Are You a Jedi, or Are You Causing a Disturbance in the Force?

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BY DR. JERRY C. HU, DDS

Unless you’ve lived under a rock—and not one on the planet Tatooine—you know the cinemagraphic tales of the Jedi and their quest to preserve peace in the universe. The success of their mission, like the success of implant treatments, hinges on balance in the Force. A Jedi harnesses the Force for knowledge and defense, but never for attack. Unfortunately, when factors affecting implant success aren’t properly considered, the Dark Side could basically destroy the overall treatment. Put another way, the Dark Side is the potential for Force imbalances to cause peri-implant bone loss and implant prosthesis failure.

So what is the Force we’re talking about? According to Merriam-Webster, force can be defined as (1) strength or energy exerted or brought to bear that causes motion or change; (2) an agent or influence that, if applied to something, leads to its acceleration or deformation; or (3) any natural influence that exists that determines the structure of the universe. There are nine forces that influence implant success or failure and that dentists must consider during treatment planning. These include apical, lingual, distal, mesio-distal, occlusal, facial, facio-lingual, mesial, and vertical axis forces. If there is a disturbance in any of these, the dental implants could be prone to occlusal overload.

The good news is that you can be a Jedi and apply knowledge of these forces to defend your treatments against the consequences of the Dark Side. Implant force disturbances can occur due to problems with large cantilevers, patients with parafunctional habits/ bruxism, occlusal interferences, and/or poor-quality bone. Limited contacts result in poor force distribution, and steep cusp inclines and increased cusp height equate to bone loss. Just like a Jedi must exercise control to better harness the power of the Force, so too must dentists take into consideration and control variables like these that affect implant occlusion in order to ensure long-term treatment success.

This means managing Force in the best ways possible; in other words, establishing protected implant occlusion, and much of that depends on implant placement and prosthetic design. Among the recommendations for achieving the best protected implant occlusion are ensuring straight and centered axial occlusal force load; a narrow occlusal table; and reduced cusp inclination, which concentrates forces over the central fossa. The Jedi implant dentist keeps in mind that ideal occlusal centric contacts are loaded as much as possible on the central fossa, avoiding the marginal ridge.

And remember, too, that the balance you’re seeking is all about how everything in the implant-restoration complex works together—like ideal occlusal timing and an increased implant surface area, which decreases stress (also known as the Dark Side of the Force). Depending on the case, you may need to create long contact areas by using wider implants and/or splinting implants, which also helps to decrease marginal bone loss, abutment screw loosening, and porcelain and component fracture. Or, you might need to reduce the length of cantilevers or the crown-implant ratio, or decrease anterior guidance, especially since a 10-degree increase causes a 30% increase in loading of the prosthesis and/or implant. If you don’t prevent disturbances in these forces, the stress will impact the abutment and implant neck, causing screw loosening, fatigue fracture, and destruction.

The bottom line: Balance in the Force is never by chance. When everything works together, that’s when peace and balance in the universe of your implant treatment occurs. And that’s why it’s essential to communicate with your MicroDental Laboratory technician throughout the implant treatment planning process. Through collaboration, components of the implant-restoration complex can be properly designed to ensure protected occlusion, an ideal crown-implant ratio, and that lateral and sheer forces are avoided.


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Jerry Hu, DDS, Dr. Jerry Hu is triple board certified in dental sleep medicine and holds masterships, fellowships, and accreditations in implant and cosmetic dentistry. He also has published numerous clinical studies in peer reviewed, highly respected journals such as AACD's Journal of Cosmetic Dentistry, and AADSM's Journal of Dental Sleep Medicine. Dr. Hu also teaches for Modern Dental Group both nationally and internationally, and for Sleep Group Solutions, VIVOS growth guidance appliance group, and Prosomnus Sleep Technologies. He also has won numerous awards in cosmetic and implant dentistry from Macstudio Model Search by MicroDental, and IAPA Aesthetic Eye competition. He is currently working on a patent for dental sleep medicine, and looking to help the US military out in dental sleep medicine.

Not All Steaks Taste the Same!

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BY DR. MARK T. MURPHY

There are several reasons that you can buy filet mignon at your grocery store or butcher for anywhere from $10.99-$25.00 per pound. Forget the fact that Authentic Japanese Wagyu Filets will set you back $214.50 per pound, and that’s at Costco! One reason is the cost they paid and profit margin they add, the other is the grade of the beef. Good, Better and Best cuts of meat, each have a different price when you go shopping.

The same can be said for the impression materials, composites, and other dental supplies you use every day. There are quality differences that sometimes create huge variances in performance. The raw materials used for ceramic or metal frames, copings and finished restorations made for you at MicroDental Laboratories have the same scope of quality available. If you start with a USDA Select or Choice Steak and try to serve it at Morton’s for $45, your customers will not come back. The quality will not match the price. Conversely, if you start with USDA Prime, dry aged and sell it for $19, you will go broke. 

The good news is the difference between Good, Better and Best Zirconia is not 2-3X. For the small incremental cost of using the best Zirconia available like the Ivoclar materials that MicroDental uses, you get a better, more esthetic and predictable restorative solution.  Cheaper Zirconia will not look or perform as well. There is a difference in the final product when you start with a lower quality raw material. The purity, how the pucks are pressed, and the performance characteristics can produce a wide variance that will compromise your patient care. The race to the bottom for the cheapest monolithic Zirconia Crown carries a huge price tag. Just like cheaper cuts of meat that will be tough to chew, the customer/patient will be disappointed.

MicroDental is proud to use the best materials available. We do buy in volume and pass the savings on to you. The new Ivoclar eMax ZirCAD raises the bar even further. It has all the quality characteristics as their other raw Zirconia solution plus incredible esthetics. It’s the first time you have seen them put the eMax brand name onto a Zr material. The next revolution in strong esthetic restorative materials is here, you are going to love it!