Views: 291 Author: Kaylee Publish Time: 2023-12-14 Origin: Site
The workflow's diagnostic denture, implant surgery, and accuracy verification phases can now be reached. Yagu dental technicians will work with you to ensure that every step of the multi unit abutment or overdenture treatment workflow is completed with the precise accuracy that is necessary to achieve the best possible final treatment outcome. These processes require close collaboration with your dental lab.
The diagnostic denture, sometimes referred to as a trial or transitional denture, is an essential next step in treatment planning for a multi-unit implant abutment. It allows the patient and dentist to evaluate a trial version of the permanent prosthesis to make sure the fit, functionality, and appearance meet their expectations.
Some dentists may be tempted to skip this step, but doing so puts them at risk of prosthetic difficulties during the restorative phase, according to Ruben Gurie, an implantology specialist at Dentsply Sirona.
According to him, "some dentists prefer to estimate where they will be placing the implants." However, the diagnostic denture should not be skipped by implant dentists, even the most skilled ones. In implant dentistry, consistency is crucial, and the diagnostic denture plays a key role in ensuring a more consistent result.
This is because a diagnostic denture serves as a kind of trial run for the outcome of the entire treatment. Over a period of time, typically a month or two, the patient can get a sense of how the diagnostic denture fits and functions and can provide the dentist valuable input on adjustments.
To assist in retraining the jaw muscles to accept the replacement, the diagnostic denture is also a crucial tool.
"If you want to put implants in a patient who is toothless and put a fixed bridge on top of them, there's a good chance that patient will have post-restorative issues," says Gurie. "A patient's muscles and TMJ joint behave differently over a length of time without teeth. Over time, the natural balance shifts.Then all of a sudden you try to introduce an implant prosthesis right away and assume that the patient would adjust. In a very short period of time, you go from zero to hero and back to zero again. The first step in training the masticatory muscles into something approaching a natural position is to fit these patients with a diagnostic or transitional denture.
Crucially, the diagnostic denture is also utilized to determine the upper and lower jaws' ideal centric relationship and occlusion. The dentist must create the ideal oral environment for the patient to receive successful treatment. The result will not be favorable if the occlusion is not done correctly.
Using a patient's current denture as the diagnostic denture is another practice that dentists should avoid. There's a chance that this will introduce errors into the updated restore. Instead, Yagu Dental can collaborate with you to create a new, temporary diagnostic/transitional denture that will help determine the exact dentate position and establish the natural jaw relationship.
According to Gurie, "achieving a positive final treatment outcome is paramount to establishing the correct tooth and natural bite positions." The patient should feel that, provided the diagnostic denture was securely fastened, they would be delighted to keep it until that is resolved, everything is in balance, and the muscles are in good condition. That's our desired destination. The occlusal plane and occlusal arrangement of the teeth on the jaw are being determined by means of the diagnostic denture.
When you get to that stage, you should take two CBCT scans and line the diagnostic denture with scan dots. Two scans will be performed: one will show the patient wearing the diagnostic denture, and the other will be a stand-alone scan taken after the denture is taken out of the mouth.
The dental lab receives these scans, and Yagu technicians use the dual scan technique—overlaying the two pictures into implant planning software—to create a dual scan. This helps us determine the exact location of the implants by providing us with a very detailed image of the patient's mouth and bone structure in relation to his or her bite.
The dentist and patient should now be content to go on to the surgical stage of the workflow after making the last adjustments to the diagnostic denture. Additionally, your dental lab is crucial to this. Yagu collaborates with the dentist to create and produce a surgical guide. In essence, this serves as a template that the dentist can utilize to pinpoint the precise depth and location of drilling for every implant.
Yagu technicians load the dual scan into our implant planning software system in order to construct the surgical guide. We will now discuss the implant system the dentist is employing as well as any additional parts that may be required with them.
From this point on, we will digitally construct the implant plan and then have a real-time online consultation with the dentist to discuss any potential issues and make sure the implants are positioned as optimally as possible.
We will then 3D print the surgical guide once the dentist has approved the final design. Yagu consistently advises use a completely guided drilling template. Nonetheless, a few dentists do favor using a pilot guide.
According to Gurie, a fully guided surgical guide and a pilot surgical guide differ in a few significant ways. The locations of the drill holes for each implant are shown by the two drilling templates. Depth stoppers, on the other hand, help a fully guided template precisely guide the drill's direction and depth.
"Putting in an implant requires a tremendous amount of focus and concentration," explains Gurie. It's an extremely intense and precise procedure that can be somewhat nerve-racking. A fully guided system will cause the drill to stop at a predetermined depth on its own. This means that the drill will stop exactly at the depth of an 8mm implant. You're achieving the perfect result in terms of placement and depth.
Although completely guided surgical templates are ideal for achieving the highest level of accuracy, Gurie notes that certain dentists may prefer using a pilot surgical guide in specific situations.
"Having adequate bone and nerve distance makes it easier to navigate freehand with a pilot guide," he says. However, a pilot guide lacks depth stoppers. It does nothing more than indicate where the starting drill position will be when you are drilling. The drill won't stop at the exact depth you desire.
According to Gurie, the implant system the dentist is utilizing may also have an impact on the decision to use a fully guided or pilot surgical guide.
He clarifies that "different implant systems have different osteotomy drill preparations." Certain implant systems, for instance, are fully guided, meaning that each drill has its own sleeve and there is only one guide master sleeve needed. There are no modifications required. On the other hand, certain implant systems might feature a master sleeve with drill keys, meaning that the diameter will vary with the size of your drill. Depth stoppers may or may not be on the drills.
Pilot drills are not fully guided, so it's critical to remember this and make sure the implant system you're utilizing is fully guided as well. I would definitely advise having a fully directed surgical guide prepared if you are not using a fully guided implant method. Here, precision is essential, and even the smallest error could jeopardize the course of treatment.
After the implants have been successfully inserted into the patient's mouth, some dentists could decide to load the implants right away. However, primary stability of 25+ must be attained in order to do so. Gurie notes that self-drilling implants that thread into the bone to boost stability may make this conceivable, but the dentist should approach cautiously.
At Yagu, we typically advise avoiding loading right away except in the most straightforward situations. Our research shows that giving the patient more time to recuperate usually results in higher stability and osseointegration. Healing times can range from six weeks to three or four months, and they may even be longer if GBR or GTR is done. This depends on the implant system you select and the specific circumstances of the patient.
It's time to build mouth models and confirm the correctness of implant placement after the patient has had enough time to heal and has reached a sufficient level of stability. We use an accuracy jig or verification tool for this.
The patient's mouth is captured by the dentist either through a digital scan or an analog multi-unit abutment impression. We'll either create a plaster mold of the analog imprint at the lab or 3D print the scan. We find that digital scans typically provide superior accuracy than analog impressions, as with most elements of digital dentistry, and it is clear that digital dentistry is the way of the future.
Precision is crucial since the final model will serve as a guide for us as we construct the permanent prosthesis. Nonetheless, the model will contain errors if the oral scan or impression is even slightly off. In order to confirm the scan or multiunit abutment impression—and hence the model—we will create an accuracy jig prior to investing thousands of dollars in the design and production of the permanent prosthesis.
In essence, the accuracy/verification jig consists of a set of cylinders connected by a resin bar. To assess the correctness of the fit, the dentist attaches each cylinder to its matching implant and takes an x-ray of the patient.
The dentist might cut the resin bar and reattach it in the mouth if there are any errors. The jig in the mouth must then be used by the dentist to obtain a fresh impression. The final prosthesis will subsequently be designed based on where that jig is placed.
Gurie emphasizes how crucial accuracy is at this point. "If you're taking analog impressions, especially, we need to make sure that the scan or impression accurately reflects the location of those implants," he says. "Any errors in this can result in treatment failure or survival rather than success."
The final, permanent prosthesis's design and manufacture are ready to start at this stage of the process.
The significance of appropriate patient assessment and selection in guaranteeing successful outcomes for implant treatment cannot be overstated. Patients may be seriously at risk for implant failure due to a variety of general health and oral health conditions, as well as problems with the structure of the mouth that could make it difficult for the dentist to provide a suitable treatment plan.
The first step in patient assessment should be a detailed medical history. A thorough evaluation should be conducted for any underlying systemic health conditions, including uncontrolled diabetes, heart disease, hypertension, autoimmune diseases, osteoporosis, and cancer.
Lifestyle choices like smoking and binge drinking can also raise the likelihood of implant failure and should be taken into account when assessing a patient's general health. Individuals receiving radiation therapy or on anticoagulant medication can possibly benefit more from an alternate course of care.
The dentist can proceed to an intraoral examination if the patient is in good general condition. The presence of periodontitis may influence a patient's suitability for a multi-unit implant procedure. Additionally, the patient should have a thorough examination to rule out alveolar bone infections.
The implant locations will require evaluation by the dentist as well. To ascertain whether implant treatment is the appropriate course of action, assess the anatomy of the implant site, look at the soft tissue's condition, and go over any cosmetic concerns there.
Next comes a radiographic evaluation using a CBCT scan. This will help evaluate the state of the remaining teeth, the health of the tissues, and the underlying bone structure. At this point, implant placement can be precisely planned using virtual treatment planning software like Simplant, which can also be utilized to find any hidden problems that could jeopardize implant treatment.
The patient is probably a great candidate for a multi-unit implant treatment with a high chance of having a favorable treatment outcome if they pass all five assessment steps.
The dentist is proactively limiting potential treatment complications and preparing each and every case for a smooth treatment workflow by choosing only patients who have a high chance of success. The patient and the practice will both gain from this.
It's now necessary to polish the diagnostic denture to guarantee a successful course of treatment, and to precisely implant the implants in the patient's mouth using a surgical guide based on the final diagnostic denture.
After that, you take an impression or scan of the healed implants. Your dental lab will then offer you with an accuracy jig to confirm the accuracy of your impression or scan.Now is the time to start designing and building the ultimate, permanent prosthesis.
