Ambridge Ceramics joined world class speaking lineup for ADi Focus on Digital Implant Dentistry 2014

Ambridge Ceramics was among the lecturers that discussed the latest technology and techniques at the ADi Focus Meeting on the 14th November 2014

This Focus meeting covered
Focus on Digital Implant Dentistry :
The Present - The Future

Using the years of experience and knowledge gained along with our surgeons and spanning many different digital systems and milling partners along the way, Steve will be sharing some of the key points that will make the use of digital tools and CADCAM for making your implant restorations a success.

As a British Bite Mark laboratory we are very proud that one of our technicians has been asked to share his experience along with a lineup of speaker who are leaders in their field from all over the world, including the founder of the Atlantis abutments system, which Ambridge Ceramics have been a pioneer of in the UK as a Beta tester before the official launch when it was acquired by Dentsply implants (at the time Astra Tech) and continued to use this market leading technology to provide our surgeons and their patients with unique restorative solutions as the range of CADCAM abutments and substructures provided by Dentsply implants continued to expand.

Dentsply Atlantis launches Conus Syncone Solution for implant overdentures in UK with Ambridge Ceramics

A sneak preview of some exciting work we are doing with Dentsply Atlantis on a great custom solution for providing a secure stable option on removable implant dentition.

This new solution will allow us to bring an internationally proven solution from the Ankylos implant system and use the Atlantis custom CADCAM platform to make it available on other implant systems in the UK.We'll soon have a full case report and images to share from our beta trials with our surgeons.

Atlantis Titanium Screw Retained Crowns are available to our clients prior to official UK launch

In the recent months many of our surgeons have been benefitting from the biological advantages of our porcelain fused to titanium implant crowns.

We have been working as a Beta lab providing these in advance of the official UK and European launch later this year.

Together we have catalogued many of these cases and they will be released after the official UK launch later this year but can give sneak preview of some of our work here.

One of the cases was this one we produced for Dr Papadopoulos where he had created the emergence profile that he wanted copying and captured that using a custom pickup which we could copy when producing the final crown.

Atlantis_titanium_crown_abutment_Ambridge

The results have been brilliant, with our ceramic team relishing the challenges of working with the new materials to produce some beautiful screw retained implant crowns with the advantage of being milled from a biocompatible material.

With this in mind we design the abutments to leave titanium against the tissues sub gingivally to ensure maximum biocompatibility and reduced risk of any tissue irritation by composite or ceramic material being deep sub gingival, which if not finished and polished correctly could attract plaque and lead to future complications..

By using using the Atlantis custom milled titanium abutments we can continue to ensure the quality and reassurance that comes from the leading worldwide provider of milled custom abutments, along with a comprehensive warranty covering both the abutment and fixture that it is restored upon.

In addition to the clinical benefits there is a significant cost saving to using these clinically superior crowns, for example you could be wasting well over £100 per fixture compared to a traditional cast screw retained crown, as shown below.

Atlantis CAD Screw vs. Traditional Pricing Astra.002

Atlantis CAD Screw vs. Traditional Pricing Astra.003

It could be surprising to see how much your traditional screw retained crowns are costing you.

Traditional cast gold methods

Or much more on larger molar cases where more metal is needed to support the porcelain work.

But with Atlantis CAD/CAM Screw Retained Implant Crowns you have the benefit of consistent cost effective pricing, regardless of the size of the crown.

With this being an Atlantis milled titanium abutment you also have the benefit of their market leading milling quality that is backed by a lifetime warranty on both the abutment and the fixture it is restoring.

Clinically superior and consistently cost effective.

Ambridge_Ceramics_titanium_screw_retained_implant_crown

We have been working with Atlantis from it's initial launch in the UK and have more information on all the benefits of this system on our Atlantis abutment page

At this stage we cannot share much more of our Beta work but are very excited about the big launch in September when this will be available throughout the UK.

It's been both an honour and a privelage to have early access to this new technology, with all the benefits it brings our clients ad their patients.

If you would like a price comparisson for your implant system or would like to offer porcelain fused to titanium screw retained crowns to your patients then please give us a call on 01765 607347 or email sean@www.ambridgeceramics.co.uk

Learn more about the lab on our About Us Page

Steve Campbell is Lecturing for the ADi on CADCAM on the 2nd July

Steve is Talking for the ADi at East Grinstead on Wednesday the 2nd July.

To see more about the latest CAD/CAM in implantology you can find more information or book here

Saving implant surgeons money and delivering better results

Have you looked at the total cost of your implant restorations lately?

By that I mean the TRUE cost, both components and lab bills?

On our many Roadshow tours of the UK it was always surprising to see how many surgeons were wasting money and getting clinically inferior results.

So today I am going to share the slides form a short presentation we give that explains exactly how many surgeons are losing money without realising it.
How much does bad advice and support on restoring dental implants cost you?

That's a lot of money, so how do we get to such a high figure? We start with showing the true cost of restoring your dental implants.

We use a true average costs which includes the cost of the components from the implant supplier and an average lab cost.

These component prices are including VAT and are correct as of 14/03/14

So on a like for like comparison of a cement retained implant option the clinically superior Atlantis custom titanium abutment not only avoids an compromise as it is completely custom designed for each patient. It also saves you £42.21. A win/win.

But that doesn't get us to our £5995 over 50 implants does it?

To see where the real genius of using Atlantis titanium custom abutments comes in we need to look at the latest solution.

Ceramic bonded to titanium screw retained implant crowns from Ambridge Ceramics

Even with the cost saving of an Atlantis abutment over a stock we still have the cost of a crown on top to finish the restoration.

On average the cost of a bonded implant crown or all inclusive cost of a traditional cast screw retained crown including components and alloy is anywhere from £100 - £200

So if we looked at an atlantis abutment at £279.99 plus the cost of a crown at £150 we get a total of £429.99

Our all inclusive titanium screw retained crown will save you £120 for every implant restored.

We have the biological benefit of these being titanium, a material we know is well accepted by the body.

nd that is simply how we get to this fact. If you are being badly advised and supported then it is costing you enough over 50 implant restorations to add up to the cost of a brand new supermini car.

We have taken great care to check all our figures and supply custom calculators and pdf breakdowns depending on the implant system you currently use.

And our all inclusive price of £319.99 is regardless of the implant system you use. so there's no more need to have to constantly keep up to date with the changing prices of various implant companies components. We take care of everything for our surgeons.

We were one of the first Beta labs for both Atlantis and ISUS in the UK. We really do know our stuff when it comes to these solutions and have the confidence of years of experience and thousands of abutments supplied to our clients.

Which allows us to concentrate on what really matters to the patient. A beautiful and predictable final result from our highly skilled ceramic team.

Clinically, biologically and financially superior restorations delivered to your patients using our knowledge of CAD/CAM. No compromises. A win/win situation for all involved.

Isn't that what technology, skill and experience combined should deliver?

Case study - CAD/CAM Implant bridge with removable individual crowns

Once complex and very expensive restorations such as the Woreley (also know as the Paulo Malo bridge) are now incredibly cost effective due to modern CAD/CAM technology. This type of bridge is simply a full arch implant structure that caries individual crowns.

So before we look at this case in detail we will cover how new technology has changed this and made the individual crown bridge (ICB) a much more attractive option for restoring a full arch.

Cost Efficiency

The quality and stability is the primary driver, with the cost efficiency also being a fantastic bonus brought about by the time saving made when a lab switches to a truly digital workflow. Add to this that we do not have to buy expensive implant components or alloy to cast the restoration and there is a significant cost saving to be made, without compromising quality. In fact quite the opposite.

By incorporating new technology we are able to exactly copy the patient approved setup and ensure our designs will be right for the final restoration. One of the most important factors is that we can check these designs and flag up any issues and discuss the best plan of action in the CAD state, before any financial commitment has been made to producing a structure.

Unmatched precision

Thanks to the CAD/CAM technology and our partnerships with world leading milling centres that specialize in the producing structures of the highest quality to the tolerances required for aerospace, medical sector and research projects such as the CERN Large Hadron Collider. Using the skill and experience of these long established partners we are able to deliver a wide range of implant options with incredibly cost effective pricing, which crucially have unparalleled accuracy, stability and passivity of fit.

CAD/CAM milled titanium or chrome frameworks are incredibly strong and stable which provides the ideal sub structure for your large span restorations, furthermore we have years of clinical trials that show us these structures perform incredibly well. They are tried and tested.

Because titanium and chrome CAD/CAM implant frameworks are milled from a solid homogenous block of material there are no casting stresses, voids or porosity within the framework which could lead to hygiene problems if against the tissue, or even failure of the whole restoration in the future.

This is the very foundation of our work so it is vital that we can guarantee that these are completely free of any flaws which may lead to future complications or even failure. We focus on the quality and integrity of the CAD/CAM structure above all else, which is why we only work with milling partners who will guarantee their structures against failure if we stay within their design protocols.

Why use a CAD/CAM implant Individual Crown Bridge? (ICB)

Now that technology has made this restorative option far more cost effective and predictable, it's perhaps a great time to benefit from the unique advantages that the ICB can bring to a full arch implant restoration.

What's different on an ICB to a traditional screw retained bridge?

Diversity

Effectively the ICB is just a platform for 12 individual crowns, which means we are liberated to use whichever material we feel is best for any particular region of the mouth. Why be locked to just one material for the whole restorative arch when we can take our pick of the best material for each quadrant?

We may want to benefit from the shock absorbency, fracture resistance and enamel matched tooth wear that we can get from the new Hybrid Nano Ceramic materials such as Vita Enamic, which have been engineered to offer an improved restorative solution to many of the traditional materials on the market today. Or perhaps even the absolute strength of a full zirconia crown making these the ideal restorative material for molar teeth, especially in patient with a history of breaking molar teeth/restorations?

We have information on both these options here.

However in the anterior region a patient will most likely want to have the very best aesthetics possible, a result that is only really achieved by working with a highly skilled ceramist using either pressed ceramics, ceramic layered on zirconia or time proven porcelain fused to metal.

The advantage is that with an ICB we are free to mix and match our restorative materials on the same arch and restore each case specifically to each patient's unique requirements.

Maintainability

Because we have a base structure that is screwed onto the fixtures and then individual crowns made upon the structure it's easy for the surgeon to repair or replace any of the individual restorations without having to remove the whole of the patients implant arch.Even if we needed to replace a whole crown (or number of crowns) many years down the line we can have an impression of the 'prep' and a new crown be made at the lab while the restoration as a whole remains in the patients mouth, which is not the case for a full arch screw retained restoration.

As with our Visio.lign implant structures the key is to ensure we are offering a clinical benefit over traditional restorative implant solutions.

Rather than layer pink ceramic onto a chrome framework which may crack and would need to be re fired in a furnace to restore to it's original state at some point, we prefer to make the CAD/CAM milled substructure out of titanium and layer Crea.lign composite onto it, which means that it is easy to repair and maintain should any of the gumwork in situ should it need this in future.

We choose crea.lign composite because it is shown to resist plaque adhesion and staining to a very high level, similar to ceramic as show in the table below.

This also allows us to do a whole refurbishment of the structure many years down the line if needed, all without the structure ever needing to be exposed to the heat and stresses of a porcelain furnace.

Average tendency to discoloration of composite materials compared to HeraCeram ceramic after storage in coffee, tea, tobacco, red wine and methylene blue.

Research report from the university of Jena on material testing of  veneering materials, July 15, 2010, by Dr. A. Rzanny and Dr. R. Göbel

Aesthetics

Using an ICB style implant bridge we will conceal the access holes in the primary structure, the final crowns do not need any access holes filling, which although not a particularly tricky problem for our experienced implant surgeons, it is still something we have to consider on a screw retained bridge such as the one shown below.

However using an ICB, it's nowhere near as vital where the access holes of the structure will emerge as we can ensure they will never be coming through the aesthetic zone of our restorations.

To reduce surgery time we cement most of the crowns into place so that the surgeon only needs to cement the crowns that go over the access holes in the preps, this happens after the structure with all crowns on has been tried in and the surgeon and patient are happy. After this the final crowns that cover the access hole preps are cemented into place with a temp cement.

We can also engineer removal notches into the crowns to allow for easier removal should the surgeon ever want to access the screws again.

With a CADCAM milled ICB is a final result that looks just like a full arch of natural dentition, even when viewed from occlusally and palatally as shown below.

Crowns tried onto bridge and final occlusion checks carried out.

Final bridge fitted, which was an exact replication of a pre agreed tooth setup and tissue contour that the surgeon had taken quite a bit of time to perfect and agree upon with the patient at the trial stages. The lower was an acrylic bridge upon titanium framework whith the prosthetics by Egan Dental Laboratory.

Not all CAD/CAM is the same

For us it was an obvious move to go from casting techniques to milled one piece structures as we were eliminating a high component and alloy costs to the surgeon, along with eliminating the inconsistencies and problems that are associated with cast implant structures. So there was both a financial and clinical benefit to the surgeon and patient by embracing this new technology, a true win/win situation.

These full arch restorations are by their very nature are a big financial commitment for the surgeon and patient even with the huge cost savings of CAD/CAM, and therefore should be designed to last our patient a very long time indeed, ensuring we have kept all potential failure risks to an absolute minimum.

We personally don't want any question marks over the strength, stability or integrity of primary implant structure or material used on this type of ICB for our clients, which is why we only work with proven materials and market leading partners who are able to guarantee the structures they provide.

Our philosophy is to offer uncompromised solutions to our surgeons utilising the latest technology and ensuring maximum cost efficiency, but crucially without any compromise on quality or integrity of the restorations or materials used to provide them.

It may well be that we are best looking to evidence based solutions and cautiously integrating the newer materials into our restorations in areas where their failure will be easy and convenient to rectify without causing the patient to lose their dentition? As they prove themselves we will have the evidence of their success and confidence to use them more widely.

Why risk all the months of planning and implant integration for the sake of saving 96 hours on the very structure that will be the backbone of the final restoration for the patient, and will be subjected to high stresses over the many years it will serve the patient as a replacement to their lost dentition?

Will the patient thank us for saving 4 days while they are in temporary restorations if the final prosthesis causes them inconvenience, or in the worst case failure that requires them to go back to temporary restoration or denture while the final is remade?

Summary

Although there is no single ideal solution that covers all full arch implant restorations the recent improvements in efficiency by using CAD/CAM systems with clinically trialed and historically proven materials have made this type of ICB restoration a much more predictable, practical and affordable solution for our patients.

From our experience the key is using the right combination of materials in their appropriate place on the restoration. For example using the shock absorbing materials on the individual final restorations in the molar region where they are easily accessible and replaceable or repairable in situ. Helping to reduce inconvenience to patient and wasted chair time for the surgeon

As with our Visio.lign implant structures the thought process is to ensure we are offering a clinical benefit over traditional restorative implant solutions by offering materials and designs that give the surgeon easy ongoing maintenance and repair options for the patient. Maintenance is especially important on the full arch restorations, which we plan and expect to serve the patient for many years to come.

We have a world of materials and options at our disposal and always pass this onto our surgeons so that they can make an informed choice regarding the best restorative solution for their patients, many of those surgeons are now choosing the ICB type structure.

Astra Tech launch EV implant system in the UK

Today we are in London for the Official UK launch of the Astra EV implant system!

This will be completely new for most of those attending the exclusive event in London today, but for almost a year now we have been secretly working with Dr Mark Willings and Dentsply in restoring the EV implants that he has been working with as part of the Ambassador program.
The design philosophy of ASTRA TECH Implant System™ EV is based on the natural dentition utilizing a site-specific, crown-down approach supported by an intuitive surgical protocol and a simple prosthetic workflow.

The EV system is an evolution of the already very successful Astra implant system, and now incorporates new design features that improve upon an already class leading and clinically proven implant system.

From a laboratory point of view there is nothing tricky about switching to this system but there are some nice touches, such as a unique index system that will only allow custom made abutments to seat in one position. This is also obviously a huge benefit for the surgeon as they don't have to worry about them seating in one of several possible positions as we do with existing implant systems.

If anything Dentsply have managed to simply improve the user friendly appeal of the already successful Astra system, and build upon the strength and clinically proven results they already provide with the existing implant and restorative range.

It’s been really difficult for us to keep this under our hat as we have naturally been very excited and keen to share the work we have done with the EV implant system. The whole team are honoured to be included in the Ambassador phase of this implant system’s worldwide pre launch roll out and as today is the official launch, we can finally share it with you (although we're not going to share too many details on the systems specifics, we'll leave that to Dentsply)

Here are a few of the many cases we have restored under prescription and guidance of Dr Mark Willings, who was selected from a handful of surgeons worldwide to work with the EV implant system during the pre launch phase.

CASES

It’s obviously a huge honour to be trusted to work on a confidential project such as this one, especially as we have had early access to some of the nice touches that this system brings to the lab when restoring implants, but more importantly for us was the opportunity to feedback on the experience from the lab.

As you would expect we have only used the very best restorative solutions and avoided all potential compromise when dealing with these new EV cases. This has been the Atlantis system for single units and Atlantis ISUS system for multiple unit cases (which is our protocol on all Dentsply implant systems)

The requirement for these cases was that they should be screw retained crowns or bridges, although we do have 1 cement retained case and a couple that were screw retained using lateral fixing screws.

Here is a sneak preview of some selected shots that were taken from the large variety of cases that Dr Willings and others will be presenting today in London. We will also have the final fitted pictures to show after Mark has presented them at the launch today. For now we have the images of the lab work we produced on the new system.

Case 1 - 2 Atlantis abutments with a 3 unit bridge, retained with lateral fixing screws

First we designed 2 Atlantis abutments and then Lee tapped them both to accept Bredent Lateral Fixing Screws. Abutment design and framework by Lee Nichols.

We then produced a framework which is secured into place with the screws. Ensuring we have a screw retained solution and avoid any issues with the access holes coming through the buccal of the restorations.

The screws are slightly flush to the restoration so that after torquing into place the surgeon can trim them flush with the contoured surface of the back of the tooth.

Although this is still screw retained, we have managed to remove the access hole which would have been coming through in the aesthetic zone.

Case 2 - Screw retained molar crown

The final crown that was layered with e.max ceramics by Mark Ambridge

With this case the patient requested a screw retained zirconia crown abutment, so we used the Atlantis system to design a zirconia sub structure that we could layer the ceramic directly onto.

The final abutment was designed and adjusted by Steve Campbell using the Atlantis Web-order Editor interface.

You can see from the image below that we used the Atlantis crown proposal to ensure we provided optimal support for the ceramic on the final crown.

Case 3 - Full arch Atlantis ISUS milled chrome and ceramic layered bridge

This case was a full arch that was scanned and designed from an immediate denture made by Mark Price, which was later converted to an immediate fixed restoration during the patients transition from temporary denture and guide to our final restoration. An effective way of working back from great prosthetic planning, which perfectly matches the EV crown down philosophy.

The final bridge that was layered with Creation ceramic by Jack Gleave.

CAD design stages that show how we used a copy of the immediate restoration which was modified for a more natural tooth emergence by Iain Baldwin, because the immediate had a flange that the patient did not want on the final restoration.

The patient wanted the overall appearance and function copying, so this became our guide. We have made the final guide transparent so that you can see the CAD framework design within.

Here is the CAD proposition of the final framework we received from Atlantis ISUS.

By using Atlantis ISUS we ensure we get a perfect framework to support our final frameworks, we prefer to offer a framework that is clinically proven to offer a superior level of fit which in turn leads to successful long term restorations.

You can see from this image that the new multi unit abutments have a wider diameter implant screw.

I know we've only shared a select few images and cases from all the work we have done here, but I wanted to keep this as brief as possible and just share the experiences and benefits we have had using the new EV system. However after the launch event we will get the final images from Mark and upload the full set and more detailed case write ups in a separate blog

SUMMARY FROM A LAB

Many of the modifications made in the EV system are just nice little adjustments that make the system very easy and predictable to work with and we found no issues at all in the cases we restored.

The biggest noticeable change is a completely new index system that moves from a hex to a spline and allows for easy seating and positive single position only engagement of all Atlantis CAD/CAM restorations, as shown in the image below.

All the components are now colour coded, from pickups and analogues right through to screws, which makes it easy to quickly visually verify you are using the correct components for the EV implant system. Also all the screws have the same 25 Ncm torque value to keep the system simple and user friendly.

There are a wide range of restorative options for the lab, although we have always preferred to stick with the CAD/CAM custom solutions.

Pickup components

Why talk about pickup components in a lab view? Here's why.

One handed self guiding pickup component which will not screw down until correctly engaged

How many times have you cast a model, made a beautiful CAD abutment and crown only to be informed that they were unable to fit it? After casting a new model with a new fixture pickup and comparing with the old cast and impression we find that the rotation and height differ, telling us the initial pickup was not correctly seated.

We're not criticising the surgeons here, traditional implant pickup components are not as user friendly as the EV system and therefore allow for technical errors, especial when having to work in a limited space and with what may not be the most co operative patient.

The Astra Tech EV System has a unique new patented pickup system that means the pickup component is self guiding and will only allow engagement and screw down when it is in the correct position. No more inaccurate implant pickups!

Option for capturing the soft tissue architecture

Again initially this doesn't seem like such a big problem, but from much experience we know of several cases where the surgeon had developed a soft tissue site and the pickup component was so big that all we saw was a big round hole where the nice anatomical tissue site should have been. In effect we had a beautiful replication of a big round pickup cylinder and not the custom tissue site we wanted.

With the Astra Tech EV system they have pickup components that allow for the capture of the cost tissue architecture, and although these are slim when you look at the design of the body and all the facets it incorporates we see that they have actually managed to produce a very retentive surface with a large overall surface area to ensure stability within the impression.

As the vast majority of our abutments are CAD/CAM custom abutments it makes sense that we contour this exactly to the soft tissue architecture that the surgeons have worked so hard to develop, leading to a superior final result for us all.

As shown the reason we are a big fan of the healing abutments is that Dentsply have managed to address the issues that cause technical difficulty or lead to false information on some of the other implant systems.

Site specific healing abutments

This system has a wide range of different healing abutments that are ovoid, round and triangular, ensuring that the surgeon can develop the soft tissue site in a wider range of options that more naturally mimic tooth root shapes than just a standard round pickup.

The reason that we as a lab are so excited and have come to love this system so much is the simple fact that most of the improvements incorporated into this system are technically driven. Therefore designed to eliminate mistakes or mis information that can cause a case we've worked so hard on to either not be fitted or not have the result we would have wanted because the information in the impression was inaccurate in some way, either implant or soft tissue site.

Astra Tech stated that this was a crown down philosophy driven design change and they are absolutely good to their word. We've greatly enjoyed working with this system for a year and look forward to seeing many more come into the lab.

Finally, thank you to the whole lab team who have kept this quiet for so long and worked so hard on all stages of the many cases we have restored over the last year. There were many more ceramic cases by Marc Tocher and Rachelle Webb that we have not shown, along with plenty of work from the team behind the scenes that makes it possible to work on projects like this. Finally we'd also like to thank Dr Willings and Dentsply for choosing us to work with them on a project this big and exciting.

There's more news to come
I’m not about to let the cat out of the bag just yet, but we do have a few more very exciting market leading projects still ongoing. Watch this space!

Want to know more about Astra Tech EV? Here is a link to the pdf

Nominated for Aesthetic Dentistry Awards 2014

It's been almost a year since we won an award at The Aesthetic Dentistry Awards 2013, and thanks to a nomination by Dr Andy Denny we're going to the awards again and hoping to make it 2 years running!

Back in 2013 we were surprised and delighted to be nominated by Andy, and overjoyed when we won, as you can see from the picture below.

(Mark Ambridge - Centre, Andy Denny - Right)

And here was the case.

So what are we up for this year?

The categories we are nominated in for 2014 are:

Restorative case – single arch

Andy Denny
Mark Ambridge (technician)
Conservative Ceramic – Smile Makeover

Andy Denny
Mark Ambridge (technician)

We think these awards are a welcome recognition of the hard work and beautiful smiles that are created by the surgical and laboratory team working closely to ensure the best restorative outcome and care for the patient.

This year, just as last we will be flying the British Bite Mark Flag. The British Bite Mark shows that a lab is using skilled General Dental Council (GDC) registered professionals to produce world class dental restorations which are produced in a laboratory that fully complies with strict MHRA and MDD regulation.

The work is anonymously assessed by a well respected panel of judges, each of whom is recognised for their skill and contribution to great dentistry, so the recognition of our work in 2013 was very much appreciated by the whole team.

We are in great company at this years awards, a full list of surgeons and technicians that have been nominated this year is available to download as a pdf here

We look forward to seeing all the nominees for a great night at the awards on the 21st March.

The benefits of CAD/CAM technology for the patient

We're very proud of the fact that we have worked with many pro active surgeons, which has allowed us to become known as a cutting edge CAD/CAM dental laboratory, with all the benefits this brings to our surgeons and their patients.

Over the years we have been involved in many Beta trials with some of the worlds biggest dental companies, which has given us a great insight into some of the benefits and potential weak points in some of the current materials and systems available today. The companies that we work on the Beta testing with are looking to overcome any potential weak points they see and improve the restorative options by heavily investing in research, and testing using the latest materials and technology.

For us as a laboratory one of the biggest leaps forward was definitely the use of CAD/CAM systems such as Atlantis and Isus to produce our titanium, chrome and zirconia sub structures (and even whole crowns in some case) as this allowed us to move away from some of the inconsistency, inaccuracy and wasted expense that the old traditional wax and cast or manual milling methods had.

But recently we have seen a very exciting shift away from focussing on the machining of the custom component parts and sub structures, and a focus on the materials which we use to deliver the final prosthesis to our patients.

What's wrong with what we have?

Realistically with many cases there's absolutely nothing wrong with the Porcelain, composite or acrylics we have successfully used for many years to restore our implant cases, but if we have an implant restoration on a posterior tooth where the patient has shown a history of destroying restorations then maybe we can look to the new hybrid materials that are now available? These mix the higher aesthetics we want from ceramics with the qualities that we would ideally want on an implant restoration such as shock absorbency and chip resistance.

Shock absorbency

One of the main characteristics of new Hybrid ceramics like Vita Enamic or 3M ultimate is the fact that they actually absorb shock from the opposing dentition.

Chip resistance

Due to the fact that these materials are produced using CAD/CAM technology, they are a monolithic structure which greatly reduces the risk of delamination, further more these new engineered materials have been specifically designed to prevent crack propagation as shown in this pdf

What does this mean for us?

Thanks to our knowledge of CAD/CAM and depth of experience in using this with the new materials such as Visio.lign (which we use on full arch cases) and Vita Enamic we have been able to produce a screw retained CAD/CAM Hybrid Ceramic crown that offers the benefits mentioned above.

Below is a Vita enamic screw retained crown which has been milled and is awaiting final staining.

Further to being an ideal posterior restoration, this crown is also vastly more cost effective than a traditional screw retained ceramic layered implant crown (although if you do prefer ceramic for the very best aesthetics, we can now produce ceramic bonded to titanium implant crowns for maximum biocompatibility)

Thanks to our partnership with Atlantis we are also able to offer a restoration that has a custom titanium contour against the tissue and then transitions to these new Hybrid Ceramics in the rest of the screw retained crown restoration, think of it as a custom link abutment +

This is not a one size fits all solution, in fact we still produce many porcelain bonded screw retained units where aesthetics are absolutely critical, but it's always great to have another solution that we can mix and match into our restorative toolkit when we are looking at the needs of our patients.

We have used monolithic crowns on cement retained restorations for many years, starting initially with full zirconia and then moving on to the new Hybrid Ceramics such as Vita Enamic purely because of the improvements in aesthetics and functionality they offer.

No patient you see is exactly the same, which is why we want to ensure we have the widest range of restorative solutions available to match their specific restorative requirements.

These materials can be used for cement retained, screw retained or even angle corrected screw retained implant cases. We have more information on both of these over on our website