Wednesday, January 18, 2012
Most dentists I know work with one or two different types of implants. Part of it is that we like what we like, and are usually partial to that particular system. The other part of it is the expense of having to outfit the office with multiple restorative kits for each type of implant. Regardless of what we prefer to work with, we often have to deal with a random assortment of other systems. Crowns need to be replaced on older types of systems, or a patient may have just moved into town with a brand new implant, but no final restoration. Obviously we could always call the office that placed the implant, but sometimes the office is closed or the records are unavailable. To figure it all out, we use a couple of different resources to get the job done.
The first tool we use to figure out what dental implant system we are dealing with is an online resource. Whatimplantisthat.com holds a collection of radiographs of dental implants, with searchable specifications for each implant. From the main page, click on “Identify”. One the left side you can then enter in all the attributes of that implant to help identify it. Choices include internal or external connection, tapered or non-tapered, shape of the apex, or what type of grooves are on the implant. Clicking on the little question mark pulls up a mini-tutorial to help answer that particular question. Once everything is entered in, click on find to see a selection of implants that match what you have in your own periapical x-ray. If you are still having problems, you can even upload the PA securely to the site. For a $75 fee, they will provide consultation services which will identify the implant for you.
Once we know what we are dealing with, we often turn to Attachments International. Now part of Implant Direct, they carry components for the most random implants out there. You can register with Implant Direct and shop right from their home page. I think the best way is to just call them up on their 800 number, and speak to Darwin directly. He has a huge amount of experience. I have sent him pictures, radiographs, or measurements of old broken screws and he has been able to get us the right part to complete the case.
One of the most important components you will need to order is a fixture level impression coping. Dr. George Perri from UCLA is a friend, colleague, and former instructor of mine. One of the earliest lessons I can remember from him is the value of the fixture level impression. Once you capture that specific location of the implant, you can do everything from a diagnostic wax-up to a final impression. You even have the freedom to change from a screw retained restoration to a cemented one. While this might seem obvious, the point is that you are in control despite the lack of experience with the new implant system.
The last tip I have is for the new practice owner. When you inherit all the new equipment, there is most likely a whole stack of old drivers and components from the past sitting around somewhere. Categorize them and save them. You never know when that random hex size will come in handy.