Providing the Best Implant Services
Technology and material advancements make new strategies possible
Doug Frye, CDT, and Kevin Westrich Jr.
Printed implant surgical guides have provided dental laboratories with direct revenue streams and more favorable implant sites to restore, but an ancillary benefit has been the relationships that can be developed with dentists through this work. So often, laboratories are fighting just to get through the door of dental practices, but guided surgery allows us to figuratively jump over the gatekeeper and go straight to the dentist. As a result, implants and hybrid dentures offer significant growth potential, and custom abutments and bars can be a large part of that.
What are the benefits of custom abutments and bars?
Our laboratory prefers custom abutments rather than Ti bases, in the interest of helping our dentists provide their clients with the best treatment. A custom abutment provides a much larger canvas to which cement can be applied, which makes it possible to achieve a higher bond strength. A custom abutment also can provide increased support for the restoration, which can be critical in avoiding failure.
We have not done as many bars, but that is starting to change because of demand for full-arch restorations. The key is to ensure that vertical dimensions are considered, and that sufficient space exists to place the bar and the restorations on top of it.
What other trends are you observing?
In recent years, hybrid zirconia all-on-X restorations have been fabricated mostly with 1,200- to 1,400-MPa zirconia, but with no periodontal ligament and only four to six implant sites, a prosthetic with that much strength and no forgiveness is concerning. When a bar is stronger than the acrylic prosthetics that are screwed into it, the bar will not have any flexibility.
We have developed a strategy that utilizes a fiber-reinforced composite material for substructures with gradient zirconia. At 800 MPa, the gradient zirconia is stronger than lithium disilicate and very esthetic, and the composite still provides absorption, but we are not damaging the opposing arch or the implant site with high-strength zirconia.
How much do digital capabilities help?
The digital workflow has allowed us to help general dentists feel more confident about their placements, from the simplest implants to full-arch rehabilitations utilizing stackable guides. We utilize a workflow that is fully stackable and clean, and we also provide custom healing abutments at the time of surgery and even immediate temporaries, which is especially beneficial for esthetically driven patients in terms of contouring the sulcus and preparing for the final restoration. Each dentist has their own preferences for abutments, but our work with custom healing abutments and temporaries helps create more working room for the restoration.
The first consideration for any laboratory handling this level of implant work is to be educated on the process and make sure they are asking dentists for the simple details. For example, do not just assume that the dentist is torquing or hand tightening correctly and that the IMPRESSION COPING AND/OR FINAL ABUTMENT ARE SEATED properly to avoid rotational issues; ask that a quick intraoral periapical (PA) radiograph be taken to ensure that it is seated properly, because that will avoid headaches for everyone.
About the Authors
Doug Frye, CDT, is the Owner of D3 Solutions in St. Louis, Missouri, and Functional Esthetics Dental Lab in Farmington, Missouri. Kevin Westrich Jr. is Co-owner of D3 Solutions and VP of Production and Product Development for Functional Esthetics Dental Lab.