Telbonatec.com/pdf/online_broshure.pdf · In summary, the development of minimally invasive dentistry is as follows; parallel pin technique Nonparallel pin technique.( Weissman, 1965)

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ContentsPermapinPin bridge-Clinical appoicationEZ GrafterEZ Lift DrillEZ HolderEZ GripRotosonic Scaler bur

04204044474848

PermaPin™ Pin retained resin bonded bridge system

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1. black plastic pin – for casting

2. Temporary pin

3. gold plated threaded pin

4. Drill – 2 size (Ø 0.60, 0.68mm)

5. EZ-grip tweezer

Conventional fixed dental prostheses(FPD) are used to restore missing teeth for a long time but implant prostheses are preferred nowadays because conventional FDP require preparation of abutment teeth. But there were not many options except conventional methods such as full coverage restoration or conventional resin bonded prostheses when implant treatment is ruled out due to anatomical or financial restriction of patient.Many times in order to repair a damaged tooth or restore missing teeth with crown or fixed dental prostheses, patient lose about 60-70% of their natural teeth crown portion. And sometimes, vital pulp extirpation may be necessary in case abutment teeth are tilted too much. Therefore, it is recommended to use a techniques that do not damage a lot to the surrounding tissue and teeth structure.

Born for Minimally invasive dentistry Evidence based, long-term evolution system for more than 50 years

Clinical background

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Tooht structure removal for a maxillary right first molar for various preparation designs. Coulmns with the same superscripted letter were not statistically significantly different.

A2 : proximal box, A3 : wing & 2 grooves, I2 : MO inlay, O : MOD onlay, HC : Half-crown, PC : Partial-crown, F1 : Full crown with chamfer, F2: Full crown with rounded shoulder, F3: Full crown with buccal shoulder lingual chamfer

Conservative approach using minimally invasive treatment is probably what both dentists and patients want. There are several attempts to restore the missing teeth or to splint mobile teeth with conservative approaches. But conventional resin bonded prostheses using resin to metal bonding technique are the most commonly used technique since its inception by Rochette in early 1970. (Fig.1)

The technology involved in RBFDP has gone through substantial changes and refinement to enhance retention. For example, electrolytic or chemical etching, air abrasion with aluminum oxide, and silicoating of the framework can be employed to enhance micromechanical retention. Macromechanical retention can be enhanced by the incorporation of mesh framework for better bonding between the metal surface and resin cement. Resin cements have also shown considerable advancement and have displayed increased capabilities of bonding strength between the metal and etched tooth surface. The framework design for RBFDP also has gone through gradual changes to minimize the debonding rate. The preparation design started with minimal to no preparation of abutment teeth but gradually became more aggressive to provide adequate retention and resistance form by including the placement of proximal grooves, occlusal or lingual rest seats and a “ wrap-around” design for more substantial enamel coverage. Despite these innovations, the prognosis of RBFDP’s were still less than desired.

(Fig.1) Conventional resin bonded fixed dental prostheses

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A study for the “ Clinical complications in fixed prosthodontics” also shows that The 3 most common complications associated with resin-bonded prostheses were prosthesis debonding (21%), tooth discoloration (18%), and caries (7%). (J Prosthet Dent 2003;90:31-41.)To minimize debonding rate, retentive tooth preparation such as proximal guiding surface, extend over a broad area of teeth, proximal groove, pin holes, rests were described but most clinicians experience that not any of them are quite satisfied in clinical situation. Probably it is because of different mobility between abutment teeth. Recently, techniques to minimize debonding for the resin bonded prostheses such as “ human bridge” (Fig. 2, 3) and “ two-key bridge” (Fig.4) were introduced.

(Fig.2) Human bridge – This is a technique using elasticity of metal and undercut of teeth.

(Fig.3) Human bridge - Patient visited for a Human bridge to restore missing left central incisor after he looked it up at the internet. Patient keep insisted that he hates his teeth to be shaved down and wanted to have “ Human bridge” although he was informed that final prosthesis would not be aesthetical due to severe cervical constriction of adjacent teeth and larger missing space. Human bridge is a technique using elasticity of metal and undercut of teeth. It is sometimes unavoidable that metal wings display. But patient was quite satisfied with his teeth not shaved down even with display of metal wings and unbalanced pontic size.

(Table 1) variable success rate with conventional RBFDP.

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The conflicting principles of conservation of tooth structure and of obtaining adequate retention have plagued the design of fixed prosthetic appliances since their inception.Clinicians should keep in mind that application of certain technique must have documented longitudinal success and clinically easy to apply without damaging surrounding tissue.(Fig.5)

Literature shows some of the pioneering method to restore the missing teeth or to splint mobile teeth with conservative approaches. The early attempt have been introduced since Finley, in 1897, first described a method of restoring the occlusal surface of bicuspid and molar fixed bridge abutments with pinlay attachments.(Fig.6)This pioneering method of using parallel intracoroanl pins as retention has thus been applied to a number of different fields as a conservative approach in obtaining strong retentive abutments with minimal reduction of tooth structure.

(Fig.4) Two Key bridge – This is a type of pin bridge but the pinholes were not standardized and need to be duplciated. There is some doubts because duplication of retention pin holes is not only difficult, but their accuracy is questionable when intraoral techniques are used.

(Fig.5) Bulky metal framework and undercut for Human bridge can cause periodontal problems and caries.

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The basic principles of parallel pin retention were utilized even before the casting process came into common use. In 1897, Finley” described a method of restoring the occlusal surfaces of bicuspid and molar fixed bridge abutments with pinlay attachments. In 1908, Hinmann described a detailed pinlay technique. Teeth were prepared and pinholes were drilled with a No. 3 round bur. Platinum foil or sheet gold was then burnished carefully over the lingual surface of the tooth preparation. Iridoplatinum pins were inserted through this coping and luted to it with modeling compound. This assembly was then carefully removed, invested, the compound removed, and solder was flowed over the entire matrix joining the pins to the gold or platinum base.With the development of the casting process and No. 700 tapered fissure bur used to perfect the pinholes. “pinledge attachment” technique became more practical. The wax pattern was made directly in the mouth, although some dentists later developed indirect techniques. The parallel pin technique was further developed until mid 1960’s by incorporating twist drill, plastic pin but necessity of using paralleling device restricted its application. (Fig.7)

(Fig.6) Parallel pins provided the main retention of the pinlays used as bridge abutments in a technique described in 1897.

History ofpin retention

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In the past, we have relied upon isthmuses, dovetails, and boxes for retention in “Black”2 cavity preparations. This is inconsistent for two reasons. First, the Black cavity preparation was designed to provide bulk for amalgam. It was adapted to gold inlays by merely eliminating undercuts and beveling the margins. The physical properties of available casting golds make such bulk unnecessary. Second, so-called “frictional wall retention” is unrealistic because there is little retention unless the cavity walls are parallel. Since expediency dictates that the cavity walls be made “slightly converging”obtain retention by this means.From this point of view, pin retention introduces a large field of application as a conservative approach obtaining strong retentive abutments with minimal coronal coverage and with margins on open caries immune areas.

Parallel pin techniques had been widely used until the early 1960s and then nonparallel pin technique introduced by Weissman which does not require intra or extraoral paralleling device became popular. Pins are an integral part of the casting in the parallel pin technique. The pin holes are drilled into the teeth before the impression is taken. The pins are usually cast in platinum iridium or gold. The retention is obtained from the frictional grip of the parallel walls of the pins through the cementing medium. On the other hand, pins in the nonparallel pin technique are not integral parts of the casting. With this technique, a paralleling device to make the pin hole preparations parallel is not required because pin holes can be placed wherever sound dentin remains and preferably, diverge each other to avoid pulp exposure. This allows for more freedom and creates more retention. However the pin holes still need to be drilled before the impression procedure and duplicated in the casts. These

(Fig.7) A pin-retained resin bonded prosthesis using parallel pin technique. It is very difficult to make all the pins parallel each other withour paralleling device.

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procedures are very complicated, time consuming, and can come with many inaccuracies.Since the inception of RBFDP using resin to metal bonding technology and cast perforated framework by Rochette, the technique using intracoronal pin retention has become less popular.

In summary, the development of minimally invasive dentistry is as follows;

parallel pin technique

Nonparallel pin technique.( Weissman, 1965)

Resin-bonded FPD

Modified Pin retained resin-bonded FPD

It is better to compare conventional non-paralleling pin technique and newly introduced modified pin technique to understand the difference easily.

[conventional non-paralleling pin technique]

(Fig.8) conventional non-paralleling pin technique

1. Pin hole preparation2. Place impression pin in each pin hole 3. Make impression and prepare working cast4. Laboratory procedurea. Nickel-silver technique pins are placed into the pin preparations on the stone dies. Sticky wax is flowed around each pin. (Fig.8-1)

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The wax-up is completed, the pins are removed, and the occlusion is checked. The pins are reinserted, and wax is added to support the pins. The pins are removed again. (Fig.8-2)The wax-up is sprued and lifted from the die, and the pins are placed once again in the wax-up. (Fig.8-3)The castings should be assembled (in quadrants) from an uncut cast. (Fig.8-4)The assembled castings are trial seated. the occlusion is adjusted, and the margins are burnished. (Fig.8-5) The direction probe (0.024 inch) is placed into the pin preparations to establish their direction. (Fig.8-6)The pin preparation is widened to 0.027 inch for its full depth.(Fig.8-7)A depth gauge is made from a standard 0.027 inch twist drill by painting red cold curing acrylic resin around the drill. After it polymerizes, the drill is reduced in diameter and the resin is shaped to expose 3 mm. of the twist drill. (Fig.8-8)After all of the pin preparations are widened, the depth of each should be checked with the 0.027 inch depth gauge. (Fig.8-9)The pin must be solidly threaded into healthy dentin. The tapered head must be completely seated against the tapered hole prepared in the gold casting. (Fig.8-10)If the pin preparation is insufficiently widened to its full depth or is too short, the head of the threaded pin will not be completely seated against the casting. (Fig.8-11)

[Modified pin-retention technique]Unlike previously introduced pin retained prostheses which need pin hole preparation before impression procedure, our company adopted a technique to prepare pin holes before cementation of prostheses to get rid of complicated impression and laboratory procedure.

b.

C.

d.e.

f.

g.h.

i.

j.

k.

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Remove occlusal surface to provide clearance, prepare groove or proximal box form if necessary and future pin hole positions are prepare with a No. ¼ round bur to expose dentin.Pour working castLocking holes are preformed on the final prosthesis at positions correspond to marked positions for the future pin holes on the abutment teeth. The pin hole preparations are done through the locking holes using a 0.68 mm diameter twist drill (Yellow twist drill; Bonatec Co.) at a 1.5 -3mm depth into dentin. The depth of the pin holes can be easily established to the 3mm depth when the casting is removed from the abutment teeth. The twist drill should not be taken in and out of the preparations to check the depths because in and out movements can widen the pin hole preparations and endanger the retention of the pins. Before cementation of the completed RBFDP, the pin holes are properly cleaned , and the inner surfaces of the retainers are air-abraded with 50 μm alumina particle. The prepared abutment teeth surfaces are conditioned with 35% phosphoric acid and the RBFDPs are cemented using an adhesive resin cement. The RBFDPs are cemented so that the locking holes aligned with the pinholes of the abutment teeth. 0.6 mm diameter threaded pins (PermaPin,Bonatec Co.), dipped in resin cement were inserted into each of the pinholes through the associated locking holes, thus fixing the prosthesis to the abutment teeth. It is advisable to fill the pinholes with adhesive resin cement, which can be done by loading an AccuDose Needle Tube and C-R syringe (Centrix Inc, Shelton, CT) before the FDP is seated on the abutment teeth (Fig.3b). After the resin cement is completely set, the threaded pins that stick out of the retainers are cut and polished to level with the retainer.

a-d.

e.f.

g.

h.

i.

(Fig.9) Modified pin-retention technique

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(Fig.12) Before

Case 01In this case, big interproximal embrasure with conventional resin bonded prostheses or metal display with Human bridge would be expected due to severe cervical constriction. Thus composite resin filling was done to minimize cervical constriction and modified pin-retained resin bonded prosthesis was fabricated instead of human bridge. (Fig.10)

For this pin bridge, pin holes were not prepared in advance but anticipated future pin hole positions were marked on the teeth surface before impression procedure. In this case, segmented type of prosthesis was planned but usually segmented type is not recommended due to the risk of possible cement washout on the pontic area. (Fig.11)

Pins are inserted after pin hole preparations are made through the locking holes on the casting at positions that correspond to the location of future pin holes on the abutment teeth. With this technique, the use of intraoral paralleling device is not necessary. Try not to use segmented type prosthesis if possible because of possible cement washout on pontic area. (Fig.12)

(Fig.10a) Before (Fig.10b) After composite resin filling

(Fig.11) Before

Clinical cases

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(Fig.13)

(Fig.14)

Case 02

In this case, pin bridge was fabricated as a non-segmented type. Again, pin holes were not prepared before impression. Instead they were prepared just before final cementation. (Fig.14)

Teeth #11, 13 shows severe cervical constriction and cervical abrasion. Thus composite resin fillings were done before pin bridge procedure to minimize interproximal gingival embrasure. (Fig.13)

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Teeth #13, 15 show severe cervical constriction. Clinicians can expect large teeth structure removal and risk of pulp exposure with conventional fixed partial prosthesis. Moreover, patient did not want her teeth shaved down. Thus modified pin bridge was planned and composite resin fillings

Further clinical investigation will be needed to restore cervical constriction with composite resin filling to minimize interproximal gingival embrasures when resin bonded prostheses are planned.

(Fig.15)

(Fig.16)

DPins can be placed wherever sound dentin remains. And the number of pin holes that need to be prepared are depend on the shape of teeth, clinical crown height, occlusal force, etc.

(Fig.17)

Case 03

were done to minimize cervical constriction for small interproximal embrasure with final prosthesis. (Fig.15)Each of 2 pin holes were prepared on the abutment teeth through the locking holes on the casting at positions that correspond to the location of future pin holes on them. (Fig.16, 17)

Location and number of pins

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Experiments done in mid 1960 indicated that pins 3 mm. in length seem to provide adequate retention. However, an experiment done in 2005 showed 1.5~2mm depth was good to provide enough resistance to dialogement. (Fig 18,19 )

(Fig.19) In this experiment, 1.3mm depth of pin holes showed comparable resistance against dislodgement which is similar to conventional bridge and there was not much difference between single and two pins on the abutment teeth.

(Fig.18)

(Fig.19)

Depth of pin hole

H

G

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a. The direction of the pinhole should be parallel to the DE Junction. b. A pulpal exposure can occur when the strater holes are placed pulpally too far from the DE junction or when the twist drill is lined up parallel to the outer surface of the enamel.

Advantages ofthreaded pin retention

Disadvantages ofthreaded pin retention

1. Minimal tooth reduction is required. 2. Stronger retention on the abutment teeth can be achieved because pins are not placed parallel to each other. This minimizes the risk of pulp exposure. 3. Also, the esthetics of the natural tooth structure is retained since minimal teeth reduction is needed. 4. There is also very little trauma to the pulp during preparation of the tooth and periodontal insult is not feared because the margins of the restoration do not need to be placed subgingivally.

1. This technique is contraindicated in teeth with extensive caries. Sufficient sound tooth structure must remain to receive the pins. 2. When the anatomy of a tooth requires extensive alteration for esthetics.

(Fig.20)

Directions of pinhole preparation

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Prothero JH. Prosthetic Dentistry. 4th ed. Chicago: Medico-Dental Publishing Co; 1928. p. 980-1.Bruce RW. Parallel-pin splints for periodontally involved splints for periodontally involved teeth. J Prosthet Dent 1964;14:739-45.Sobel SL. A technique for using parallel pins. J Prosthet Dent 1968;20:526-53.Lorey RE, Embrell KA, Myers GE. Retentive factors in pin-retained castings. J Prosthet Dent 1967;17:271-6.Nealon FH, Sheakley HG. An extraoral pin technique. J Prosthet Dent 1969;22:638-46.Mann AW, Courtade AB, Sanell C. The use of pins in restorative dentistry. Part I. Parallel pin retention obtained without using paralleling devices. J Prosthet Dent 1965;1:502-16.Mann AW, Courtade AB, Sanell C. The use of pins in restorative dentistry. Part II. Paralleling instruments. J Prosthet Dent 1965;1:691-703.Mann AW, Courtade AB, Sanell C. The use of pins in restorative dentistry. Part III. The use of paralleling instruments. J Prosthet Dent 1966;16:286-96.Weissman B. A nonparallel horizontal pin splint. J Prosthet Dent 1965;15:339-50.Timmermans J, Courtade GL. Nonparallel threaded pin retention of fixed prosthesis. J Prosthet Dent 1968;19:381-92. Weinberg LA. The vertical nonparallel pin splint. Part I. Preparations. J Prosthet Dent 1969;21:19-33.Weinberg LA. The vertical nonparallel pin splint. Part II. Construction, cementation, and troubleshooting. J Prosthet Dent 1969;21:143-53. Weinberg LA. Vertical nonparallel pin-inlay fixed partial prosthesis. J Prosthet Dent 1970;23:420-33.Rochette AL. Attachement of splint to enamel of lower anterior teeth. J Prosthet Dent 1973;30:418-23.Livaditis GJ. Cast metal resin-bonded retainer for posterior teeth. J Am Dent Assoc 1980;101:926-9. Thompson VP, Livaditis GS, Del-Castillo E. Resin bond to electrolytically etched nonprecious alloys for resin bonded prostheses [abstract 265]. J Dent Res 1981(Special issue A).Livadities GJ, Thompson VP. Etched castings; an improved retentive mechanism for resin-bonded retainers. J Prosthet Dent 1982;47:52-8. Livaditis GJ. A chemical etching system for creating micromechanical retention in resin-bonded retaines. J Prosthet Dent 1986;56:181-8.Isidor F, Stokholm R. Resin-bonded prostheses for posterior teeth. J Prosthet Dent 1992;68:239-43.Talghani M, Gerbo LR. Using a mesh framework for resin-bonded retainers. Compendium 1987;8:166-8.Simonsen R, Thompson V, Barrack G. Etched cast restorations: clinical and laboratory techniques. Chicago: Quintessence publishing Co. Inc; 1983. p. 41-56.Burgess JO, McCartney JG. Anterior retainer design for resin-bonded acid-etched fixed partial dentures. J Prosthet Dent 1989;61:433-6. Simon JF, Gartrell RG, Grongono A. Improved retention of acid-etched fixed partial denture. J Prosthet Dent 1992;68:611-5.Imbery TA, Eshelman G. Resin-bonded fixed partial dentures: a review of three decades of progress. J Am Dent Assoc 1996;127:85-96.Barrack G. Recent advances in etched cast restorations. J Prosthet Dent 2005;93:1-7.Besimo C. Resin-bonded fixed partial denture technique: results of a medium-term clinical follow-up investigation. J Prosthet Dent 1993;69:144-9.Priest GF, Donatelli HA. A four-year clinical evaluation of resin-bonded fixed partial dentures. J Prosthet Dent 1988;59:542-6.Hansson O, Bergström B. A longitudinal study of resin-bonded prostheses. J Prosthet Dent 1996;76:132-9.Goodacre CJ. Bernal G. Rungcharassaeng K. Kan JYK. Clinical complications in fixed prosthodontics. J Prosthet Dent 2003;90:31-41.Lankford JR, Christensen LC. Pin-retained, resin-bonded fixed partial dentures. J Prosthet Dent 1991;65:469-70.

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References

Pin bridge-Clinical Applications

20 Pin bridge- Clinical Applications

Case 01a. 54 years old man with congenital missing of lateral incisors b. # 15, 21 extraction due to advanced periodontitis

Since lateral incisors were congenitally missed, several treatment plans were proposed such as: (1) conventional 6-unit fixed dental prosthesis (FDP) for the missing central incisor (2) 3 single implants (3) 6-unit RBFDP following orthodontic treatment to secure spaces for lateral incisors. (4) modified pin-retained 3-unit RBFDP leaving existing

congenital missing lateral incisor spaces. Patient opted for the most conservative and least complicated treatment plan. So Modified pin-retained RBFDP was chosen as the treatment of choice.

In the framework, one cast pin and one 0.68 mm locking hole was made on the right central incisor and two 0.68mm locking holes were made on the left lateral incisor. The positions of the locking holes corresponded to the marked positions for the future pin holes on theabutment teeth. The directions of the locking holes diverge each other in order

(Fig.21)

(Fig.22)

To restore missing teeth

Pin bridge- Clinical Applications 21

to avoid pulp exposures. The castings were tried in the mouth to adjust the occlusion before the pin holes were prepared. The pin hole preparations were done through the locking holes using a 0.68 mm diameter twist drill (Yellow twist drill; Bonatec Co.) at a 1.5-3mm depth into dentin.The RBFDPs were cemented so that the locking holes aligned with the pinholes of

the abutment teeth. 0.6 mm diameter threaded pins (PermaPin, Bonatec Co.), dipped in resin cement were inserted into each of the pinholes through the associated locking holes, thus fixing the prosthesis to the abutment teeth. It is advisable to fill the pinholes with adhesive resin cement, which can be done by loading an AccuDose Needle Tube and C-R syringe (Centrix Inc, Shelton, CT) before the FDP is seated on the abutment teeth. After the resin cement was completely set, the threaded pins that stuck out of the retainers were cut and polished to level with the retainer.

Case 02 # 16 missing with lack of bone height for single implant.Patient had existing amalgam restoration on # 17 and chose a pin retained bridge to restore missing tooth.

(Fig.23)

(Fig.24)


The conflicting principles between conserving tooth structure and obtaining adequate retention have been two major components in determining the design of fixed prostheses since their inception.Simple and easy method to achieve better retention for RBFDP was described. With this technique, debonding of the prostheses, which is the most common complication, can be significantly reduced with the adoption of intracoronal pins and precisely perforated locking holes formed at positions corresponding to said marked positions.

(Fig.26) (Fig.27)

(Fig.28)

Case 03lower right lateral incisor missing

Case 04, 05combination of full coveragecrown and pin retention When a tooth next to existing crown needs to be extracted, combination of full crown and pin retention can be considered.

Pin retained bridge was chosen as treatment of choice since # 41 had severe cervical constriction with long clinical crown.

(Fig.25) Pin hole does not need to be prepared over 3mm depth.


Case 01 # 48 received endodontic treatment and shows very low clinical crown height. Crown lengthening was planned at first time but decided not to do due to the location of tooth and risk of furcation involvement after surgery. So pin retention was planned to provide resistance to dislodgement.

Case 02 Preformed locking holes on the occlusal surfacea. #36, 37 teeth show severe wear by the opposing teeth and patient complained pain and hypersensitivity.b. # 36, 37 teeth got pulpotomy and 2 pin holes were preformed on the occlusal surface of # 37 crown.

BCrown lengthening is advisable when clinical crown height after reduction is less than 3mm. However, it is sometimes difficult and kind of complicated procedure just for single crown.

(Fig.31) (Fig.32)

(Fig.29) 2 pin holes were preformed on the buccal and lingual side of # 48 gold crown.

(Fig.30)Pin holes were prepared through preformed locking hole and pins were placed at the time of cementation.

Short clinical crown


Pin holes were prepared non-parallelly just before cementation. Clinician can expect excellent resistance to dislodgement.In this case, #36 ,37 teeth got pulpotomy but this concept can be used for vital teeth as well if clinician can design the direction of pin holes to avoid pulp exposure.

Case 03 Patient had large broken resin filling on # 47 and needed to get crown. # 47 was prepared but clinical crown height on the buccal side is not high enough. Generally, lower part should be rebuilt with pins & core and then shaved down again before impression but decided to apply pin-retained crown in this case.

(Fig.34) 2 pin holes were prepared and made impression with 2 plastic pins. It is very important to make pin holes parallel when several pin holes are prepared before impression taking. But on second thought, single pin hole will be good enough in this case.

(Fig. 35) A porcelain fused to metal crown with 2 cast pins inside. With adoption of this technique, we could change complicated work to simple one.

(Fig.33)

(Fig.34)

(Fig.35)


C Case 01 Sometimes clinicians can encounter very big cavities which is difficult to decide between crown and inlay, onlay because of lack of retention. In this case our modified pin-technique can provides an excellent option.a. Cavity shows lack of dovetail formb,c. A pin hole is prepared to avoid pulpal exposure. The direction of locking hole preformed on the inlay can be any direction if its direction can avoid pulpal exposure.

Case 02 a. More than half of tooth structure was removed and small dovetail form was prepared on # 27. b,c. To aid resistance to dislodgement, our modified pin technique was applied.

(Fig.36)

(Fig.37)

Case 03Patient visited due to amalgam filling fell off. a. # 48 shows large cavity with worn out buccal cusp. Single crown after pin and core build up was preferred but patient wanted to have same amalgam filling saying that she have had it for more that 10 years.

To aid retention of inlay or onlay


Case 052 pins were placed through lingual locking hole to fix Crycera® onlay.

Case 04Pin-retained inlay using Crycera® a. In case patient wants tooth colored Inlay or Onlay, either Crycera® or IPS e-max® can be used. b,c. A single pin was placed at the buccal cusp area after pin hole was prepared through locking hole.

(Fig.38)

(Fig.39)

(Fig.40)

b. Considering lack of retention, pin retained gold inlay was chosen and pin hole was prepared through preformed locking hole. c. Pin inserted through preformed locking hole shows it’s heading to lingual side to avoid pulp exposure.d. post op x-ray


Case 06 # 32, 33 had severe wear. # 32 was restored with pin retained partial crown made of Crycera after endodontic treatment and # 33 was restored with pin-retained Crycera inlay.

(Fig.41)

(Fig.42)

Case 07Pin-retained IPS e-max onlay 2 non parallel pins were used

(Fig.43)


Case 08 Pin retained onlay Patient visited due to broken buccal cuspal area. Generally, crown after pin and core build up is required in this case, but we tried pin-retained gold onlay to increase resistance to dislodgement.

Case 09 Pin-retained onlay This case is similar with Case 08. In this case preparation was extended to lingual side and 2 pins were used to fix gold onlay.

(Fig.44)

(Fig.45)


DSometimes, it is better to splint abutment tooth with neighboring tooth. But it is not acceptable to shave down virgin tooth and make full coverage crown just for splinting purpose.

Case 01 # 24, 34 did not have long enough roots and decided to splint with neighboring teeth. Pin-retained partial crowns were designed on # 23 and 33.

Case 02 # 33-32-0-0-0-43 pin retained bridge – cingulum rests are designed on the canines

(Fig.46) Before (Fig.47) After

(Fig.48)

For abutment teeth for Removable partial denture


E Case 01 Patient was referred due to severe mobility on the upper anterior teeth after orthodontic treatment

Some overjet left between upper and lower anterior teeth and there was no need to remove lingual surface of upper anterior teeth. Splint with 1 preformed locking hole on each teeth was fabricated as thin as possible.

Pin holes were prepared through locking holes just before cementation and fixed.

(Fig.49)

(Fig.50) (Fig.51)

Horizontal pin-retained splinting


F

Case 02 Patient had short roots before orthodontic treatment and horizontal pin-retaind splint with 1 pin on each teeth was placed after orthodontic treatment.

Case 01 Teeth # 22, 23 showed severe wear due to opposing porcelain fused to metal crowns. Patient also had very deep overbite. Full coverage crowns are usually not recommended due to lack of retention in this case. teeth was placed after orthodontic treatment.

a,b. 3 pin retained partial crown was planned to cover exposed dentin on tooth # 23. One pin hole was formed before impression and casted to stabilize partial crown during other two pin hole preparations. c,d. After pin cementation

(Fig.52) (Fig.53)

(Fig.54)

Some other clinical tips


G

Case 02Tooth # 13 received a post & core after endodontic treatment. Mesial rest seat and modified pin retention technique on # 14 was designed to minimized lateral force on # 13.

Case 01Patient who had heart surgery due to myocardial infarction visited for his missing upper left quadrant. Bone loss around lower right implant and loose implant prostheses were detected through clinical and radiographic examination.

(Fig.57)X-ray after prosthesis removal from implants showed fractured implant around neck area. (Fig. 58)X-ray after reposition of implant prosthesis.

(Fig.55)

(Fig.56)

(Fig.57) (Fig.58)

Application of modified pinretention concept on implant failure cases


Case 02Same as case 1, patient came for loose implant crown and found out fracture of neck of Astra implant. Fixture should be removed and replaced but patient wanted us to apply modified pin retained inlay to stabilize loose implant crown on # 47. a. Before fractured part was removed.b. After implant crown and fractured part removal c. Implant crown was placed back just to show its relationship to fixture.

a. Since patient had a history of heart surgery and implant removal surgery was ruled out. Implant prosthesis was cut between # 46 and 47 to help patient to eat. Since # 46 implant could not provide anti-rotation due to fracture on the neck of implant, modified pin-retained inlay was planned to stabilize # 36 implant crown. b,c. A gold inlay showing 2 preformed locking holes for pins on # 46 and 1 locking hole on # 45.d. Cemented inaly and threaded pins. e,f. On the second thought, it is better to do endodontic treatment on # 45 and make a crown on that tooth with a post hole to make a modified post-retained metal inlay instead of pin-retained metal inlay.

(Fig.59) (Fig.60)

(Fig.61)


Since # 46 was root canal treated, 2 pins on # 46 and 1 pin on # 47 was planned. Again, post-retained metal inlay to stabilize will be better than pin-retained inlay considering occlusal force.

(Fig.63)Patient’s implant crown fell out due to fracture on the abutment hex. (Fig.64)a. The abutment hex was cold welded to internal hexed part of fixture and the fractured abutment hex could not be romoved. Post & core and a new crown was fabricated on the # 26 implant. But we realized # 26 implant crown had a bad C/R ratio. b. A Mesial occlusal rest seat with post hole on # 26 implant crown and a distal occlusal rest seat with locking hole for post were prepared to provide stabilization on # 26 implant crown. So # 25 gold crown was prepared to make a distal occlusal rest seat and post hole for post-retained metal inlay.

Case 03

(Fig.62)

(Fig.63) (Fig.64)


(Fig.65) A post hole on # 26 implant crown was prepared before impression to make a cast post and the other post was cemented through preformed locking hole on # 25.

(Fig.66) If the C/R ratio was considered properly beforehand, it was better to make an implant crown with mesial occlusal rest and preformed locking hole on # 25 than separate post-retained metal inlay.

a,b. # 25 implant showed bone loss andre movedc. Mesial rest seat with post hole was prepared on # 26 implant crown. d. 2-unit fixed prosthesis with distal occlusal rest which has a cast post was fabricated. e,f. After cementation

# 36 need to be extracted and distal side of # 34 was cut to use as single crown for that tooth. # 36 was extracted and several treatment options such as 1. # 35, 36 implant with bone graft on # 36 and 2. # 35 implant and 3-unit bridge on # 35-0-37 were provided to the patient.Patient chosed to go for option 2.

(Fig.65)

(Fig.66)

(Fig.69)

(Fig.67)

(Fig.68)

Case 04

Case 05


(Fig.70) In this case, existing # 37 was not removed to make 3-unit implant prosthesis. Instead, mesial occlusal rest seat with a post hole was prepared on # 47 implant crown. (Fig.71) a.b ; 2-unit fixed prosthesis with distal occlusal rest which has preformed locking hole was fabricated .

(Fig. 73)a,b. Mesial occlusal rest seat and a post hole on # 37 existing implant crown, mesial and distal occlusal rest seat with round indentations for future pin hole positions on # 35 was prepared. c,d. shows a post & pin retained prosthesis.

(Fig.70) (Fig.71)

Case 06# 36 tooth was extracted but decided not to go for implant and bone graft due to patient’s medical history with diabetes.

(Fig.72)

(Fig.74) (Fig.73)


Case 07# 42, 45 were extracted and patient did not want to have implants.

Patient visited for loose contact between # 35 tooth & # 36 implant crown. Contact was added but it was not effective because of mobility on # 35.

(Fig. 79) Pin-retained gold inlay was placed to reduce mobility of tooth # 35 and solve loose contact

Full coverage crown on # 31, 41 and pin retained resin bonded prosthesis on # 43 was fabricated to restore # 42 missing space. And occlusal rest seats on # 44 tooth and # 46 implant crown so as to fabricate pin-retained resin bonded prosthesis for # 45 missing.

(Fig.75) (Fig.76)

(Fig.78) (Fig.79)

(Fig.77)

Case 08


Case 09

Case 10

Tooth # 31 next to # 41 Cherchev implant needed to be extracted. The missing space was not good enough for another implant placement and conventional full coverage 3-unit fixed dental prosthesis was not desirable due to a long clinical crown with cervical constriction on #32.

Patient visited due to broken Cherchev implant on # 41. Broken implant was decided to be slept and 3-unit fixed dental prosthesis was planned.

A new full coverage crown on # 31 Cherchev implant and pin retention on # 42 was used to restore broken implant space.

(Fig.80)

(Fig.81)

(Fig.82) (Fig.83)

New full coverage crown on the # 41 Cherchev and pin-retention was used on # 32 to restore # 31 missing space.

EZ Grafter 39

EZ Grafter

All round bone grafter! For autogenous bone graft

Structure

As bone pulverizing drill

40 EZ Grafter

Case 01Particulated bone graft on the failed implant site

Case 02Particulated bone graft on the splitted ridge

Case 03Maxillary posterior immediate implant

EZ Grafter 41

Case 04

Case 05

Mandibular posterior immediate implant

Mandibular posterior immediate implant placement

As trephine drillfor Block bone graft or for removal of broken fixture

42 EZ Grafter

Case 01

Case 02

Case 03

Block bone on the extraction socket

Block bone graft

Broken fixture removal

EZ Lift Drill 43

EZ Lift Drill

For rachet adapter and hand torque wrench

Conical shape and corkscrew shaped apical end helps to drill into the bone and push up the bony debris without damaging schneiderian membrane.

Mark where implant will be placed using round bur and then use 2mm drill to prepare the site. Drilling should stop 2-3mm below the sinus membrane. In case the remaining bone height is very low, just remove the cortical bone and use the EZ lift drill directly.

surigical Manual Sinus Lift

44 EZ Lift Drill

Case 01

The only sinus drill, can be use in case of slanted sinus floor.

Case 02

1. Place the EZ lift drill into the osteotomy and turn it in with a speed of 30 rpm and 45 Ncm torque.2. There is no need to lift up the sinus membrane more than 3mm after the basal cortical bone is perforated.(drill should not lift up the membrane more than it’s elastic limit.)3. EZ lift drill has conical shape and corkscrew shaped apex. It has self-drilling ability and can drill into the bone even if they are very hard.

Drill Speed 30rpmTorque : 45N-cm

1. Once the basal cortical bone of the sins is perforated, place bone substitute in the osteotomy site and push it up with 2mm osteotome to lift up and fill the space created during the procedure.2. Repeat as necessary.

After identifying the sinus membrane is elevated, clinician can use either large diameter osteotome for both compaction of osteotomy site and increase the amount of bony substitute to be placed or can use a final drill to increase osteotomy diameter and add up more bone substitute if needed.

EZ Lift Drill 45

Drill a pilot hole to a depth below the horizontal osteotomy.

Use final drill if necessary.

Use EZ lift drill to a depth below horizontal osteotomy to expand and out fracture buccal cortex. Self drill function of EZ lift drill make this possible.

Make a full thickness flap and a narrow crestal osteotomy. Make a wider horizontal osteotomy 3mm above the mandibular canal.

EZ lift drill has conical shape and can be used as bone expander.

Taper fixtures are recommended for the ridge expansion or splitting cases.

surigical Manual Ridge splitting

46 EZ Holder

Abutment holder 4ea(M, R, W) + Claw tweezer(Straight, curved)

1. No risk to drop abutment in patient’s mouth2. No need to make custom made abutment holder & time saving3. Can place abutment at the exact position of fixtures.

EZ Holder

Each abutment holder has crucially incised annular club at its bottom and snap fits into abutment screw hole

Deliver assembled abutment holder to its mating part of fixture.

Once abutment is connected to fixture, remove abutment holder from abutment while pushing down the abutment with Claw tweezer

Tighten abutment screw.

- All-round Abutment Holder!

EZ GripEZ grip has round serrated end and minimize to lose things very slippery such as abutment, driver, post etc.

Can also be used to remove stiches.

1

2

Rotosonic Scaler Bur

EZ Grip / Rotosonic Scaler Bur 47

AFeatures1. Designed for use in a high-speed handpiece ( 200,000~ 400,000 rpm) and produce rotary ultrasonic of about 20,000 vibrations per second. 2. These burs have 6 sides and non cutting edges. They will not injure soft and hard tissue.

The six fl at sides of the scaler strike the calculus and fracturing it and the water mist from the high-speed handpiece cools the scaler and fl ushes away the debris. 3. For best effect, use light had pressure and always check the handpiece P.S.I.

- Almighty gripper

48 Rotosonic Scaler Bur

B

CIndications

a. Rotosonic perio ; made of Stainless steelb. Rotosonic Flame ; made of Carbide

a. originally designed for scaling & root planning b. gingival troughing before impression procedurec. can be used as periotome before tooth extraction - For this purpose, clinicians can usually use perio type bur. Push it in the alveoloar sulcus several times and connet them together. Then the bur widens alveolar sulcus just like Periotome.

d. Smoothing of exposed fi xture thread to treat peri-implantitis.

Types

Panoramic x-ray shows bone loss around # 24, 25 implants.

# 25 implant was removed and exposed thread on # 24 implant was smoothened with Rotosonic fl ame bur.

(Fig.1) (Fig.2)

Documents

Telbonatec.com/pdf/online_broshure.pdf · In summary, the development of minimally invasive dentistry is as follows; parallel pin technique Nonparallel pin technique.( Weissman, 1965)