hello and welcome to chairside live I'm your host Megan strong in this episode we're giving
you a look at another presentation from the inaugural Glidewell dental symposium it took
place in Dallas Texas in November 2017 and this episode is featuring dr. Timothy Kaczynski with
his presentation aesthetic implant success he's sharing his proven techniques for generating
beautiful aesthetic results from your implant cases this lecture will equip you with specific in
simple protocols providing you with the confidence and competence in placing implants all to achieve
those optimal restorative outcomes let's listen in dr. Timothy Kaczynski began his career as a
general dentist in Bingham Farms Michigan and quickly adapted to the rapidly expanding field
of implantology an expert in the surgical and prosthetic phases of implant dentistry
dr. Kaczynski teaches aspiring dentists at the University of Detroit Mercy School of Dentistry
serves on the board of numerous dental journals and has published over a hundred and eighty
articles on dentistry he's also the recipient of the academy of dentistry internationals
Humanitarian Award today his presentation aesthetic implant success provides an engaging
discussion on proven techniques for generating beautiful aesthetic results for implant cases but
before we begin I have a question how many general dentists we have in the audience well I'm one two
I'm a general dentist from the other D Detroit and you'll probably feel sorry for me that I'm from
Detroit Detroit's doing great by the way but we were hit with the economy very badly and yet I've
been very successful with my implant dentistry practice I've been practicing implant dentistry
for 32 years I'm in the suburbs of Detroit but our patients come to us in need there's that there's
an incredible need for our patients to to have in dentistry today but it doesn't have to be a $7,000
per unit event for the patients patients can't afford that so working with the team at Glidewell
their outstanding implant department we've created some things that I want to demonstrate I'm just
gonna show you one case that I think all of you here are capable of doing but we have to
understand why we get the results that we get so let's look at a clinical case in your practice
this patient presents to our practices with a fractured tooth he came from another office
already had a little flipper little transitional removable appliance replacing his central incisor
he was not in pain but he heard about these implants the internet changed everything didn't
it with implant dentistry patients are very very astute now we have some aesthetic issues here and
I'm a big believer in my practice I try to address the patient's concern he has other issues his
concern is missing his front tooth and he wants it replaced now we have a CB CT in our practice which
gives us an advantage in diagnosing you can see we have a tooth that has a very very very thin facial
plate so we have the tooth that we're going to remove I think we all agree that it can be
extracted and we use some a traumatic extraction technique some tools that allow me to to maintain
the interceptive bone some of us here would take a period tome or a separator or a burr or a Lux
ater or an elevator and try to remove this tooth but I try to stay away from the interproximal area
because remember the intercept the bone is what's going to hold at interdental papilla let's see
if we can do this so I'm not going to go into the technique here but we ate dramatically remove this
tooth we try to maintain the papilla as much as possible and we indeed maintain the facial plate
a bone with this technique so we take a digital radiograph and we can see we have a socket we want
to make sure that we don't have any tooth roots in tact and we make sure that we we have a clean
extraction so what I'm doing is I'm taking that route and I'm simply measuring I want to know how
long of an implant I want and again what we what we try to teach is a recipe the rules that you
have to follow we want to extend our primary bur are our pilot bur at least two millimeters beyond
the apex of that remove tooth that's going to give us initial stability of the implant so it doesn't
move around now the first thing that we're going to do is we're going to take a pilot burr into
that socket but I said earlier you don't place the implant directly in that socket why would that be
because the facial plate of bone is very thin and I don't want to lose that I don't want to
blow that away so we're actually going to place our our pilot burr three millimeters palatal to
the facial aspect of the adjacent teeth and we we can take a radiograph and we can see exactly where
we are we're again placing the the pilot birth three millimeters palatal to the facial aspect
of the adjacent tooth look at the interdental papilla this is immediate extraction immediate
placement of an implant we will take a radiograph to establish depth we are following certain rules
we don't want to be too close to the adjacent periodontal ligament all right so we look like
we're pretty Center if you look at the the incisal edges the dark space on either side of that burr
is fairly equal right so we're trying to establish emergence and and contour of this tooth to make it
look more natural if we don't do this oftentimes we end up having to restore the the adjacent
teeth with a veneer or a crown then once once we establish proper angulation positioning and depth
stability extending it beyond the extending it beyond the apex of the root we will simply wide
me Asti it's a brilliant system that is a simple system these are side cutting osteotomy burrs that
will simply widen the osteotomy sight and then we will end up with a 4.3 diameter implants or
widening in it one more step the Hans system as I said is brilliant doctor dr. Han is a brilliant
inventor very practical a dentist there are micro threads there's a machine collar the reason we
have a machine collar on this rather than then coating the implant all the way to the type
top is because dr. Han in all his years of study realizes that physiologically we are going to get
some bone loss around an implant its natural okay and this polish a machine collar allows for a much
healthier periodontal and results so here I simply use a graph material and I'm going to thread my
implant right into it the implant is aggressive enough the threads are aggressive enough that
it's going to push that grafting material along the sides and fill that void so we're placing
the implant and we ended up again I'm not trying to show you the surgical technique I really want
to show you the prosthetics is we were able to torque this to 25 Newton centimeters so I want
you to look at this this image it's the schematic especially the implant was not placed where the
socket was the implant was placed palatal II to the where the socket was and it extended beyond
the apex of that root that's where we got our initial stability I decided to bury this implant
so I just put a cover screw into the implant and we allow it to heal so you can see the placement
of my dental implant on it on the sagittal view of a CB CT I have plenty of facial bone
I'm not going to have a gray shadow there I'm not going to have an issue there the thinness of the
thinnest areas at the apex which is one point one millimeters so plenty of a facial bone to
create an aesthetic area now it comes to Glidewell lab and the technicians will will do a cad candle
they'll they'll make a model they'll scan it as dr. just demonstrated earlier and they will
fabricate a transitional or temporary abutment for me custom-made I'm a big custom custom abutment
guy I like contours they will establish the design of the crown they can communicate with me and
they're creating an ideal crown for me digitally they make a composite temporary crown for me now
let's look at the at the tissue let's look at the the interproximal tissue look let's look at the
facial tissue it looks good we have good attached gingiva so I did a tissue punch it's just simply
a round instrument and I can see the implant and I'll remove the little cover screw that we
have and I will immediately place the temporary abutment the custom temporary abutment that was
created by the lab my margins are at or ever so slightly sub gingival you can see the position of
the of the implant screw the access hole is about three millimeters palatal to the facial aspect of
the adjacent teeth these are rules that if you follow you will get the same results that I get
I'm not creating this I'm just laying a foundation for the lab the laboratory will then send me
a seating guide which allows me to torque the abutments that every implant system the seating
screws have to be torqued to a certain amount with with the hand system it's 35 Newton centimeters
you can't break that rule is anybody here had an abutment come loose under a crown I have and it
happens but if with the new technology with these new torque tight screws that's not going to happen
as long as you follow the rules and this is the temporary big-deal Kosinski you it doesn't look
that good you know what it's a temporary well if you simply get up go have a cup of coffee or
go make a phone call or check your emails in a matter of minutes it'll start to close down its
physiologic it's the body's response to what we're creating after a couple weeks you can see how that
interdental papilla at least on the mesial aspect has filled in correct the distal it's a little
bit more of a challenge and we have to decide how are we going to to address that do we do something
with the malposition lateral incisor or not this situation we're not going to we're going to deal
with the patient's main concern but you can see how the tissue starts to heal with a temporary
restoration our margins are at or slightly sub gingival this is the impression coping and I will
do again a standard polyvinyl siloxane in this situation and I replace the temporary abutment
in the temporary crown that we created look at those margins the laboratory then has a an ideal
final impression with tissue contours that mimic a natural tooth we're creating emergence profile to
hopefully create smile design in the aesthetic zone look at the tissue the tissue response is
amazing we get a beautiful gingival cuff in that area Glidewell lab will then fabricate for me a
final zirconia Brux or abutment which is very strong very capable we are going to torque that
abutment screw and 35 newton centimeters when we do that I feel very comfortable that that
abutment will not come loose and we will have an outstanding restoration this is the final
crown this happens to be a knee max crown that they created in immediately after placement okay
and this is not something that I created the expert Tech's created it and they created it
almost exclusively with cad/cam technology with milling as we just saw the interdental papilla in
the medial aspect is what I expected because I had enough bone to be able to do it so the
final smile I think is is is very satisfactory for this patient I think we established health contour
aesthetics and we met every one of these patients of the patient's goals thank you everybody thank
you dr. cousins see to see more of the action from the symposium you can head to chairside
live.com and check out some other presentations for more of the talented speakers that hit the
stage well that about wraps it up for this episode of chairside live so on behalf of everyone here at
global dental thank you for watching and I'll meet you right back here next time
you