Neoss Links
Customer Highlights & Case Feedback
Check out "The Curious Dentist" is a blog for dentists by Chris Salierno DDS, an internationally-recognized lecturer and author on clinical dentistry and practice management. In this post, Dr. Salierno discusses why he thinks the Neoss impression coping has the best design on the market.
___________________________________________________________________
 | Jin Y. Kim,
DDS, MPH, MS Ph. 909-860-9222
|
Neoss Case Presentation: Creating and restoring the ideal peri-implant gingival architecture
Jin Y. Kim, DDS, MPH, MS - Diamond Bar & Garden Grove, CA
Linette is a healthy 39-years-old female who sustained trauma to the maxillary central incisor during whitewater rafting. With subgingival fracture of the upper left central close to the bone level, the tooth was not restorable (fig 2). Immediate implant placement with concurrent bone graft was carried out with a 4.0mm x 15mm Neoss Proactive dental implant. The PEEK healing abutment was utilized to create a screw retained non-occlusing provisional restoration. The coronal portion of the restoration was the actual extracted tooth, which was fused with light-cured composite resin. The implant was well integrated at 2 months, and Osstell ISQ of 70 was recorded. The well formed soft tissue was accurately picked up by a custom impression allowing the dental laboratory to fabricate a definitive restoration with form and shape that will be supporting the peri-implant architecture.
Fig 1 Initial presentation of patient. The fractured tooth was stabilized with bonded resin in an emergency visit, three days prior.
Fig 2 CBCT view of maxillary left central incisor
Fig 3 The fractured tooth was bonded to the PEEK healing abutment with ideal soft tissue contours. This non-occluding implant tooth was used as an immediate provisional restoration.
Fig 4 Peri-implant tissue was preserved in the ideal form and shape.
Fig 5 Periapical intraoral radiograph.
Fig 6 The provisional restoration was able to maintain gingival shape, especially the papilla topography.
Fig 7 A custom impression was taken with impression coping and light-cured flowable resin to duplicate the soft tissue shape. (Restorative dentist: Dr. Howard Ngo, Cypress, CA)
Fig 8 The custom impression transferring information to the dental laboratory.
Fig 9 The final master cast with precise information of peri-implant tissue. (Spectrum Dental Laboratory, Tustin, CA)
-------------------------------------------------------------------------------------------------------------------------------------------------  | Paul S. Apfel, D.D.S.
Ph. 631-427-4095 |
Neoss Case Presentation: Access Abutment Application and Transfer Device Paul S. Apfel, D.D.S. The ability to successfully fabricate an implant-supported esthetic fixed prosthesis is usually dictated by the surgical precision of implant placement in relation to the desired tooth positions. Unfortunately, even with our best attempts to insert implants in anatomical positions which would permit fabrication of the restoration according to an "ideal" functional and esthetic design, it is often necessary to accept compromises to avoid nearby anatomical structures. These would include, for example, an adjacent natural tooth root, a pneumatized maxillary sinus, the mental foramen, or where insufficient bone volume exists to achieve the desired implant angulation. Screw retained prostheses are especially vulnerable to undesirable implant angulations since the acrylic or ceramic materials may be placed at increased risk for fracture if, for example, a screw access hole were to compromise a cusp tip or tooth facial surface. This 82 year old male presented with a hopeless partial dentition due to extensive periodontal disease. Esthetic and functional full-arch tooth set-ups were performed by the dental laboratory on diagnostic casts and evaluated in the patient's mouth for lip line, speech, freeway space and occlusion. The patient subsequently had a CT-scan of his maxilla to evaluate bone volume for dental implant placement. A surgical guide was fabricated and seven Neoss dental implants were surgically placed. The patient was fitted with a provisional maxillary complete denture at that time.  | | Fig. 1-3 |
After six months the dental arch was ready for the final restoration (Fig. 1). A full arch impression was taken for fabrication of a master cast which was verified prior to preparation for a screw-retained cast metal frame "hybrid" prosthesis. Critical to the esthetic tooth requirements in the anterior region and the integrity of posterior occlusal surfaces is the optimal placement of screw access holes. Analysis of the master implant fixture-level cast was facilitated using a clear vacuform stent, created over a stone cast of the initial tooth set-up. Impression coping screws were then seated into the analogs revealing implant angulations which would result in screw access holes positioned too far labially for the desired prosthesis (Fig.2). The Neoss Access Abutment offers a low profile, internal implant connection with 0, 10, 20, and 30 degree angulations. Photograph #3 shows the Access Abutment with its frictional retentive plastic carrier used for transfer to the implant. Access Abutments with 20° angulations were selected to provide realignment of the prosthetic screw access holes to more favorable anatomical positions according to the desired prosthetic tooth set-up. To further facilitate the proper rotational insertion orientation of multiple Access  | | Fig. 4-5 |
Abutments intra-orally, which were determined by the prosthetic dental laboratory, a positioning device was fabricated. This is essentially a resin-based splint which rigidly connects each Access Abutment's plastic carrier to each other on the master implant cast (Fig. 4). Resin (GC America Inc., Alsip, IL) is applied to each plastic Access Abutment carrier, and bridged together as a single verifiable positioning component. This permits the clinician to lift off and carry multiple angled abutments simultaneously inserting them in the mouth (Fig 5). Once the Access Abutments are stabilized, their screws are torqued to 30ncm. Neoss Access Abutments were selected by the dental laboratory based on the amount of angled correction necessary. Photograph #6 illustrates the patient's maxillary arch with six Access Abutments secured in place permitting the dental laboratory to fabricate the final prosthesis with all screw access holes correctly positioned (Fig. 7-9). While angled abutments are not suited for every situation, especially when superficial implant heads co-exist with a high smile lip line anteriorly, they significantly ease the burden of relying on ideal implant placement in the presence of anatomical restrictions, as well as the need for costly and often bulky sub-frames as a means of coping with unfavorably located access holes in screw-retained prostheses.  | | Fig. 6-9 |
|
