Teeth-on-the-Spot™
By Steven Pigliacelli, CDT
Vice President, Marotta Dental Studio

We all have the need for speed. In the dental industry, speed often comes at the expense of quality. Now, however, Marotta Dental Studio is offering a new system of implant placement that works quickly without compromising quality. This system has very appropriately been dubbed TeethontheSpot™ and accomplishes almost exactly that which its name implies.
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Implants Made Simple
Part IV
By Steven Pigliacelli, CDT
Vice President, Marotta Dental Studio
Marotta Means Education
By Steven Pigliacelli, CDT
Vice President, Marotta Dental Studio
Here at Marotta Dental Studio, we strive to be a fullservice laboratory. This means that we provide the highest quality prosthetics for your dental practice. But our services do not end there. At Marotta, we believe that helping you keep up with the latest techniques in esthetic dentistry is a vitally important part of our job. Providing the education that dentists need in order to practice successfully in this constantly changing industry is a challenge that we meet in several ways.
 
Following is an introduction to some of the many ways that Marotta means education:
Monthly Seminars
Each month we offer another educational seminar devoted to an important topic in esthetic dentistry. These
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NobelGuide™
By Steven Pigliacelli, CDT
Vice President, Marotta Dental Studio
People want comfort; they want convenience; they want security.
 
 
For people active in the field of dentistry, such qualities have often been hard to come by. In the past, dental treatments have often been difficult, timeconsuming, and sometimes even risky, both for patients and practitioners alike.
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Overdenture – The Sleeping Giant
For this chapter of Implants Made Simple we will be constructing an overdenture. There are two popular methods of doing an implant overdenture: a clip bar or a direct overdenture attachment.

Before describing the next steps, however, let’s define a few of the more common attachments and bar systems being used today.
Hader bar: The Hader bar is designed for patient removable bar restorations. The Hader bar is a 1.8mm thick semiprecision bar attachment that is cast to the implant cylinder. The bar will be placed in the mouth and secured by screws to the implants. The bar allows hinging movement with a mechanical snap retention. The Hader accepts either a varying color coded retentive strength nylon rider or an adjustable gold alloy rider.
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Implants Made Simple
Part IV
Overdenture – The Sleeping Giant (continued)

Dolder Bar: The dolder bar is a precision bar attachment that comes in either rigid or resilient strengths. Both the bar and the clip, or channel as it is called, is made of gold alloy. The channel engages the entire length of the bar and has an adjustable retention.

Milled Mesio Frame: A completely custom under frame that can have both patient removable and doctor removable prosthesis engage it. Any number of attachments can be used with a Mesio frame.


ERA Attachment: An extra coronal semi precision attachment that is cast to the distal or on top of a cast frame. Six color coded nylon males offer varied consistent levels of retention. An ERA attachment is quite often placed on the distal of a clip bar that has a Hader clip in the front anterior section and 2 ERA attachments as distal cantilevers.

Ball Attachment: Ball attachments were popular on subperiosteal frames in the past. Today they are still sometimes placed on top of bars to give retention, usually with a rubber Oring.

Ball Abutments: These are the same as the cast ball attachment except they are premachined and affix directly to the implant via a screw. There are many different brands and manufacturers for ball abutments such as DalRo, Oring, and EDS, with varied retentions and sizes.

ERA Abutments: The ERA implant abutment applies the ERA overdenture attachment concept to a series of titanium abutments made for most implant companies. There is a direct ERA abutment that is a straight 0 degree and screws directly to the implant and a 5, 11, and 17 degree two piece angled abutment.

Locator Abutments: These are direct overdenture abutments that attach directly to most of the implant manufacturers. They have a self locating design that allows correction of angles up to 40 degrees between divergent implants using the same abutments. They offer an advantage when interocclusal space is limited. They also have color coded varied degree retention males with metal housings. There is a locator attachment that can be screwed onto a clip bar.

There are other bar and direct overdenture abutment systems on the market but these are the most popular. Which way to go with a case is the tricky part. First off there have been debates since direct overdenture abutments came on the market that too much force is placed on the implant with these abutments and that a bar offers a more evenly distributed force between the implants. Both sides have their own research and studies to support their claim. To argue these facts is reminiscent of debating politics or religion. It is purely up to the restorative dentist and the surgeon or periodontist to make the final decision which way they want the case restored. Other factors that come into place are the number of implants placed, inter arch distance, and cost. If two implants are placed, there will be only one clip, which means one retentive element vs. 2 abutments and 2 retentive elements. If there is not enough vertical room, the bar will be too high and not allow enough room for the acrylic and the clips. Finally a 4 overdenture abutments denture will be substantially cheaper than a clip bar on the same number of implants.

Clip bar frame tryin and insertion
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 waxup 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 will be returned with a separate overdenture. A cast steel partial is always made to strengthen the overdenture and add support. Most upper overdentures have a horseshoe mesh cast that reinforces the overdenture and allows minimal bulk to the overdenture, thus giving it a more fixed appearance. The teeth will be reset onto the frame as a final tryin.

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
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found, the frame has a passive fit. If a rock is found, section the frame and relute in the mouth until it seats passively without
any rock. The lab will then modify the master model and weld the frame back together. 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, attach the overdenture to the bar with the clips that are inside the overdenture. Recheck 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.

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 screwretained structures to the implant from Nobel Biocare 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. Place the overdenture into the mouth carefully, making sure the attachments are all engaged. Listen for a snap. The case is completed.
Overdenture abutment tryin and insertion

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 tissue depth and occlusal measurements can be taken to insure the proper abutments are chosen. A cast steel partial is always made to strengthen the overdenture and add support. Most upper overdentures have a horseshoe mesh cast that reinforces the overdenture and allows minimal bulk to the overdenture thus giving it a more fixed appearance. The teeth will be reset onto the frame. At this point everything can be returned for a final tryin or, as in most cases, the overdenture will be processed and finished.

All the abutments will be sent on the model to insure that the proper ones are placed into the proper implant. Most abutments cannot be torqued in. The locator abutment can be torqued to 20 NCM. The abutment driver is compatible with the ISOLatch. Torque instruments using a 0.050 hex driver tip. After the abutments are torqued in, the denture can be placed into the mouth. Listen for the even snaps of the abutments. Check the bite, etc. If this is just a tryin, send it back for processing. If it is the final, the case is completed.

All the abutments will be sent on the model to insure that the proper ones are placed into the proper implant. Most abutments cannot be torqued in. The locator abutment can be torqued to 20 NCM. The abutment driver is compatible with the ISOLatch. Torque instruments using a 0.050 hex driver tip. After the abutments are torqued in, the denture can be placed into the mouth. Listen for the even snaps of the abutments. Check the bite, etc. If this is just a tryin, send it back for processing. If it is the final, the case is completed.

The cure for this is a simple reline. If the case is a clip bar, all the attachments inside the denture must be removed and the denture reamed out. Block out any undercuts around the bar in the mouth as well as the screw holes. Take a traditional reline impression over the bar, the exact same way as a traditional denture. When the material hardens, remove the denture then remove the bar afterwards. Send the bar and denture to the lab. The bar will have analogs placed onto it and will then be placed into the denture. The lab will reline the denture and place new males into the denture. Within a day, the bar will be returned for reinsertion and the denture will fit and snap into place.

The cure for this is a simple reline. If the case is a clip bar, all the attachments inside the denture must be removed and the denture reamed out. Block out any undercuts around the bar in the mouth as well as the screw holes. Take a traditional reline impression over the bar, the exact same way as a traditional denture. When the material hardens, remove the denture then remove the bar afterwards. Send the bar and denture to the lab. The bar will have analogs placed onto it and will then be placed into the denture. The lab will reline the denture and place new males into the denture. Within a day, the bar will be returned for reinsertion and the denture will fit and snap into place.
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Marotta Means Education (continued)
evening seminars are like our own study club. They offer CE credits, a complimentary dinner and best of all a cooperative, family atmosphere. Look for invitations to these seminars in your mail. Some of the topics we cover in our seminars include:

• Esthetics Made Simple - Esthetic cosmetic dentistry (laminates, all porcelain restorations, invisible braces, and implants) has become one of the fastest growing trends in our field. Our research and experimentation has made esthetic dentistry much easier to achieve with stronger, less problematic, less techniquesensitive, and more predictable results. Topics covered in these seminars include: Laminates, Pressed Ceramic Systems, Empress, Captek, Procera, Zirconia, GoldElectroforming Systems, InCeram, custom shades and custom stains, VeneerOnTheSpot ™ , the Shadevision from Xrite, diagnostic wax ups, composites, and new and emerging systems.
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Marotta Means Education (continued)
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NobelGuide™ (continued)
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