Guides and FAQ

Dental Designs has compiled the following Guides and FAQ for your convenience. If you have any questions or issues, our excellent Dental Technicians are available to assist you over the phone– call toll free (800) 927-7990.

Guides

Appointment Protocol

Single Unit:

  • 2 appointments; 3 weeks apart
  • 1 hour each
  • Components needed; Impression coping, Screwdriver, full arch plastic tray.
  • Torque tool is required for the final appointment.

Multiple Units:

  • 2-3 appointments; 2-3 weeks apart (framework try-in and bite verification may be required)
  • 1 hour each
  • Components needed: Impression copings, Screwdriver, full arch plastic tray
  • Torque tool is required for the final appointment.

Seating Custom Abutment

Instruments Needed:

  • Screwdriver (specific to implant type), used to remove the healing cap/abutment and seat the final abutment.
  • Insertion Guide, fabricated by Dental Designs for seating all titanium abutments.
  • Torque Driver

Step-by-Step:

  1. Remove the healing cap or abutment using the appropriate screwdriver.
  2. Deliver the abutment inside the insertion guide to the implant fixture in the mouth. (If unable to seat multiple abutments using the seating guide, seat them individually using the guide)
  3. Insert the screw through the opening of the insertion guide.
  4. Hand tighten the screw with appropriate screwdriver. (DO NOT torque yet)
  5. Remove the insertion guide. (Should pop right out)
  6. Take a Radiograph to verify that the abutment is completely seated into the implant fixture.
  7. Insert the crown on top of the abutment. [For Metal Try-in, Stop here and disregard #8-10]
  8. Check contacts and occlusion.
  9. Torque the Abutment using the appropriate torque level. (specific to implant type and size) [See Torque Driver instruction below]
  10. Cement the Crown onto the abutment and clear away excess. [See
  11. Cementation instructions]

Using the Torque Wrench:
The DynaTorq Torque Wrench is designed to tighten abutments and fasten screws to a defined torque. Proper use of a torque wrench is critical.

  1. Select the proper torque wrench based on the recommended torque values of the implant system used, and insert the correct driver insert (also specific to the implant system) into the wrench head.
  2. Engage the driver with the implant abutment screw (be sure the driver is fully engaged in the screw or stripping could occur).
  3. Place a finger on the head of the torque wrench. Follow the direction of the arrow (clockwise) and tighten.
  4. The wrench’s torque limit will break at a pre-set level (labeled on the handle in NCM). The proper torque limit has been applied when the head of the wrench breaks away from the handle. Do NOT tighten further as additional torque may strip or break the abutment or screw.

*When finished Please clean the torque wrench and driver insert with a disinfectant wipe, rinse under warm tap water, wipe dry (Do NOT place in ultrasonic) and then Autoclave.

Metal Contents

Metal Contents
Full Cast Crowns

Argenco 58 (Type III Gold) 

58% Gold

27% Silver

3.5% Palladium

Argenco 46 (Type III Gold)

46% Gold

39.5% Silver

6% Palladium

Argenco 77 (Type II Gold)

77% Gold

14% Silver

1% Palladium

Argenco W

70% Silver

25% Palladium

Argenco Y+

30% Silver

35% Palladium

Porcelain Crowns

Argedent 76SF+

2% Gold

76% Palladium

Argedent 52SF

52% Gold

38% Palladium

Argedent Y73

73.8% Gold

8.5% Platinum

5.4% Palladium

Argedent 98

97.7% Gold

1.99% Platinum

Goldtechbio 2000

99.7% Gold

Argedent Euro

40% Gold

39% Palladium

Ceradium

78% Nickel

15% Chromium

Durabond 

23% Chromium

0% Beryllium

Balance Nickel

Implants Supported Dentures

Final Restoration Steps

  • Call Dental Designs and order copy of 3D printed Provisional Denture

First Appointment (4 Days in Lab)

  • Take wash impression inside provisional copy to capture
    new tissue surface using Medium Body PVS
  • Make occlusal adjustments and take new bite registration

Second Appointment

  • PMMA Prototype for Zirconia Full Arch Bridge (7 Days in Lab) or
  • Wax try in for Traditional Hybrid (5 Days in Lab)

Third Appointment

  • Scan PMMA for Zirconia Full Arch Bridge / Impression

or

  • Bar try in for Traditional (10 Days in Lab)

Fourth Appointment – Process and Finish

  • Zirconia Full Arch Bridge (10 Days in Lab)

or

  • Traditional Hybrid (10 Days in Lab)

Fixture Level Impressions

Single or Multiple Units

The purpose of the fixture level impression is to accurately relate the position of the implant fixture in the mouth to a working laboratory model.

Upon receiving clearance from the surgeon to begin the restorative process, be sure to obtain the necessary information regarding number of implants placed, implant type and fixture size. Next, call the Implant team at Dental Designs with the aforementioned implant information for consultation on the necessary components and proper instruments to achieve an accurate impression. Finally, call the patient to set up a 1 hour appointment to take impressions.

Component Checklist for Implant Impression Appointment:

  • impression coping (one per implant)
  • proper screwdriver (*an additional tool is required for removal of temporary abutments if present)
  • full arch plastic trays for upper and lower arches
  • conventional crown and bridge impression material (NO alginate or hydrocolloid on implant arch)
  • bite registration may be required on free-end or in cases of unusual
  • occlusal scheme.

Step-by-Step:

  1. Remove the healing abutment or cap using the appropriate screwdriver.
  2. Insert the impression coping immediately after removal of the healing abutment to prevent tissue collapse.
  3. Verify that the impression coping is fully seated with a Radiograph.
  4. Obtain a full arch plastic tray (stock or custom) for the impression. Try in the tray to verify that there is no contact with the coping.
  5. Using a medium or heavy body impression material, syringe around the impression coping and into the tray. Allow time for the material to set and remove the tray. (impression coping will remain connected to the implant.)
  6. Remove the impression coping and immediately replace the healing abutment.
  7. Take an impression of the opposing arch (it is okay to use alginate if pouring yourself or delivering to the lab in the appropriate time).
  8. Take a bite in cases of unusual occlusal scheme or free-end.
  9. Take a shade.
  10. Pack all parts and send to Dental Designs (*include same impression coping used to take the impression)

Prescription:
*Include the name of the surgeon and the type and size of the implants
*List the desired restoration type as discussed with the patient
*Shade
*Include a copy of the Radiograph with the impression coping in place
*Call Dental Designs when scheduling patient to confirm appointment

Cement Level

Instruments Needed:

  • Screwdriver (specific to implant type), used to remove the healing cap/abutment and seat the final abutment.
  • Insertion Guide, fabricated by Dental
  • Designs for seating all titanium abutments.
  • Torque Driver

Step-by-Step:

  1. Remove the healing cap or abutment using the appropriate screwdriver.
  2. Deliver the abutment inside the insertion guide to the implant fixture in the mouth. (If unable to seat multiple abutments using the seating guide, seat them individually using the guide)
  3. Insert the screw through the opening of the insertion guide.
  4. Hand tighten the screw with appropriate screwdriver. (DO NOT torque yet)
  5. Remove the insertion guide. (Should pop right out)
  6. Take a Radiograph to verify that the abutment is completely seated into the implant fixture.
  7. Insert the crown on top of the abutment. [For Metal Try-in, Stop here and disregard #8-10]
  8. Check contacts and occlusion.
  9. Torque the Abutment using the appropriate torque level. (specific to implant type and size) [See Torque Driver instruction below]
  10. Cement the Crown onto the abutment and clear away excess. [See Cementation instructions]

Using the Torque Wrench:

The DynaTorq Torque Wrench is designed to tighten abutments and fasten screws to a defined torque. Proper use of a torque wrench is critical.

  1. Select the proper torque wrench based on the recommended torque values of the implant system used, and insert the correct driver insert (also specific to the implant system) into the wrench head.
  2. Engage the driver with the implant abutment screw (be sure the driver is fully engaged in the screw or stripping could occur).
  3. Place a finger on the head of the torque wrench. Follow the direction of the arrow (clockwise) and tighten.
  4. The wrench’s torque limit will break at a pre-set level (labeled on the handle in NCM). The proper torque limit has been applied when the head of the wrench breaks away from the handle. Do NOT tighten further as additional torque may strip or break the abutment or screw.

*When finished Please clean the torque wrench and driver insert with a disinfectant wipe, rinse under warm tap water, wipe dry (Do NOT place in ultrasonic) and then Autoclave.

Implant Bars

Dental Designs uses state of the art scanning and milling for denture bars. NobelProcera® bars set new standards. They are individually designed using 3D prosthetic driven software, industrially milled from a solid biocompatible monobloc of titanium. Thanks to precision milling, these bars exhibit exceptional fit, ideal load transfer and long-term stable screw joints.

Appointment protocol:

  • Primary impression to fabricate custom tray allowing for implant transfers
  • Final impression either to fixture level or after addition of multi-unit abutments
  • Bite registration with bases stabilized by addition of a screw to one or two implants
  • Tooth arrangement try-in to confirm bite registration, esthetics and function
  • Metal bar try-in to verify passive connection
  • Optional: Wax try-in with teeth and the bar together

Final seating appointment

In-Lab days needed:

  • custom tray 3-4 days
  • bases and rims 3-4 days
  • tooth arrangement 4-5 days
  • CAD/CAM Titanium Bar -depending on the system 10-15 days
  • Re-wax teeth over bar for additional try-in 4-5 days
  • Process and polish, ready for seating 6-7 days

FAQ

Implant Bar FAQ

Question: What does the lab require to fabricate milled bars?
Answer: A fixture or abutment level, verified cast, with the final waxed tooth arrangement.
Question: What is the best way to verify an implant cast?
Answer: Connecting open top tray impression copings together directly on the abutments in the mouth. Take that back to the cast to verify. Another option is, after connection, capture that jig inside an open top impression.
Question: What appointment will I have the metal bar try-in?
Answer: After the tooth arrangement try-in appointment. The lab needs to know the final position of the teeth to design the bar to support those teeth and not create excess bulk in the denture base.
Question: Will I need another try-in after the bar is checked?
Answer: This is optional. You usually should have another try-in if it is a fixed denture bar because the teeth need to be transferred and re-waxed to the bar. This will also show the final dimensions of the fixed denture for final check. Most overdenture bar dentures can be finalized because the dimensions of the base are not changing.
Question: What should my fee be for a implant supported denture.
Answer: There are several ways to look at fees. One way is to charge a denture fee and a separate implant bar fee. Another is to consider the lab fee plus your personal overhead costs for your office. Lab fee estimates are available at the time of case planning and fees should be discussed up front and not after the implants are placed.

Implant FAQ

Please refer to this list of questions to see if your problem is stated. Remember there are a number of Implant technicians at Dental Designs that can field your question if you do not see it here.
PROBLEM: Impression coping will not fit into the implant…

Diagnosis Questions:
1. Does the color of the impression coping match that of the healing cap?

If not, then a new impression coping is needed. If yes, the color matches, but it won’t fit.

2. Is there any soft tissue and/or bone over grown across the implant?
If yes, then either you or the surgeon will need to remove it. If it is bone then most likely the surgeon will need to remove it.

3. Are the adjacent teeth impeding the insertion of the impression coping?
If yes, then you can;
1) Grind on the adjacent tooth or
2) Grind on the impression coping to get it to fit. Just make sure you make us aware that you have done so on the RX.

PROBLEM: Can’t tell if the impression is seated all the way on X-ray…
Diagnosis questions:
1. Is it a platform switching implant?
If yes, then the small indentation at implant/impression coping interface is normal Remember Astra, Nobel Active and Straumann Bone Level have a built in fail safe, where you cannot screw the impression coping in until it is fully engaged.
2. Can you see a definite horizontal space between the implant and the impression coping?
If yes, then use a greater tactile sense to feel the impression coping fall into place.
PROBLEM: Can’t get the abutment to seat into the implant. (ONE OF THE MOST COMMON)…
Diagnosis Questions
1. Has a guide been sent?
If yes then try the guide.
If the abutment still doesn’t fit then most likely either the initial impression was not accurate or the lab did not pour up the impression properly.
2. Is there heavy blanching of the tissue, or bone overgrowth?
Some blanching is normal, especially for extreme subgingival implants. Try slowly screwing down the abutment to allow the tissue to adapt to the abutment.
If bone is present, then you or surgeon will need to remove the overgrowth.
ninety-nine% of the time seating problems come down a to poor impression, or the lab improperly pouring the model work.
PROBLEM: Can’t get the crown seated…

1. Is the abutment seated all the way?
If yes;
2. Are the contacts too heavy?
If yes, then lighten the contacts If no;
3. Is the tissue blanching and pushing back the crown?
If yes, have the patient bite on a cotton roll.

PROBLEM: The occlusion is way too high (more common) or way too low (rare)…

1. Is the abutment seated all the way?
If yes then:
a) Either the occlusion was not ground in properly,
b) The crown has been improperly mounted,
c) The bite is off.

PROBLEM: Can’t get the bridge to fit…

1. Are the abutments down all the way?
If yes, then refer to troubleshooting seating problems for the crown. If no, then refer to abutment seating problems. If all abutments are seated and problems with contacts and tissue have been addressed, then either
a) The lab did not get impression poured properly.
b) Impression was not taken properly.

NOTE: If you are seating multiple abutments for a bridge and lose orientation, always refer back to the model you can see how it should look.

PROBLEM: Can’t get the seating guide out of the patient’s mouth…

Solution: It can be cut away and destroyed.

PROBLEM: Screw driver won’t engage the abutment screw/impression coping…

Solution: 1. Make sure you have the right screw driver for the implant.
2. Make sure the access hole of the abutment is free of debris.
3. Make sure the screw driver is long enough.

PROBLEM: Torque driver won’t break…

Solution: Make sure the screw is not stripped. Another possibility is that the torque wrench could be broken. Refer to the section on how to properly use a torque wrench.

PROBLEM: Can’t remove the healing abutments…

Solution: You can use a torque wrench to back them out.

PROBLEM: The crown keeps popping off abutment…

Solution: Perhaps there is not enough retention on the abutment. Re-cement and check to see if lateral and occlusial forces are light. If temporary cement was used, you may switch to a permanent cement, but be aware that the crown will have to be cut off should the abutment ever need to be removed.

PROBLEM: The abutment screw keeps coming loose…

Solution: Make sure it is torquing properly. You could try replacing the screw with a newer screw. If the screw still comes loose it may be a sign that there is something wrong with the actual implant itself.