F.A.Q.s

The technical answer from Nobel Biocare is “5 times.”  While the following explanation is based on the science of Nobel Biocare products, I consider the information a good baseline for all implant systems.  Nobel Biocare screws have a coating called “Torque Tight” on the surface of the screw. This material lubricates the internal threads of the implant or abutment to achieve a more true torque. According to Nobel, the 2nd and 3rd torque actually achieve the most accurate torque. The 1st time a screw is torqued, the torque tight coating is just beginning to come off in the threads of the implant or abutment.  By the 2nd and 3rd time, there is already some lubrication from the torque tight helping to achieve a more accurate torque. By the 5th torque, too much of the torque tight has come off the screw to be effective. The engineer from Nobel did go on to say that torqueing a screw more than 5 times will not break the screw, it just will not achieve as accurate of a torque. A screw will only break if it is over torqued, not torqued too many times.  

Lab work is a direct reflection on the doctor. It can make the doctor shine or look bad in the eyes of the patient. In any full-service lab, dentures are always an afterthought. They don’t get the attention they deserve and require. We work hard every day to make doing dentures precise, predictable and profitable for our doctors on a consistent basis. We don’t skip steps and we get it right the first time. For combination cases, we are happy to work with any C&B lab of your choice.

Due to our depth of expertise, our technician understands material limitations and the physics involved in successfully converting a denture that will not break lasting until the implants are healed and ready for final restoration. It is important to make sure that the provisional is contoured properly so it is comfortable for the patient and so it can be easily cleaned because it cannot be removed by the patient. When a patient invests in this complex treatment option, the last thing they want is a broken denture right out of the gate.

We have multiple ways of streamlining denture fabrication to cut back on the number of appointments. We are happy to discuss the options with you on the phone in relation to the specific case details. But, one is the use of Staub™ Cranial Technology which allows for final delivery in three appointments. Read More About Staub™ Cranial Technology

A hard nightguard is fabricated with 100% hard acrylic. A thermoplastic nightguard has a flexible liner that enables the material to flex over the height of contour of the tooth but has a hard occlusal surface. Our feedback from our doctors is that the thermoplastic nightguard is a much more comfortable option for the patient and does not create a pulling sensation on the teeth.

For a hard night-guard follow the denture instructions above. For a thermoplastic night guard, simply use a soft toothbrush and water.

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All full and partial dentures should be relined every 2-3 years. The reason is that every patient is different and that bone reabsorbs constantly. With a partial denture, we want to maintain tissue support. As you lose bone under a partial denture saddle, you are creating more torque on the abutment tooth. Rather than waiting until there is a visible gap under the saddle of a partial, we recommend relining every two years as preventative maintenance. As for a full denture, as you lose tissue support due to the bone absorbing, the patient is prone to more sore spots and denture base fractures. Relines also open the door to talking about implant options with your patients. Consider them an opportunity!

We get asked this a lot and the answer is two-fold. First, an accurate impression is a must. Taking the time upfront to take an accurate impression will save you time, money and frustration later in the treatment plan. We guarantee that our products will fit the model. But if the model is not accurate, it won’t fit the mouth. We recommend the use of a custom tray in conjunction with border molding using either PVS or rubber based material for edentulous cases or the Accu-Dent System II for partials.

Second, we must also have an accurate bite registration. An easy way to accomplish this is with intra-oral tracers. They cost about $300 but are well worth the investment. We are happy to order them for you upon request.

All of our models for partially edentulous cases and Night Guards are duplicated so that we are able to fabricate the restoration on the duplicate cast and seat the final restoration to the master cast before delivery. By doing this we are able to save the doctor significant adjustment | chair time.

A processed base allows the doctor to verify the accuracy of their impression and the fit of the denture base as well as make any necessary adjustments during the bite registration and wax try-in as this will be the final base of the denture. The benefit is that all adjustments are made before final processing eliminating the need to make any adjustments to the final denture thereby reducing post-op appointments.

A rigid cast partial is always the best solution for long-term treatment. When a flexible partial is desired, the DurAcetal partial is constructed in the same manner as a cast partial. It is a flexible, tooth colored partial that is tooth supported via occlusion rests and the saddle areas are processed with regular acrylic and can be relined, repaired or added to in the same way as a regular cast partial. DuraFlex (Val Plast), however, is tissue supported and must be re-based when a reline, repair or addition is desired.

The answer is yes to both. DurAcetal clasps are retained through mechanical retention which can be created on a new framework, existing partial, acrylic partial and even a flexible partial.

For partial dentures, we prefer the Accu-Dent System II. However, because this is an alginate impression material it must be poured up immediately and not be inverted after being poured. If alginate is not desired, then we suggest a light bodied PVS material of your choice. If PVS is chosen, we advise the use of a custom tray to keep the thickness of the impression material more consistent in order to avoid distortion of the impression.

For full dentures, we suggest the use of a custom tray in conjunction with border molding with either PVS or rubber based material. Also, we have found the Accu-Dent System I to be a good alternative to traditional border molding. But again, because Accudent is an alginate impression material it must be poured up immediately and not be inverted after being poured. We have information on both upon request.

With CAD | CAM we are able to achieve a true passive fit which is unachievable with traditional bars. They are one solid piece of titanium thus eliminating the chance of the casting separating from the UCLA abutment. Because they are milled from a solid block of titanium, we also eliminate any porosity and weak spots in the bar. In addition, they are extremely lightweight.

The steps for fabricating a CAD | CAM bar are the same, but they go in a different order. We provide a step by step guide to our doctors using this treatment option for the first time.

A thermoplastic night guard has a hard occlusal surface but is flexible on the buccal and lingual sides thus allowing it to flex comfortably beyond the height of contour of the tooth for increased retention yet is more comfortable than a traditional hard night guard.

The Acculiner is an alternative to using a face bow which uses average values to align the maxillary cast properly on a semi-adjustable articulator using a Hamular Incisive Papilla (HIP) plane. This helps us in setting the teeth to the correct occlusal plane and reduces the chance of a reset due to a canted occlusal plane.

All of our full denture and nightguard cases are transferred from the Acculiner to a semi-adjustable articulator. We prefer the Stratus 200 because it can be calibrated avoiding the need for transporting the articulator back and forth to the doctor’s office. However, we have many other types available as well.