown further down the page was done in Ivoclar (softer porcelain) and high noble Gold.
We start a possible implant with a consult with the oral surgeon for a 3D Tomograph, etc. to see if they are a candidate for an implant.
Enough bone, grafting, patient health, etc. If all is well we start with a surgical template or stent made of clear plastic that snaps over the
existing ridge and teeth to aid the
oral surgeon in placing the implants in the ideal angles and position.... The photo above shows the instructions to the oral surgeon to
consider for the implant and the photo just below this shows what a clear surgical template looks like. Getting the post in at the spot,
the right angle and in enough bone is the surgical goal! Why take a chance without a template?
We leave the surgical post in the bone to heal in the lower jaw for 5-6 months before we build the new crown on it and leave it to heal in
the upper jaw for at least 9 months because the bone there is more porous. I know this is longer than many dentists allow .... but having
been in the trenches for so many years and having waited for such predictable implants like we have now and seeing over the years that the
ones that were left in the longest before loading held up the best .... "I will not load an implant before it's time"!
We have been doing more multiple implants lately ... everything is working great!
Gingival Cuff
As previously mentioned, at the 1st consultation appointment with a 3D Tomograph Xray the oral surgeon will determine if
there is enough bone for an
implant and whether
some bone grafting might be required. On the surgery appointment he will place the implant(s) into the bone, using a template or stent
the dentist doing the case will provide as a guide so the posts are put in at as ideal an angle as possible and the bone mass allows.
He will at the same time place a thin metal healing cap allowing the gum tissue to heal in above it keeping all bacteria, etc. away from it as
it heals (think about it .. this is even a common sense thing!) And, about 6 weeks before the
implant is ready to start impressions for the crown I have him surgically expose and replace the healing cap with a taller gingival cuff
so we can access the implant for our crown to follow.
It is best to let the implant heal in the lower jaw for 5-6 months and 8-9 months in the upper jaw, because the bone is much less dense there..
The first thing your dentist will then do after healing, is remove the gingival cuff (shown above) with the hex wrench shown above (#3).
He will then put the retaining screw into the implant post, (#1) and snug it down into the implant where the healing cap was. Take an xray
to be sure it is seated all the way. Place a little cotton or foam into the top of the post so no impression material gets in there. Then he will take an
impression of your whole arch. We make a custom tray, but you must make allowance for 18 mm of clearance for the length of the impression post.
After the impression is taken the implant post is unscrewed and the post with the screw in it is snapped into the impression .. it has angled
flat sides to seat in the impression perfectly. The analog part (#2) that goes into the lab plaster model is screwed onto protruding screw at
the bottom of the implant post and poured up. This then 100% duplicates what you the patient has in your mouth. Your dentist will then with tight
finger pressure reseat the gingival cuff until the lab can deliver your new crown or you mill it out with you Cerec machine!
On your appointment to place your implant crown your dentist will first, again, remove the gingival cuff. He will then place the recessed
post screw (#3) down into the crown post (#4) and then screw the post into the implant (shown on model #6). This is then torqued into
place with the hex drive insert (#2) that is placed into the torque wrench (#1). Each implant brand has it's own torque wrench with it's own
setting.
David at Sun Labs makes the above pictured key that shows us that the implant is seated down in the right position. It also insures
that the crown post is seated all the way, as the key is made to fit perfectly over the top edge of the post. after trying on the crown and
checking the bite, if all is well, the post is torqued into place.
A small cotton pellet is placed in the top of the post so none of the cement we glue these implant crowns on with gets down in
the recessed part of the post, in case we ever have to remove it again later.
The finished crown in place, nice gingival papilla
Looks like the rest of the natural teeth
It is important to check the bite on these about
every 3 months or so the first 1 - 2 years to keep the lateral forces controlled.
There are no guarantees with any implant, but they are becoming much more predictable, especially if the stents or templates are used during
surgery and you have an oral surgeon or periodontist place them that does them routinely. ....And as already mentioned several times ... I also
think it is very important that the standard implants are left in the bone for plenty of time to really osteointegrate
as much as possible before loading them!. We usually wait 6 months on lower teeth and 8-10 months on upper teeth (the bone is less dense on
the upper teeth). We know how predictable these long time healing implants are and they keep the bone from resorbing! The immediate loading
ones might be okay, but it will take 10 -12 years to really find out.
One last thing .... I never pressure anyone into an implant ... We explain all the options first .... Plus ... If a patient is doing just fine with their
existing partial or what ever .... Why not leave things alone? Why even risk a possible complication not to mention all the costs involved.
These patients need not be coerced into implants.
- Kainos Dental Technologies Will Gianni DDS - Laser Instructor and Owner of this Fine Dental Laboratory
And Jerry Peck ... The Imaging Guru! ... 3D imaging center, Stents, etc.
If you are in So. Calif.
- Return to Doc Hemp's Dental Site
