Cases like these can change a patient’s life.  For the technician, it can present a new level of challenges and requires one to draw on every skill that they have developed.  These cases are not only challenging technically, but also requires tight collaboration between the lab and the dentist. While technical skills are absolutely necessary, the real key to a successful full arch case is clear communication between the lab, the dentist and patient.  

We interviewed Open Implants’ customer Gary Grosclaude, an expert in these cases, and here is what we learned.  

OI: How long have you been in the business?
Grosclaude: I went to John Archibald’s school in Provo, Utah in 1995.  John is an incredible technician and is recognized throughout the industry as an educator and leader. I have been in business since 1995. I started a lab immediately after graduating from that program.

OI: When did you go digital?
Grosclaude: It’s funny because I always tell my kids that I remember when we only had three television channels brought to us through an antenna on top of our TV and I also remember when we got our first microwave. In 2005, I bought my first digital scanner. I was in love with I thought the technology was amazing. It was very expensive then, but I wanted to be able to control the end result and at the time we were doing a lot of implants and I can confidently say that the fit was amazing.

OI: What advice would you give a lab owner/technician who has not yet started or who is just getting started in digital?
Grosclaude: When selecting scanners, milling machines and now 3D printers, one needs to be careful to pick a system that will serve you well for a period of time and take advantage of all the technology and materials that are already out there.  

OI: How many full arch cases do you do in a month?
Grosclaude: Generally, three or four per month, but not all are implant bridges, many are an entire arch of prepped teeth or a mix of bridge work, singles units and implants. However, I really enjoy doing implant supported bridge work because it takes every bit of skill that I have to make them resemble natural teeth and tissue. If I fall short in my efforts, I have mentors that come closer than I do to nature and these days with instagram it is not difficult to find inspiration. I must give a shout out to Michele Frapporti at Zirkon Zahn for his amazing artistry. I would encourage anyone who is doing large implant work to go to the Zirkon Zahn website frequently to see artistry in dentistry on display. Lastly, so many lab technicians believe that digital is he end of the “art” in dental technology. This is certainly not the case.  

OI: What advice would you give to someone who is new to multi-unit cases?
Grosclaude: We owe it to the patients we serve to do our very best every day. You are going to be asked to do a case that you’re not technically prepared for. That’s OK, take the challenge but put in the time. My advice is to seek out help when you need it and to give yourself way more time than you think you’ll need. Mentors have been and continue to be very helpful to me.

OI: How do you work with the doctor on full arch cases to ensure the best outcomes?
Grosclaude: Great question, so let’s define a real challenge for technicians. Particularly a technician with fixed experience but no real removable experience. Let’s face it, unless we went to years of dental technology school most of us have never made a wax rim, so for us to guide a dentist through that process may be challenging.  If you don’t have that experience, then working with a denture lab is critical because they are experts at this. Once you are confident you have the correct placement of the upper and lower arch on the articulator you can spend hours on the design of the case without worrying that all the time you are spending is wasted.

The key is being confident.  You spend time on a diagnostic wax up, trying to make the teeth look natural. You must feel is confident that everything you are getting bite registrations, position of implants, smile line and diagnostic cast are all accurate. As you move forward as a technician, you can focus on both function and artistry.  When working with a doctor for the first time, I am going to make sure that the doctor understands the full protocol. For a fully edentulous case, we start with a screw retained wax rim. That will get you a very close to a final vertical dimension (VD). If you feel confident in both the impression and vertical we go to the diagnostic wax up and use the wax rim will show you where the key landmarks are going to fall.  The dentist has marked the incisal edge, they will notch the lower and the upper and leave extra space for a flowable bite registration material.

Once I have the diagnostic wax-up scanned into the CAD software I like to fabricate a try-in prosthesis milled form PMMA.  In addition, I CAD and mill a thick PMMA bar that fits over the abutments. Once complete I send them both the bar and the PMMA try-in appliance. The bar, designed with no tissue contact is used to confirm the accuracy of the final impression and cast. The try-in appliance is used to check VD, phonetics, esthetics tooth size and placement and so on.  Check to make sure it is interfacing with the implants correctly. Patient spends a ton of money on this. It is like a second mortgage for some people. It is unfortunate when a patient’s expectations are not met. Doctors need to be comfortable doing these complex cases.

OI: Tell me about this particular case.
Grosclaude: I worked with Dr. Stephen Edgerton, DDS in Wilmington, NC on this case. He is an excellent dentist that I have been working with for over 10 years. This case was about as ideal as you can get. Plenty of interocclusal space. implants were placed in ideal locations and the patient had realistic expectations. It was a fun case to work on because I felt confident it would be a success. The fact that it was a full mouth fully edentulous case was a bit challenging just because it was the largest case you can do. I used a lot of high quality photos for communication with the dentist, we had a lot of discussion and time invested in the diagnostic phase. Once everything is correct diagnostically, the definitive case goes pretty fast and is very predictable.

OI: How long have you been using Open Implants?  
Grosclaude: I have been using OI for a year now, since June of 2017. Before that I was using other companies but the support wasn’t always good. From the start I really liked the interaction I had with OI because I felt they were very interested in taking care of me as a customer.

OI: Why did you start using Open Implants?
Grosclaude: Truthfully, the reason I started using Open Implants is because they consistently had what I needed. My supplier no longer had the Ti inserts that I was using and after going through a period of backorders, it was getting frustrating. We installed the DME files from Open Implants, the products worked perfectly with my CAD/CAM system and the results were great. So again, for me it’s all about confidence in the process so I can do what I need to do not waste any time.

OI: What do you like about the OI system?
Grosclaude: First of all, I like the people and that might not sound like it’s that important, but I am a very loyal person so if I feel like people are interested in making sure I’m taken care of, well, it goes a long way with me. Of course, I also really like the products. They are simple, logically designed parts that make complete sense to me as a technician and allow me the confidence that cases will go smoothly. It definitely doesn’t hurt that they are competitively priced, but that isn’t the most important thing to me. It does make it easier to have stock on hand though, which in nice.  I also like that OI asks for and listens to feedback from me, which is unique today and feels very much like a partnership.

-> Check out OI components for full arches.

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