Pterygoid Implant All on 4, Direct Composite Veneer & Zirconia Abutment Cautions Professional Newsletter
Dear Colleagues,
We hope this message finds you safe, healthy and prosperous! We are excited to share this newsletter with you about some information our office and a few recent cases and a few clinical pearls to help you in your practice.
Our office is staffed by 2 Board Certified Prosthodontists—Dr. Avinash Bidra and Dr. Xiao Chun Li who are committed to excellence and offer only the highest quality of dental treatment. Dr. Bidra also serves as Director of the Prosthodontics Residency Program at UConn Dental School in Farmington, CT. (Go Huskies! 17 times NCAA champions!) Our office is located right in the center of Glastonbury and we serve patients who travel from various parts of Connecticut and across the country.
As specialists, we are not only committed to helping patients with advanced dental needs, but also committed to helping other dentists who need help serving their own patients. Whether you are looking to just get some guidance on difficult cases that you want to complete on your own, or stuck halfway or need help referring patients with complex situations such as occlusal plane issues, vertical dimension challenges, multiple failing teeth, restorative space issues, or bone grafting failures or implant misangulation or implant failures, we are here to help!
As an educator for 15 years, Dr. Bidra loves to teach!
We will offer complimentary consultation for your patients and refer them back to you for their maintenance after treatment is complete. We are out of network with all dental insurances but will offer your patients a very fair and reasonable price for their treatment. Our office is certified for IV sedation and we will provide a safe and comfortable “one stop” experience for their dental treatment. Please check out the cases of the month and please visit our website at for additional such cases. Thank you for your time and look forward to working with you!
Dr. Avinash Bidra, Owner
Board Certified Oral and Maxillofacial Prosthodontist
Practice focus: All on 4, Complex implant surgeries, bone grafts and advanced reconstructions
Dr. Xiao Chun Li
Board Certified Prosthodontist
Practice focus: Veneers, Bonding, Difficult shade match cases, Advanced cosmetics, VDO alterations, Full mouth rehabilitations
All on 4 (Full Arch Implant) Case of the Month!
This grandmother had a teeth grinding habit and had a mouth full of cavities, gum disease, reduced bone and failing teeth and wanted the best possible result as she was also dissatisfied with her smile. She hated her lower partial denture and was told by 2 previous surgeons that she was not a candidate for posterior implants as she had a lot of bone loss and required major bone grafting. After CBCT evaluation and treatment planning, systematic angulation of the implants were planned. Full mouth extractions and double jaw All on 4 treatment using Pterygoid Implants in the maxilla was completed with immediate loading following the Teeth in a Day protocol. No bone grafting was done and the patient eventually received Monolithic zirconia bridges. Total time in treatment was 7 months. This is a 5 year follow-up of the case and the patient has given her full permission to share her full face photographs. ☺
Cosmetic Dentistry Case of the Month!
This patient was referred to Dr. Li by her orthodontist as she had just finished orthodontic treatment and was eager to enhance the look of #7 in a minimally invasive way as she did not want her teeth prepared for a porcelain veneer. Therefore, a conservative chairside cosmetic solution was chosen. The existing composite restoration was intended to enhance the length. A customized layered composite technique was used to carefully match the color to her natural teeth and rebuild the contour and shape. Then, a special polishing sequence was performed to create the natural surface texture and ensure a seamless finish at the margin.
This treatment was completed in one appointment for a single chairside direct composite veneer.
Clinical Pearl of the Month!
*Caution related to use of Zirconia Abutments*
Zirconia is an excellent material that has transformed not only implant prosthodontics, but prosthodontics as a whole! Zirconia abutments have been used for over 25 years. We would like to share 2 pearls backed by scientific evidence about indiscriminate use of Zirconia abutments.
1) Do NOT use a full zirconia abutment no matter how “strong” the lab claims the zirconia is! Always have the tallest possible Titanium base underneath the zirconia abutment. With a full zirconia abutment, there is a high risk of fracture of the zirconia abutment at the neck where it interfaces with the titanium implant. Additional risks include wearing away of the inner hex of the implant, future misfit and additional titanium debris, all resulting in a very costly fix and remake for you and the patient! Are you prepared to deal with this complication on a Monday morning? ☺
2) For Narrow diameter implants with a cement-retained crown, do NOT use a zirconia abutment as it has a high incidence of fracture. Instead, use a custom titanium abutment that is anodized with gold color for better esthetic result.
Bidra AS, Rungruanganunt P. Clinical outcomes of implant abutments in the anterior region: a systematic review. J Esthet Restor Dent.
