STAR DENTAL LAB JACK FOUNTAIN C.D.T CEDAR PARK TX Please cut out

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1 STAR DENTAL LAB CEDAR PARK TX Dr, Thank you for taking time to look over our services. We are Austin area NOBEL ESTHETIC LAB that specializes in implant bars and custom abutments. We are trained in the ALL ON 4 techniques and bars designed for implants We offer complete support and services from assisting in case planning, working with the surgeon at surgery converting the denture to a temporary bridge, making the final bridge and helping walk the restorative dentist thru the final steps. I am one of only a hand full of lab techs in the USA to offer this complete seamless transition. Prices vary depending on the services you are interested.we will be happy to help in any way we can. We have enclosed a coupon were we help in the surgery a half day at our normal fee of $450 and will give you a $450 credit to use in the future on any implants products or services we offer even another surgery. JACK FOUNTAIN C.D.T Please cut out All on 4 surgeries credit to be used on any future implant procedure$450

2 STAR DENTAL LAB CEDAR PARK TX ALL ON 4 SURGERY CONSULTING FEES WE WILL AT THE REQUEST OF THE DOCTOR AND SURGEON ASSIST THE SURGEON THE DAY OF SURGERY WITH CONSULTING AND THE CONVERSION OF THE DENTURE TO A FIXED TEMP BRIDGE WE HAVE ALL THE EQUIPMENT AND WILL BRING IT ONSITE. CONSULTING FEE FOR ½ DAY IS $450 WITH A $100 DISCOUNT FOR PAYMENT THE DAY OF SURGERY. $550 NET 30. MINIMUM FEE IS $100 CONSULTING FEE FOR ALL DAY IS $700 WITH A $100 DISCOUNT FOR PAYMENT THE DAY OF SURGERY. $800 NET 30. MINIMUM FEE IS $150 APPOINTMENTS WILL NEED TO BE MADE AT LEASE ONE WEEK BEFORE TO ASSURE AVAILABILITY. ALL CANCELATIONS NEED 24 HR NOTICE FOR FULL REFUNDS OTHER WISE THE MINIMUM FEE WILL BE CHARGED. PLEASE SIGN THIS AND FAX TO PLEASE CALL TO VERIFY RECEIPT. DR PATIENT SURGERY DATE SURGERY TIME SURGEONS NAME TO BE PAID BUY DR. JACK FOUNTAIN C.DT 2804 Great Valley Dr Cedar Park Texas

3 STAR DENTAL LAB ALL ON 4 SURGERY TIME LINE AND TIPS TIME AM PROCEDURE START IV SUDATION MARK VERTICAL ON CHIN AND NOSE LAY FLAP ON MAXILLA HORIZONTAL REDUCTION 15MM OF ROOM NEEDED PER ARCH FOR BAR AND TEETH.12MM IS THE MINIMUM PLACE FIRST IMPLANT PLACE LAST OF 4 IMPLANTS PLACE MULTI UNIT ABUTMENT 30 DEGREE ON POSTERIOR 17 DEGREE ON ANTERIOR LAST MULTI UNIT PLACEMENT CHECK ANGLE THE CUFF SHOULD BE AT OR SLIGHTLY BELOW THE TISSUE SUTURE AND TRIM TISSUE BLUE MOOSE PICK UP WITH CORRECT VERTICAL AND BITE. PUT IN LOWER DENTURE AND BITE. IF THIS IS NOT RIGHT DO AGAIN! OR THE OCCLUSION WILL BE WRONG PLACE OPEN TRAY IMPRESSION COPINGS ON AND TAKE PRELIMINARY IMPRESSIONS TAKE A OPEN TRAY IMPRESSION. WIPE OFF SCREW HEADS REMOVE SCREWS COMPLETELY AND SET ON TABLE BEFORE REMOVING IMPRESSION POUR IMPRESSION WITH LOW EXPANSION FAST SET STONE PLACE AND PICK UP TEMP ABUTMENT IN DENTURE FRONT TWO ONLY USE BITE AND CHECK VERTICAL AM START LOWER ARCH PM LOWER IMPLANTS ARE PLACED SUTURE AND TRIM TISSUE FINISH MAX DENTURE CONVERSION AND SCREW IN 15 NCM TORQUE FOR FINAL PROSTHETIC SCREWS LOWER IMPRESSION IMPLANT SITE PICK UP WITH BLUE MOOSE USE BITE AND VERTICAL MARKS PLACE IMPRESSION COPINGS TAKE OPEN TRAY IMPRESSION.

4 POUR LOWER IMPRESSION USE BITE AND VERTICAL TO PROPERLY PLACE LOWER AND PICK UP FRONT TWO TEMP COPINGS. DO NOT TRY TO PICK UP ALL FOUR AT SAME TIME FINISH LOWER CONVERSION INSERT LOWER AND ADJUST AS NECESSARY. COVER SCREW HOLES WITH PVS IMPRESSION MATERIAL AND FLOWABLE COMPOSITE TO COVER SCREW HOLES TAKE IMPRESSION AND BITE FOR NIGHT GUARD (CAN BE MADE BEFORE HAND) INSTRUCT PATIENT ON PROPER HYGIENE AND EATING PM FINISH. SURGERY TIPS 1. A CLEAR DUPLICATE DENTURE CAN HELP GUIDE YOU WITH PROPER IMPLANT PLACEMENT MARK THE DENTURE USING A BLACK MAKER THE FALLOWING. HIGH LIP LINE, 15MM AROUND DENTURE, IMPLANT PLACEMENT FOR AP SPREAD. YOU CAN THEN PUT IT IN MOUTH TO CHECK REDUCTIONS AND PLACEMENT. 2. IMPLANTS SHOULD BE LINGUAL TO THE CREST OF THE RIDGE IN MOST CASES(EXCEPT CLASS 3). 3. MAKE SURE TIME FINISH LINE OF THE BRIDGE IS ABOVE THE SMILE LINE. 4. IMPLANTS CUFF SHOULD BE AT OR BELOW TISSUE LEVEL FOR THE FINAL. 5. WE WILL NEED 15MM OF SPACE 12MM IS THE MINIMUM SO REDUCE THE PROPER AMOUNT. 6. A BITE FROM LAB WILL HELP TO GET THE DENTURES IN THE CORRECT POISSON. 7. MARK VERTICAL BEFORE YOU START. 8. IT IS BETTER TO HAVE SCREW HOLES LINGUAL TO THE TEETH AS HOLES IN THE DENTURE TEETH WILL WEAKEN IT. 9. USE THE 17 DEGREE ABUTMENTS ON ANTERIOR. 10. WHEN PICKING UP FRONT TEMP COPINGS USE THE BLUE MOOSE BITE IN THE POSTERIOR OF THE DENTURE TO HELP STABILIZE IT AND THE BITE. THIS IS WHERE THE OCCLUSION MOST LIKELY WILL GET OFF. 11. TRIM PAPILLA S AND IRREGULARITIES OFF RIDGES THAT CAUSE CONCAVITIES AT A LATER CHECK UP WITH LASER TO GIVE A SMOOTH CONVEX PONTIC SITE FOR BRIDGE. 12. A PRELIMINARY IMPRESSION AT SURGERY WILL LET LAB MAKE THE NECESSARY JIGS FOR THE RESTORATIVE DR AND SAVE THEM ONE APPOINTMENT.IT CAN ALSO BE USE FOR REPAIRS. 13. A NIGHT GUARD WILL HELP TO PROTECT THE NEW TEETH. 14. A WATER PICK WILL HELP KEEP RESTORATIONS CLEAN. THESE TIMES AND TIPS OR ONLY A GUIDE YOUR TECHNIQUES MAY VARY. PLEASE CALL ME IF YOU HAVE ANY QUESTIONS. JACK FOUNTAIN C.D.T

5 STAR DENTAL LAB Nobel Esthetics Dental Laboratory 2804 GREAT VALLEY DR CEDAR PARK TX ALL ON 4 PROCEDURE 1. REMEMBER IN MOST CASES IT TOOK MANY YEARS OF PATIENT NEGLECT TO ARRIVE WERE THEY ARE NOW, DO NOT LET THEM RUSH YOU. MEASURE THREE TIMES CUT ONCE EVERY TIME. 2. THE RESTORING DENTIST SHOULD MAKE A FULL COSMETIC WORK UP ON THE PATIENT (BITE, MODELS, TOOTH SHAPE, COLOR AND SIZE BUT MOST IMPORTANTLY GET PATIENT FEED BACK AND EXPECTATIONS. 3. ALL ON 4 IS A PROTOCOL DRIVEN PROCEDURE. IT IS IMPORTANT TO USE SURGEONS AND DENTAL LABS THAT ARE VERY FAMILIAR WITH NOBEL BIOCARE PROTOCOL FAILURE TO DO SO MAY TURN OUT TO BE VERY EXPENSIVE DO NOT CUT CORNERS. 4. THIS IS A NOBEL BIOCARE ALL ON 4 PROCEDURE THEREFORE WE HIGHLY RECOMMEND THAT YOU USE ONLY NOBEL PARTS AND PORCERA IMPLANT BRIDGE (PIB) TO COMPLETE THIS CASE 5. A PORCERA IMPLANT BRIDGE MADE FROM TITANIUM IS RECOMMEND FOR ITS LIGHTWEIGHT AND BECAUSE IT IS EXTREMELY STRONG. 6. START PATIENT ON ANTIBIOTICS 2 DAYS BEFORE SURGERY. 7. MARK PATIENTS VERTICAL ON THE CHIN AND NOSE AND TAKE MEASUREMENT. 8. MARK SMILE LINES FOR LOWER LIP. 9. MAKE SURE THERE IS A BITE WITH THE IMMEDIATE DENTURE. 10. A HORIZONTAL OSTEOTOMY IS DONE TO LEVEL THE IMPLANT SITE, MAKE TOOTH SOCKETS SMALLER, GET ENOUGH ROOM FOR PIB BAR AND DENTURE. (AT LEAST 12MM PER ARCH WE RECOMMEND 15MM ) 11. USE THE NOBLE ALL ON 4 GUIDE TO SEE HOW MUCH BONE HAS BEEN REMOVED. 12. AFTER POSTERIOR IMPLANTS ARE PLACE YOU WILL NEED TO REMOVE THE BONE TO THE DISTAL OF THE IMPLANT TO GET THE 30 DEGREE ABUTMENT TO SEAT. 13. ANTERIOR POSTERIOR SPREAD OR A-P SPREAD IS THE DISTANCE BETWEEN IT ANTERIOR IMPLANT AND THE POSTERIOR IMPLANT THEN USING A MULTIPLE TO DETERMINE THE AMOUNT OF CANTILEVER ON THE FIXED BRIDGES USUALLY 1X TO 2.5X. 14. FOR ALL ON 4 WE LIKE TO USE 1X ON THE MAXILLA AND 1.5X ON THE MANDIBLE. 15. CHECK THE TRANSITION ZONE TO MAKE SURE THE SMILE LIP LINE IS NOT GOING TO SHOW THE SPACE BETWEEN BRIDGE AND RIDGE.

6 16. TAKE A PRELIMINARY IMPRESSION TO MAKE JIGS FOR THE RESTORATIVE DR AND HAVE FOR ANY TEMP REPAIRS IS A GOOD IDEA. 17. IF USING THE NOBEL SPEEDY GROOVY YOU WILL HAVE 12 POINTS OF ROTATION ON THE 30-DEGREE ABUTMENT. DOUBLE THE HEX. 18. THE REPLACE YOU HAVE 3 POINTS. 19. THE NOBEL ACTIVE HAS MORE POINTS. 20. START WITH UPPER WHEN DOING FULL MOUTH SO YOU CAN SEAT IMMEDIATE DENTURE TO PALATE. WE USE CLEAR ACRYLIC PALATE, 21. LOAD DENTURE WITH BLUE MOOSE AND SEAT TO PICK UP IMPLANT SITE. 22. GRIND A HOLE BIG ENOUGH THAT THE TEMP COPING WILL FIT PASSIVELY. 23. BLOCK OUT TEMPORARY COPING SCREW ACCESS HOLE. 24. PLACE RUBBER DAM AROUND IMPLANTS TO PROTECT SITE. 25. PUT ERA PRIMER ON ACRYLIC 26. INJECT ERA AROUND HOLES AND PICK UP TEMP COPINGS. 27. LET SET FOR 5 MINUTES. 28. PICK UP TEMP COPINGS WITH ACRYLIC. 29. REMOVE AND FILL IN WITH FAST CURE MAKING DENTURE CONVEX. 30. NO EXTENSIONS OVER ONE TOOTH FOR THE IMMEDIATE ALL ACRYLIC SCREW RETAINED BRIDGE 12 TEETH MAXIMUM 31. PUT IMPLANTS IN LOWER ARCH. 32. SCREW IN UPPER AND USE BITE TO LINE UP LOWER.CLOSE TO VERTICAL MARK. 33. CHECK YOUR VERTICAL MEASUREMENT. 34. PICK UP LOWER TEMP COPINGS FRONT 2 THEN BACK REPEAT STEPS INSTRUCT PATIENT ON PROPER USE OF WATER PICK. 37. RECALL PATIENT AND CHECK IMPLANTS. 38. REEFER TO NUMBER GINGIVAL PASTY IF NECESSARY TO REMOVE UNEVEN IRREGULAR TISSUE THIS WILL MAKE IT EASIER TO CLEAN AND MAKE THE FINAL BRIDGE CONVEX. 40. TAKE NEW IMPRESSION WITH IMPRESSION JIG. 41. SCREW TEMP BRIDE BACK ON AND LET HEAL. 42. MAKE MODELS WITH SOFT TISSUE CAST. 43. TRY IN VERIFICATION JIG (ACRYLIC BAR) TO CHECK THAT IMPLANTS ARE CORRECT ON THE CAST. (CAN BE COMBINED WITH #40) 44. IF NOT TAKE NEW IMPRESSION OR CORRECT THE CAST. 45. MAKE PIB TITANIUM BAR AND SET UP TEETH IN WAX. 46. TRY IN WAX UP THIS IS THE TIME TO CHECK FINIAL FUNCTION, FIT SIZE, SHAPE, COLOR AND PERSONALIZE THE SET UP OF TEETH. 47. PROCESS FINAL BRIDGE.

7 STAR DENTAL LAB 2804 GREAT VALLEY DR. CEDAR PARK, TX PRE - SURGERY ALL ON 4 APPOINTMENT GUIDE 1. COSMETIC EVALUATION, IMPRESSIONS AND PICTURES. SURGERY 2. PLACE IMPLANTS AND TAKE A PRELIMINARY IMPRESSION WITH PVS IMPLANTS NOT NEED TO BE ATTACHED TOGETHER FOR THIS STEP AND THEN CONVERT DENTURE TO TEMPORARY BRIDGE WITH PRELIMINARY OPEN TRAY IMPRESSION DAY OF SURGERY POST SURGERY RESTORATIVE 3. COSMETIC EVALUATION, IMPRESSIONS WITH IMPRESSION JIG, VERIFICATION JIG TRY IN, BITES AND FACE BOW. 4. WAX TRY IN, CHECK TOOTH SET UP. 5. SEAT FINAL IMPLANT BRIDGE AND TAKE IMPRESSION FOR HARD NIGHT GUARD. INSTRUCT PATIENT ON PROPER CLEANING AND EATING. 6. RECALL AND PLACE HARD NIGHT GUARD. THIS STEP MAY BE IN SOME CASES COMBINED AT APPOINTMENT NUMBER 4.

8 PRE-SURGERY 1. COSMETIC EVALUATIONS,PICTURES, IMPRESSIONS FOR IMMEDIATE DENTURE SURGERY 2. PLACE IMPLANTS AND TAKE A PRELIMINARY IMPRESSION WITH PVS IMPLANTS NOT NEED TO BE ATTACHED TOGETHER FOR THIS STEP AND CONVERT DENTURE TO TEMPORARY BRIDGE RESTORATIVE 3. COSMETIC EVALUATIONS AND TAKE AN OPEN TRAY IMPRESSION WITH DURALAY IMPRESSION JIG IT WILL BE CUT AND NUMBERED AND READY TO DURALAY TOGETHER. MAKE SURE IT IS SEATED WITH X RAY. TRY IN THE VERIFICATION JIG IT WILL BE CUT AND NUMBERED AND READY TO DURALAY TOGETHER CHECK FIT WITH X RAYS. WE HAVE NUMBERED THE JIGS TO SHOW ORIENTATION FOR TRANSFER TO MOUTH. WE WILL ALSO SEND A BITE RIM THAT WILL SCREW IN TO CHECK VERTICAL, MIDLINE, SMILE LINE, AND TAKE A NEW BITE. YOU CAN USE TEMP BRIDGE FOR THE ENTIRE ABOVE IF IS ACCURATE. PLEASE TAKE A FACE BOW (PLEASE USE PANADENT OR IVOCLAR SO WE CAN USE OUR SET UP TABLES AND JIGS.) WE SUGGEST THE KOIS DENTO-FACIAL ANALYZER SYSTEM. 4. WAX TRY- IN WITH TEETH TO CHECK BITE, SHADE, TOOTH SHAPE, AND PHONICS. AT THIS TIME DR. SHOULD HAVE PATIENT SIGN OFF ON SET UP. YOU CAN SEND PATIENT TO LAB FOR ANY PERSONALIZATION OF SET UP. 5. FINAL SEAT OF BRIDGE ADJUSTS AS NECESSARY TORQUE SCREWS TO 15 NCM. TAKE IMPRESSION FOR NIGHT GUARD. 6. RECALL AND SEAT OF NIGHT GUARD TIME THIS CAN MAKE THE BRIDGE LAST 20% LONGER AND HELPS WHILE THE PATIENT IS GETTING USE TO THEIR NEW TEETH. INSTRUCT THE PATIENT ON CLEANING AND PROPER EATING. WITH OUT PRELIMINARY OPEN TRAY IMPRESSIONS OF THE MULTI UNIT ABUTMENTS THE DAY OF SURGERY THE RESTORATIVE WOULD START WITH A NEW OPEN TRAY IMPRESSION. PLEASE FEEL FREE TO CALL US WITH ANY QUESTIONS. JACK FOUNTAIN CDT ALL ON 4 RESTORATIVE TIP SHEET

9 RULE #1 MEASURE TWICE CUT ONCE. MEASURE TWICE CUT ONCE IF YOU THINK SOMETHING IS WRONG RETAKE PROCEDURE. 1. READ NOBEL ALL ON 4 MANUAL 2. MAKE SURE THE PATIENT HAS OCCLUSION THAT WILL SUPPORT THE RESTORATION. 3. KNOW AND SET REALISTIC PATIENTS EXPECTATIONS. 4. TAKE NECESSARY PRE OP AND POST OP PICTURES. AND IMPRESSIONS RECORDS. 5. THINGS TO ASK THE SURGEON FOR IMPLANTS LINGUAL TO CREST OF THE RIDGE, CUFF HEIGHT OF IMPLANTS AT OR BELOW TISSUE LEVEL, SMOOTH PONTIC SITE FOR FINAL RESTORATION WE WANT A CONVEX PONTIC. 6. IF TAKING AN IMPRESSION FOR DENTURE TO BE CONVERTED THE DAY OF SURGERY BE SURE TO PICK UP ALL LAND MARKS IN CASE THERE IS A PROBLEM AND THEY CANNOT CONVERT TO TEMP BRIDGE. 7. TAKE IMPRESSIONS AT SURGERY AND USE TO CHECK TEMP AND MAKE JIGS FOR FIRST RESTORATIVE APPOINTMENT 8. IT IS PREFERRED THE FINAL BRIDGE TO HAVE SCREW ACCESS HOLES LINGUAL TO ANY TEETH SO AS NOT TO WEAKEN THEM WITH A HOLE. 9. IF ANTERIOR IMPLANTS ARE TO FAR FROWARD PUT 15 OR 30 DEGREE ABUTMENTS ON 10. USE A PREMIUM DENTURE WITH THE SAME TEETH AND SHADE AS THE FINAL RESTORATION. SAVING A FEW DOLLARS HERE CAN BE A MISTAKE. THIS WILL GIVE THE PATIENT PLENTY OF TIME TO MAKE NOTES ON WHAT THEY LIKE OR DO NOT LIKE. THE WAX TRY ON FINAL IS THE LAST CHANCE AND THEY ONLY HAVE A FEW MINUTES TO DECIDE 11. A CLEAR DUPLICATE DENTURE WILL HELP THE SURGEON WITH IMPLANT PLACEMENT AND REDUCTION 12. USE ONLY OPEN TRAY IMPRESSION FOR IMPLANTS. A CLEAR IMPRESSION TRAY LIKE THE ONE PATTERSON SELLS WILL LET YOU SEE THE IMPRESSION COPINGS MARK TRAY WITH A PIN AND REMOVE TO ALLOW ROOM FOR IMPRESSION COPING 13. LET PATIENT KNOW THE TEMPORARY IS JUST A TEMPORARY ADJUSTMENTS WILL BE MADE IN THE FINAL 14. KEEP PLENTY OF PROSTHETIC SCREWS ON HAND SOME WILL GET LOST AND ONLY TORQUE TO 15 NCM. 15. TAKE A PICTURE OF THE TOOTH CARD THAT WILL TELL TYPE OF TEETH, COLOR AND SHAPE USED SO YOU WILL KNOW WHAT TEETH WERE USED. 16. HAVE LAB SENT MASTER CAST TO RESTORATIVE OFFICE FOR CHAIR SIDE MOUNTING USING THE PROVISIONAL RESTORATION AS A MODEL VERIFICATION JIG AND A MOUNTING INDEX USING A BITE. 17. INCLUDE A WATER PICK IN THE PRICE THIS WILL HELP MAKE SURE THE PATIENT KEEPS IT CLEAN AND HAS GOOD HYGIENE. 18. MAKE SURE THAT THEIR SIGNIFICANT OTHER IS THEIR ALSO TO LOOK AT SET UP.THIS TIP WILL SAVE YOU A LOT OF MONEY 19. MAKE A CONSENT FORM AND HAVE PATIENT SIGN AND CHECK OFF THE FINAL SET UP AND TOOTH SHAPE AND COLOR BEFORE PROCESSING THAT WAY THERE IS NO CONFUSION. 20. IF YOU DO NOT KNOW SOMETHING ASKS THIS COULD BE THE MOST IMPORTANT THING YOU DO. STAR DENTAL LAB 2804 GREAT VALLEY DR CEDAR PARK TX

10 THE TEMPORARY IS ONLY A TEMPORARY This is a good time to set patients expectations at the first appointment. The temporary fixed all on 4 bridge is a temporary appliance that is made to as close as possible to the final PIB bridge by converting the patients new denture to a screw in bridge. But it has no titanium bar for strength. We recommend a new premium denture with the correct teeth this will give the patient time to wear it for a few months and take notes about what they like and dislike about it. Using an old denture or economy denture will mean at the wax try in for final the patient will have only a few minutes do look at new set up and decide if they like it. We have remade the finals at a great expense to the Dr because the patient went home after the final was processed and changed their mind about set up. Because the implants need time to heal it is recommended not to remove it until all implants have integrated. So let the patient know that all the likes and dislikes will be addressed in the final bridge. It is important also to note that this may need to be repaired for time to time because of a tooth or acrylic chip or fracture. This is normal and may not happen at all in some patients. It is recommended that a night guard be made to help the patient adjust to the new teeth and in some cases a new vertical and bite. Although the finial Porcera Implant Bridge is very strong with titanium substructure it is not bullet proof and will need the protection of a night guard at night when most of patient s para functions occur. In some cases an immediate denture with the implant sites relived may be indicated if the patient lives out of town or does not understand that the conversion is just a temporary bridge may need to be repaired.