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Such an important aspect of implant success. I have created those food traps... My question is the concept... " 1mm subgingival equals a root trunk?" thanks again.
Thanks for the video James, super informative. I've just returned to work as a Prosthodontist after a year off for maternity leave and I feel like it's in the little details that all the difference is made. Just thinking about the cases where switching gingival masking on or off might be more appropriate helps hugely! Thanks again, Sonia
Welcome back! Yes, it is in details. I use implant restorative principles that I have observed in Dr. Chu and Dr. Tarnow's presentations in regard to emergence and biotype. All the best
Hello Dr. Klim, Thank you for another great presentation with detailed explanation. I have watched you polishing crowns after glazing to remove surface microporosity to create a more smooth surface ! Over the years I observed that emax crowns have tendency to stain. Since I watched your polishing video I polish the crowns before I deliver resulting better stain resistance. I routinely use lab made emax crowns with titanium custom abutments made exactly to gingival level shaped based on the logical principles you just mentioned. I get excellent tissue response. It makes me think that titanium nitrite coated custom abutment has a much smoother surface thus having a better tissue response. Your thougts ? A lot of respect for your passionate contribution to the art and science of dentistry. Monterey, CA
Thanks for the comments! From what I have seen in the research, it is more about how the subgingival implant restoration surface is finished than the material. As long as the healing collar is not removed more than once following surgery, the epithelial attachment will occur to the cervical side of the emergence zone. All the best.
Thank you for these implant restorative tips. I am new to Cerec. I am an associate in an office who has one. Restoring an implant recently was very challenging. After watching this video there are valuable tips to improve emergence and tissue support. This holistic/biological practice uses zirconium implants. The implant and post are one unit. Will I use the gingival mask in this case to edit the base?
In the one-piece zirconia implant, prep to where the margins are indicated, similar to a stock abutment, and then impression and design for a crown. Sounds like an interesting case. All the best to you!
In my case a 4 units bridge over 3 implants was placed following a sinus lift and grafting (immediate implantation). 1. In retrospect I learned that implants with internal hex connection had been used. Any reason you might think for not using implants with a conical connection? 2. This is a zirconia bridge. I can see very massive connectors. Is that inherent to zirconia bridges? 3. Due to the massive connectors, I cannot reach with flossing or proxy-brush. I use a water pick every evening. Is there any way to design a zirconia bridge with the implants accessible by the proxy-brush and floss? 4. I am a thin biotype. 5. A similar unit is going to be planned on the other side of the maxillary. How an emergence profile should be designed for the implants in the bridge. Your feedback is greatly appreciated.
1. There are a lot of different attachment styles based on implant brand and application. I have used Internal hex, conical, etc., which all work. It may also be based on the applications and alignment condition of the implants. 2. The connector(s) size is based on engineering needs for the bridge's strength and occlusal space. Zirconia bridges are designed in software that provides metrics for connector size. 3. Water pick is often the best way to clean around implants and implant bridges. 5. Emergence style is impacted by many factors such as biotype, where the implant is placed to the bone, how much bone, etc.. These are good questions and should be asked by you to your provider of care. The condition of your mouth, gums, bone, and bite will play into how the restorative work can be implemented. I wish you all the best.
I’ve been taking a 15 blade and making an incision mesial/distal without a flap, and screwing the implant crown in. Thoughts on that? Does that cause any issues in loss of tissue? I haven’t noticed any issues but maybe because I am not looking hard enough.
It depends on your systems and workflow. With in-office CAD/CAM and software, we plan the restorative strategy virtually, then develop the implant placement with the crown-down approach. This will provide a more optimal restorative design and placement. In my practice, I customize most of my implant restorations because I can control emergence, functions, and final aesthetics.
