Communications and Communications and Procedures Necessary to Procedures Necessary to Achieve Success with Milled Achieve Success with Milled Titanium Bars for Attached Titanium Bars for Attached Overdentures and Screw Overdentures and Screw Retained Hybrids Retained Hybrids Aristides A. Tsikoudakis, Aristides A. Tsikoudakis, DMD DMD Maxillofacial Prosthodontist Maxillofacial Prosthodontist Lakewood, Colorado Lakewood, Colorado Thomas Wade, C.D.T Thomas Wade, C.D.T Owner, New Horizons Dental Laboratory Owner, New Horizons Dental Laboratory Broomfield, Colorado Broomfield, Colorado
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Aristides A. Tsikoudakis, DMD Maxillofacial Prosthodontist Lakewood, Colorado Thomas Wade, C.D.T
Communications and Procedures Necessary to Achieve Success with Milled Titanium Bars for Attached Overdentures and Screw Retained Hybrids. Aristides A. Tsikoudakis, DMD Maxillofacial Prosthodontist Lakewood, Colorado Thomas Wade, C.D.T Owner, New Horizons Dental Laboratory - PowerPoint PPT Presentation
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Communications and Procedures Communications and Procedures Necessary to Achieve Success Necessary to Achieve Success with Milled Titanium Bars for with Milled Titanium Bars for Attached Overdentures and Attached Overdentures and
Screw Retained Hybrids Screw Retained Hybrids
Aristides A. Tsikoudakis, DMDAristides A. Tsikoudakis, DMDMaxillofacial ProsthodontistMaxillofacial Prosthodontist
Lakewood, ColoradoLakewood, Colorado
Thomas Wade, C.D.TThomas Wade, C.D.TOwner, New Horizons Dental LaboratoryOwner, New Horizons Dental Laboratory
Broomfield, ColoradoBroomfield, Colorado
ObjectivesObjectivesReview of fundamentalsReview of fundamentals
Initial exam and work upInitial exam and work upDiagnosisDiagnosisPatient expectationsPatient expectations
Classification of ProsthesesClassification of ProsthesesImplant supportedImplant supportedImplant assistedImplant assisted
Case presentationCase presentationDetailed examination of restorative and lab componentsDetailed examination of restorative and lab components
Diagnostic CastsDiagnostic CastsIf patients existing dentures have If patients existing dentures have adequate form and function then…adequate form and function then…
Denture Information TransferDenture Information Transfer
Initial ExamInitial Exam
Diagnostic Set-UpDiagnostic Set-UpChairside arrangement of anterior Chairside arrangement of anterior teethteeth
Implant SupportedImplant SupportedForces are borne entirely by the implants Forces are borne entirely by the implants without support from the soft tissuewithout support from the soft tissue
Implant AssistedImplant AssistedSupport is shared between implants and Support is shared between implants and soft tissuesoft tissue
Clinical StepsClinical Steps
Number of Visits: 6-8Number of Visits: 6-8Preliminary impressionsPreliminary impressionsVerification and master impressionsVerification and master impressionsAnt set-up and jaw recordsAnt set-up and jaw recordsWax try-inWax try-inSubstructure try-inSubstructure try-inClinical remount & deliveryClinical remount & delivery
1:001:002:002:001:001:001:001:001:001:001:301:30
ObjectivesObjectivesPhoto Montage…Photo Montage…
Guided surgery Guided surgery
All-0n-4All-0n-4
Radiographic guidesRadiographic guides
Milled titanium barsMilled titanium bars
Troubleshooting common problemsTroubleshooting common problems
Accurate impressions and proper castsAccurate impressions and proper casts
Information & communicationInformation & communication
Treatment planningTreatment planningCollaboration between surgeon, restorative, labCollaboration between surgeon, restorative, lab
Troubleshooting Troubleshooting
““If you don’t have time to do it correctly If you don’t have time to do it correctly the first time…the first time…
When are you going to have time to do it When are you going to have time to do it over?”over?”
Troubleshooting Troubleshooting Accurate impressions: sets level of excellenceAccurate impressions: sets level of excellence
Custom tray when indicated Custom tray when indicated
Properly poured and based castsProperly poured and based castsHeelsHeelsAvoid mandibular horseshoe castsAvoid mandibular horseshoe castsInspect prior to sending to lab (pack properly)Inspect prior to sending to lab (pack properly)
Selection of appropriate gypsumSelection of appropriate gypsumPlaster: Plaster: neverneverDie stone: splints, implants, RPD Die stone: splints, implants, RPD Stone: everything elseStone: everything else
Troubleshooting Troubleshooting Information and CommunicationInformation and Communication
Case info: more is Case info: more is ALWAYSALWAYS better than not better than not enoughenough
gendergenderageageshade, opposing cast, jaw record shade, opposing cast, jaw record
photos photos (important for tooth selection)(important for tooth selection)accurate extraction infoaccurate extraction infocast of existing prosthesescast of existing prostheses
Troubleshooting Troubleshooting Relines and adding teeth/clasp to RPD:Relines and adding teeth/clasp to RPD:
Pick-up impressionPick-up impression
Alginate vs. PVSAlginate vs. PVS
Proper pouring techniqueProper pouring technique
Treatment PlanningTreatment Planning
Collaborative EffortCollaborative Effort
SurgeonSurgeon
Restorative Dr.Restorative Dr.
Lab technicianLab technician
Treatment PlanningTreatment PlanningGoal:Goal:
To devise the most predictable and To devise the most predictable and straight forward approach for meeting straight forward approach for meeting the patient’s expectationsthe patient’s expectations
Essentially comes down to 2 factors:Essentially comes down to 2 factors:Patient expectationsPatient expectationsBone: where and how muchBone: where and how much
Treatment PlanningTreatment Planning
Cases: Implant Supported Fixed vs. Cases: Implant Supported Fixed vs. RemovableRemovable
Attachment: Criteria for selectionAttachment: Criteria for selection
Implant Supported:Implant Supported:Only needed for retentionOnly needed for retentionMinimal heightMinimal heightEasy & inexpensive to replace insertEasy & inexpensive to replace insertReadily availableReadily availableMinimize wear between componentsMinimize wear between components
Treatment PlanningTreatment PlanningAttachment: Criteria for selectionAttachment: Criteria for selection
Implant Assisted:Implant Assisted:RetentionRetentionMinimal heightMinimal heightEasy & inexpensive to replace insertEasy & inexpensive to replace insertReadily availableReadily availableMinimize wear between componentsMinimize wear between componentsResilientResilientAllows for rotation Allows for rotation