Tips For Fixed Roundhouse Restorations
Good morning and welcome to the Shatkin F.I.R.S.T.® Monday morning minute.
Hi, I’m Dr. Todd Shatkin, and welcome to this Monday morning Minute. Today I’m going to give you a few tips on how to do a roundhouse or a fix on six round restoration properly so you don’t have to have any remakes and limit the number of times that you have to send it back to the laboratory. Because, of course, chair time is valuable and patient time is valuable of course, too. So the steps involved in proper planning and processing of a fixed roundhouse restoration, whether it’s a detachable fixed on six restoration or a cemented fixed on ten or twelve restoration, is this number one proper planning of the placement of the implants is of utmost importance.
Which means send in either your good quality impressions and a CT scan or a good quality panoramic X ray along with good quality impressions. Or if you have digital impressions, that’s great too. Upload all of those to the Shatkin F.I.R.S.T.® Portal, if it’s an STL file or the DICOM files, whatever you might have, upload all that. Or just send in your manual impressions to us and we will pour those impressions, scan them into our system and we will help you plan the case properly.
When we talk about planning the case properly, we’re going to take our time. Either myself or Dr. Powers will spend ample time planning out your case to make sure we plan the position of those implants in the available bone that you have so that we put as many implants as we possibly can in the available bone. Angle them properly to avoid the sinus cavity, avoid the nerve canals, avoid the adjacent teeth so that we can place the implants in the placement positions that we want to use, ideally to finish the case properly, that’s number one.
Number two, we’re going to make you a surgical guide stent so that when you place the implants, you can be comfortable placing them where you want to place them. Once you’ve got the implants in place and you know they’re in good bone and they’re solid, you’re going to take a very good quality impression. Now, what kind of impression material you use is up to you. I truly enjoy using the Ketton Bach impression material. I started using that about six months ago and I love the product. It’s very, very hydrophilic, it’s very good quality impression material and I have almost a perfect impression every time.
If you’re using a digital impression, that’s perfectly fine as well. Take a good quality impression. Do not use alginate or alginate substitute. Use a permanent polyvinyl or polyethor impression. Take the best impressions you can of the opposing arch as well and take a good bite registration. If you’re not sure of your bite, have a wax bite Roommade. Let’s take that extra step to have a good quality bite Roommade and get that patient back to get a good bite. When you do that bite, make sure you mark that midline. Midline is very important.
The midline of the freedom is not always the midline of the face as you know. You need to mark the midline. Look at the midline of the nose. Midline of the nose may not to be the midline of the face. The midline of the lower teeth may not be the midline of the face. You need to pick that midline where you want the midline of the teeth. Okay? Usually it’s the midline of the freedom and the incisive papilla, but it may not be right. So make sure you mark the midline and mark the smile line. If you want to use some toothpicks to mark the horizontal and the vertical, that’s great too.
You can put those in the wax. Once you’ve got that all marked, send it back to us and we will mount the case and we will do a try-in. The try-in is very important. We will send you back a nice acrylic milled try-in. You’ll try that milled framework in the patient’s mouth, it’s going to be a milled plastic try-in that you’re going to try in and this is your chance to look at it in the patient’s mouth.
Let the patient take a look at it, see if they’re happy with the way it looks. This is not something for them to take home with them, it’s just for them to try in the mouth and make sure that the midline is good, the Occlusion is good and the general smile line is good. At that point, if you need to make some adjustments, go right ahead, grind on them, adjust them, add composite to them, subtract from them, adjust the bite. If you need to move the midline, go ahead and grind on it. Mark a new midline. Write any notes you need to our lab technicians so that they can make the corrections you want.
When doing your try-in, make sure you refer to this slip and fill it out properly. If you want a second try-in, we’ll do a second try in for you. Once you’re comfortable with the final try-in, then we’ll go to finish restoration and hopefully you’ve communicated all the changes you might need to our lab techs. A picture is worth 1000 words. Take photos of the try-in. Take a shade guide, put it next to the patient’s face. Make sure that you select the proper shade for the patient’s result. And I’m talking about not just the porcelain color of the teeth, but also the gingival color too. So have a gingival porcelain shade guide as well. Get all of those records and send it back to the lab and they will make a beautiful zirconia restoration with pink porcelain if you desire it.
In some cases you may, some cases you may not. For example, in this case we’ve got the porcelain teeth butting right against the gum line. You may not need pink porcelain. In other cases, you may need pink porcelain. If you have to build a porcelain flange, for example, in a case like this where you need to add extra pink gingiva.
So it all depends on the specific situation. If the patient needs more lip fullness, you may need a much larger pink porcelain flange. So those are the things you need to communicate with our laboratory. I hope this information was helpful to you. As always, you can reach out to myself, Dr. Powers, or if you have any questions at all about the process of doing your fixed roundhouse cases. We are doing more and more fixed roundhouse restorations on many implants. Generally, I cement them, but I do a lot of fixed detachable restorations that we call our fixed on six. We say six, but we usually use eight to ten implants.
Just the name fix on six kind of is our comparison to the all on four, which and oftentimes they use six conventional implants, we use eight to ten minis. But whatever you choose to do, just communicate properly with the lab and take the necessary steps to get the job done correctly. And keep in mind that those fix on six restorations work very well with our beautiful new O-CAP housings. You don’t have to use the O-ring housings anymore. You can use the O-caps, which are smaller in diameter, fit very nicely in those fix on six restorations, and snap on more snugly.
So check those out as well. And we’ll be back next week on the Monday Morning Minute. Thanks for joining me again. I’m Dr. Todd Shatkin, and see you next week.