Meeting started at 8:45 AM
Introduction of speaker by Dr Roy Yanase
Speaker: Dr Steven Eckert (SE)
SE is a board certified prosthodontist (Mayo Clinic, Dental
Division,
Lecture outline
Part One (Literature review): SE reviewed criteria for critical literature review. Several articles were reviewed. Significance of the clinical findings was discussed. “Evidence-Based Decision” should guide our therapeutic options.
Part Two (Decisions in clinical dentistry): Going back in time, using clinical cases treated in private practice at different periods, SE discussed the criteria used at the time to provide the best treatment to his patients. Using modern scientific criteria, the therapeutic decisions were revisited. Nuances of life analysis were discussed and their influence on study results discussed. SE discussed the criteria for successful evidence based dentistry.
Part Three
(Implant system selection): benefits and risks from yesterday and today implant
were discussed. SE philosophized on Art, Science and Marketing when it comes to
osseointegration. FDA,
Part Four (Classifications in dentistry): Purpose: better communication; prognosis prediction; fees structure; referral guidelines.
Example: prosthetic staging (4 categories)
Part Five (Having fun in Prosthodontics):
Due to: -lack of planning
-lack of site preparation
-both of the above from a restorative and surgical end
Restorative options- Screw or cement. Eckert has no preference
-custom abutments (easiest)
-prepable abutments (time consuming)
-angled abutments (difficult to orient in a multi-unit case)
It is nice to have a laboratory orientation jig in order to orient multiple implants
Eckert feels the first step and easiest start is to always take fixture-level impressions in order to evaluate the situation and then chose the abutments.
He then showed cases of restoring the following types of implants:
-the labial implant
-the lingual implant
-the mesial implant
-the distal implant
-the deep implant
-the shallow implant (the most difficult)
-mal-aligned single molar implant
-multi-unit supported F.P.D. using offset implants
-centrally located
-minimum 4 mm. implant width (Eckert rarely uses wider implants since he has seen a lot of previous failures with the wider implants…5 mm)
-he has not seen fractures, screw-loosening with 4 mm implants like he has in the past with the 3.75 mm. implants.
-he believes in flatter cusp forms for the restoration in order to minimize lateral moments on function.
-pterygoid implants
-tuberosity implants
-implants inorder to avoid the sinus
-avoiding the mandibular canal
“Tripodization” of implants
-Reduce esthetics
-Hard to accept by patients
-He recommends a maximum of 3 mms. of offset from the central groove of the restorations (access holes of the implants) in order to acceptably restore
-Does it really make a difference in longevity?
1) UCLA-type- use a screw that is not fully threaded in order to decrease loosening
2) Ti-Adapt (prepable)
3) Procera Cad/Cam
He demonstrated the use of a 3-D conceptual program and production of a Procera abutment and he feels that, with cost and software legal issues aside, this is the best way to easily customize every implant restoration even compared to custom abutments or the wax-up, cut-back Procera abutments.
HIS E-MAIL ADDRESS: seeckert@mayo.edu
Meeting adjourned at 4:10 PM