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Written by Andrew Sedler

Written by Andrew Sedler

Perfecting The Patient Experience for 2020

THE PLAN IS JUST THE BEGINNING

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Fixed dental implant restorations are a good alternative in the treatment of tooth replacement in restorative dentistry. The number of dental implants placed differs from case to case, but full-arch implant-supported prosthesis is a successful modality in these various situations. There is no better option in terms of quality of life for the patient. These restorations support healthy bone maintenance, improve soft tissue management, restore oral function, provide comfort, and offer improved esthetics.

There are several types of prosthetic options, including acrylic fixed hybrids, zirconia hybrids, metal to porcelain fixed dental implant bridge, and composite hybrids. Many factors will influence which of these options to use in a specific implant-supported rehabilitation. These factors may include the patient’s financial situation, bone health, parafunctional issues, and esthetic expectations.

Burbank Dental Lab

"Burbank Dental Lab offers a diagnostic package that includes bite blocks, wax set-ups, and photos to help determine what will be the best options to ensure the best results."

--- Andrew Sedler, COO

SmartComposite® Hybrid Prosthesis

Burbank Dental Lab provides a great fixed implant prosthetic option in the SmartComposite® Hybrid Prosthesis. The SmartComposite hybrid is a combination of a milled cobalt-chromium alloy and milled composite. The metal frame is nickel and beryllium free. Cobalt-chromium has very high corrosion resistance. It is a biocompatible metal that is wear-resistant and chemically inert. It has incredible mechanical properties, including increased hardness and tensile strength.  

Milled frameworks, such as those used in the SmartComposite prosthetic, have been found to fit more passively than casted frameworks. Milled frameworks eliminate the inaccuracies that the many steps involved in casting introduce. A more passive fitting framework lowers mechanical and biologic complication risk. The Co/Cr substructure can be designed to work with a multi-unit abutment or straight to the implant fixture. 

A hybrid composite overlay is designed and then milled to fit the framework. The Co/Cr frame is opaqued, etched, and then the composite is bonded to the frame. Pink composite is added to mimic tissue, and then the entire prosthesis is polished by hand. The best application of this type of fixed prosthesis is in large-segment and full-arch cases. SmartComposite requires that interocclusal distance from the implant to opposing be at least 13mm. The buccal to lingual width must be at least 9mm, and the buccal and lingual thickness from the screw access channel must be a minimum of 3mm.

It is essential to evaluate the vertical dimension of occlusion (VDO). If the adequate vertical height is not considered in the planning phase, and the VDO is opened arbitrarily to accommodate the restoration, this can cause increased forces placed in the mouth. In tooth-borne restorations that are carefully restored, the alveolar processes adapt to compensate. Edentulous patients don’t have the advantage of alveolar adaption because of implant treatments. This lack of alveolar adaption causes increased elevator muscles and ultimately increased contractive forces. 

Benefits of SmartComposite Hybrids

In full-arch fixed implant restorations, a nonadaptive masticatory system establishes under these occlusal forces. Since this likely will create issues within the oral cavity in some instances, the use of a restorative material that can both wear gradually and is easily repairable is extremely important. A SmartComposite® hybrid is an excellent option for cases like these. This restorative option has the following benefits:

Smart Composite
  • Durable restoration with a compressive strength of over 480 MPa
  • The hybrid design of a strong rigid metal, bonded to resilient composite adds to the strength and durability.
  • Milled composite will not dislodge like denture teeth.
  • Easily polished intraorally.
  • Lightweight.
  • The composite can repair intraorally.
  • Cost-effective when compared to other types of hybrid options.
  • Esthetic
  • The density of the composite resists the absorption of fluids and odors.
  • Reduced stress to implant integration due to the resilient nature of composite
  • Kind to opposing dentition; wears at about the same rate as natural teeth.

Also, when two screw-retained prosthetics are opposing one another, it is very common to prescribe a monolithic zirconia prosthesis on the maxillary. In cases like these, it has proven very successful in placing a SmartComposite hybrid on the mandibular. It's possible to achieve desirable stress relief throughout the oral cavity by having a SmartComposite prosthesis opposing a zirconia hybrid.

Proper Case Planning

A common challenge to the success of fabricating a fixed dental prosthesis is a lack of proper case planning. The lack of planning causes the arbitrary placement of implants that make it very difficult to achieve the desired results. Consider the following before moving forward on any edentulous rehabilitation.

  • Determine facial esthetic issues such as those caused by bone loss
  • Determine vertical clearance
  • Evaluate the smile line

Burbank Dental Lab offers a diagnostic package that includes bite blocks, wax set-ups, and photos to help determine what will be the best options to ensure the best results.

U'sing a Lois Facial Analyzer Facebow

These diagnostic steps are necessary to ensure a smooth process that takes into consideration the physical condition of the mouth and makes an informed determination of what steps need to be taken to ensure case success.

Once the dentist establishes diagnostics, Burbank Dental Lab can help create surgical guides to help ensure proper placement of hybrid implants during dental implant surgery.

Next, we'll look at what steps to provide during the first post-operative appointment.

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Steps for the First Post-Operative Appointment

  • 1

    Take a post-operative bite registration using the conversion denture

  • 2

    Use a Kois Dento-Facial Analyzer to capture:

    • The condyle relationship
    • Facial midline
    • Horizontal planes

  • 3

    Photos

    • Full face forehead to chin
    • Close-up smile
    • Lip at rest
    • Pictures with the desired shade (include shade tab)

  • 4

    Open tray pick-up impression of the conversion denture

  • 5

    Attach analogs to conversion denture

  • 6

    Pour soft tissue

  • 7

    Pour stone model

  • 8

    Remove conversion denture articulate

  • 9

    Record vertical of the conversion denture by setting the pin

  • 10

    Send to lab

Kois Face-bow instructions
Burbank Dental Lab Kois Bow procedures
Articulate model first using the Kois Bow mouting plate
Burbank Dental Lab, Kois Bow transfer procedure

Burbank Dental Lab has one of the most extensive dental implant departments in the nation and has unparalleled expertise in the planning and fabrication of fixed dental implant-supported restorations. The implant team at Burbank Dental Lab offers unique and critical input regarding case design and implant placement. Free evaluation and pretreatment consults are available in all cases. Contact our implant specialist at Burbank Dental Lab for your next fixed implant-supported bridge.

Burbank Dental Lab

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Burbank Dental Lab has three new state-of-the-art Carbon M2 printers. We are very excited about the options that these cutting-edge printers will allow us to offer our dental clients. Here are some of the advantages that these printers will begin to deliver to you and your dental practice.

Our New
State-Of-The-Art
3d Printers

Carbon offers a highly dependable 3D manufacturing solution for many dental applications with its breakthrough Digital Light Synthesis™ technology, enabled by a wide range of dental materials.

Fabrication
of the future
is here!

Burbank Dental Lab has three new state-of-the-art Carbon M2 printers. We are very excited about the options that these cutting-edge printers will allow us to offer our dental clients. Here are some of the advantages that these printers will begin to deliver to you and your dental practice.

Our New
State-Of-The-Art
3d Printers

Carbon offers a highly dependable 3D manufacturing solution for many dental applications with its breakthrough Digital Light Synthesis™ technology, enabled by a wide range of dental materials.

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