What Our Lab Can Do to Help You With Roundhouse Cases
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 want to talk to you about what our lab can do to help you with your roundhouse cases and make it go smooth, and simple. So when you place ten to twelve mini implants for a roundhouse, there’s a few certain steps that you need to take in order to get the result that you and your patient are working toward.
The first step is take really good photos and pre operative impressions, whether they have no teeth or some teeth that you’re taking out. Just get a good baseline of what they have to start with and we can work from there. The next thing we can do is we can do a diagnostic wax up, which is simply sending in those models and having our lab do a wax up on the teeth or on the ridge so that you can present it to your patient, if you so choose. To let them see what the teeth might look like after they’re all done. This is an optional step, but in certain situations I like to do this, especially if I have a very particular patient and I think it’s going to be a tough case to get a perfect result with.
The next step you’re going to do is have your surgical guide stent made right and let us help plan the case. And you’ll place all the implants and I know you all know how to do that at this point. Once you’ve placed all those implants, take your impressions of your final impression of those implants in place. And if you can do your bite right there, do it that day. I usually use cotton rolls to take the bite.
But if you need a bite rim made, you can either make one in the office or send one out to the lab to have a wax bite rim made and have them back in for a wax bite. It’s up to you how you do your bite. I usually use a couple of cotton rolls, have them bite down and get an idea of where I want their vertical. And then I take a registration bite on the opposite side and then do the same on the other side. So there’s a couple of different ways you can do your bite. The next thing we want to do is a try in, and this is very important. You want to do a milled try in that’s troughed out so that it fits over the implants.
And you can check the vertical, the aesthetics, the bite, all of that stuff on a try-in. Those things can all be adjusted and you get this little card with it, with the try-in. And this is a milled plastic try-in. You’re going to check the midline, the occlusion canting size and shape of teeth over jet and the next steps. Okay? So make sure you mark those off. And if you’re making some changes, make a note to what you changed. And all you need to do is go ahead and do the changes on that try-in. You can grind them, you can adjust the bite if you adjust the bite significantly. Take a new confirmation bite with that try-in in place. And that’s not a bad idea to do anyways, okay? But go ahead and make those changes and make a note of what you changed. After you get it all finished.
The next step is, if you want, you can go to a temporary restoration or a permanent restoration at that point. And here’s a typical temporary. The nice thing about the Temporaries is we can give you a temporary to put in the day you place the implants or you can use a patient’s existing denture as a temporary. It’s up to you. But this is a really nice milled temporary roundhouse, completely troughed out. And what I usually do is put housings in the patient’s mouth on the implants and pick these housings up with a lux attempt type material or protemp or Visalys, whatever product you’re using for your temporaries.
I squirted in the trough, pick up those housings at the time of implant placement and the patient has a nice looking temporary to wear for the next several weeks while we’re going through these steps to fabricate the final restoration. That’s pretty much it at that point. You should get back a permanent restoration that looks beautiful, fits beautifully and is aesthetically pleasing to the patient. I’m Dr. Todd Shatkin, and thanks for joining me on this Monday morning minute.