Quick Summary of Otto Prandtner’s IDEA Course

November 24, 2009

As stated previously, I spent the weekend in CA at the IDEA educational facility with Otto Prandtner listening to his ideas on how to create an esthetic implant restoration.  The following is a brief outline of his presentation -

1.  One of the keys to success is an inter-disciplinary approach involving the restorative dentist, surgeon and technician.  Otto (and Dr. Lamb) was careful to draw the distinction between an inter-disciplinary (ID) approach versus a multi-disciplinary (MD) one.  MD implies that all three persons treat the patient, but there is very little interaction between the participants.  The ID approach calls for each specialist to meet the patient, and then discuss any options prior to commencing treatment.  Ideally, the restorative dentist should “quarterback” the process with advice from the surgeon and technician.  I like this approach as all too often it seems restorative dentists and technicians are left to devise intricate solutions to situations created by surgeons placing implants in less than ideal positions – seemingly without regard to the degree of difficulty in satisfying the patient’s expectations.  We do more than our fair share of implant cases, and it is rare that we are invited for a pre-treatment consultation.  And, don’t get me started about the marketing ploy by which surgical practices provide free restorative components to their referrals.  It irritates the hell out of me to have to fabricate a cast-to custom abutment when a shaded zirconia abutment would provide the patient with a much better result simply because we’re instructed to use these “free parts”.

I will now step down off my soapbox…

2.  Otto went into great detail concerning the design of a custom abutment as it relates to tissue support and the final restorations.  He believes strongly in contouring that portion of the abutment that extends from the interface up to the margin placement for the crown in manner as to simulate the root structure of the missing tooth.  In other words, don’t expect a crown replacing #9 that is fabricated on a cylindrically-shaped abutment to look natural.  In the anterior, abutments should be almost triangular in shape to mimic the root structure of the natural tooth and create a platform for a pleasing emergence profile.  Once the correct shape is achieved, correct margin placement is just as vital to your success – facial margins should be positioned 1.0 mm sub-gingival; mesial and distal proximal margins should be between .5 and 1.0 mm sub-gingival; and the lingual margins can be placed at the height of the crest of gingiva.  Care should be taken that any contouring of the abutment structure to “push” the tissue in any specific direction should be done in the 2mm of tissue apical to the crest of the gingiva.

3.  Mr. Prandtner expressed a preference for one-piece screw-retained zirconia abutment/restorations in the lower anterior region with the implant being placed slightly towards the palate.  He has found this type of restoration beneficial in such circumstances where the mesial-distal width is too small to allow for adequate wall thickness of a custom abutment and a coping and veneering ceramic.  Otto also noted that care should be taken anytime ceramic is baked directly to an abutment as errant particles of porcelain may find their way to the surface of the interface which would cause degradation that could lead screw loosening.

Below are pics of the case we completed during the hands-on portion of the course -

Shaded Zirconia Custom Abutment

Lava Crowns with Creation Zi-F

Close-up

Personally, I would have liked to close up the interproximal space between the centrals, but after 14 hours on Friday and another 11 on Saturday, I just didn’t feel like doing another bake – Sue me.

And, BTW – We were instructed to make the centrals longer at the patient’s request…

© 2009, Jeff Saylors. All rights reserved.