223. Bill Robbins DDS, M.A. - Should You Be Placing Anterior Implants?
May 21, 2024
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Dr. Bill Robbins discusses implant challenges in the anterior maxilla, emphasizing bonded zirconia bridges over implants. The podcast also covers patient satisfaction in dentistry, handling difficult patients, and comparing abutment teeth for anterior bonded bridges with insights on stability and spacing.
Proper wing design and enamel preparation are crucial for successful bonded bridges, highlighting the importance of groove depth for resistance form.
Instructors emphasize a hands-on teaching style for upcoming courses on treatment planning and dental photography, providing a systematic approach.
Implant placement challenges in young adults advocate against implants for missing maxillary lateral incisors due to unpredictable facial growth and long-term implications.
Managing patient dissatisfaction requires honesty, transparency, and potential reimbursement for unsatisfactory work, emphasizing patient-centered approaches.
Material choice for anterior bonded bridges involves using strong zirconia substructures and aesthetic ceramics for enhanced appearance, emphasizing effective bonding methods.
Deep dives
Bonded Bridge Design and Importance of Enamel Preparation
When creating a bonded bridge, it is crucial to consider the wing design and enamel preparation. It is highlighted that you cannot thin the lingual of a canine or central incisor enough to support a zirconia wing of the required millimeter thickness. Proper preparation involves removing around three tenths of the enamel to ensure a positive seat for the wing. The primary seating comes from the groove, which should be moderately deep, similar to a three-quarter gold crown preparation. This groove depth provides resistance form for successful bonding.
Course Overview and Teaching Approach
The podcast introduces an upcoming course focused on treatment planning, crown lengthening, pre-orthodontic bonding, and dental photography. The course will provide a systematic approach to these topics. The instructors emphasize a hands-on teaching style, with a two-weekend format comprising lectures and practical sessions. The primary positive seat for me though is coming from the groove.
Challenges and Pitfalls of Implant Placement
The episode delves into the challenges and pitfalls of single dental implant placement in the anterior maxilla. The speaker advocates against routinely placing implants in young adults for missing maxillary lateral incisors. Factors such as facial growth unpredictability and long-term implications are discussed, arguing for alternative options like bonded bridges. The primary concerns include potential bone and tissue changes, leading to aesthetic and functional issues over time.
Handling Patient Discontent and Treatment Redo
The speaker discusses managing patient dissatisfaction with dental work, emphasizing honesty and patient-centered approaches. He shares insights into handling cases where patients are unhappy with the aesthetics or functionality of restorations. The importance of open communication, transparency, and sometimes providing reimbursement for work that fails to meet patient expectations is highlighted. The podcast emphasizes the significance of patient satisfaction and ethical practice management.
Anterior Bonded Bridge Materials and Aesthetics
Regarding the material choice for anterior bonded bridges, the focus is on using a strong zirconia substructure with high flexural strength. The podcast highlights the use of 3Y zirconia as a reliable substructure and layering with aesthetic ceramics on the facial surface for enhanced appearance. The decision to stack porcelain on the facial surface in conjunction with zirconia substructure is noted for its strength and aesthetic appeal.
Innovative Bonded Bridge Techniques and Considerations
Innovative techniques for bonded bridges are discussed, emphasizing the importance of knowing the zirconia used for the substructure. The podcast mentions the practice's approach of bonding the zirconia substrate directly to the tooth without additional layers. By using the strongest zirconia type and adding glass ceramic for aesthetics, the speakers advocate for effective bonding methods and material selection in creating bonded bridges.
Practice Management and Patient Relationships
Insights on managing patient relationships and navigating contentious scenarios in dental practice are shared. The episode highlights strategies for addressing patient dissatisfaction, offering solutions, and potentially reimbursing for unsatisfactory work. The importance of maintaining professional integrity, clear communication, and handling challenging patient interactions with transparency and ethical conduct is stressed. The speaker underscores the significance of patient-centered care and ethical responsibility in dentistry.
Key Design Considerations for Successful Bonded Bridges
The episode emphasizes the importance of key design considerations for successful bonded bridges, specifically focusing on the canine as the primary abutment tooth due to its anti-rotation groove potential. Enamel preparation is crucial, with a recommendation to remove around three tenths of enamel to accommodate the zirconia wing. The discussion underscores the significance of achieving proper resistance form and aesthetic results in creating bonded bridges.
Implications of Facial Growth in Implant Dentistry
An exploration of facial growth dynamics in implant dentistry reveals the potential challenges and risks associated with placing single dental implants in young patients. The speaker highlights the impact of facial growth on implant positioning and occlusal relationships over time. The episode underscores the importance of understanding the unpredictability of facial growth patterns in treatment planning and the potential implications for long-term implant stability and aesthetic outcomes.
J. William Robbins, D.D.S., MA., maintains a full-time private practice and is an Adjunct Clinical Professor in the Department of Comprehensive Dentistry at the University of Texas Health Science Center at San Antonio Dental School. He graduated from the University of Tennessee Dental School in 1973. He completed a rotating internship at the Veterans Administration Hospital in Leavenworth, Kansas and a 2-year General Practice Residency at the V.A. Hospital in San Diego, California. Dr. Robbins has published over 80 articles, abstracts, and chapters on a wide range of dental subjects and has lectured in the United States, Canada, Mexico, South American, Europe, Middle East and Africa. He co-authored a textbook, Fundamentals of Operative Dentistry – A Contemporary Approach, which is published by Quintessence, and is in its 4th edition. He recently co-authored a new textbook, Global Diagnosis – A New Vision of Dental Diagnosis and Treatment Planning, which is also published by Quintessence. He has won several awards including the Presidential Teaching Award at the University of Texas Health Science Center, the 2002 Texas Dentist of the Year Award, the 2003 Honorary Thaddeus V. Weclew Fellowship Award from the Academy of General Dentistry, the 2010 Saul Schluger Award given by the Seattle Study Club, the Southwest Academy of Restorative Dentistry 2015 President’s Award, and the 2016 Academy of Operative Dentistry Award of Excellence. He is a diplomat of the American Board of General Dentistry. He is past president of the American Board of General Dentistry, the Academy of Operative Dentistry, the Southwest Academy of Restorative Dentistry, and the American Academy of Restorative Dentistry.
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