Chapter
10
The Laboratory Technician’s Key Role in MDI Prosthodontics ANDREW JAKSEN JOHN KIRDAHY MURRAY SCHEINER LEONARD MAROTTA
Outline Introduction by Dr. Victor Sendax The Laboratory Technician’s Key Role in MDI Prosthodontics: Andrew Jaksen
Introduction by Dr. Victor Sendax Just as vital to the success of the Mini Dental Implant (MDI) System—and comparable with the seminal role of the MDI Insertion Protocol—is the MDI Reconstructive Protocol, both of which are given equal attention in the original Sendax Patent granted by the United States Patent Office. The foremost firing line experience to be encountered in applying MDIs to clinical implant prosthodontics is the dental laboratory connection. This text has reserved an individual place of respect for the laboratory technicians who partner with doctors in establishing the specialized standards that apply to
The Laboratory Technician’s Key Role in MDI Prosthodontics: John Kirdahy, Murray Scheiner The Laboratory Technician’s Key Role in MDI Prosthodontics: Leonard Marotta
MDI restorations or reconstructions, whether for single tooth replacements, removable overdentures, or hybridized fixed bridges. The learning curve in restoring minis is subtle to much the same degree as mastering the essentially simple and typically straightforward intraoral MDI insertion steps, as long as attention is also paid to the often less obvious fine points. The imaginative and skilled certified dental technician (CDT) is often in the catbird seat (and occasionally the hot seat!) when it comes to refining those unique, hard-to-define MDI elements and taking them to full fruition. Our colleagues presenting herein are prime exemplars of this critical attribute.
The Laboratory Technician’s Key Role in MDI Implant Prosthodontics: Andrew Jaksen The author and dentist-lecturer Dr. Benjamin Oppenheimer has been devoted to the process
of consolidating advances in MDI laboratory coordination and work simplification via updated
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s tep-reduction techniques for fixed (and removable) applications and has pioneered in advancing MDI education with specialized seminars specifically oriented to the dental laboratory community. Rapidly evolving ceramic abutments for MDI fixed crown and bridge cases, along with CAD/CAM generated models, have also come to offer unique contemporary imaging and stent guidance approaches to esthetic restorative simplicity and affordability. Dr. Oppenheimer has been especially productive in presenting MDI educational seminars throughout the United States, emphasizing the close coordination needed between the laboratory staff and the implantologist to refine the essential MDI technology, with special emphasis on fixed crown/bridge applications. The series of lab images (Figures 10-1 to 10-4) illustrates a typical multiunit Ponabut structure with ridge laps, embrasures, and flange elements designed to produce a secure and esthetically satisfying result. When inserted with self-cure resin
cement, this fixed, splinted full-arch system can be made hygienically cleansable with a water irrigator lavage, preferably teamed up with a dedicated curved-bristle implant brush (e.g., ACCESS Implant Brush), for a well-emphasized labiolingual approach after meals and, of course without exception, before retiring at bedtime. MDI fixed bridge-splint laboratory technology embodies MDI Ponabuts, which for multipleunit fixed embodiments require a passive fit of the prosthesis overlaying the abutments and an easy draw without binding interferences, irrespective of any off-angle or nonparallel considerations. This requires the laboratory to block out sufficient relief room around the abutment heads on the working model (made chairside from a polyvinyl siloxane or polyether impression), with MDI analogs inserted, and poured in model stone or epoxy so that either individual castings can be fabricated, tried in and connected intraorally, or a one-piece cast
FIGURE 10-3. Ponabuts in the esthetic zone. FIGURE 10-1. Ponabut prosthesis, lingual view.
FIGURE 10-2. Full arch Ponabut palateless prosthesis, lingual view.
FIGURE 10-4. Final full arch Ponabut prosthesis, anterior view.
The Laboratory Technician’s Key Role in MDI Prosthodontics
s ubstructure can be manufactured and passively fitted intraorally. Bite registrations and records with any opposing jaw impressions are also produced to further the lab processing. Porcelain or composite resin is then layered and processed over the substructure. Various other techniques with or without an infrastructure are currently undergoing extensive development for both MDIs, conventional implant systems, and hybrid combinations and await additional studies and clinical case reporting to confirm their outcomes.
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The updated Celara denture wax-up and duplicate modeling technology offers improved accuracy and directness in building the MDI-related removable prostheses and insertion guidance control for stent devices. Technician Andrew Jakson and dentist/associate Dr. Benjamin Oppenheimer, aided by Keith Henry of 3M-ESPE and a cross-section of MDI dentists and laboratories, have been instrumental in illuminating this user-friendly lab processing aid for conventional denture prostheses and removable MDI overdentures.
The Laboratory Technician’s Key Role in MDI Prosthodontics: John Kirdahy, Murray Scheiner John Kirdahy, CDT, with pioneering forays into simplified MDI laboratory technologies and representative suggestions and tips, helped launch affordable MDI prosthodontic solutions. John Kirdahy’s Innovation Laboratory has consistently offered evolving lab techniques that have helped standardize the coordination of MDI chairside procedures with the implant-oriented dental laboratory and advanced the progressive design and processing of both fixed and removable MDI cases, two of which are represented in Figures 10-5 to 10-14. Murray Scheiner, CDT, who has been Dr. Sendax’s in-office personal lab technician for more than 40 years dating from the earliest MDI clinical trial cases, was initially exposed to the MDI restorative protocol at its inception in 1976, and since then has processed many fixed and removable MDI cases. Together with a consistent offering of the
daily practical tips and suggestions that can be key to successful long-term case outcomes, Murray’s benevolent contributions have been a highly-valued practice asset in developing and applying MDI laboratory technology advances and innovations.
FIGURE 10-6. Maxillary and mandibular MDIs.
FIGURE 10-5. Maxillary and mandibular preoperative removable MDI Case No.1.
FIGURE 10-7. Maxillary 6 MDI O rings.
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FIGURE 10-8. Mandibular 4 O rings.
FIGURE 10-10. Maxillary MDI guide stent.
FIGURE 10-12. Maxillary 6 MDI O ring attachments.
FIGURE 10-9. Maxillary Preoperative; MDI Case No. 2.
FIGURE 10-11. Maxillary 6 MDIs Postoperative.
FIGURE 10-13. Maxillary MDI O ring attachments in removable prosthesis.
The Laboratory Technician’s Key Role in MDI Prosthodontics
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FIGURE 10-14. Maxillary and mandibular MDI postoperative; Case No. 2.
The Laboratory Technician’s Key Role in MDI Implant Prosthodontics: Leonard Marotta The following images (Figures 10-15 to 10-47) illustrate the laboratory steps in fabricating an MDI fixed bridge and a comparable sequence for two single tooth fixed full-coverage restorations, all embodying the unique MDI “Ponabut” design that combines a pontic and abutment in a single entity. MDI fixed bridge-splint laboratory technology embodies MDI Ponabuts, which for multipleunit fixed embodiments require an atraumatic, unstressed fit of the prosthesis overlaying the abutments and an easy draw without binding interferences, irrespective of any off-angle or nonparallel considerations related to varied emergence profiles of the MDIs as they penetrate the crestal bone and soft tissues (through the periosteum and attached gingiva) into the oral cavity. This protocol requires the laboratory to block out sufficient relief room around the abutment heads on the working model (made chairside from a polyvinyl siloxane or polyether impression), with MDI analogs inserted, and poured in model stone or epoxy so that either individual castings can be fabricated, tried in and connected intraorally, or a one-piece cast substructure
can be manufactured and then passively fitted intraorally. Bite registrations and records, with any opposing jaw impressions are also produced to complete the lab processing. Porcelain or composite resin is then layered and processed over the substructure. Various other techniques with or without an infrastructure are currently undergoing extensive development for both MDIs, conventional implant systems, and hybrid combinations and await additional studies and clinical case reporting to confirm their outcomes. Single tooth replacement MDIs lend themselves particularly well to individual crown restorations with the Ponabut design as the underlying structural element. The Marotta Laboratory has produced herein a series of MDI case views that effectively illustrate the essentials when working with MDIs for individual crown and bridge restorations and define the sequencing steps, which basically follow conventional lab procedures but with several design modifications to simplify MDI fixed prosthodontics for both lab and doctor (Figures 10-48 to 10-59).
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FIGURE 10-15. Polyvinyl siloxane O-ball implant impression.
FIGURE 10-16. O-ball analog in packaging.
FIGURE 10-17. O-ball analog.
FIGURE 10-18. Three analogs inserted into polyvinyl sulfate impression.
FIGURE 10-19. Three seated analogs.
FIGURE 10-20. Full arch impression.
The Laboratory Technician’s Key Role in MDI Prosthodontics
FIGURE 10-21. Duralay reinforcement.
analogs
antimovement
FIGURE 10-23. Model with soft tissue component.
FIGURE 10-25. MDI impression and waxing coping.
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FIGURE 10-22. MDI impression and waxing coping in packaging.
FIGURE 10-24. Before waxing.
FIGURE 10-26. Waxing coping detail.
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FIGURE 10-27. Waxing coping detail.
FIGURE 10-28. C & B Ponabut wax-ups, occlusal view.
FIGURE 10-29. C & B Ponabut wax-ups, lingual view.
FIGURE 10-30. C & B Ponabut wax-ups, linguoocclusal view.
FIGURE 10-31. C & B Ponabut wax-ups, buccal view.
FIGURE 10-32. C & B Ponabut wax-ups, buccal view.
The Laboratory Technician’s Key Role in MDI Prosthodontics
FIGURE 10-33. Ponabut cast framework.
10-35. Ponabut FIGURE occlusolingual detail.
casting
framework,
FIGURE 10-37. Ponabut cast framework, occlusal detail.
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FIGURE 10-34. Ponabut cast framework, occlusal view.
FIGURE 10-36. Ponabut cast framework, buccal detail.
FIGURE 10-38. Porcelain Ponabuts, buccal view.
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FIGURE 10-39. Porcelain Ponabuts, anterior view.
FIGURE 10-41. Porcelain Ponabuts, buccal view.
FIGURE 10-43. Porcelain Ponabuts, occlusion detail.
FIGURE 10-40. Porcelain Ponabuts, occlusolingual view.
FIGURE 10-42. Porcelain Ponabuts, buccal view.
FIGURE 10-44. Porcelain Ponabuts, occlusal view.
The Laboratory Technician’s Key Role in MDI Prosthodontics
FIGURE 10-45. Ponabuts, buccal detail.
FIGURE 10-47. Glazed ceramometal MDI-supported fixed bridge.
FIGURE 10-49. Single tooth replacement, right lateral incisor Ponabut.
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FIGURE 10-46. Porcelain Ponabuts, occlusal detail.
FIGURE 10-48. Single tooth replacement, right Ponabut view.
FIGURE 10-50. Single tooth replacement, right Ponabut.occlusal view.
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The Laboratory Technician’s Key Role in MDI Prosthodontics
FIGURE 10-51. Single tooth replacement, left lateral incisor Ponabut.
FIGURE 10-52. Single Ponabut view.
FIGURE 10-53. Single tooth replacement, close-up detail.
FIGURE 10-54. Right single tooth replacement, porcelain Ponabut.
FIGURE 10-55. Right and left Ponabut single tooth replacements.
FIGURE 10-56. Right and left Ponabuts, occlusal view.
tooth
replacement,
left
The Laboratory Technician’s Key Role in MDI Prosthodontics
FIGURE 10-57. Right and left Ponabuts, occlusal details.
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FIGURE 10-58. Single tooth replacement, right and left porcelain Ponabuts.
FIGURE 10-59. Single tooth replacement, right and left porcelain Ponabuts, anterior view.