Slides from the Indianapolis Implant Restorative Study Club (IRSC) on August 29, 2013 by Christine Bishop, DDS, MSD and Savi Abey, DDS, MSD featuring common problems associated with implant therapy in both fixed and removable prosthodontics.

1. Slideshare
To IRSC Members: some slides have
been removed from the slideshare. If
you need more information about any
of the topics mentioned in the
headings, feel free to contact Dr.
Bishop or Dr. Abey by email.
Bishop(at)teethin.com
Abey(at)teethin.com

2. IRSC
2013
Final Meeting for 2013
November 14: Dental Laboratory
Showcase

3. Implant Restorative Study Club
Problem Solving in the
Restorative Phase of
Treatment
sponsored by
Prosthodontics of Central Indiana
August 29, 2013
The Monon Center, Carmel

4. Goals for this evening
Assuming everything has been done to prepare for
success to this point!
Managing problems at try in/place
When to return to the lab, or not
Managing “emergencies” and later
problems

5. Problems
Fixed
Removable

6. Problems: Fixed
At try in/placement:
1. Proximal contacts
2.Seating
3. Occlusion: missing.....where should it be anyway?
4. Buccal emergence profile/proximal contour
5. Excess cement
At follow up and emergencies:
1. Porcelain fracture
2. Loosening:
crown
abutment
implant
implant

7. Problems: Fixed
At try in/placement:
1. Proximal contacts
2.Seating
3. Occlusion: missing.....where should it be anyway?
4. Buccal emergence profile/proximal contour
5. Excess cement
At follow up and emergencies:
1. Porcelain fracture
2. Loosening:
crown
abutment
implant
implant

8. proximal contacts:
not usually perfect
from the lab...why?

13. Sequence:
Check both proximal contacts (floss test)
which contact is tightest?(floss test)
Disclose
Adjust
Check seating (explorer)
Check BOTH contacts again(floss test)
Which contact is tightest?
Disclose
Adjust
Check seating(explorer/bite cotton roll
hard 5min/10min)
Check BOTH contacts again(floss test)
Which contact is tightest?
Disclose
Adjust
Check seating (seems down)
Check contacts again. If 1or 2 open
contacts, If perfect,
Make BWX (quite often has to be
vertical)

23. Problems: Fixed
At try in/placement:
1. Proximal contacts
2.Seating
3. Occlusion: missing.....where should it be anyway?
4. Buccal emergence profile/proximal contour
5. Excess cement
At follow up and emergencies:
1. Porcelain fracture
2. Loosening:
crown
abutment
implant

24. Where should it be?
Discuss:
A.out of occlusion
B. occlusion in clench. (What about non-clenchers)?
C. normal, tooth-to-tooth type contact

25. Suggested
Sequence for centric:
Assumptions:
2 proximal contacts are present.
Full seating confirmed with VBWX
1. (Implant crown out): confirm contact of
adjacent teeth with shim
2. Place crown onto abutment
3. Check adjacent teeth with shim
4. If out of contact, mark with Accufilm
5. Adjust
Repeat steps 3.-5. until shim contact
present adjacent teeth.
6. Check implant crown with shim. If out of
contact,
7. If in contact, adjust a tiny bit more.
(always get pt feedback on occlusion; and
metal occlusal more forgiving)

29. How about excursive
movements?

36. Problems: Fixed
At try in/placement:
1. Proximal contacts
2.Seating
3. Occlusion: missing.....where should it be anyway?
4. Buccal emergence profile/contour
5. Excess cement
At follow up and emergencies:
1. Porcelain fracture
2. Loosening:
crown
abutment
implant
implant

42. Problems: Fixed
At try in/placement:
1. Proximal contacts
2.Seating
3. Occlusion: missing.....where should it be anyway?
4. Buccal emergence profile/proximal contour
5. Excess cement
At follow up and emergencies:
1. Porcelain fracture
2. Loosening:
crown
abutment
implant
implant

51. Problems: Fixed
At try in/placement:
1. Proximal contacts
2.Seating
3. Occlusion: missing.....where should it be anyway?
4. Buccal emergence profile/proximal contour
5. Excess cement
At follow up and emergencies:
1. Materials fracture: porcelain/acrylic resin
2. Loosening:
crown
abutment
implant
implant

52. Problems: Fixed
At try in/placement:
1. Proximal contacts
2.Seating
3. Occlusion: missing.....where should it be anyway?
4. Buccal emergence profile/proximal contour
5. Excess cement
At follow up and emergencies:
1. Materials fracture: porcelain/acrylic resin
2. Loosening:
crown
abutment
implant
implant

61. Problems:Removable
At try in/placement:
which inserts to use?
locator height
At follow up and emergencies:
soft tissue problems
unstable/non-retentive
fractured base

64. At try in/placement:
locator height
- tissue height
- restorative space
- position of implants
- ability of patient to seat

67. Problems:Removable
At try in/placement:
which inserts to use?
locator height
At follow up and emergencies:
soft tissue problems
unstable/non-retentive
fractured base

70. Problems:Removable
At try in/placement:
which inserts to use?
locator height
At follow up and emergencies:
soft tissue problems
unstable/non-retentive
fractured base

74. Problems:Removable
At try in/placement:
which inserts to use?
locator height
At follow up and emergencies:
soft tissue problems
unstable/non-retentive
fractured base

78. IRSC
Finally:
Please complete your survey online:
http://www.surveymonkey.com/s/68TMNG9
November 14: Dental Laboratory
Showcase

79. This is the information that I mentioned about a
course for the Prettau Bridge: the full arch zirconia
bridge. Dr. Weir feels that Dr. Tischler is a highly
appropriate authority on the subject. Check out the
website below, or contact Dr. Weir.
From: "C. Douglas Weir" <dweir1(at)netsurfusa.net>
Subject: Date: August 27, 2013 4:44:01 PM EDT
To: Bishop Doctor Christine <chrisbishop88(at)gmail.com>
http://www.tischlerdental.com/
There is a great amount of info if you click on the "for dentists" tab.
The next course is Nov 8-9.