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Episode 6 - Prosthetic Durability

Full-Arch Restoration - Mission Possible (Mini-Series)

It is our pleasure to present the 6th episode of “Full Arch Restoration, Mission Possible” mini-series. In this episode, Dr. Frank LaMar will discuss the factors that contribute to creating a durable long-lasting full-arch prosthesis. Please enjoy episode six, “Prosthetic Durability.”

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Episode 6 - Prosthetic Durability 

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For more information, click here to Contact Us or call (585) 319-5400. We look forward to bringing you the next episode of Full-Arch Restoration - Mission Possible.

Watch the Hybridge Podcast Video: Episode 6 - Prosthetic Durability


Randal: Thank you for joining me today Dr. LaMar.

Dr. LaMar: Hi Randal.

Randal: I think we'll start with talking about how sometimes doctors can focus so much on the treatment plan that they might underestimate the importance of the prosthetic design and manufacture.  Does that happen?

Dr. LaMar: You know it's happened to all of us.  It certainly happened to us in the early days. The example of that is, back in the 90's, and that sort of dates me a little bit, we've been doing these for over 25 years, so the materials and the methods of manufacturing of the final restoration have changed dramatically in the last 25 years.  In the early days, these were just screw retained dentures that had a little bit of metal support within them, and so it didn't take long for these materials to fatigue. So if we're really talking about the prosthetic design, what we're normally talking about is what's it made out of? How thick is it? The materials and the methods of manufacturing and even the layers of materials and how they're put together really do determine the durability and longevity of these restorations. Our tagline for Hybridge is "The Simple Way To A Lasting Smile". The lasting smile really is all about the prosthetic design and the durability.

Randal: What could happen if a doctor doesn't give full consideration to the prosthetic elements?

Dr. LaMar: So, consideration would be maybe not appreciating that all hybrid type prostheses, they're not all made the same way. As a matter of fact, they might even be made of the same materials, but maybe the materials aren't used correctly in the way that they're put together. So if the question is really about what might go wrong, certainly historically prosthetic failure with hybrid restorations was, I believe the literature was 35% prosthetic failure in the first 5 years. It may have even been 4 years depending on the article.  That's really high, one in three is going to have a prosthetic failure with the conventional hybrid materials, and so those failures typically looked like things breaking. The cantilever over time, and Hybridge is a cantilevered prosthesis, so we're typically putting implants in between, we call it the good real estate, between the foramen and between the sinus and the maxilla, and then we cantilever back to the first molar. So, we know we have to extend unsupported, and by extending unsupported we're creating a potential flexure, so materials that don't flex are better than materials that flex. So, titanium is not a good material, as a substructure for a Hybridge restoration. A lot of people have gotten out of the hybrid type restorations because of those older materials and they did, they fatigued over time. Even opposing a denture sometimes, those cantilevers would fatigue right at the point of flexure which is the distal part of the last implant and three to five years later they would develop a crack in the acrylic where it was flexing, and then it would just snap off. So that's one example of a materials failure. 

Randal: With the Hybridge full arch protocols, what has been your failure rate in terms of prostheses over the last four years?

Dr. LaMar: Well the newer materials which are not only giving it its core strength but also what's the functional surface that we're using as the teeth themselves. And of course, that's where a lot of the stress and strain of everyday life happens. The newer materials which are the double cross-linked acrylics, milled acrylics, that we're using, and they're FDA approved for long-term use, these materials are far superior to the denture teeth we used five years ago. It's all one piece, it's stronger, we fuse it to the framework, and so our prosthetic failures have pretty much gone down to less than one half of one percent in the last four years. So we've pretty much eliminated the prosthetic failures for both structural integrity of the frame and the durability of the functional surface. 

Randal: And that obviously comes from a lot of years of experience. But less than one half of one percent is fairly significant.

Dr. LaMar: Yes. We always say our fast failures are research and development for our future endeavors. We have had a fair amount of bumps in the road prosthetically, over 25 years, and although it was tempting along the way to just give up on this prosthetic design, I think today what we have by bypassing all of these little obstacles and running into patients that are like animals. You know I've got two patients in particular, I actually mention it right to them, you're like an animal. The forces that they put on their teeth, and actually two patients, in particular, I give full credit to for this evolution in our materials. Brian and Carl, I know them very well because these two gentlemen, no matter what I put in their mouths they broke it. They broke the first generation materials, the second generation materials, and the third generation, and they've been my true test. With our fourth generation, both of them are going very smoothly. So if they can survive in those mouths, then we've really come up with something here.

Randal: Well, we hope we never run into both Carl and his friend Brian, but thank you for sharing that, that's very insightful and we appreciate you coming today.

Dr. LaMar: Thanks Randal.

Randal: And thank you ladies and gentlemen, for joining us on Full Arch Restoration: Mission Possible.

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