Volume 20, Issue 1

Visit us at www.aurumgroup.com

The Aurum Group® - Specializing in Comprehensive Aesthetic and Implant Dentistry

Advanced EstheticsTeeth in One Day – Which Full-Arch Hybrid Prostheses Are Right For Your Office?

ImplantologyReverse Margin™ Custom Abutments and Fixed Prosthetics

Innovative Implant Solutions The “Impression Jig” – Guaranteeing Passive Implant–Based Fit

Proudly announcing our partnership with Digital Smile Design’s (DSD)

Dr. Christian Coachman

Visit www.aurumgroupsummit.com

SAVE THE DATE…The EVENT OF THE YEAR is back!Dental Technology and Business Growth SummitOctober 19–21, 2017 in Lake Louise, Alberta

Featuring Leaders in Business Growth, Entrepreneurship

and Dental Technology

Kevin O’LearyKnown as Mr. Wonderful and Canadian businessman, investor, journalist, writer, financial commentator and television personality.

Dr. Christian Coachman Founder and CEO of Digital Smile Design.

Daniel BurrusBusiness Strategist and Global Futurist. Founder and CEO of Burrus Research.

Leonard BrodyBusiness and Technology Visionary.

FEATURING...

Special Guest: Shaun Majumder Cast member of “This Hour Has 22 Minutes”, comedian and entertainer.

Spousal and Children Activities will be available

Check out www.aurumgroupsummit.com for the full speaker lineup

EARLY BIRD PRICINGAVAILABLE NOW!

“One of the best decisions I have made is to attend this meeting. 5 Star.”- Dr. Karstan Lachman

Advanced Esthetics Teeth in One Day - Which Full-Arch Hybrid Prostheses Are Right For Your Office?Dr. Bobby Birdi

Technique TipEffective Communication Between Clinician and Technician – The Key Details That Can Save You Money!Ulf Broda

ImplantologyReverse Margin™ Custom Abutments and Fixed Prosthetics Dr. Fred Li

Innovative Implant Solutions The “Impression Jig” – Guaranteeing Passive Implant–Based Fit Daniel Kohm

DentureSimplus™ Denture System: Precise, Aesthetic Dentures in 3 AppointmentsGary Wakelam

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In the News: Contents

Aurum Group WelcomesDean of Dalhousie University Faculty of Dentistry

The Aurum Group was pleased to welcome Dr. Tom Boran, Dean Faculty of Dentistry and Victoria Colpitts, Development Officer, Health Faculties from Dalhousie University for a recent visit to our head office and tour of our laboratory and production facilities. We have been pleased to partner with the Dalhousie Faculty of Dentistry over a number of years and to support the education and on-going development of young dental professionals across North America.

Ms. Colpitts sent us a note after their visit stating, “Dr. Boran and I had the privilege of an extensive guided tour of the Aurum Lab. The facilities are modern and efficient, setting the bar high for technology and ensuring dentists are given the best possible options for their patients. The pride and dedication of the Aurum group were evident in everything we saw. Meeting with the Aurum team was a great pleasure and seeing the lab first-hand helped to solidify our partnership and common goals for excellence in oral healthcare.”

p Victoria Colpitts and Dr. Tom Boran view milling process.

p Dr. Tom Boran (left) and Mike Brost, Vice-President Sales, the Aurum Group.

Aurum Ceramic® Dental Laboratories LLP E-mail: aurum@aurumgroup.com

Spokane 1320 N. Howard, Spokane, WA 99201-2412 (509) 326-5885 Toll Free 1-800-423-6509

Visit our Website at: www.aurumgroup.com

Except where specifically stated otherwise, views expressed in this newsletter are the opinions of the individual contributors and do not reflect the views of the Aurum Group®. The information contained herein is not intended to be comprehensive and readers are advised to rely exclusively upon their own skill and judgement and to inquire further before acting on the information. The Aurum Group® assumes no responsibility for any errors or omissions found herein nor for any loss or damage caused by any errors or omissions, whether such errors or omissions are the result of negligence or any other cause. Offers contained in this newsletter are not valid where prohibitedby provincial regulation.

© Aurum Ceramic Dental Laboratories LLP (2016) All Rights Reserved.

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Certification Number: AJAEU/09/13949

“Teeth in One Day” has become an everyday phrase in our practice, and I can confidently say that the integration of immediate function full-arch therapy has revolutionized how we provide treatment in our office. We now plan to utilize immediate loading protocols for 100% of the full-arch fixed implant cases we provide. This is irrespective of whether the final restoration is a “hybrid” type prosthesis, or implant supported crown & bridge restorations. All arches are immediately provisionalized utilizing a cross-arch stabilized fixed provisional restoration that is screw-retained onto multi-unit abutments. The key to this is the utilization of implants that provide good initial stability while still allowing for variability in depth of placement. I find this is best met by using a parallel-walled internally connected implant which allows for bi-cortical fixation where needed (e.g., Avinent Coral). Furthermore, it is essential to utilize angled multi-unit abutments and for a system to have multiple angulation options available (e.g., Avinent 22 degree multi-unit abutment).

However, understanding the various final restorative options available to finish the cases allows us to plan our surgical therapy accordingly. As a result, we truly aim to provide prosthetically-driven implant surgery. Now there are many different restoration types and materials available in the market. Various materials and designs have been marketed such as Prettau® Zirconia, Chrome-cobalt based Acrylics, and porcelain fused to metal. It can be a daunting task to utilize all of these types of restorations, and it can also be a very overwhelming idea from a patient’s point of view to understand which type of restoration you are recommending.

In deciding which types of restorations to offer in our office, we set the following minimum requirements:

1. Esthetically pleasing and functionally stable opposing all restoration types.2. Minimization/Elimination of all chipping possibilities.3. Ease of repair or adjustment.4. Retrieval option (Screw-Retained).5. Utilization of CAD-CAM technology only.

“Teeth in One Day” Which Full-Arch Hybrid Prostheses Are Right For Your Office?A

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Through our partnership with Aurum Ceramic Dental Laboratories and Core3dcentres®, we have narrowed our options for full-arch hybrid prostheses to 3 final restorative designs. As a result, each patient is presented with 3 different final restorative options and the advantages vs disadvantages of each. This article will showcase all 3 of these designs and highlight the pros and cons of each.

p Figure 1 – 22 Degree Multi-Unit Abutments.

p Figure 2 – Immediate Maxillary Full-Arch Provisional Bridge.

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Dr. Bobby Birdi, DMD, Dip. Perio, Dip. Prosth, MSc, FRCD(C), FACP, DABP

Dr. Bobby BirdiDr. Birdi is one of North America’s very few Certified Dual Specialists in Periodontics and Prosthodontics, and the first and only specialist in the world to attain Canadian and American board certifications in both Periodontics and Prosthodontics.

He received his dental degree from the University of Saskatchewan and his post-graduate specialty training in both periodontics and prosthodontics from the University of Minnesota. He is a Fellow and Examiner for the Royal College of Dentists of Canada, and a Diplomate of both the American Board of Periodontology, and the American Board

of Prosthodontics. He is also an active member of the Canadian Academy of Periodontology and the British Columbia Society of Periodontists, as well as the Association of Prosthodontists of Canada and British Columbia Society of Prosthodontists.Dr. Birdi is a member of the American Academy of Implant Dentistry, the International Congress of Oral Implantologists, the Academy of Osseointegration, and the International Team for Implantology. He is well-published in the areas of dental implants and surgery. Dr. Birdi is a reviewer for the Journal of Oral Implantology, Clinical Advances in Periodontics, and the International Journal of Oral and Maxillofacial

Implants (JOMI). Dr. Birdi is an adjunct Assistant Professor at the University of British Columbia and the University of Minnesota. He also actively lectures both nationally and internationally in the fields of implant surgery and prosthetics, as well as aesthetic dentistry. Dr. Birdi is presently the co-director of the Pacific Institute for Advanced Dental Education located in Vancouver, Canada. He is also currently practicing at the BC Perio Dental Health and Implant Centres in Vancouver, Canada. His practice focuses on comprehensive periodontal and prosthetic treatment with a major focus on esthetics and implant dentistry.

p Figure 3 – Pre-Operative Intra-oral Image.

p Figure 5 – Maxillary Occlusal View. p Figure 6 – Pre-Operative Smile.

p Figure 4 – Final Fixed Titanium-Acrylic Hybrid Prostheses.

p Figure 7 – Post-Operative Smile with Titanium-Acrylic Hybrid Prostheses.

1. Titanium Milled Bar with Acrylic Overlay

This type of prosthesis is more of the “classic” hybrid prosthesis that classically involved a cast bar (precious metal or base metal alloy) with an acrylic overlay. Now, with the use of CAD-CAM technology, we now utilize a custom titanium milled bar and a custom acrylic overlay that provides superior results. This is by far the most common type of hybrid prosthesis design utilized in the market.

Advantages:1. Low Cost.2. Ease of repair/adjustment and additions.3. Long-term evidence based.4. Provides less rigidity and more occlusal “cushioning”.5. Major changes in tooth position/shape can be attained.

Disadvantages:1. Teeth stain and wear down over time. Will need to be replaced.2. Acrylic can harbor bacteria.3. Not as aesthetic as other options.4. Not as strong. Acrylic can chip and fracture.5. Wear more easily when opposing porcelain restorations.

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p Figure 8 – Pre-Operative Intra-oral Image.

p Figure 9 – Final Fixed Monolithic Zirconia Hybrid Prostheses.

p Figure 10 – Maxillary Occlusal View.

p Figure 11 – Pre-Operative Smile. p Figure 12 – Post-Operative Smile with Fixed Monolithic Zirconia Hybrid Prostheses.

2. Monolithic Zirconia

CAD-CAM technology has paved the way for Zirconia milled restorations. Zirconia was first introduced as a substitute for metal to be utilized as a substructure. However, through the evolution of this material, new techniques and versions allow for staining and coloring prior to final sintering. This is a major advantage which allows for zirconia to look “alive”. As a result, we are now utilizing it as a monolithic restoration with little to no staining or glazing. In our practice, the advantages of this type of restoration far outweigh any drawbacks, and with the help of Core3dcentres®, it is becoming our most popular final restoration type.

Advantages:1. Median Cost.2. High Strength, virtually no chipping or wear.3. Good Esthetics.4. Less restorative space needed.5. Can be broken up into sections as a final restoration.

Disadvantages:1. Can wear opposing dentition if not correctly polished.2. More difficult to repair/adjust and add to.3. Not as much long-term evidence.4. Not as esthetically flexible.5. Precision in tooth position is mandatory.

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Teeth in One Day” has become an everyday phrase in our practice, and I can confidently say that the integration of immediate function full-arch therapy has revolutionized how we provide treatment in our office.

p Figure 13 – Pre-Operative Intra-oral Image. p Figure 14 – Maxillary AMIS Zirconia Framework.

p Figure 15 – Final Maxillary AMIS Bridge. p Figure 16 - Maxillary Occlusal View.

p Figure 17 – Pre-Operative Smile. p Figure 18 – Post-Operative Smile with Maxillary AMIS Bridge.

3. AurumTek® Multiple Implant Solution (High Esthetic) Bridge

The AurumTek® Multiple Implant Solution (High Esthetic) Bridge provides the highest level of esthetics while still remaining flexible and repairable. This type of restoration utilizes a patient specific, digitally designed and precision-milled screw-retained all-zirconia framework onto which IPS e.max® restorations are cemented. Pink porcelain and/or pink composite are utilized for gingival contour and color.

Advantages:1. High Esthetics.2. High Strength.3. More natural feeling and can floss between crowns.4. Flexible and can be repaired.5. Shade/shape of teeth can be changed by replacing crowns.

Disadvantages:1. Higher Cost.2. More restorative space required.3. Not as much long-term evidence.4. Chipping is minimized, but possible.5. More complex of a restoration.

Dental materials are an area which is ever evolving with new materials and designs coming to the market every year. It is important to understand the attributes of new materials, and how they can be effectively utilized in treating out patients. New materials with very different attributes are coming to the market (e.g., PEEK plastic, Pectin, etc.) and we will have to stay tuned to see how they perform over time.

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CAD-CAM technology has paved the way for Zirconia milled restorations.

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American Dental Association to assist dental professionals in identifying quality providers of continuing dental education. ADA CERP does not approve or endorse individual courses or instructors, nor does it imply acceptance of credit hours by boards of dentistry.

Online registration and information at PACIFICINSTITUTE.CO or call 1-604-868-9700

PI’s CORE IMPLANT TRAININGCORE 1: Implant Tx Planning & Restorations• Treatment Planning the Implant Patient• of Implant Therapy• Implant Selection and Positioning• Implant Planning from Simple to Complex• Abutment Selection• Impression Techniques Hands-On

• Cement Retained Prostheses• Screw Retained Prostheses• Provisional Restorations• Proper Cementation Techniques• Implant Occlusion

CORE 2: Implant Surgery & Treatment• Implant Surgical Principles• Anatomical Considerations & Biology• Bone Physiology & Healing• Proper Implant Placement in 4 Dimensions• Single Tooth Implant Surgery• Multiple Tooth Implant Surgery

• Edentulous Implant Surgery• Implant Placement Hands-on Using Multiple Systems• Implant Pharmacology• Stage 2 Implant Surgery &

CORE 3: Atraumatic Extraction & Bone Grafting• Atraumatic Extraction Principles• Proper Instruments for Treatment• Bone Biology & Socket Healing Principles• Mechanical Extraction Systems• Bone Grafting Materials & Principles• Membrane Materials & Principles

• Understanding whichTechniques to use when

• Suturing Principles Hands-On• Socket Grafting Hands-On• Ridge Augmentation Hands-On

CORE 1: Implant Tx Planning & Restorations

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prior experience in Oral Implantology or who has already started the journey but would like to increase their skill

and knowledge. Our graduates have proven track records of successfully implementing implant dentistry into

their practice. All CORE programs have didactic, hands-on with models, and home study components.

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SAVE AROUND 30% BY COMING TO VANCOUVER CANADA FOR THEIR ORAL IMPLANTOLOGY TRAINING!

Soft Tissue Considerations

In previous articles in this series, we discussedmany different individual aspects of communication: photographs; tooth preparation design; critical measurements; shades; models; and supplying all the rest of the required information. We have also discussed the impact of missing information: calls from the technician to the doctor’s office, calls back from the doctor when time allows, schedule interruptions, case delivery delays that impact on patient and practice scheduling and worst of all, errors based on assumptions made on both sides. All of this creates a major inconvenience for both doctor and especially the patient – and costs the practice money!

Now, let’s talk about an easy way of avoiding all this and pulling it all together in fast-paced, often chaotic, day-to-day practice life. There are certain key aspects of communication on every case that, when not completed or included, almost invariably end up costing the practice money in the long-run:

Here is an overview of these critical aspects, varying depending on the clinical situation:

Printable checklists (such as the Checklist pads available free of charge at our aurumgroup.com website) organize and prompt everyone involved.

• Ensuring all the pertinent information and key details that will make a case a success are sent to the laboratory each time. • A simple, systematic and effective approach to consistent communication between dentist and technician, particularly in the realm of Comprehensive Aesthetics.

Quadrant dentistry – conventional impression / digital impression• Pre op models and or impressions of temp.• Bite registration over the prepped teeth.• Photos, shade, dentin shade - (Email).• Clear Rx with instructions, material choice.

Recommended impression trays if using ½ arch quadrant trays• Triple trays with anterior/posterior tooth stops.• Anterior trays with posterior tooth stops.

Recommended digital scans• Full arch preferred.• Quadrant, anterior/posterior tooth stops.• Anterior, posterior tooth stops to include 2 bicuspids.

Effective Communication Between Clinician and Technician

The Key DetailsThat Can Save You Money!

Implants – conventional impression/ digital impression• Provide X-ray of abutment to ensure fully seated.

Comprehensive dentistry – conventional impression / digital impression• Full arch impressions.• Full arch temps.• Full arch pre op impressions.• Photos, shade, dentin shade - (Email).• Bite registration, bite management sheet.• Stick bite or symmetry bite with full head photo.• Clear Hamular notches on upper arch.• Clear Rx with instructions, material choice.

Email• Brightsquid Secure-Mail™. Patient privacy is a growing concern for dental professionals across North America... especially when sharing patient information using common tools like Outlook, Gmail, Dropbox, and many others. These are NOT compliant with today’s patient privacy laws. The Aurum Group is committed to protecting your patient’s information. Ask us about our sponsored subscription to Brightsquid Dental Link and their Secure-Mail feature, the compliant messaging system designed to enable dentists, specialists and labs to easily and safely share private patient information. Secure-Mail works just like the e-mail tools you are used to - with an important distinction - all your communications will meet compliance standards. And, you can securely send multiple high resolution photos with every message if you wish.

Shade taking• ShadeWave, call to order (Minimal fee – resulting in exceptional shading).

“Covering these bases” makes all the difference!

With a completed checklist in hand, consideration given to these critical aspects, and all the key elements packed in the case box to send to the laboratory, very little guesswork is left for the technician. It is this detail that allows the best result to be crafted – created to your exact specifications using your written instructions on the Rx, digital scan/impression/models, photos and checklists as the communications blueprint. Above all, the patient receives a well-fitting, functional and aesthetic restoration that meets all of their expectations.

p Computer printout of teeth photo; color mapping; value and chroma from Shadewave.

p Itero models on screen as seen by technicians.

p Great looking impression, with captured HIP.

p Reline bite.

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Ulf Broda, RDT, CDT, AACD, ICCMO, LVIFNeuromuscular and Comprehensive Esthetic’s Manager, Aurum Ceramic

Reverse Margin™ Custom Abutments and Fixed ProstheticsIncrease Your Implant-Based Restoration Success Rates!

As the use of implant-based restorations has increased around the world, so too have the complications arising from the implementation of that modality. One of the most difficult to avoid and treat has been peri-implantitis. The prevalence of peri-implantitis in dental treatment is startling, having been shown to be 10% of all implants placed and 18.8 to 20% of all implant patients in two studies (Mombelli1 in 2012 and Atieh2 in 2013). A full explanation of the causative factors of peri-implantitis has not been established as of yet3 but retained excess cement has been linked in several publications.4, 5

There have been a number of techniques and methodologies discussed aimed at reducing peri-implantitis caused by retained cement. These range from the type of cement used itself to the amount of cement utilized, margin placement, the design of abutment, and venting access. One relatively new, and very interesting, technique is the Reverse Margin™ design created by Emil Svoboda PhD, DDS which helps redirect the flow of cement upwards to allow easier cleaning. The shape of the margin built into a custom abutment and its complimentary prosthesis reduces or “prevents” the flow of excess cement into the subgingival environment for clinicians utilizing intra-oral cementation. The Reverse Margin™ custom abutment and prosthesis design actually redirects the flow of cement away from, rather than into, the tissues that surround dental implants. This has the potential to provide a variety of important benefits for the clinician in day-to-day practice of implantology:

• Controls the flow of excess cement.• Optimizes the implant-abutment connection. Improves the passive fit of implant components due to intra-oral cementation.• Reduces peri-implant disease and infection related to residual excess cement and open implant-abutment connections.• “Prevents” the movement of excess into subgingival locations that are difficult to clean.• Increases Success Rates. Minimize or eliminate some of the risk factors that are known to cause failure of dental implants and their attached teeth.• Decreases Liability. It cannot be understated that any implant-based restoration failure is very expensive for all concerned – maintenance of ailing/failing implants, removal of failed implants and attached prosthetics, paperwork and legal fees.

This has the potential to provide a variety of important benefits for the clinician in day-to-day practice of implantology.

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Dr. Frederick Li

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11Dr. Frederick LiDr. Frederick Li graduated from the University of Manitoba College of Dentistry. Desiring to further his dental education and experience, he moved to New York City and completed two years of dental residency in hospital facilities associated with Cornell Medical Center and Columbia University. Dental implantology was a focal component of the post-graduate training, enabling Dr. Li to gain surgical implant experience from some of the top implant surgeons and prosthodontists in the Greater New York Region.

Dr. Li is a graduate of the Misch Implant Institute, a Fellow of the International Congress of Oral Implantologists and Associate Fellow of the American Academy of Implant Dentistry. A general practitioner in private practice in Vancouver with a large volume of surgical and prosthetic dental implants, Dr. Li lectures across Canada. He conducts a variety of training programs on oral implantology and dental implant placement while also mentoring a large implant study club in the Vancouver area.

Case Study

This case study illustrates how easily the Reverse Margin approach can help you avoid retained cement around your implant restorations.

The female patient had been eating spare ribs and, when biting down, fractured tooth 1-1 right at the gum line. On considering her alternatives to replace the now missing tooth, she decided on an implant-based restoration as the most conservative approach. In addition, she decided against immediate loading of the implant to reduce cost. With a low smileline, matching gingival levels is not crucial.

The remaining tooth was extracted and an AVINENT Ocean implant (size 3.5 x 13) was placed. This particular implant was chosen due to its excellent stability in the socket. At this point, we, as clinicians, face another choice. A screw-retained prosthesis is the obvious answer to avoid cement completely but this is not always possible. In this case, bone anatomy prevented placement of the implant in the correct position to hide the access hole. As can be seen in Figure 1, the access hole was closer to the buccal making it all but impossible to hide the retaining screw. With a cement-retained crown now indicated, it was time to consider the design of the restoration. In restoring the anterior, we need to place the margin lower than we would in the posterior to avoid having any underlying gray show through the restoration. This case was a perfect application for a Reverse Margin abutment and crown.

An AVINENT closed tray impression post was placed on the implant (Figures 2A and 2B) and a closed tray impression taken. The Reverse Margin is a simple design and should be placed subgingivally in the esthetic zone and equal or supra gingival in the non-esthetic regions. In this case, I requested that Aurum Ceramic fabricate an abutment with 1 mm subgingivally on the buccal and equal gingival on the remaining margin (Figure 3). The resulting abutment fit perfectly on try-in.Aurum Ceramic creates an invaluable jig (Figure 4) that allows easy, precise and accurate placement of the abutment every time.

p Figure 1 - Implant in place. Note the access hole is slightly to the buccal.

p Figures 2A and 2B – Impression post for AVINENT Ocean implant in place, ready for closed tray impression.

p Figure 3 – Reverse Margin abutment on the model. Note the shape of the margin itself.

p Figure 4 – Laboratory-fabricated jig used to place the abutment with extreme accuracy.

You simply place the abutment in the jig and place the “assembly” in the mouth. The jig is easily removed and the abutment is perfectly positioned on the implant (Figure 5). Figure 6 shows the subgingival placement of the abutment margin on the buccal intraorally. Aurum Ceramic also created a Zirconia Crown with labial cutback. We all know how difficult it can be to match the shade and staining of a single anterior restoration to the remaining dentition.The Advanced Esthetic team at Aurum Ceramic did a superb job!

While the Reverse Margin approach assists in handling excess cement, it is still important to carefully apply the cement inside the crown, taking care to avoid using too much material at the outset (Figure 7). As you can see on Figure 8, the Reverse Margin abutment and crown have directed the excess cement away from the subgingival region on insertion (i.e., supragingivally) allowing for easy clean-up. This helps to avoid long-term problems and increases the long-term positive prognosis for the implant-based restorative solution. The final result: a natural smile restored in keeping with the patient’s remaining dentition (Figure 9).

p Figure 5 – Abutment in place intraorally. p Figure 6 – Note the placement of the margin in relation to the gingiva.

p Figure 7 – Cement is carefully applied inside the crown.

p Figure 8 – Crown inserted. Note natural shade match and easy clean-up of cement.

p Figure 9 – Final restored smile with new crown in position.

Bibliography1 Mombelli A, Müller N, Cionca N., Clin Oral Implants Res. 2012 Oct;23 Suppl 6:67-76. doi: 10.1111/j. 1600-0501.2012.02541.x. Review. PMID:2 J Periodontol. 2013 Nov; 84(11):1586-98. doi: 10.1902/jop.2012.120592. Epub 2012 Dec 13. The frequency of peri-implant diseases: a systematic review and meta-analysis. Atieh MA1, Alsabeeha NH, Faggion CM Jr, Duncan WJ.3 J Periodontol. 2016 Mar; 87(3):212-20. doi: 10.1902/jop.2015.150450. Epub 2015 Nov 5. Investigation of the Association Between Cement Retention and Prevalent Peri-Implant Diseases: A Cross-Sectional Study. Kotsakis GA1, Zhang L2, Gaillard P3, Raedel M4, Walter MH4, Konstantinidis IK4.4 Clin Oral Implants Res. 2013 Nov; 24(11):1179-84. doi: 10.1111/j.1600-0501.2012.02570.x. Epub 2012 Aug 8. Does residual cement around implant-supported restorations cause peri-implant disease? A retrospective case analysis. Linkevicius T1, Puisys A, Vindasiute E, Linkeviciene L, Apse P.5 Clin Implant Dent Relat Res. 2015 Oct; 17 Suppl 2:e434-43. doi: 10.1111/cid.12265. Epub 2014 Sep 2. Peri-Implantitis Associated with Type of Cement: A Retrospective Analysis of Different Types of Cement and Their Clinical Correlation to the Peri-Implant Tissue. Korsch M1, Walther W1.

This case study illustrates how easily the Reverse Margin approach can help you avoid retained cement around your implant restorations. Im

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The “Impression Jig” Guaranteeing Passive Implant–Based Fit

A passive fit is an important prerequisite for the long-term success of abutment-based framework designs and prostheses, limiting the amount of stress transferred to the bone-implant interface. Yet, achieving a reliable passive insertion of a screw-retained metal framework on every case remains one of the most challenging areas in implant dentistry today for practitioner and technician alike.

Over the past twenty or more years, there have been reams of published data on the long-term clinical effects of non-passive fitting or distorted frameworks. Poorly fitting bar structures can exert tension or stress on the supporting abutments, resulting in a host of complications such as component joint opening, on-going screw loosening, component stress fractures and adverse tissue reactions (pain, tenderness, marginal bone recession, and/or loss of osseointegration).

The first critical step to long-term success in achieving a passive fit, in even the most challenging clinical situations, is creating a perfectly accurate impression. This can be achieved fairly easily and reliably with the use of a simple Impression Jig and Open Custom Tray.

The “Impression Jig” Allows For Superb Accuracy

Impression Jigs have been standard protocol in implant cases for many years now. To create an impression jig, the practitioner first takes a fixture level impression with polyvinyl siloxane impression material. This impression is sent to the laboratory. The laboratory pours the model, removes the impression copings from the impression, and places them on the model. The copings are wrapped with self-curing acrylic, splinting them together. Small cuts are then made, separating each coping. The laboratory then fabricates an open custom tray with the impression copings clearly visible and accessible on the top of the tray.

pq Figures 1 and 2 – Impression copings splinted with self-curing acrylic.

Daniel Kohm, CDT, RDTManager and Implant Specialist, Aurum Ceramic Dental Laboratories

As originally published inThe Seattle Study Club® Journal.

Final Impressions Taken With Open Custom Tray

The open custom tray, along with the separated impression copings on the model, is returned to the practice. The dentist takes these laboratory-fabricated impression jig copings, places them in the mouth and takes x-rays to ensure they are seating properly. The clinician then splints the copings together intraorally with a self-curing acrylic (preferred) or light cure composite. The Final Master Impression is taken using the open custom tray and returned to the laboratory.

Case Histories Illustrate Aspects of the Technique Clinically

In our first clinical example, Dr. Tim Kearns (Calgary, AB) had prescribed a full upper arch roundhouse restoration. Six implants had been placed, grouped “2 by 2 by 2” (two implants in the anterior and two implants each on each side in the posterior), with multi-unit abutments. The dilemma, as it often is in these more comprehensive cases, was in achieving a passive fit on each of the implants. Figures 1 and 2 show the copings in-lab wrapped with self-curing acrylic, splinting them together as outlined earlier. Figures 3 and 4 shows the open custom tray with the impression copings clearly visible and accessible on the top of the tray.

In a second example, Dr. Ned Nippoldt (Woodbury, MN) also applied the Impression Jig technique with the case illustrated in Figures 5 through 8. The patient in this instance was completely edentulous and was to receive full milled zirconia framework-based, implant-supported, non-removable upper and lower bridges. In Figures 5 and 6, you can see the upper and lower impression jigs splinted together and placed on the implants intraorally. Figure 7 shows the all-zirconia milled framework resting passively on the abutments, as does Figure 8 with the temporary acrylic crowns in place to check the bite in the mouth.

When this type of impression jig is employed, fit rarely becomes an issue through wax-up, abutment fabrication and try-in, and final placement of the prosthesis.

p Figures 3 and 4 – Open Custom Tray. Note clear access to the impression copings.

p Figure 5 - Lower Impression Jig intraorally. p Figure 6 - Upper Impression Jig intraorally.

p Figure 7 - Custom-milled all-zirconia substructures fit passively.

Daniel KohmDaniel Kohm, CDT, RDT has been a practicing dental technician for over 50 years. He has specialized in all aspects of implantology and cosmetic dentistry since their early introduction in the mid-1980’s. Today, he serves as Manager and Implant Specialist with Aurum Ceramic Dental Laboratories.

p Figure 8 - Upper and lower substructures and acrylic temporary crowns.

Poorly fitting bar structures can exert tension or stress on the supporting abutments, resulting in a host of complications.

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Simplus™ Denture SystemPrecise, Aesthetic Dentures in 3 Appointments

North American demand for treatment of edentulism is rising exponentially! Despite the fact that edentulism is declining as a percentage of the total population at a rate of 10% per decade, the absolute numbers of cases can be expected to increase — based on overall increases in (and the aging of) the total population as a whole (i.e., there has been an 80% increase in adults older than 55). The current market numbers are staggering (and growing):

• More than 35 million Americans are edentulous.

• 90 percent of those who suffer from edentulism have dentures.

• Almost 15 percent of the edentulous population has dentures made each year.

• About 23 million geriatrics are completely edentulous and about 12 million are edentulous in one arch.

• Dr. Chester Douglas (Centers for Disease Control and Prevention) estimated that 37.9 million arches will require treatment by 2020.

Other studies have talked about the number of current denture units currently being worn (e.g., 52 million units in the U.S.). These current units are estimated to have an average age of 17 to 18 years – dentures that will need to be re-made. No matter how you look at them, these numbers represent both a challenge and an incredible opportunity for the dental profession.

At the same time, there are tremendous changes occurring in the demographic make-up of the denture and cast partial population. Have you considered what the growing number of “baby boomers’ will demand in terms of their expectations for esthetics, along with function? Today’s patient demands cleaner, brighter and more perfect teeth no matter what the restorative situation. Perhaps even more critical, time has become a precious commodity, both for the patient and for the practitioner.

Don’t Like Doing Dentures?

It is not uncommon for today’s practitioner to be uncomfortable, or quite honestly, just not like, creating dentures. They may find current techniques too cumbersome, the process too time consuming, the results are not consistent - and they are simply not doing enough cases to offset these challenges. Yet, the need and the potential revenues in the marketplace are increasing. In these times where there is an on-going search in many practices for new revenue sources, it may well be that that new revenue is already there – it just needs to be captured.

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Today’s patient demands cleaner, brighter and more perfect teeth no matter what the restorative situation.

Gary Wakelam, RDT, CDT and Clarence Spring, RDT

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p Existing upper and lower dentures intraorally p Cheek and Lip support moulage.

p Upper and lower existing dentures with desired vertical Centric Occlusion.

p Lower denture embedded in putty.

p Completed mould removed from denture cup. p Two halves of the mold separated.

p Upper and lower 3D-Matrices and centric bite registration bite ready to go to lab.

p New dentures in occlusion on models.

The Solution – The Simplus™ Denture System

At The Aurum Group, our Advanced Esthetic Teams continually search for advancements in denture materials, fabrication techniques and skill enhancements that help patients and practitioners alike reap the benefits of this growing market. With our new and exclusive Simplus™ Denture System Technique, you’ll be Ready To Catch that Wave of Growing Demand— and with far fewer appointments for the practitioner and patient in the operatory! Utilizing in-operatory materials, systems and products already found in your practice – there is no need to make any investment in new equipment - this concise technique is a repeatable, faster and easier way to provide all of your applicable patients with functionally and esthetically pleasing complete dentures.

Designed to provide dental practices with a precise and efficient way to re-create new complete dentures in far fewer visits, the Simplus™ Denture System is based on using the existing denture that most of your edentulous patients already have. Then we create a lighter, stronger, more aesthetic patient-pleasing replacement, far more easily and reliably than ever before. For our purposes the existing denture (or custom tray impression and conventional bite block if that existing denture is not available) is used as a custom tray, vertical analysis record base, occlusal rim, and facial form reproducing device to create a “3D-Matrix (Matrices)” we will cocoon to create a beautiful and functional Prosthesis.

Designed to provide dental practices with a precise and efficient way to re-create new complete dentures in far fewer visits, the Simplus™ Denture System is based on using the existing denture that most of your edentulous patients already have.

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A. First Appointment Steps - In Operatory

01. Getting The Measurements A. Conduct Occlusal Assessment and Determine Rest Position using Golden Proportion (creates a starting Vertical dimension and serves as aid in locating a workable occlusal plane). Record the measurement and transfer to the existing denture. B. Determine Face and Lip Support. C. Record Existing Centric Occlusion with PVS (Take a bite registration of existing dentures in the acquired centric). D. Measure and record desired Vertical dimension. E. Determine desired incisal edge position (with papillameter).

02. Functional Impression and Occlusal Plane Position A. Preform temporary functional relines. B. Locate and record occlusal plane position with relined upper denture and PVS. C. Introduce Patient to the Fox Plane. Mark Alla Tragus on patients face.

03. Create cheek and lip support moulage.

04. Build incisal edge matrix.

05. Record desired vertical centric occlusion with PVS.

06. Preparing the 3D-Matrix (Matrices) A. Manufacture side A tooth surface half 3D-Matrix with indices. B. Manufacture side B tissue surface 3D-Matrix. C. Once fully set, separate side A and B and remove denture from 3D-Matrix. D. Repeat steps for 05 - Record desired vertical position with PVS, and 06 - Preparing the 3D-Matrix (Matrices), for lower denture.

07. Return existing dentures to patient.

Quick Technique Summary

B. Send all required materials to laboratory

C. Second In-Operatory Appointment

• Try-in stage. Evaluate and verify appearance, smile, phonetics, shade, tooth position and display, etc.; occlusal contacts (centric only); occlusal plane; and fit. • Advise laboratory if regular denture case or implant-based case. • Take Final impressions: with open mouth for lower denture and with closed contact in Centric Occlusion.

D. Send impressions and Finishing instructions to Laboratory

E. Third In-Operatory Appointment – Insertion

p Incisal edge matrix and bite registration.

p Embedded denture covered in putty.

p Upper 3D-Matrix.

p Dentures ready for try-in.

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p Final Complete Dentures in-lab ready for shipment to the practice.

p Photos of patient after insertion.

Simplus™ Is Even More Help With Implants!

As the gateway to dental implant therapy, Simplus can even help your implant practice. Well-fabricated dentures are crucial in the long term success of many implant restorations. Simplus makes creating precisely fitting implant-supported dentures a snap!

Position your practice to thrive over the next 20 years!

Applying the Simplus Denture System in your practice will give you the systems, and confidence, to market to and treat a nearly unlimited, and growing, number of edentulous patients. While a detailed technique is available on request, for the purposes of this article we have provided a quick summary of the steps involved in each of the three appointments to illustrate the simplicity and key points in the technique.

Contact your closest Aurum Group laboratory today TOLL FREE and give your patients the confidence and comfort they deserve with the new Simplus™ Denture System. (See Page 3 for locations and contact information)

Watch www.aurumgroup.com for courses in your area.

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