Entering The Field Of Implantology
Many Dentists may feel daunted by the prospect of undertaking Implant their first cases. Often simply referring their implant cases to a specialist.
If you look at the big picture of Implantology, it can of course seem daunting. However, like anything, when broken down in to small steps it is far less so.
If the simple protocols are adhered to, and shortcuts avoided, then confidence rapidly grows.
The fact is however, that in many ways Implant cases are more straightforward than conventional Crown and Bridge cases. This is particularly true in regard to the accurate registration of working impressions.
Over the years, we have worked closely with many Dentists wishing to enter the field of Implantology.
Obviously clinical training will need to be undertaken, and we always recommend that the initial course should ideally be of a non-generic type, with no one system being promoted. An overall approach is then taught which allows the delegate to approach implant system selection with an open mind.
A good working relationship, with a Laboratory possessing a depth of experience in Implants is essential for predictable and stress-free and satisfactory results (just as it is of course in any aspect of restorative dentistry).
With sufficient experience of a wide range of Implant systems, your chosen Laboratory can also be of great assistance in system selection. Their perspective on the relative advantages and disadvantages of each system in any given situation will be invaluable in building “real world” knowledge and experience.
Armed with this information and with the selection of one's preferred system/s done, the next stage is careful first case selection.
Anterior cases, especially with a high smile-line, can be extremely challenging from an aesthetic perspective and are initially best avoided until one has more experience. Poor soft tissue control, being the Achilles heel of cases falling within the aesthetic zone.
A good first case might be a single unit lower premolar or molar site in an otherwise dentate case, with good bone width and plenty of room away from the nerve.
A discussion of the case with your Laboratory, and their supplied treatment plan and notes having been supplied, the first stage for simple cases should always be a stent.
Inexpensive and available in a variety of designs (according to your preference), they give an accurate indication of the final crown position in relation to the available bone, and should always be used (even for single tooth cases).
For bigger cases prior to the fabrication of stents, we always recommend initial try-in denture setups and/or diagnostic wax ups.
Regarding Special Tray design, whilst the closed tray technique is generally fine for single units, we always recommend open type special trays, especially for bridge work. One needs to ensure that the impression pickups are very firmly secured in the impression material (Impregum and Honeygum being the popular choices).
The following is a Laboratory Information Checklist for optimal results:
1. Photos especially for the anterior cases
2. Upper and lower rubber impressions
3. Any pre-op impressions or study models
4. Always ensure diagnostic wax ups and/or stents are employed
5. An accurate bite
6. The implant system used (we deal with many different systems)
7. Your implant account number
8. Request a metal try-in particularly for bridge work
9. Desired Shade/s
10. State whether cement or screw retained
When choosing between Screw Retained or Cement Retained restorations, one needs to bear in mind that each approach has it own advantages and disadvantages.
Screw retention gives greater ease of retrievability. However the screw access holes can increase the risk of stress within the porcelain, and the composite used to temporarily fill those holes, will wear at a different rate to the porcelain (potentially causing occlusal problems).
Cement retention avoids the potential problems listed above, however even when cemented with temp bond, retrievability is less straightforward (and periodic re-cementation will be required)
The most important thing to remember is to discuss your case in detail at every stage with your Laboratory. Draw on their experience, and use it to help make your entry in to the field of Implantology a rewarding and stress free one!