Can we Discuss Patient Case Studies about the Vortex Screw?

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For FP1, this is what I wanna do. I want to use FP1, change the heights of my multi-unit abutments and not, or change the heights of zirconia underneath my multi-unit abutment and get really predictable results and get really nice tissues and not have to mow down bone. Like this lady had a really high smile line. I wanted to give her a pretty smile and I wanted to stay at FP1 and I didn’t wanna mow down her bone. Alright, what else? What about cases where, you know, you got to pterygoid off here. Are you, you? This is my canine. So this is my first bicuspid and this is my like third molar back here. This is a long span for zirconia, not expecting it to fracture. And for these, if I have long pontics I’ll add a titanium substructure into my arch and I still wanna be able to mill angulated screw channels.

So this is a good reason to be able to use this screw and be able to mill a titanium substructure for your arch. Alright, and this is the case that we delivered for him, his upper and lower before and after results, right? And it’s a long span from this tooth all the way to the back. So this is the canine premolar all the way to the back here. It’s a long span and not to expect it to fracture, so I put up titanium substructure in there to prevent it from fracturing. I’m running outta time here so I better speed it up a little bit. What about a, a patient that you had, you did pterys, zygos and an anterior implant. You have long spans of pontics. You’re gonna need a titanium substructure of some sort. I mean, these implants are not spaced appropriately like we’re commonly used to.

The zygos are 40 millimeters all the way trim bursting lateral sinus to the zygoma. Again, shout out to Dan Holtzclaw, who a wonderful book on pterygoid and zygomas. Definitely check it out. But you can see the prosthesis is very tall ’cause she’s, she lost all of her maxilla and there’s no puck of zirconia that’s taller than 35 millimeters. So I couldn’t even fit her arch in a puck. So what did I do? I created a titanium substructure and I cemented her zirconia into the titanium substructure. So I get it, I got strength from the titanium, decreased the weight because I wasn’t as much zirconia, it was less expensive zirconia puck I needed to use because the thicker the zirconia puck, the more expensive it is. There’s definitely less chance for distortion during centering on a smaller puck. And there’s greater flexibility on milling angulated channels through the titanium and the zirconia.

So this woman, this is her before and after result and this is her upper arch and this is her smile. I mean the upper arch goes all the way up to her nose. That’s how much maxilla she lost. But these are before and after results. Her tissues, look at the long span here. And this is this titanium substructure. You can see it here in these images. I mean this is gonna last a length of time. And I also started, I’ll go through the last couple slides quickly ’cause I’m running outta time. So the main reasons for using titanium structures are greater than two pontics. Kinda like all on four situation, extreme brux reserves. I want to get more rigid support. Also have affordability issues with some patients in south Louisiana. So what I started doing was milling titanium substructures and milling. PMMA, like you see on this case, on the bottom right that’s milled PMMA on top cemented with a resin cement.

This is a very, very, very strong full arch for this patient and you know, later on if, if she wears out the PMMA teeth, I just re-mill PMMA teeth and cement ’em onto the titanium bar. Or if later on in the future she says, you know what I’m tired of PMMA, I wanna go to zirconia. Well now it just mill in zirconia and cement it onto the titanium substructure. So these titanium substructures are really, really awesome and they’re not difficult to work with. A lot of times I need strength from my full upper arch, right? And sometimes the size of these people’s arches are so big it’s just not gonna fit in a zirconia puck. And that’s when titanium comes to the rescue, right? So this is a case I delivered for this patient here, her upper and lower arch where we did PMMA. And she’s an older female, she didn’t wanna pay for zirconia, so we made her a cheaper PMMA option that she loves and she’s happy. This is the arch I showed you guys earlier in the exocad drawing. These were the two second molars that wouldn’t fit. So they’re milled into the titanium substructure. This is the superstructure of zirconia and this is that big old guy in his mouth. And this is his smile. This is it seated, fully torqued out. And this was the drawing that I showed you earlier. I really should probably stop the webinar right here. Thanks for the time. I really appreciate it. Thanks ROE for having me.

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