Smart Partnerships for Implant Prosthetics

Know when to outsource and which milling centers will provide the quality you need

John Wilson

Implant dentistry is clearly the future of dental technology. Laboratories can differentiate themselves in today's market with a better understanding of the componentry of implant dentistry and the dynamics that can affect outcomes. Fit and finish are critical as well, however, and in this digital landscape, we so frequently utilize split files; therefore the quality of the custom abutments and bars that we receive from milling centers must match the quality that we want for our prosthetics as a whole.

What do you need from a milling partner?

Any time we outsource manufacturing, we need to ensure that the milling center will replicate our pattern. We have worked hard to develop our CAD skills, so we need the milling center to utilize the proper CAM strategy and not rush the process. If a milling center is using a strategy that prioritizes getting the bar off the mill as quickly as possible, then the pattern likely will not be replicated identically. Using higher-end milling partners is worthwhile to achieve the finish we want.

What considerations are involved with milling abutments and bars in-house?

Even with a very robust smaller machine, milling abutments or bars for 24 hours a day is not ideal for multiple reasons. We utilize in-house milling when we need a fast turnaround or when there are special circumstances that we would rather handle ourselves. Most of the time, however, milling these products in-house is inefficient and puts too much wear and tear on our machines. Abutments and bars involve complex geometries and hard materials, both of which industrial machines are better suited to handle.

What design concepts have worked well for you?

The No. 1 concept for single-unit implant abutments is understanding that what you cannot see is more important than what you can see. Radiographs are critical. Subgingival contours will make or break any restoration—not just based on esthetics but also on the longevity of the fixture. We can design our custom abutments with subgingival contours matching bone to be able to skirt it, which is so important. For bars, our laboratory is very well versed on fixed full-arch zirconia, and we have been increasingly utilizing a bar with a cemented sleeve. That has been a game-changer because it provides more predictability in terms of strength and overcoming the challenges of dimension.

Key Takeaway

Every technician today has many resources at their fingertips that will allow them to become an expert on implant dentistry. Mastering all of the componentry involved and how it is best utilized makes you a resource upon whom your clients can rely.

About the Author

John Wilson is the owner of Sunrise Dental Laboratory in Yucaipa, California.