Protrusive Dental Podcast podcast

Rochette Bridges and Provisional Prostheses for Implants – PDP145

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Rochette Bridges are a popular option for interim tooth replacement whilst implants in the aesthetic zone are 'cooking'. In this episode with Dr Pav Khaira we discuss his interim restoration protocols using Rochette Bridges and Dentures, as well as gaining an insight in to custom healing abutments. https://youtu.be/InBOBHfYxEA Watch PDP145 on YouTube Which cement is best for Rochette Bridges? How do you remove them? Ceramic or Composite pontic? When might we consider a Denture instead? We then expand in to soft tissue augmentation at the time of implant surgery to get the best pink aesthetics. This episode is packed full of gems even if you do not place implants - much of the benefits of soft tissue augmentation can be applied to non-implant fixed prosthodontics. The Protrusive Dental Pearl:  Steal my Resin Bonded Bridges consent form! It is a visual aid for patients and helps with information and consent for RBBs. If you are on Protrusive Premium, head to the 'Protrusive Vault' to download it. Otherwise you can request your free download here. Need to Read it? Check out the Full Episode Transcript below! Download Protrusive App on iOS and Android and Claim your Verifiable CPD/CE by answering a few questions + You can get EARLY ACCESS to the episode + EXCLUSIVE content "It's all about how you communicate the soft tissue grafting surgery to your patient" - listen/watch the episode to hear this absolute peach of a communication pearl! Learn Implants from Dr Pav Khaira Highlights of this episode: 3:40 Dr Pav Khaira's Introduction7:20 Interim Restoration vs Immediate Loading of Implant10:12 TWO Golden Rules of Temporary Dentures for Implants11:15 What is a Customised Healing Abutment?17:40 Rochette Bridges Protocol23:54 Temporary Implant Crown Protocol31:36 Communicating Soft Tissue Grafting If you enjoyed this episode, check out Success with Resin Bonded Bridges. Click below for full episode transcript: Jaz's Introduction: If you've placed an implant or maybe your surgical colleague has placed an implant and now it's come to you as the restorative dentist, and you need to give this patient a tooth because they're not going to go for immediate loading, i.e, they're not going to have the temporary crown on this implant the same day. Jaz's Introduction:We're going to wait some healing, and therefore, how can you give this patient a tooth? It's going to be a denture or a bridge of some sort temporarily. There might be some other ways, but these are the two most common ways to do it. Now, you might have heard of something called a Rochette Bridge. Rochette Bridge is basically like a metal resin bonded bridge with HOLES in it. It's very popular way. A lot of the implant dentists use to TEMPORARILY have a tooth there so that everything can heal, the soft tissue can heal, the implant can osseointegrate, and then you can take off this bridge and continue on with placing a crown for that implant. But there's lots of nuances when it comes to Rochette Bridges. So I've got on Pav Khaira today to talk about Rochette Bridges. Talk about dentures, like how do you make sure the denture's not impinging on the soft tissues and on the healing abutment. Now if all these terms aren't making sense to you, then I'll make sure that Pav breaks down exactly what a healing abutment is. So really is the bare bones of everything and builds you up and we build up all the way towards the end. We talk about soft tissues and how in many cases soft tissue augmentation to get a nice papilla is so important and Pav will share with you a very interesting stat about the number of people that show their papillas. Have a guess, actually, if you don't know this already, when people smile, when our patients smile, what percentage of them will show a papilla? At least a papilla, one papilla anteriorly, right? So what percentage of patients will show papilla, at least. Protrusive Dental Pearl:The Protrusive Dental Pearl I have you, is that you can steal my resin bonded bridge consent form. I thought it would be a good little gift to give to you guys. If you're on Protrusive Premium, I stuck it on the download section already for you so you can download it. If you're not on Protrusive premium yet, then you can now to protrusive.co.uk/rbbconsent. That's RBB consent and I'll send you my resin bonded bridge consent form, which I'm super proud of, because it's pictorial. It's got Images. Like images of black triangles, images of long connectors and how on one place you might have a papilla and the other place where the tooth was extracted, you don't. Now, patients get to visually see this. And what metal show through looks like and just, it's really, really good to have these visuals for your patients. It's more like an information sheet, but this is a big hit. Every dentist who ever downloaded it as part of my resin bonded bridge course has always found this and the lab prescription form very useful. Now let's join the geekiest implant dentist I know, Pav Khaira. Main Episode:Pav Khaira. Once again, welcome back to the Protrusive Dental Podcast. How are you mate? [Pav]I'm very good Jaz. Thanks for having me back and as we spoke about just a few seconds, I'm going to push this out on my podcast as well, so it always feels twice as productive whenever we do it. [Jaz]Excellent. Well, I've referred to you before as the 'oracle of the implant world', but the themes we're covering today, and we'll just get an instruction just in case someone hasn't heard of the previous ones we've done and some of the group functions we've done, have been really well received because people message me saying, 'Jaz, you're covering these real world topics'. And what we covered in those topics, like how you probe periodontally around implants, right? Things like that. Screw loosening. We covered these really big themes and so today's theme, but for those listening, all watching on YouTube is a twofold. One that will help every single dentist, I think, right? We'll learn about rochette bridges. How do you take them on, how do you take them off? How do you put them on? What cement do you use? The selection criteria, that kind of stuff for like temporary, before they have the implant and while implant restoration, while we're waiting for osseointegration and the grafting, et cetera. And how we can optimize our temporary implant ground to better serve our future implants and soft tissue augmentation. So something in it for those who are already doing implants. So this is going to be a bit of a beast. But Pav, for those who haven't heard of you and the lovely work that you do, including your podcast, just give us a flavor about yourself again. [Pav]Yeah, thanks Jaz. So I am a full-blown Titani-nerd. I mean, to the point where when my wife and I went out shopping for wedding ring, she was like, 'I want that one'. And she was like, she said to me, 'why do you want that one?' I said, 'because it's titanium'. And she was like, 'why don't you want gold or platinum?' She didn't realize until afterwards that titanium is what her implant, because she's not a dentist. That titanium is what implants are made of. So I literally live in breathe implants. I have placed over 10,000 implants. I have been very, very fortunate to have been exposed to a lot of surgery. So I've become very confident and proficient at it. And, I still have a lot to learn cause I'm a great believer as soon as we turn around and stop learning. We do ourselves a disservice and we do our patients a disservice. And this is a philosophy that both you and I have in common. So I run the 'Dental Implant' podcast, which is kind of like, off the back of a discussion that you and I had a few years ago. And you were like, 'Pav, you know so much, why don't you run a podcast?' And I was like, 'I don't know how'. And you were like, 'let me show you'. So, you've been my sage and mentor in that context. And now I've also set up and I run the 'Academy of Implant'. So I'm busy, busy training, mentoring and everything relating to implants. My daughter's only two and a half and it won't be long before I've got a motor in her hand practicing on models to place implants. So. [Jaz]Excellent. Well, I can definitely vouch for your geekiness, like when I was a newly qualified, I think maybe 10, 12 years qualified, that stage and the amount of knowledge that you had on occlusion and splints and obviously osmosis. I try to absorb as much of that as possible. And I've kind of run with that and I have seen you diversify into implants and how you really take into that. So I think you've got this personality Pav, whereby when you take something, you properly latch on. Am I right in that? [Pav]It's obsessive. I can't help it. That's just me. And that's purely from a point of view. I'm a great believer if you're going to do something, do it properly. And in order to really help our patients, and it's a personal journey as well. I don't want to get to the end of my career and think to myself, I didn't do this, I didn't do that. I want to get to the end of my career and think to myself, actually, you know what? There's nothing more that I could have put into this. Absolutely nothing. I've helped as many people as I can. I've trained as many dentists as I've could. I've gotten x number of, careers off the ground, and those people have helped more patients as well. And I think you have to be obsessive about it. And that's just my philosophy. If you're not obsessive about it, you don't have to be quite as obsessive as me, but you at least need to have a passion about it. There's a difference between passion and obsession. I've got an obsession with it. You need to at least have a passion about it. And the rewards that come off the back of that professionally, personally are just unmatched. [Jaz]Amazing.

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