Watch this video to see the development of this intricate case

OI: How did you get involved in Dental Technology and what was your path that lead you to where you are today?

RUDOLPH: I have been a technician for 44 years and I have been working for myself for 38 years.

I started making jewelry in art class and learned to cast.  When I started looking for work, the trade school I was at was showing dental technology.  My dentist had a technician who started his own lab. That lab owner referred me to a school for training and then I went to work for him.

My lab today focuses on crown and bridge implants. I don’t do removable partials or dentures.  We are specialized because we are small lab and I wanted to focus and excel on our product line. I am a ceramist by training so when I went on my own that is all I did and I outsourced the frameworks and applied ceramics. I became astute at form, so when we moved to digital I turned into a designer.

OI: How was your transition to digital?  

RUDOLPH: This was rather easy for me as I was very comfortable with computers, I even built my own computers back in the 90s.  Digital lab production was enticing to me and I thought it was exciting and felt there was a huge potential to go digital.  When it first started, equipment was expensive so I used to send things out. Then I bought a used scanner and design software to get started.

When full contour crowns were introduced, the scanner and CAD were not cutting it so I updated to a new scanner and exocad.  The company I bought it from trained me how to use it. That training provided the basics. From there, I pretty much learned it on the fly as I did more and compext designs.

OI: What advice would you give a lab owner/technician who has not yet started or who is just getting started in digital?

RUDOLPH: Start out with a scanner and design software.  Make sure you buy a fully open architect solution such as 3Shape or exocad and the scanner of choice. Many systems claim to be open but they are not and you get stuck in their ecosystem.  With an open system you have more choices of materials outsources facilities and indications.

Before purchase, do some research on who you are buying your scanner and software from.

This should NOT be a priced based decision. You will receive your training and get support from them on an ongoing basis. This is such a needed piece of the digital puzzle that picking the best training and support can save you thousands of dollars over time.

OI: How many full arch or multi unit cases do you do in a month?

RUDOLPH: Full arch cases are not cases that come along every day.  Many general dentists don’t have the experience of knowledge to treatment plan and execute on these cases.  We get a couple of these per month. I love doing them. It’s fun. I’m currently working to do many more cases like this. It’s a great challenge, especially the screw retained implant cases. Also a very profitable part of the business.

OI: How do you communicate with the doctor throughout the case?

RUDOLPH: It is great when the docs collaborate with us prior to implant placement on the treatment plan.  Unfortunately, that doesn’t always happen. Often the implants are placed before we ever see the case and they send us a final impression.  Then it’s up to us to find the solution for the best treatment plan. If the implants are too convergent or divergent or misplaced it make the cases far more complex and costly. When dentists get us involved before implant placement, cases are easier to fabricate, more hygenic and esthetic.

Perhaps the best communication tool we insist on is a CAD verification bridge. Once we have our final design, we mill it form PMMA and send it for try-in. This gives the dentist and patient the opportunity to check every aspect of the CAD design in the mouth. By taking this step we can make changes to the definitive restoration. This improves predictability as the final case is delivered with reduced complications.

OI: Thank you for sharing the video for your recent case and allowing us to showcase this great work. Tell us about this particular case.

RUDOLPH: In that case, the doctor had a acrylic temporary placed on Open Implants multi unit abutments. There was limited vertical dimension.  The temporary kept breaking and the patient did not like the bulk and wanted less material on the final restoration. As a result, we decided on zirconia for the final restoration due to the strength properties. There was also a desire to bring the anterior teeth back or lingualized. In addition, this case was more complicated because of very divergent implant placement, thus requiring angled screw channels. The degrees of angulation were rather extreme. To lingualized the anteriors I needed to angulate screw channels and driver direction. If we had been involved in the case prior to implant placement, we may have been able use a standard screw even with a possibility of a more subtle angulation corrections.

A lot of design time went into that case prior to fabricating the CAD verification bridge. Once tried in, changes will be made to make it easier for the patient to clean. There may be other issues found during this try-in that require CAD modifications.

The fit of the case is now so much simpler. Through initiatives at Open Implants we have digital libraries of the geometry for the Open Implants caps. This includes the cement gap. Prior to using the OI parts and related library fitting these bridges was far more challenging.

Screw retained full arches are one of the most complicated digitally designed cases you can do.  When I saw them years ago, I decided this is what I want to do. These cases are life changing for patients that have been wearing dentures. The patient acceptance on these cases is so satisfying.

I always tell my dentists – it is my job to make you look good!  We want the patient to feel good and you can be the hero.

OI: What advice would you give to someone who is new to full arch or multi-unit cases?

RUDOLPH: Take some courses on hybrid screw retained full arch restoration.  The brands you may see are called IZIR, Pearl, Pretteau, All on 4. You can learn to do a complex bridge or full arch.

OI: How long have you been using Open Implants (OI)?  

RUDOLPH: Since February of this year. I had been looking at it since it came out.  Then I met with the OI team in Chicago at Lab Day and have used their parts and IP ever since.  What got me? I was in the midst of these complex hybrid cases and I really needed the OI multi unit solution.  I thought, this is the way it should be made. The reasons are many. Relative ease of assembly in cementing to the restoration due to the conical design of the cap.  Especially when you have divergent implants. The digital library provide a precision fit that I never got before.

I also use the OI titanium bases.  If I need a slight degree of angulation, I cut them to H4 or 4mm. If I have a taller restoration I can leave the cylinder taller. There is also a digital library that relates to several different heights for each cylinder. This also helps keep inventory down as each cylinder an be used at 10mm or cut to 8mm, 6mm, 5mm or 4mm. I like the fact that I can customize the heights.

I like the OI scanbodies as they are PEEK, which scans really well, on a steel base with a titanium screw that won’t fall out. Because I have guys that are starting to use intraoral scanners, this is the perfect scanbody design. They can be x-rayed. It is a good design, not too tall not too short.

Lastly the OI analogs are great as they can be used in either a digital or conventional model. This again, reduces my inventory needs.

Watch the video to see the development of this hybrid zirconia bridge.