Marotta Dental Studio is proud to announce its relocation to an expanded, state-of-the-art facility.
Implants Made Simple – Part III
By Steven Pigliacelli, CDT Vice President, Marotta Dental Studio
For this chapter of Implants Made Simple we will be constructing full arch screwretained and cementable bridges. At this stage the models have been poured, mounted and a diagnostic setup has been approved. When the lab receives the models, as outlined in Implants Made Simple Part II, all the previous prescriptions, estimates and frame design memos are reviewed. Once verified and approved, the framework is started. Believe it or not, the hardest part is over.
( Continued on page 2 )
Three Generations of Tradition
By Steven Pigliacelli, CDT Vice President, Marotta Dental Studio
It all began in New York City in 1935 when 16-year-old Leonard Marotta, Sr., began working in a machine shop fabricating radar equipment for the war effort. The shop also constructed steel frames for dental appliances, and Len apprenticed in this department. He was one of the first technicians to cast Vitallium and Krupps steel partial frames and Vulcanite Dentures.

In 1950 he opened Artwork Dental Lab in Valley Stream which specialized in steel-work for removable partials and SubPeriosteal and Blade restorations. Len would take extra work home, and his son, Leonard Marotta, Jr., got his start in the field of dental technology working with his father in their basement. In fact, he still has the very first paycheck he received on February 26, 1960, for $1.25 an hour; he was 14 years old.

The dental industry is constantly changing. Emerging techniques require new systems, new machines, and new expertise. We've always been at the cutting edge of this development, and we intend to continue to be an industry leader in utilizing the most up-todate materials and perfecting the newest techniques. Our 12,000 sq. ft. laboratory has room to do just that.

In keeping with our commitment to searching out and perfecting the latest systems and techniques, we have developed research facilities through which we can work with the surgeon, periodontist and the restorative dentist.

We can accommodate your patients' custom shade needs in a private operatory where we perform custom shading, staining, adjustments and insertion of prosthetics. Our computer center pretreatment room is where we case plan implant restorations with software such as NobleGuide and Simplant. We conduct many seminars for dentists and technicians in our Media Center with CE credits offered. Courses are listed on our website www.marottadental.com
 
1

 
 
Implants Made Simple – Part III (continued)

Before describing the next steps, however, let’s define a few general terms concerning implant restorations:

Abutment: An abutment is generally a transmucosal attachment that is placed onto the implant and acts as an intermediary between the framework and the implant. Abutments attach to the implant via a screw and have a seat for a machined gold cylinder to rest on. A screw will go through the cylinder and attach to the abutment. One of the main advantages to this system is that the screw acts as a shock absorber and therefore will break prior to stressing the implant. Another is that if the implant is very deep, the abutment raises the collar of the frame to a more agreeable level.

UCLA: This is one of the most mis-used implant terms. First, a UCLA is not an abutment. It is a gold cylinder which engages the implant directly. The UCLA bypasses the abutment altogether. Another misconception is confusing a UCLA with a custom post. In most instances, the lab will custom wax and cast an abutment post with a UCLA. However, it is not the only device used for posts and it is not only used for posts. A screw-retained bridge can be made to attach directly to the implant via non-hexed UCLA cylinders, whereas a single unit screw-retained crown will use a hexed cylinder. A custom post can be made with any number of pre-machine solid or straight titanium abutment posts made for all the manufacturers. GUCA is another name attributed to these cylinders. GUCA was the part number from 3I in the past for one style of gold cylinder. There are numerous other part numbers from 3I for these cylinders. Nobel Biocare calls them Goldadapts; Zimmer and Strauman never used the term at all. It is due to this confusion that the names UCLA and GUCA are not used by the manufacturers. We do not use these terms either. We refer to these parts simply as gold cylinders direct to the implant.

Fixed doctor-removable: This is a frame that the doctor inserts into the mouth via screws that cannot be removed by the patient but only by the doctor. This term can be applied to almost all implant restorations, therefore an addition to the term is used to differentiate the restoration. For example, a 12-unit screw-retained bridge that has denture teeth processed to it would be a fixed doctor-removable processed denture tooth bridge. This was, and in some cases is still, referred to as a hybrid. The big misconception there is the term hybrid. Any material may be applied to the frame: porcelain, denture teeth and composite. A 12-unit screw-retained porcelain-fused-to-metal bridge, a composite-fused-to-metal bridge and a hybrid case are all different names for the exact same case. The only difference is the esthetic material applied to the frame.
Therefore, the classification for these frames is as follows:

• Fixed doctor-removable processed denture tooth bridge: A screw-retained bridge that attaches to either the implant or an abutment and that has denture teeth processed to the frame. The doctor can remove the frame but the patient cannot.Composite is placed into the screw holes on the restoration to mask out the holes after inserting the bridge.

• Fixed doctor-removable porcelain-fused-to-metal bridge: A screw-retained bridge that attaches to either the implant or an abutment and that has porcelain fused to the frame.

• Fixed doctor-removable composite-fused-to-metal bridge: A screw-retained bridge that attaches to either the implant or an abutment and that has composite fused to the frame.
2
 


 


Fixed patient-removable:
This refers to any form of removable appliance that is affixed to an implant. This could be a cast frame that attaches to and is screwed through an abutment or directly to the implant, the same as a fixed case. A denture will lock onto it via some form of attachment such as a hader clip, dolder bar, era, locator, or many other attachments. This also refers to direct overdenture attachments such as the locator mentioned in Implants Made Simple Part I.

Cementable: A cementable is also a fixed-doctor removable yet is rarely referred to in this way. Basically the two most common terms are cementable or custom post case. In this case design, a cylinder is either custom waxed, cast and milled, or a pre-machined component is milled, to replicate a prepped tooth. The final frame is then cemented over it. This case design is very popular today. In the early implant days this design was the exception, only used when implants were placed at a poor angle and no pre-machined angled abutments existed. Today many dentists like this design better since it is closer to regular crown and bridge and is, to some, more esthetic since there is no occlusal screw hole to fill.

  

Frame Try-In
The next step is the frame try-in. Depending on which frame design was chosen by the rubber index detailed in Part II, the frame try-in procures may vary.

Fixed doctor removable screw-retained bridge:
The procedure for trying in a screw-retained restoration is the same for all case designs whether it is a processed denture tooth, ceramicto-metal or composite-tometal. The first thing that is done is a stone index. The stone index is made to maintain the tooth position over the implants on the model. Each tooth will remain in the index and the index will attach to the model. This way the wax-up can be made within the confines of the setup. If abutments are required, they are placed onto the implants and the index is then placed back onto the model and machined gold cylinders are attached to the abutments. If they are not required, then just gold cylinders are attached to the implants. Regardless of the system used from this point on, we will only refer to the gold cylinder without mentioning abutments or implants. The overall case design is the same either way.

The frame might be returned in two ways, either with the teeth reset onto it or just the bare metal. Most of the time, the teeth will be reset onto the frame as a final try-in. If the final restoration is to be ceramic or composite-fusedto- metal then, of course, just a frame will be returned. Place the frame on top of all the abutments in the mouth. Look for any sign of a rock in the frame. Screw in the most distal screw and look to see if the frame lifts on the other side. Remove the screw and do the same on the most distal implant on the other side. Continue with this procedure until every screw has been tried in and no lifts have been seen. If no rock is found, the frame has a passive it. If a rock is found, section the frame and re-lute in the mouth until it seats passively without any rock. The lab will then modify the master model and weld the frame back together.
 
3



 

Since a verification jig was used it is highly unlikely that this procedure will ever have to be done.

After the frame is tried in, re-check the setup to verify the bite and esthetics, etc. Let the patient approve the esthetics and do any adjustments necessary. If everything is good, return it for the final processing. If a reset is needed, take a new bite and return for a reset. If the teeth were not reset or the final restoration is to be ceramic- or composite-fused-to-metal, take a check bite and send for the reset onto the frame or bisque bake.

Depending on what case design we are constructing, the next visit may vary. The fit of the frame will not be affected. The next visit is purely esthetic. Whether it is a bisque bake, composite build-up or reset, proceed with the normal protocol for a full arch restoration. Check bite, esthetics, contour, etc. Get patient approval. Do any chairside adjustments needed and return for a finish.

The final insertion is the same for all the case designs. Screw in the screws as previously described. Torque in the screws. The torque settings for implants vary from manufacturer to manufacturer. Ask what the proper setting is for the case. For example, all screw-retained structures to the implant from NobelBiocare are torqued in at 35 NCM while screws to an abutment are 15 NCM. 3I externally hexed implants are torqued to 32 NCM if using their gold UCLA screw but the 3I Certain Implant screw cannot go beyond 20 NCM. There are too many settings to list in this report so it is best to ask for the correct torque setting when the case is delivered.

After the screws are torqued, place gutta percha into the hole to protect the screw and fill in the hole. Place composite into the hole and blend it. The case is completed.

Porcelain-fused-to-metal bridge to cement over custom implant abutment posts.

The custom abutment posts are returned on the model. There is a pink placement jig on top of it. The jig can be removed and replaced easily. The jig is used as a placement device to deliver the custom abutments to the mouth in the correct position. It is suggested that you practice on the model first. Unscrew the posts from the model. Place the posts inside the jig. They can fit only one way. Use the jig as a means to place the posts into the mouth. It will engage the neighboring teeth or other posts.

You can either use the jig to completely screw down the posts or use it just for the first few turns of the screw to insure proper position. Then you can remove the jig and finalize the screw-down procedure. You can then replace the jig to check the position.

After the post is down and verified by an X-ray, the copings can be placed on top of them. The copings may
already be cast in one piece or most likely will have been sent in pieces for a solder pickup. Pick the copings
up in a master impression for solder connections. Treat the case like a regular crown and bridge case.
( Continued on page 5 )
4
 


 
Implants Made Simple – Part III (continued)
All the pre-existing rules apply. Check for fit and make sure there are no rocks in the seat of the frame. Take a check bite and send to the lab. A Processed Provisional is included to be placed on top of the posts so you won’t have to remove the posts. From this point on the case is a typical crown and bridge case and screws, abutments or impression copings are no longer required. Remember to torque the screws as mentioned previously in the screw-retained portion of this article. The next visits are relatively simple. If solder connections were made, remove the temps and try in the soldered frame exactly as you would with a regular tooth bridge. Once a final frame is verified, take a good check bite and, if necessary, do a pickup impression and return for the bisque bake. When the porcelain bridge is returned, follow all the traditional procedures, do any necessary chairside adjustments, get patient approval, and return for the glaze. When doing the final cementation over the posts, make sure to place gutta percha inside the screw hole to protect the screw. Then cement your bridge.

brother-in-law Steven Pigliacelli. The lab quickly gained a reputation for quality work, primarily cast gold inlays, onlays, full cast crowns and copings. Porcelain was sent out to a freelance ceramist. Steven apprenticed directly under Lenny, learning the intricacies of waxing and casting gold inlays, onlays and full cast crowns. A ceramist was eventually hired to keep all the work under one roof and under one standard of quality at a new professional location in Farmingdale, NY.

Lenny studied with the first graduating class of restorative dentists and surgeons in the Branemark system from the University of Toronto in 1984. With the advent of dental implants, the need for in-house denture fabrication was required and a denture technician was hired.

Marotta Dental Studio was one of the first labs to construct Maryland bridges and laminates, using such systems as the Optec system and Renaissance crown which are predecessors of the Empress and Captek systems of today.

The lab continued to grow, adding on a few more technicians and moving to a larger location, also in Farmingdale. Steven took on a supervisory role to assist Lenny in maintaining the quality and standards of the lab. The motto of the lab was always Quality over Quantity. Education and customer support became a vital part of the protocol of the lab. Lenny and Steve took on the task of sponsoring educational programs to support the needs of both dentists and dental technicians. They both believed that dental technology was an art form that needed to be nurtured and promoted. To that end, Lenny became a Clinical Associate Professor in 1989, a position he still holds today, at New York University College of Dentistry. He is on staff or a member of the board of several universities. He has also completed numerous certificate programs. Both Lenny and Steven lecture extensively, and are members of many professional organizations and societies.
Three Generations of Tradition(continued)

Lenny graduated from the Kerpel school of Dental Technology in New York City in 1965. He worked parttime in dental labs during his training as well as in dental offices. Lenny continued his training through graduate studies at Farleigh Dickenson University, where he focused on Gnathology and SubPeriosteal, Blade and Staple implants, graduating in 1972. He earned his CDT in four categories: Ceramics, Crown and Bridge, Partials and Dentures.

In 1980, Lenny opened his own laboratory, Leonard Marotta Dental Studio, in the basement of his home in Old Bethpage, NY, with his wife, Christine and his
 
5


 
Three Generations of Tradition(continued)

In the 1990’s the implant market took off. The demand for quality craftsmanship and esthetic restorations grew. The lab began to host seminars and to provide continuous telephone support and chair-side assistance. An in-office room for custom shades was installed to meet the ever-increasing esthetic demands. New systems such as the Cad Cam system were developed. Marotta was one of the first labs ever to deliver the first three Cad Cam milled titanium NobelBiocare frames as well as to produce the first Procera milled abutments and crowns. Write-ups in journals about the precise frame and esthetic restorations appeared across the industry. All-ceramic systems became commonplace. Custom-shade cosmetic dentistry grew in the lab from being an add-on service to the standard. “Where Dentistry is Art” became the slogan of the lab.

At this time, the number of technicians in the country began to dwindle. Many of the schools closed up and the need for quality technicians increased. An apprentice program needed to be developed that would ensure quality technicians for the new century. Many technicians joined the Marotta team and worked their way up the ranks. Many of the technicians came from other countries to work for the lab, and some were even sponsored to do so. The diversity of the lab is celebrated by the display of a flag for the home nation of each technician. Steve earned his CDT in crown and bridge in 1997, while Lenny continued his pursuit for new technology and advancement in the dental field. Cranial Facial Engineering became a part of the lab’s services when Lenny applied the same standards, principles and techniques to medical implants that he did with dental implants.

By 2000, Cad Cam technology became a regular part of life. New systems came into the lab with modern methodology and machinery required. The team at Marotta has easily taken on these systems. Esthetics has become a major part of the lab with a specialized team of ceramists who work together as comrades rather than rivals and innovate new ceramic procedures. Steriolithography and biomodels are part of the new direction Marotta has embarked upon.

Joshua Marotta, Lenny’s son, began working at Marotta Dental Studio in 2004. Like his father, he is training in all facets of the industry from the bottom up.

In January of 2005, Marotta Dental Studio made its final move to its own building. Josh, who has an engineering background, was instrumental in designing and overseeing the building of the lab himself, ensuring that it perfectly fit the needs of the technicians. The departments flow with precision and the design easily accommodates a wide range of new technologies. A highlight is the Conference Center/Media Room dedicated to Lenny Marotta Sr. that seats more than 60 people for seminars and training. A mini museum of antique dental devises and machines is also proudly displayed.

Marotta Dental Studio is affiliated with Farmingdale State University of New York as an accredited educational facility. Lenny Marotta is an Associate Professor and Director of Clinical Engineering and Biomedical Technology, School of Engineering Technologies.

Marotta Dental Studio hosts monthly CE credited educational seminars on all facets of the Biomedical industry from esthetics to implants. We are also affiliated with National Dental Network a business television network exclusive to the dental community which broadcasts live seminars via satellite.

What began nearly 70 years ago as a sideline in a machinist shop has turned into an industry at the cutting edge of medical technology. And Marotta has been there every step of the way. We look forward to continuing to lead the dental industry into the future.