oh oh Oh oh oh oh Oh oh
I don't know 我不知道
Hello 你好
and welcome to the first session of our online a to z and dental implant therapy 欢迎来到我们的第一次在线的a to z和牙科植入疗法
uh There'll be six sessions in each of those sessions will try to cover the things most pertinent 每一节课都有六节课会试着涵盖最相关的内容
The implant dentistry, as we see it today in 2007 我们今天看到的2007年的种植牙
Probably the biggest change in implant dentistry over the last few years has been the 在过去的几年里，种植牙的最大变化可能是
realization that we need to respect the biology to the.of 意识到我们需要尊重生物的
giving us predictability of how the final restoration will turn out 使我们能够预测最终的恢复将如何进行
based on where the implant will be placed 基于植入物将被放置的位置
So for us, it's very exciting 所以对我们来说，这很令人兴奋
to have that predictability 有这样的可预测性
and We'd like to share that with you 我们想和你们分享一下
uh Today's or this session 今天还是这次会议
will be involved in first um understanding that biological predictability 会首先涉及到生物的可预测性
And then what are the restorative issues 那么什么是恢复性问题
So this is probably the most important core 所以这可能是最重要的核心
of all the sessions to follow 接下来的所有环节中
so Um 所以
I think when we look at implants and practice success 我认为当我们看着植入和实践成功
probably the most exciting thing in my office has been the realization 可能我办公室里最令人兴奋的事就是
I've really how straightforward and reasonable 我真的有多直接和合理
implant restorations can be 种植体修复可以是
and There are certain keys, though 不过，有一些钥匙
to create the success that we all want to have 创造我们都想拥有的成功
I think the bottom line is that we create it a or develop an environment where all tissues 我认为底线是我们创造它或发展一个环境中所有的组织
including soft tissues are stable 包括软组织都很稳定
I don't believe that we can include a success 我认为我们不能包括成功
an implant situation where the soft tissues are continually changing, or you'll read about creeping attachments 一种软组织持续变化的植入情况，或者你会读到爬行附着物
We find that unreasonable and we should have stability and 我们认为这是不合理的，我们应该有稳定和
in fact 实际上
and the great 伟大的
great majority of our cases. That's what we see 我们大部分的案子。 我们看到的就是这样
In order to have that predictability 以便具有可预测性
we need bone and the bone needs to be present 我们需要骨头，而骨头必须存在
to allow the development of the soft issue with that stability that we find so important 允许我们认为非常重要的稳定的软问题的发展
The correctly sized implant needs to be in a specific 正确尺寸的植入物需要在特定的
biologically compatible position to produce 生物相容的生产位置
the aesthetically and functionally stable results that we desire 我们所期望的美学和功能稳定的结果
to have the success that we're looking for 才能获得我们所期待的成功
But ultimately, especially from the restorative.of view 但最终，尤其是从恢复的角度来看
success depends on the patient's acceptance of the final result 成功取决于病人对最终结果的接受程度
This is achieved through patient 这是通过耐心来实现的
education and communication skills 教育和沟通技能
so Part of these sessions 所以这些课程的一部分
certainly is 当然是了
evaluating and examining how we can talk to patients 评估和检查我们如何与病人交谈
how we develop a relationship with them 我们如何与他们建立关系
that keeps them on our sides and makes them understands the advantages of implant dentistry 这让他们站在我们这边，让他们明白了种植牙科的优势
as well as the challenges 以及各种挑战
of any 任何
dental restoration 牙齿修复
Another way to look at the biological basis of our 另一种看待我们的生物基础的方法
philosophy is that restorative success is dependent on the implant being in the right position 哲学是，恢复的成功是取决于植入在正确的位置
This position is determined by basic biological parameters 该位置由基本生物参数确定
If healthy bone exists or is created in the right position 健康的骨骼是否存在或产生于正确的位置
and the implant is placed according to these biological principles 并根据这些生物学原理放置植入物
The correct aesthetic display of the soft tissue will follow 软组织的正确美学表现将随之而来
for me as a restorative dentist 对我来说是一位修复牙医
I need in my general practice the confidence 我需要我的全科医生的信任
that I can restore it to the level that the patient requires 我可以把它恢复到病人需要的水平
for their appreciation and acceptance of that result 感谢他们对这一结果的赞赏和接受
We need to be able to predict to the patient what the final result will look like 我们需要能够预测病人的最终结果会是什么样子
It isn't just stick the implant into the bone and hope that we can achieve it, whatever result it might be 这不仅仅是把植入物植入骨头，希望我们能够实现它，不管结果如何
We should be able to look at the case 我们应该可以看看这个案子
have a consultation with our surgeon to understand what the 与我们的外科医生进行会诊了解
um surgical complexities might be so that we can speak intelligently to the patient 复杂的外科手术也许能让我们更聪明地和病人对话
about a range of possibilities 一系列的可能性
that they may encounter in the final result 他们在最终结果中可能会遇到的
Our skill is we're started, then is coming to play 我们的技术是我们开始，然后开始玩
and that we can take sometimes less than ideal implant placement 并且我们有时可以采用不太理想的植入位置
and still make it look acceptable to the patient 但仍能让病人接受
So that's our skills, but we really prefer 这就是我们的技能，但我们更喜欢
and if we can begin with the case with the implant placed 如果我们可以从放置了植入物的病例开始
ideally 理想情况下
then we get a much better and more predictable result 然后我们会得到一个更好、更可预测的结果
to achieve all these things 去完成所有这些事情
Certainly 当然可以
i'm a strong believer in having talented people working with me 我坚信有才华的人会和我一起工作
I have a restorative dentist understand the challenges that I face 我有一个修复牙医了解我所面临的挑战
and I understand that if I have a very good surgeon in a 我明白如果我有一个非常好的外科医生
very good laboratory technician 很好的实验室技术人员
I can achieve at the highest possible level 我可以达到尽可能高的水平
Part of my job certainly is communicating with the patient 我工作的一部分当然是与病人沟通
what these results might be in the limitations of them 这些结果在它们的局限性中可能是什么
My great appreciation is when the surgeon also sits down with the patient and talks about the restorative challenges 我最大的感激是当外科医生也坐下来和病人谈论恢复的挑战
and not just glosses them over 不仅仅是掩饰
don't worry of the restorative 别担心恢复精力的药
Dennis will take care of that 丹尼斯会处理的
I need a team effect really with the surgeon 我真的需要和外科医生团队合作
so that we can both examine the challenges that are ahead of us 以便我们都能审视我们面临的挑战
And then 后来
create a good working environment and with the um patient as well as everyone else 与病人和其他人一起创造一个良好的工作环境
From the office staff point of view 从办公室工作人员的角度来看
they need to reinforce and support the things that we say to the patient 他们需要加强和支持我们对病人所说的话
Quite often 很多时候
I might say a lot of things to the patient and I feel that they understand it well 我可能会对病人说很多话，我觉得他们理解得很好
But then as I leave the room 但当我离开房间时
I notice that they're asking the office staff 我注意到他们在问办公室职员
the questions that I thought were handled 我以为已经解决的问题
uh you know very clearly while I was there 我在那儿的时候你就很清楚了
so It's very important for everybody to be on the same page 所以对每个人来说保持一致是非常重要的
And certainly for all of us 当然也是为了我们所有人
for the restorative dentist to understand the limitations 以供修复牙医了解其局限性
surgically 手术上的
And for the surgeon to understand the limitations 以及让外科医生理解这些限制
restorative 修补剂
I sat down and I thought about what the potential issues 我坐下来想了想潜在的问题是什么
might be in terms of restoration 可能是在恢复方面
I've said already that I love ideal implant placement 我已经说过我喜欢理想的植入位置
I haven't really defined that yet, but we will 我还没有真正定义，但我们会的
with ideal implant placement 完美的植入位置
It's almost anything that I do will give me the correct emergence profile, the correct intercontinental papilla 我所做的几乎任何事情都会给我正确的出现轮廓，正确的洲际乳头
And then with a reasonable laboratory effort 然后通过合理的实验努力
we can have a nice aesthetic restoration 我们可以有一个很好的美学修复
But what do we do when we have non ideal, implant placement 但是当我们有非理想的植入位置时，我们该怎么做
Whether intentional 是否是故意的
or lack of uh actual planning 或者缺乏实际的计划
but we end up with the situation 但我们最终还是要面对现实
that is an ideal 那是一种理想
And then also compounded with the fact that we've lost our soft tissue contours 再加上我们失去了软组织轮廓这一事实
How do we handle that 我们该怎么处理
It isn't guaranteed that we won't get an ideal result 不能保证我们不会得到理想的结果
It's possible that through careful manipulation of the soft tissue 有可能通过小心处理软组织
we might be able to create 我们或许可以创造
still a wonderful emergence profile 仍然是一个很好的突发事件简介
a nice aesthetic frame to the restoration with the soft tissue 软组织修复的良好美学框架
But there are limitations. And sometimes 但也有局限性。 有时候
the limitation might be a lack of soft tissue and or bone 限制可能是缺少软组织和/或骨骼
and The restoration that we must develop will be uh 我们要做的修复工作是
require some prosthetic management of that sort tissue defect 需要对那种组织缺损进行修复治疗
I'd also might require a different contour to the 我也可能需要一个不同的轮廓
intercontinental porcelain 洲际瓷器
It might require the use of pink porcelain 它可能需要使用粉红色的瓷器
restoration of adjacent teeth 邻牙修复
and even the use of removable overlays to achieve the aesthetic result that the patient wants to have 甚至使用可移除的覆盖物来实现患者想要的美学效果
Another thing we need to look at 另一件我们需要关注的事情
which remains still a somewhat controversial 这仍然是有点争议的
A topic is immediate placement and privatization 一个主题是直接安置和私有化
The reason it may be controversial is that there is a range of techniques 它可能引起争议的原因是有一系列的技术
uh that are seen in some techniques are not as conducive to immediate restoration as others 在一些技术中看到的，并不像其他技术那样有利于立即恢复
But when we can successfully place an implant immediately with the extraction of the tooth 但是当我们成功地植入了一个可以立即拔牙的种植体
without the loss of this soft tissue contours 不会失去软组织的轮廓
if we can maintain that 如果我们能保持下去的话
to me, that can be one of the most conservative 对我来说，这可能是最保守的
ways of managing a case possible 管理个案的可行方法
But of course, it's not acceptable 当然，这是不可接受的
to look at a lower success rate 以观察较低的成功率
just because we're placing immediately, in fact 只是因为我们要立即，事实上
we should strive for a higher success rate 我们应该争取更高的成功率
These are the situations that we're in 这就是我们所处的情况
all right Now, when we think of ideal implant placement 好了，当我们想到理想的植入位置
we realize that placing the implant in the right position allows the restorative dentistry to occur 我们认识到，将植入物放置在正确的位置允许发生恢复性牙科
more easily 更容易了
But for the restorative dentist 但对于修复牙医来说
it's also how we manage the case 这也是我们处理案件的方式
This is a young man that had an encounter with the baseball 这是一个年轻人，他曾与棒球打过交道
instead of in his glove, in his mouth 不是戴在手套上，而是嘴上
which um 哪个嗯
fractured off two number seven 七号断裂了
leaving only a fragment above the tissue 只在组织上方留下碎片
broke the corner of tooth number eight 折断了八号牙齿的一角
8 volts 26 and broke the corner of 25 8伏26并断开25的拐角
So of course on the experience like that late in the day and emergency patient that shows up in your office 所以，当然是在一天中的晚些时候，在你办公室里出现的紧急病人身上
There's many questions to go through your head 你脑子里有很多问题
Do I need to extract number seven 我需要提取7号信号吗
it's It's no longer salvageable 它已经无法挽救了
My concept would be to leave the root if you're not prepared to place an implant immediately 我的想法是，如果你不准备立即植入，就离开根部
to allow you to have the um 才能让你拥有
time to talk to the surgeon 是时候和外科医生谈谈了
to work out the the 去解决问题
the logistics of the restoration and also to communicate to the patient what we can accomplish 恢复的后勤工作，以及向病人传达我们所能完成的工作
In this example, basically, we just numbed up the patient 在这个例子中，基本上，我们只是麻木了病人
ground 接地
the fragmented part of tooth number seven below the tissue 组织下第七颗牙齿的碎片部分
bonded off the bonded on, excuse me 把这些联系在一起，抱歉
the uh tooth number seven in place 七号牙齿就位
and Honestly, 7 days later, he looked good 老实说，七天后，他看起来不错
the root was still subchangeable sitting there waiting 树根仍然是可换的，坐在那里等着
for our restoration 为了我们的重建
6 months later, uh doctor giovanni and I went into the case 6个月后，乔凡尼医生和我调查了这个案子
doctor giovanni doctor giovanni
uh remove the root 呃把根去掉
And 以及
looking at the socket, placed an implant 看着牙槽，植入了植入物
and the key here is the position of the head of the implant 这里的关键是植入体的头部的位置
So many times 很多次了
we think it doesn't really matter or to be safe 我们认为安全并不重要
Let's think the implant further 让我们进一步考虑植入
it's an immediate extraction site. We've laid a flap 是个紧急撤离点。 我们已经做了些准备
We know we're gonna lose some of that label bone 我们知道我们会失去一些标志性的骨头
But still, we know 但我们还是知道
and and really the things that have been shown to us over the years is that if the head of the implant is placed 事实上，这些年来我们看到的是，如果植入物的头部
in a very narrow parameter of 2 2 在非常窄参数2.2中
5, maybe 3 millimeters from the desired emergence profile 5毫米，或者3毫米，从期望的出露轮廓
we will predictably achieve the emergence that we're desire on every case 我们将可预见地在每一种情况下实现我们所期望的出现
So that common sense thought of thinking the implant further 因此，常识思维的植入更深入
for greater success is absolutely totally wrong 争取更大的成功是完全错误的
The further the implant head is seated 植入头安装得越远
it may give you comfort, right 它可能会给你安慰，对吧
When the implant placement is occurring 当发生植入物放置时
but will not give you the restorative success we're looking for 但不会给你带来我们所期待的恢复性成功
so Here, we see an example of the head of the implant placed 所以在这里，我们看到一个植入物头部的例子
and You see this large 你看到这么大
space around the implant 植入体周围的空间
and You think well that's not good. We need a larger implant 你觉得这样不好。 我们需要一个更大的植入物
The next thing I really want to think about 下一件我真正想考虑的事情是
is the biological predictability of the bone surrounding the implant 是植入物周围骨头的生物可预测性
The only thing a larger implant does, in this case 在这种情况下，大型植入物的唯一作用是
is reduced the biological potential 降低了生物的潜能
the less bone that we have in that area 我们在那个地区的骨头就越少
The less soft tissue support 软组织支持就越少
uh the less uh support to the implant itself 植入物本身的支撑就越少
So we really don't want a larger implant 所以我们真的不想要更大的植入物
We also notice how carefully doctors of one of a place 我们还注意到一个地方的医生
the implant 植入物
to the adjacent teeth 到邻近的牙齿
If the implant gets closer than 1.5 如果植入物接近1.5
maybe as small as 1 millimeter 可能小到1毫米
but certainly one and a half to two would be ideal 但肯定一到两个是最理想的
As the implant gets closer 因为植入物越来越近了
we're reducing the biological potential of that bone 我们在降低那块骨头的生物潜能
and perhaps leading to bone loss 可能会导致骨质流失
from a schema 从一个模式
lack of circulation or actual bone loss from the implant placement 缺乏循环或植入物放置导致的实际骨丢失
so a larger implant 所以一个更大的植入物
isn't an advantage on this case 不是这个案子的优势
But of course the surgical skill comes in how to manage that defect 当然，外科手术的技巧在于如何处理这些缺陷
The grafting techniques that are involved 所涉及的接枝技术
uh probably a two stage procedure with this magnitude of a graph 可能是两个阶段的过程，有这么大的图
followed by an attachment of a healing apartment 接下来是一间疗愈公寓
And then whatever restoration we decide to create 不管我们决定重建什么
whether it's a 不管是不是
uh ceramic cat camp type involvement and a cemented crown 陶瓷猫营地类型的参与和一个粘结的皇冠
a screw, retained crown 螺丝钉，固定的牙冠
There's literally hundreds of ways that we could restore this case 我们有上百种方法可以恢复这个案子
But the key here is that because the implant was placed 但这里的关键是因为植入物的放置
ideally 理想情况下
and because we manage the case, well 因为我们负责这个案子，所以
we're able to go ahead 我们可以继续下去
and get this wonderful result 得到这个美妙的结果
with very simple effort on the restorative side 在恢复方面非常简单的努力
We look at that case 我们看看那个案子
and then we turn our attention to a case like this one 然后我们把注意力转移到像这样的案子上
which i'm sure to everyone that's done implants is the most disappointing result that we can possibly achieve 我敢肯定，每个做过植入手术的人都会对我们可能达到的最令人失望的结果感到失望
We have a relatively young patient, a nice aesthetic smile 我们有一个相对年轻的病人，一个美丽的微笑
and then 12, the implant retained a lateral incisor 然后12，植入物保留了侧切牙
is literal 是字面上的
literally 3 or 45 millimeters 精确的3或45毫米
longer than it. It would be ideally 更长的时间。 再理想不过了
we have a lack of soft tissue 我们缺少软组织
And then we look 我们再看看
and we see this very red and shiny area above the implant 我们看到植入物上方的红色发光区域
And that immediately implies that there's no bone there 这立刻就意味着那里没有骨头
When we don't have bone 当我们没有骨头的时候
we realize that we're not gonna have a stable situation 我们意识到我们不会有稳定的局面
and There is no 但是没有
a surgical skill that would allow us to graft 一种能让我们移植器官的外科手术技巧
soft tissue 软组织
into that area 在那个区域
When there's no bone, we can't create the soft tissue 当没有骨头的时候，我们就不能制造软组织
How do we manage a case like this 我们如何处理这样的案子
Another way to look at this case, as you realize 从另一个角度看这个案子，就像你意识到的
when you look closer, we showed you the x rays 当你仔细看的时候，我们给你看了x光片
that the canine is actually a retained deciduous canine 这只狗实际上是一只留乳的狗
One thing that often leads to restorative and surgical failure is a failure to 一件事往往导致恢复性和手术失败是失败的
treatment plan, the whole patient 整个病人的治疗计划
We need to look at the whole patient 我们得看看整个病人
and make a decision. Should we remove? That? Decision 做个决定。 我们要切除吗？ 是那个吗？ 决定
Was canine and and 是犬科动物
In this case, I think that was a definite 在这种情况下，我认为这是一个明确的
We do have that opportunity now, though 不过，我们现在确实有这个机会
that we could remove it 我们可以移除它
when we look at the surgical surgical 当我们看外科手术时
retreatment, though 不过，要重新治疗
we realize what a challenge these cases are to retreat 我们意识到这些案子的挑战是撤退
and Here 在这里
we see a 5 millimeter diameter implant that have been placed 我们看到5毫米直径的植入物已经被放置
No bone labeling 无骨头标识
And probably even worse is that the implant was placed so close to the natural central incisor 可能更糟糕的是，植入物被放置得离自然的中切牙很近
trying to maintain that bone can be extremely difficult 想要保持那块骨头是非常困难的
and lead to future problems 会导致未来的问题
So removing that 所以把它拿走
implant, grafting the site 移植，移植这个部位
Perhaps extracting the retained deciduous 或许是提取残留的落叶
uh canine, placing an implant in that site 犬类，把植入物放到那个位置
And we might consider and we have 我们可以考虑一下
canniwavering, the lateral incisor off that 同类相残，侧切牙脱落
implant on the canine site 在犬类部位植入
just because reconstructing this site 就因为重建这个地方
now that is so damaged 现在已经损坏得很厉害了
by a malpositioned implant 因为植入的位置不对
it's very difficult to proceed with the case 这个案子很难进行下去
when we can place the implant. Ideally 当我们可以放置植入物。 理想情况下
the key here 钥匙在这里
from a restorative point of view 从恢复的角度来看
is that I can be predictable with my patients 我可以预测我的病人
I can talk to them during treatment planning about the result that we can achieve 我可以在治疗计划中告诉他们我们可以达到的效果
We can educate the patient perhaps to 我们可以教育病人
doing crown lengthening on adjacent teeth 在邻牙做牙冠延长术
restoring adjacent teeth 修复邻牙
whatever might be required to achieve the result that we want to have 实现我们想要的结果所需要的一切
What are these numbers 这些数字是多少
Now i'm not gonna go into them in depth 现在我不想深入了解他们
I know that doctor giovanni in his surgical series will cover these things 我知道乔凡尼医生在他的外科手术系列将涵盖这些事情
But I think it's important for the restorative dentist to understand these numbers 但我认为对修复牙医来说了解这些数字很重要
Even from the.of view of talking to the orthodox 甚至从与正统交谈的观点来看
I've had so many patients referred to me ready for implant restoration 有很多病人推荐我做植入修复手术
and Then I get the case from the orthodontist 然后我从正牙医师那里拿到了这个病例
And basically there's 5 millimeters 基本上有5毫米
of medial distal space for the restoration 用于修复的内侧远端空间
And we all realize 我们都意识到
that except in very limited situations 除非在非常有限的情况下
that's impossible to do an implant restoration with any kind of predictability 不可能有任何可预测性的植入物修复术
so The numbers, as I see them that are critical is that 所以，在我看来，关键的数字是
the ideal distance to the adjacent tooth 与邻牙的理想距离
is 1.5~2 millimeters 为1.5~2毫米
Now 现在
I realize that we can look at many cases and see oh look there's only a, 1 millimeter space here 我意识到我们可以看到很多情况下，看这里只有1毫米的空间
But if we begin these implant placements with such a tight tolerance 但如果我们开始植入时就有这么大的耐受性
and the drill drifts, maybe just 1/2 a millimeter 钻头会移动，可能只有1/2毫米
And all of a sudden 突然之间
we only have a half a millimeter of space 我们只有半毫米的空间
and We end up with the 最后我们得到了
surgical restorative failure 手术失败
and The patient is not happy 病人很不高兴
The next important 下一个重要的
number that I think we should all understand 我认为我们都应该明白的数字
is where the head of the implant needs to be 是植入装置的头部所需要的位置
to achieve the emergence profile we like to have 以达到我们想要的涌现形象
We can't place the implant 7 millimeters apical to the desired emergence profile 我们不能将植入物放置在期望的出露剖面的7毫米顶端
and then achieve the predictability that we want to have 然后实现我们想要的可预测性
We can't achieve that emergence profile 我们无法实现这种紧急情况
so We need to have the surgeon understand that the head of the implant 所以我们需要让外科医生知道植入物的头部
needs to be within a certain range 必须在一定范围内
so that we can achieve the result we want to have 这样我们就可以达到我们想要的结果
for the especially the anterior placement of implants 尤其是植入物的前部放置
The labial plate tends to be thin and very easily damaged 唇板往往很薄，很容易损坏
If we place the implant too far legally 如果我们把植入物放得太合法的话
we can press on that label plate leading to bone loss 我们可以按压标签导致骨质流失
And as we saw, in the previous case 正如我们所看到的，在前一个案例中
the lack of bone, the lack of soft tissue 缺少骨头，缺少软组织
and a terrible restorative outcome 一种可怕的恢复结果
so We'd like to see at least a, 2 millimeter 所以我们想看到至少一，2毫米的
lingual positioning of the labial edge of the implant 种植体唇侧边缘的舌侧定位
from the desired emerges profile 从期望的出露轮廓
for the restorative dentist during a restorative planning session 为修复牙医在修复规划会议
we also need to understand how much space needs to exist between implants 我们还需要了解植入物之间需要有多大的空间
We've mentioned that we need 1.5~2 millimeters being 我们已经提到过，我们需要1.5～2毫米
between a natural tooth and the implant 在天然牙和种植体之间
We need more space between two implants 两个植入物之间需要更多的空间
because of the reduced biological potential in that area 因为那个地区的生物潜力降低了
We don't have the same connective tissue fibers 我们的结缔组织纤维不一样
We don't have the same uh support fibers that are embedded in teeth 我们的牙齿里没有嵌入相同的纤维
to help support the bone in those areas 帮助支撑那些区域的骨头
so We need more space 所以我们需要更多的空间
We would like to see 3 to 4 millimeters of space between implants 我们希望看到植入物之间有3到4毫米的空间
Quite often, we realize when we look at, let's say 很多时候，当我们看着它的时候，比如说
an anterior evangelist area between teeth number seven and ten 在第七和第十颗牙齿之间的前传福音地区
if we don't have a significant amount of space 如果我们没有足够的空间
the concept of placing one implant per tooth 每颗牙齿植入一个种植体的概念
just doesn't work 只是不起作用
We need really to think about a bridge, maybe two implants 我们真的需要考虑一座桥，或者两个植入物
to restore that four unit space 恢复四个单位的空间
as the restorative dentist along with all these other factors 作为一个修复牙医还有其他的因素
I need to think about how i'm gonna do with the restoration 我得想想我该怎么做修复工作
I need a certain amount of 我需要一定数量的
a clues or clearance 一条线索或许可
for whatever apartment that i'm choosing to use 不管我选择住哪间公寓
and I need to communicate that to the surgeon 我需要和外科医生沟通
In today's world, the uh use of cemented crowns 在今天的世界里，使用粘结的牙冠
as becoming more and more popular 变得越来越受欢迎
But we still need to understand that we need a certain height 但我们仍然需要明白我们需要一定的高度
to the uh apartment that will allow seeming of the restoration 去一间能让人看得出来是装修的公寓
We need a certain axial wall 我们需要一堵墙
We would like to see the cement line 我们想看看水泥生产线
near or close to the gingival margin 接近或接近牙龈边缘
If we're forced into cementing a crown 3 or 4 millimeter subchangeable to achieve enough for attention 如果我们被迫将一个3毫米或4毫米的牙冠进行胶合以获得足够的注意力
that is not gonna be a long term biological success with a cement line 从生物学的角度来看，用水泥生产线是不会成功的
That is so far subchangeable when we realize that there's no way that we can completely remove 当我们意识到我们不可能完全消除它的时候，它是可以被彻底改变的
All of, the cement 所有的，水泥
We can also think as a restorative dentist 我们也可以考虑作为一个恢复性牙医
the type of implant system that we want to use 我们想要使用的植入系统的类型
When we like an external connection, an internal connection 当我们喜欢外部连接，内部连接
we still use both types of implants to great success 我们仍然使用这两种类型的植入巨大的成功
depending on the situation 视情况而定
We realize uh that there's certain biological value to using titanium 我们知道使用钛有一定的生物学价值
But the biggest occurrence over the last few years has been the realization that the surface texture 但是在过去的几年里最大的事件是意识到表面纹理
of the implants certainly leads to a change 一定会导致一些变化
and how rapidly bone can be developed on the surface of the implant 以及骨头在植入物表面的生长速度
And even the strength of the bone that is developed 甚至是发育中的骨头的强度
We look as restored of dennis uh at the different diameter of implants 在不同的植入物直径下，我们看起来像丹尼斯的修复体
realizing that the biggest issue here is the strength of the implant itself 意识到这里最大的问题是植入物本身的强度
My concern as a restorative dentist is that the implant never be chosen 作为一名修复牙医，我担心的是植入物永远不会被选择
based on the amount of available bone 基于可用骨头的数量
but based on the force that will be applied to the area 而是基于将施加到该区域的力
where it might be very reasonable to use a narrow platform implant in the anterior segment where the loads are 其中在载荷所在的前段中使用窄平台植入物可能是非常合理的
lower 较低
I would never want to use a narrow platform implant in a posterior quadrant 我可不想在后象限使用狭窄的平台植入物
where I know that the lows might be extremely high 我知道那里的低点可能非常高
uh The heads of the implant, as I mentioned, really 呃植入物的头，就像我说的，真的
is sometimes a personal choice 有时是个人的选择
But there are certainly advantages to some of these new implants 但是这些新的植入物肯定有好处
and the implants that we've been using for many years 以及我们已经使用了很多年的植入物
And we look at each one independently 我们分别看待每一个人
As a restorative dentist 作为一个修复牙医
I need to understand certain restoration design options 我需要了解一些修复设计的选择
Over the next five sessions after this one 在接下来的五次治疗中
we're gonna consider 我们会考虑
the design options for enter your teeth 进入你的牙齿的设计选择
for post to your teeth for adventurous situations 为冒险的情况张贴你的牙齿
And we need to understand those, particularly 我们尤其需要了解这些
but in general, we need to we 但总的来说，我们需要
and we also see situations where I splintered final restoration, maybe to the patient's advantage 我们还看到了一些情况，我把最终的修复过程进行了分割，也许对病人有利
That could be a bridge to implants 那可能是一座通往种植体的桥梁
to replace three or four teeth 更换三或四颗牙齿
and The answer segment, certainly 答案部分，当然
But it also might be a bridge on three implants 但也可能是三个植入物之间的桥梁
a three unit bridge 一座三单元的桥
Why would we do that? We need to talk about those issues 为什么我们要这么做？ 我们需要谈谈这些问题
although it's becoming quite 不过，现在有点
popular 很受欢迎
and I think the most standard thing is to cement the final restoration 我认为最标准的做法是加固最后的修复
I can tell you that there's many times that the only way to 我可以告诉你有很多次唯一的方法
successfully restore restoration is with the screw retain design 成功的恢复修复是与螺钉保持设计
and Sometimes it's easier 有时候更容易
It's sometimes uh more predictable to do a screw retained 有时候用螺丝固定会更容易预测
And i'm only saying that 我只是说说而已
because I think it's important for us to master all aspects of implant dentistry 因为我认为掌握植入牙科学的各个方面对我们很重要
so that we can decide on any given case 以便我们能决定任何一个案子
What's the best way 最好的办法是什么
to restore the case for that individual patient 恢复个别病人的病情
There's certain standards in terms of a causal design and materials 在因果设计和材料方面有一定的标准
uh that we need to look at 我们需要看一下
But basically 但基本上
there's a lot of options and a lot of ways that we can restore any given case 有很多选择和方法，我们可以恢复任何给定的情况
When I do restorative lectures 当我做恢复讲座的时候
probably the most difficult thing for the person listening to the lecture 对听演讲的人来说可能是最困难的事
is to grasp all the apartment options 掌握所有的公寓选项
My goal today and during most of the lecturing is not to 我今天和大部分讲座的目标都不是
try to teach you every apartment option 试着教你所有的公寓选择
but it is to try to give you the skills so that you can understand 但它是试图给你的技能使你可以理解
the different apartments 不同的公寓
So the regardless of the name or 所以不管名字还是
uh the newest ones that come out 最新出来的那些
you can look at it and understand that it's perhaps a custom apartment 你可以看着它理解它可能是一个定制的公寓
It's perhaps a customer department that will be cemented in place or screw retained 它可能是一个客户部门，将被巩固到位或螺丝钉保留
What's the flexibility? What's the interdisciplinary 灵活性有多大？ 跨学科是什么
And then you can understand how you can best utilize it 然后你就会明白怎样才能最好地利用它
This chart it helps me 这张图表对我很有帮助
understand and look at cases 了解和研究案例
For when I want to split the final restoration or when I want to do individual crowns 当我想分割最终的修复或当我要做单独的牙冠
Of course 当然了
we all think of, the ease of creation 我们都认为创造是容易的
and So 所以
Many times 很多次
It's sold as 卖的是
well it's easier to do individual crayons because we can 嗯，单独画蜡笔比较容易，因为我们可以
cement the individual crowns and it's just like regular dentistry 加固单个牙冠，就像普通的牙科一样
But in some cases, it's much harder 但在某些情况下，就更难了
especially on some aesthetic cases 尤其是一些美学案例
which might surprise you 可能会让你吃惊
to do splintered crowns to do splintered crowns
The number one thing is we need an outstanding lab support 最重要的是我们需要杰出的实验室支持
And also, from the restorative 同时，也是因为它的滋补作用
of view, you need to know and have mastered 你需要了解并掌握的观点
the techniques to taking an accurate impression 获取准确印象的技巧
If you haven't mastered those techniques 如果你还没有掌握这些技巧
we'll have significant issues 我们会有大麻烦的
Individual crowns, on the other hand 另一方面，单独的牙冠
can make up for 才能弥补
maybe marginal lab support 或许是边缘实验室的支持
You might have heavy contacts that you can adjust chair side 您可能有沉重的接触，您可以调整椅子的一面
But I don't think there's any sort of dentists that are 但我不认为有任何种类的牙医是
excited about spending an hour trying to adjust interpersonal context 为花一小时调整人际关系而兴奋
Also, if we don't have good skills to take a good impression 而且，如果我们没有良好的技能，以采取良好的印象
that also leads to the same challenges and where people may opt to 这也导致了同样的挑战和人们可能选择
doing individual crowns 做单独的牙冠
Hygiene, I think, is irrelevant almost with these issues 我认为，卫生几乎与这些问题无关
uh Individual crowns of course allows simple flashing 呃个人皇冠当然允许简单的闪光
Splendid crowns allows floss ing with the threat 华丽的王冠允许用牙线来威胁
uh I don't think there's a big challenge energetically with these issues 我不认为在这些问题上有什么大的挑战
Load support may be an issue that drives you toward splitting 负载支持可能是促使您分裂的一个问题
of course sharing the load across the implants 当然，在整个植入物上分担负荷
as long as that bridge fits 只要那座桥合适
passively 被动的
We should have the ability to protect a 我们应该有能力保护
weaker implant 植入更弱
or maybe just make a group of implants much stronger by splitting them together 或者通过把它们分开来使一组植入物变得更坚固
Individual crowns requires each implant to totally support the load on it 单独的牙冠需要每个植入物完全支撑其上的负载
uh independently 呃，独立的
and On some situations, it's like murphy is law 在某些情况下，就像墨菲定律一样
The weakest implant 最弱的植入物
will have the heaviest load 会有最重的载荷
So you have to make decisions in that regard 所以你必须在这方面做出决定
I find that most important in the posterior maxima 我发现最重要的是在后极部
But sometimes with the situations where I have guidance 但有时在有我指导的情况下
and other issues on the implants 以及植入物的其他问题
sharing the load has has advantages 分担负载具有优点
I think the first thought, almost on a common sense 我想第一个想法，几乎是基于一种常识
is that individual crowns 是那个独立的皇冠
should always be more aesthetic 总是应该更有美感
The surprising thing is 令人惊讶的是
without perfect implant placement 没有完美的植入位置
perfect soft tissue reconstruction 完美的软组织重建
many times my ability to split crowns together 很多次我能把皇冠分开
to carry porcelain interapproximately 近中带瓷质的
then i'd have to worry about the line of draw of a 那我就得担心画这条线了
of aa custom apartment 一间定制的公寓
Gives me more flexibility to create the final result that i'm looking to have 给了我更多的灵活性来创造我所期待的最终结果
Also 另外
from the point of view of not having one implant per tooth in the aesthetic zone 从在美观区域中每个牙齿没有一个植入物的角度来看
having politics also gives me more flexibility 有了政治也给了我更多的灵活性
to create the aesthetic result that i'm trying to achieve 创造出我想要达到的美学效果
A final thing is the ease of seating, the final bridge 最后一件事是容易入座，最后一座桥
And the first assumption is always, well, so many crowns 第一个假设是，嗯，有很多皇冠
I do that every day. That's got to be easier 我每天都这样。 一定很简单吧
But if we don't have cement margins right at the tissue 但如果没有组织的水泥边缘
level 水平
and we're trying to cement 我们在努力加固
uh Substantively atively, if we have 实际上，如果有的话
they put heavy pressure 他们施加了很大的压力
on the soft issue, pontiac areas 在软问题上，庞蒂亚克地区
Believe it or not, a seating 信不信由你，一个座位
a screw retained crown might be easier 螺钉固定牙冠可能更容易
than doing cemented crowns 也不愿做粘结牙冠
But saying that, of course 当然，这么说
it is so simple 太简单了
When we plan these cases, well 当我们计划这些案子的时候，嗯
to just take a crown, maybe have an all ceramic customer 只是拿个皇冠，也许有个全陶瓷的客户
and to take that ceramic crown and cement it in place with beautiful margins, beautiful, soft tissue contour 并把陶瓷冠用在有美丽边缘、美丽的软组织轮廓的地方
of course That's a very simple and easy way for us to proceed 当然这对我们来说是一个简单易行的方法
The next group of things that we really need to talk about and i've alluded to already 我们真正需要讨论的下一组问题，我已经提到过了
is crew retained or cemented restorations 是否保留船员或骨水泥修复体
Scrutiny uh is always a surprise to me at how difficult 仔细检查对我来说总是很奇怪
for the laboratory it can be to make something that fits my uh. My impression, my master model 对于实验室来说，可以做一些适合我. 我的印象，我的名模
It's also surprising to me 这对我来说也很令人惊讶
how difficult it is for some people to create that accurate master model 对于一些人来说，创建精确主模型是多么困难
If we can do that, though the screw retained 如果我们能做到的话，虽然螺丝钉卡住了
uh restoration becomes an option that is very viable and reasonable for anybody 对任何人来说恢复都是可行和合理的选择
that goes to make an implant restoration 这样就可以进行植入修复了
The thought with so many crowns is that basically 有这么多皇冠的想法基本上是
it's the same techniques as conventional crown and bridge 它的技术与传统的冠和桥相同
and which is a good technique 这是一个很好的技巧
It's simple and straightforward 很简单明了
but I'd like to say that sometimes there are easier ways to do it 但我想说有时候有更简单的方法
I think a cemented crown works better in the flow with 我觉得用水泥做的牙冠效果更好
immediate restorations 即刻修复
And that's related to the fact that the implants quite often have a slight labial inclination 这与植入物通常有轻微的唇侧倾斜有关
that precludes a direct scrutiny, restoration 排除了直接的审视和恢复
so I expect an immediate restoration that we're gonna do some sort of cemented crown 所以我希望能立即修复我们要做的是用水泥固定的牙冠
and That's just as. What follows 就像这样. 接下来是什么
Um 嗯
Simultaneously requires if we go on a standard crown and bridge technique requires a certain axial wall length 同时要求如果进行标准的冠桥技术要求一定的轴向壁长
requires an understanding that the cement can't be significantly substantial 需要理解水泥不可能是显著的
and that we need to think about the contour of that crown as it comes through the soft tissue 我们需要想一想，当它穿过软组织时，牙冠的轮廓
So biologically, if we have our crown margins 所以从生物学上讲，如果我们有皇冠的边缘
significantly 意义重大
subchangeable and were unable to completely remove the cement that's accumulated there 而且不能完全清除积聚在那里的水泥
we expect 我们期待
but not immediately probably, but over the course of that uh 但不一定是马上，但在那过程中
restorations lifespan, we will have an experience where 恢复生命，我们将有一个经验
we'll have an adverse paradigm reaction to the cement that we leave behind 我们会对我们留下的水泥产生不良反应
Now, also, we could look at a cement retained rest, or 现在，我们也可以看一下水泥保持架，或者
i'm sorry, a screw retained restoration. And we realize 抱歉，螺丝固定修复件。 我们意识到
that if we're doing a let's say, aucla above 如果我们做一个假设，上面的aucla
which is a cast 是个演员
gold alloy uh crown 金合金皇冠
We bake porcelain on that, but still we have a gold 我们在上面烤瓷，但我们还是有金子的
implant interface, the goal of the government 植入界面，政府的目标
the A titanium implant, will that lead to biological issues A的钛植入物，会导致生物问题
Abramson made an argument that that's true 艾布拉姆森认为那是真的
Some people will debate that now 现在有些人会争论这个问题
But it's something that we need to consider is that an issue 但我们需要考虑的是这个问题
Future access or maintenance 未来的访问或维护
My goal with every restoration I do is never have to remove it. So certainly 我做的每一次修复工作的目标都是永远不用移除它。 所以当然
i'd never use the term retrieval. I mean I don't like to 我从不使用术语检索。 我的意思是我不喜欢
have to say well to clean this restoration 我不得不说，清理这个修复工程
I have to retrieve it every few months. That's not our goal 我每隔几个月就得取一次。 那不是我们的目标
but There are times 但有时候
that there is an advantage to be able to take a restoration out to alter it, to repair broken porcelain 有一个优点，就是可以修复破损的瓷器，改变它
Maybe to add more 或许可以多加点
uh t to it by adding more implants 给它加更多的植入物
There there are those advantages 有这些优势
um If you have a round house cemented bridge 如果你有一座圆形的水泥房子
which I certainly don't advocate 我当然不赞成
uh if you have a problem in one area 如果你有什么问题
break the portion in a significant area 将该部分分成重要区域
to have to remove that entire restoration 必须移除整个修复体
is not a goal that anybody would have if you have to go in and cut it off 不是任何人都会有的目标，如果你必须进入并切断它
so That's not our goal 所以这不是我们的目标
Aesthetics with a cemented 美学与水泥
All ceramic crown on a ceramic apartment can be the most outstanding 所有的陶瓷冠上的陶瓷公寓可以是最突出的
natural aesthetics that we can. Achieve it is beautiful 我们能做到的自然美。 实现它是美丽的
It has beautiful light transference through the restoration 它有美丽的光通过修复转移
and It's something that I think we all strive to achieve 我认为这是我们所有人都在努力实现的目标
It is more difficult if you have a metal above that may require 如果您有一个以上的金属可能需要更多的困难
uh or show 呃或者表演
a soft tissue glow of the titanium or gold bombardment through the tissue that may not be aesthetic 软组织中的钛或金会轰击组织，这可能不是美观的
We also might see that a porcelain fused to metal crown doesn't have the aesthetic potential 我们还可以看到，烤瓷熔附在金属牙冠上并不具备美学上的潜力
of an all ceramic crown 全瓷冠制作的
It's 它是
Technician puts into the case 技术员把东西放到箱子里
so Those are bouncing 所以它们在跳动
And I think everybody needs to look at their own laboratory 我认为每个人都应该看看自己的实验室
support to decide what is the best way to achieve the aesthetic result we desire 支持决定什么是最好的方式来实现我们所期望的审美结果
The ease of seating the, final restoration varies of course 当然，最终复原的坐姿也各不相同
If you have a simple 如果你有一个简单的
uh cemented crown, that's right 嗯，水泥皇冠，没错
At the tissue level 在组织层面上
it can be one of the easiest things we do 这可能是我们做的最简单的事情之一
On the other hand, though, as i've said again and again 另一方面，就像我说过的一次又一次
if we have cement margins that are significantly objectionable 如果我们有明显不满意的水泥利润
this not only is difficult sometimes 这不仅是困难的时候
but also is very unpredictable and what the final outcome 但也是非常不可预知的和最终的结果
might be that day or months later in terms of tissue response 在组织反应方面可能是在那天或几个月之后
If we know how to take a good impression 如果我们知道如何给人留下好印象
achieve an accurate master model 实现精确的主模型
we have excellent laboratory support 我们有很好的实验室支持
We can see it a screw crown, very, predictably, very simply 我们可以看到它是一个螺旋冠，非常，可以预测，非常简单
We can carry porcelain perhaps further, substantially 我们或许可以把瓷器带得更远，更大
On a given case 在特定的情况下
with the screw retained 螺丝保持不动
uh None of these statements are definite 这些陈述没有一个是明确的
They all vary according to the case that we're working on 它们都根据我们正在处理的案子而不同
and We need to look at all those factors before we make a decision. How will restore any given case 在做决定之前我们需要考虑所有这些因素。 如何恢复任何给定情况
so My only goal with these two charts 所以我唯一的目标是这两张图表
was to bring up concepts and ideas 就是提出一些概念和想法
that will help you evaluate any given restorative technique 这将帮助你评估任何给定的修复技术
in terms of a causal anatomy 从因果解剖的角度
What are we trying to achieve 我们到底想达到什么目的
I think that it's always reasonable and prudent to attempt to achieve loading of the implant down the long axis 我认为它总是合理和谨慎的尝试，以实现负荷的种植体长轴
One of the most detrimental cannilever is 最有害的插管之一是
especially on a single tooth restoration, on a single molar 尤其是一颗牙齿，一颗臼齿
is to have a significant labial cantilever 是有一个明显的唇侧悬臂梁
Quite often, practically, the implant is placed 实际上，植入物经常被放置
More legally than would be ideal 比理想的更合法
and then to achieve a full contour 然后实现完整的轮廓
to that restoration 为修复工作
we end up with a significant label can a labor 我们最终得到了一个重要的标签,可以劳动
What we need to do is to perhaps limit or narrow the buckling dimensions 我们需要做的也许是限制或缩小屈曲尺寸
of our restoration to the.that we keep the accuser contact 恢复到.与原告保持联系
closer to the implant position 更接近植入位置
We also like, in general, terms to flatten the cusp bengals 总的来说，我们也喜欢把尖点的鼻骨弄平
for our poster or occlusion 为了我们的海报或者遮挡
uh we would like to have centric only context 我们希望只有中心的上下文
It's my goal to minimize guidance or transverse loading whenever possible 我的目标是尽可能减少引导或横向载荷
Unless of course the more difficult case 当然除非更困难的情况
our guidance needs to be on these restorations 我们的指导应该是这些修复工作
and Then we have to plan them at another level 然后我们必须在另一个层次上计划它们
We can legalize or buckled eyes are occlusion based on 我们可以合法化或扣眼是基于遮挡
where the implant has been placed 在植入物被放置的地方
so that we keep the loading directly over the head of the implant 因此我们将载荷保持在植入物的头部正上方
Another issue that I like to look at during treatment planning, and then certainly when we make a restoration 我喜欢在治疗计划中关注的另一个问题，当然，当我们进行修复时也是如此
is how can we maximize the hygiene access for the patient 如何让病人最大限度地享受卫生服务
Minimize difficulty for cleaning 尽量减少清洁困难
It isn't always related 它并不总是相关的
then certainly it's just having the ability to floss through separate crowns 当然，它只是有能力通过单独的牙冠牙线
To me, isn't some enormous advantage to the patient 对我来说，对病人来说不是很大的优势
It may be as simple as just having the laboratory technician have a proxy brush on hand 这可能很简单，就像实验室技术人员手上拿着一把刷子一样
to create the hygienic space to slip a proxy brush through 创建卫生空间以滑动代理刷子通过
It might be uh considering where the implants will be placed 可能是考虑植入物的位置
so that we minimize cantalevers or rich lab situations 所以我们把蜡烛和丰富的实验环境最小化
Our goal is certainly to have smooth flowing emergence profiles 我们的目标当然是拥有流畅的涌现轮廓
Now, when we talk about abundance 现在，当我们谈论富足
I like to put them in in a couple of basic categories 我喜欢把它们分成几个基本的类别
We could talk about samantha amenable final restorations 我们可以谈谈萨曼莎最终的恢复
or screw retain final restorations 或螺钉固定最终修复
We can also talk about uh custom apartments 我们还可以谈谈定制的公寓
versus pre machine developments versus pre machine developments
We'll look at them in both those fashions 我们会用这两种方式来观察它们
But since from the restorative dentist 不过，既然是从牙医那里来的
I think the simplest way to look at these things 我认为看待这些事情最简单的方法是
is how do we 我们如何
correct uh connect our final restoration 正确连接我们最后的修复
And how do we achieve that final restoration 我们如何实现最终的修复
I like to split up in the categories of symmetrical final restorations versus screw retained 我喜欢分为对称的最终修复和螺钉保留两类
uh The first category that's uh 第一类是，呃
especially for the beginning implant restorative dentist 尤其是对于刚开始的牙种植体修复的牙医
is an easy above and a stappy above and a solid above. And 是一个简单的上面和stappy以上和固体以上。 以及
that has a very simple impression technique and allows cementing the final restoration 这有一个非常简单的印象技术，并允许水泥的最终恢复
the The downside to this apartment might be that it has 这间公寓的缺点可能是它有
a fixed 一个固定的
uh cement line at one level completely around the apartment 一层的水泥墙完全围绕着公寓
and In some areas, it might be the perfect depth objectively 在某些方面，客观上可能是完美的深度
Other areas, it may be significantly subchangeable and 在其他方面，它可能具有显著的易变性和
So we need to look at those 所以我们需要看看这些
The next custom type apartment for a symmetrical final restoration is a preferable titanium 用于对称最终修复的下一个定制类型的公寓是优选的钛
or ceramic above and 或者上面的陶瓷还有
That comes in certain diameter, certain height 有一定的直径，一定的高度
certain angles 一定的角度
that allows us to prep 帮助我们准备
usually in the laboratory 一般在实验室里
to achieve the correct marginal position 以达到正确的边缘位置
the correct angulation, the correct clues clearance 正确的角度，正确的线索
so that we can send in a final restoration 以便我们能送去一个最终的修复
my preference to that type of apartment these days 如今我更喜欢那种类型的公寓
is a cat can produce development 是一只猫能产生发育
of the processor 关于处理器的
where we can plan the ideal apartment 在那里我们可以规划理想的公寓
the perfect angle, the perfect 完美的角度，完美的
uh clues of height 关于身高的线索
the perfect uh marginal position 完美的边缘位置
so that we can have this ideal restoration 这样我们就可以进行理想的修复
And we can do that in both titanium and ceramic 我们可以用钛和陶瓷来做
Historically. And still today, there are times, for me 历史上。 但直到今天，对我来说，还是有的
using aucla type customer 使用aucla类型的客户
that allows me to create any shape that i'd like to have 这使我可以创建任何形状，我想有
And then some in a restoration over the top of it 然后一些人在它的顶部进行修复
is still a valid way to proceed 仍然是一个有效的方法
I think this depends completely on the laboratory that you have to work with 我认为这完全取决于你所工作的实验室
whether you send your cases to a pro sarah certified lab 不管你是不是把案子送到专业的萨拉认证实验室
or to one that is unable to do that 或是不能做到这一点的人
which in today's world seems unlikely 但在今天看来似乎不太可能
for screw retained restorations 用于螺钉固位修复
Probably the standards are either aucla apartment 可能标准要么是奥克拉公寓
which i'll explain more if you're not aware of that type of apartment 如果你不知道这种类型的公寓我会解释得更清楚
That allows casting a, restoration 允许铸造，修复
that will be screwed directly to the head of the implant 直接用螺钉固定在植入物的头部
That is a very valid way to proceed 这是一个非常有效的方法
Also, the use of the multi unit development 同时，采用多单元开发方式
that has the classical uh tear of a 有典型的呃眼泪的
implant 植入物
the multi unit apartment and then a gold cylinder and the gold cylinder is cast into the final restoration 多单元公寓，然后是一个金圆筒和金圆筒是铸造的最终修复
so We have a three tiered restoration 所以我们有一个三层的修复
with the gold screw holding the restoration to the multi unit above 用黄金螺丝钉将修复体固定到多单元上面
So the solid development 所以坚实的发展
the snappy involvement does the originally 活泼的参与做最初的
the easy involvement 简单的参与
has a very simple protocol of a simple impression coping 有一个非常简单的协议一个简单的印象处理
that snaps over the head of the apartment 从公寓头上弹开的
Once it's in place in the mouth 一旦它在口中就位
we inject impression material we inject impression material
we use a closed tray technique 我们用的是闭盘技术
We pick up the impression coping 我们学会了如何处理印象
send it to the lab with an analog 把它和一个模拟物送到实验室
and In a short period of time, we have a traditional 在很短的时间内，我们有一个传统
symmetrical crown that looks just like any crown that would be cemented on a prep tooth into orally 对称的牙冠，看起来就像任何一种可以粘在预备牙齿上的口腔牙冠
We can cement that crown 我们可以把皇冠粘起来
advantages, also include uh 好处，还包括
the fact that we don't need to do retraction cord 事实上我们不需要做牵引线
But I would suggest that if you need to use significant retraction cord, because the margins are so far subchangeable 但我建议，如果你需要使用重大的撤退线，因为边缘是迄今可互换的
this isn't an ideal restoration because you shouldn't be cementing 这不是一个理想的修复，因为你不应该水泥
that far objectively 太客观了
uh We can do immediate temptation with these apartments since they come already set with the margins 我们可以对这些公寓进行即时的诱惑，因为它们已经有了边际收益
and Hopefully a closely 希望是个很近的
especially with the snappy apartment 尤其是有这么漂亮的公寓
we don't have to do any preparation at all 我们根本不需要做任何准备
It's ready to go. There we go 一切都准备好了。 我们到了
It works wonderfully, I believe 我相信它工作得很好
in a pre molar area in a molar area where sometimes the aesthetic demands or at least the soft issue and adamant 在前臼齿区域中，有时需要美观，或者至少需要柔软和刚硬
Adam anatomy is fairly flat 亚当的解剖结构相当平坦
and allows us to cement a restoration with great predictability 使我们能够以极大的可预测性来修复
Here we just see an example of the impression coping snapped over the involvement 在这里，我们只看到一个例子的印象应对崩溃的参与
We would inject the impression 我们会给人留下印象
material around that 关于那个的材料
Pick it up and send it to the lab 把它捡起来送去实验室
My favorite department to use at this point certainly is the prosera bombardment 在这一点上，我最喜欢使用的部门当然是prosera bombation
Whenever i'm going to cement a crown 无论什么时候，我都要去给它镶牙冠
I have great flexibility in achieving 我有很大的灵活性在实现
this ideal restoration 完美的修复
I need my laboratory to support me on this in the sense that 我需要我的实验室在这个问题上支持我
I need the margins to follow the soft issue 我需要边距来跟踪软问题
Otherwise I lose some of the advantage of this totally customization restoration 否则我就失去了完全定制恢复的一些优势
I like 我喜欢
many times to use a ceramic apartment annually as I proceed into higher stress areas 当我进入压力较大的地区时，很多次每年都要使用一套陶瓷公寓
I still opt more towards using a titanium type 我还是选择使用钛型
uh custom involvement of this of this type 呃，这种类型的客户参与
We can make these uh apartments for hexheaded, restorations 我们可以建造这些呃公寓来做修复工作
uh uh sort of 呃呃算是吧
Excuse me, hex headed implants 不好意思，是六角头植入物
and also internal connection replace type 以及内部连接替换类型
Prosera can be expanded more than just single units Prosera可以扩展超过单个单元
It can be utilized for bridges 它可以用于桥梁
for a classic hybrid type restoration of 为典型的混合型恢复
the fixed bone type restoration 固定骨型修复
We can use it uh for the core for the acrylic resin 我们可以用它来做丙烯酸树脂的核
We can uh do a more traditional type of acrylic metal framework where we have a metal finish line 我们可以做一种更传统的亚克力金属框架，我们有一条金属装饰线
We can use uh 我们可以用呃
porcelain that can be baked to this titanium framework 可在此钛框架上烤制的瓷器
Orgo ORGO
as far as the prosarimplant bridge with individual all ceramic crowns 直到具有单独的所有陶瓷牙冠的前牙种植体
There's submitted over this framework 已经提交了这个框架
that has either pink porcelain or more commonly a pink acrylic 有粉红色的瓷器或者更多的是粉红色的丙烯酸
uh connected to it 呃和它有关
So you have a very natural and aesthetic outcome 所以你有一个非常自然和审美的结果
all right Now, um 好吧现在，嗯
as we look at 当我们看着
customer ments will begin with the the historical one 客户体验将从历史体验开始
the customer department that 客户部门
uh we developed that ucla uh the custom, ucla above and 我们开发了ucla定制的ucla上面的和
uh This involvement uh certainly has been called many different things. The gold adapt, gold cylinder to fixture 这种参与当然被称为很多不同的事情。 黄金适配器，黄金圆柱夹具
But the bottom line is that what we're looking at is connecting the restoration directly to the implant 但底线是我们所看到的是将修复体直接连接到植入物上
There are no cement lines 没有水泥线
There's no um secondary restoration to the apartment. So 公寓里没有二次装修。 所以
the apartment 公寓
uh historically 呃，历史上的
the gold cylinder in the restoration all became one 修复中的金柱全部合而为一
And this was 但这是
a big issue 是个大问题
Uh20 years ago, 15 years ago when we developed this 嗯，20年前，15年前我们发明了这个
Because what it does is it allows us to carry porcelain 因为它让我们可以携带瓷器
significantly subgenerically for the first time 第一次明显的次通用
And that was a great advantage, aesthetically 这在美学上是一个很大的优势
so Our uses dell include aesthetics 所以我们的用法包括美学
It includes limited intercausal space 它包括有限的因果空间
and I think I can make this accurate statement that there is no way 我想我可以准确地说没有办法
to restore a restoration closer to the implant head 以恢复更靠近植入物头部的修复物
than with the ucla type apartment 比加州大学洛杉矶分校的公寓要好
That becomes the restoration 这就是复原法
We also use it for angulation correction as any uh customer government can do 我们也用它来校正角度，就像任何客户政府可以做的那样
We can vary the angulation of the uh ucla development 我们可以改变uuula发展的角度
and then put a secondary or a cemented restoration over the top 然后在上面放一个二次或粘结的修复体
We use it also to make custom substructures 我们也用它来制作自定义子结构
and that's my probably my primary use today 这可能是我今天的主要用途
will make either individual units for custom substructures 将为定制子结构制造单独的单元
or splintered comes custom substructures 或者分裂成定制的子结构
so that we can achieve the restoration we're trying to have 这样我们就能实现我们想要的恢复
It's important to understand that there's two basic types of ucla apartments 了解加州大学洛杉矶分校的公寓有两种基本类型是很重要的
One is engaging so that inside uh the uh 其中一个很吸引人所以里面呃呃
castable involvement castable involvement
there are uh 有呃
components that will engage the head of the implant to prevent rotation 将与植入物的头部接合以防止旋转的部件
This is what we need to do single units 这是我们需要做的单一单位
to do a single custom substructure to do a single custom substructure
But if we're doing bridges But if we're doing bridges
there really is no advantage to engaging these structures inside the implants 在植入物内部接合这些结构确实没有好处
and In fact 实际上
it can lead to problems with the line of draw or other issues 它会导致画线的问题或其他问题
and so We prefer a non engaging 所以我们更喜欢不吸引人的
inferior portion to the development 低于开发的部分
From this picture 从这张照片里
we can see that there's a precast usual component to the ucla apartment. It's precast out of a gold alloy 我们可以看到在加州大学洛杉矶分校的公寓里有一个预制构件。 它是用金合金做的
and Then there's a waxing sleeve above 上面还有一个上蜡套
so we'll wax directly around this 所以我们直接在这周围打蜡
and cast directly to this pre 并直接浇铸到该PRE上
a cast component 铸造部件
We do that to maintain predictability of the fit 我们这样做是为了保持合身的可预测性
There is variability in casting and we need machine tolerances 在铸造中有可变性，我们需要机器公差
that may not be possible in any given laboratory 这在任何给定的实验室中都是不可能的
The minimal inner arch clearance 最小的内拱间隙
the advantage of the ucla bubble UCLA泡沫的优点
is that from the head of the implant 是从植入物的头部
we can have a restoration, only3.5 millimeters tall 我们可以进行修复，只有3.5毫米高
There is no way to do a cemented restoration at that level or really any other development 没有办法做一个水泥修复在这一水平或实际上任何其他发展
uh Just to look at a case or kind of a diagrammatic view of a case 只是看一个案例或者一个案例的示意图
we would take the 我们会带着
pre made ucla government pre made ucla government
wax directly around it 直接在它周围打蜡
We can just barely see in this example 在这个例子中我们几乎看不到
The gold ucla course still sitting there 金色的加州大学洛杉矶分校的球场还在那里
casting to it 铸造它
We could take this as the shape of a customer that was cemented finish lines 我们可以把它看成是一位客户的轮廓，那是一条胶合的终点线
Or we could bait porcelain directly to that above and 或者我们可以直接用瓷器做诱饵
If we can have a lingual screw access 如果我们能进入舌侧螺钉
my goal is not to have the surgeon place 我的目标不是有外科医生的位置
the implants to achieve this access, though 不过，实现这个通路的植入
because quite often, as you can see in this picture 因为很多时候，正如你在这幅图中所看到的
at least the implant had slightly angled 至少植入物有轻微的角度
palatley or lingually 腭的或舌面的
and then having a non ideal contour to the final restoration 然后具有最终修复的非理想轮廓
We can also take that 我们也可以接受
gold casting 黄金铸件
place it into orally 放入口中
and make a final restoration that is cemented directly over the top 并在顶部直接进行最终修复
and Since the implant was angled more accurately 因为植入物的角度更精确
really through the incisal edge or through the incisal 是通过切缘还是切缘
Third 第三
liberally 很自由
were able to achieve a 我们能够实现
better contour to the final restoration 更好的轮廓最终修复
But if you look closely at the picture 但如果你仔细看照片
you'll see that our cement lines 你会看到我们的水泥生产线
our diagram directly at or even to the soft issue 我们的图表直接或甚至到软问题
may be labeling 1/2 millimeter or so 可以标记为1/2毫米左右
In order to feel predictable as a restorative dentist in this regard 以便在这方面作为恢复性牙医而感觉可预测
we need to feel that the soft tissue was stable 我们需要感觉软组织是稳定的
so when we get into the sessions in regards to anterior restorations 所以当我们开始前牙修复术的时候
we need to talk about the time frames required 我们需要谈谈所需的时间
to achieve that's soft tissue stability before we make our final restoration 在我们做最后的修复之前达到软组织的稳定
so We look at one other case. We're just real quickly 所以我们看另一个案子。 We're just real quickly
We see a case with a 我们看到一个案子
the head of the implant 植入物的头部
We've decided to use aucla apartment 我们决定用奥克拉的公寓
We do a full contour wax, casting 我们做全轮廓蜡，铸造
cast it 铸造它
bake our, porcelain 烤我们的瓷器
and Really, it's a screw retained crown. It's simple 实际上，是螺钉固定的牙冠。 很简单的
What are the debates that we might have this in today's world? We might say well that we haven't 在当今世界上，我们可能会有什么争论呢？ 我们可以说我们还没有
implant 植入物
to alloy connection here at this level 在这个层面上的合金连接
It's actually subbony in some aspects 在某些方面，它实际上是亚骨制的
Will that lead to a biological with issue 会不会导致有问题的生物
Will it lead to bone loss 会导致骨质流失吗
Because of that 因为这个原因
and I have to tell you that I feel the jury is still out on those issues 我不得不告诉你我觉得陪审团还在讨论这些问题
I can show you literally hundreds of cases where we don't have that issue 我可以告诉你上百个我们没有这个问题的案例
But I think we need to understand biologically 但我认为我们需要了解生物学
what is going on in those areas. And certainly 在那些地区发生了什么。 当然还有
I could make an argument where there's an advantage 我可以在有优势的地方争论
They're having a all ceramic 他们有全陶瓷的
uh restoration 呃修复
uh especially ombudsman screwed directly to the 尤其是申诉专员直接和
implant 植入物
And then an all ceramic restoration cemented over the top as perhaps having biologically more potential 然后用全瓷修复材料加固顶部，因为它可能在生物学上更有潜力
My only issue there is the level of the cement 我唯一的问题是水泥的高度
Here, we're going to just show using ausa development 在这里，我们将展示如何使用AUSA开发
to create a custom substructure 创建一个定制的子结构
just taking the master model 只是拿了主模型
and connecting 以及联系
aaucla buckment pattern to that model 模型上的扣扣图案
We realized that the scratch vessels can come out 我们意识到刮伤的血管可能会出来
quite a bit labeling. And we see this here in this picture 相当多的标签。 我们在这张照片里看到了这个
This is not ideal implant placement 这不是理想的植入位置
but it's the reality of some situations 但这是某些情况下的现实
When we see this 当我们看到这个
we can go ahead and cut the wax up back to make this ideal shape to the final ucla apartment 我们可以继续，把蜡切回去，使这个理想的形状最终加州大学洛杉矶分校的公寓
where we could put a crown over the top 在那里我们可以把皇冠放在顶上
That crown could be cemented 你的牙冠可能被粘住了
Or as you'll see here, just to give you another option 或者就像你在这里看到的，给你另一个选择
we can have a lingual set screw 我们可以用舌侧固定螺钉
so We've created our apartment with the lingual uh set screw 所以我们用舌侧固定螺丝建造了我们的公寓
We go ahead and wax the final crown over the top 我们继续为最后一顶王冠打蜡
and then bake our porcelain 再烤我们的瓷器
and We're ready with our lingual set screw to place the restoration into orally 我们已经准备好用舌侧固定螺钉将修复体放入口腔
First, the apartment is placed 首先，公寓被安置好了
and I should.out on this picture 我应该.在这张照片上
We see a little bit of 我们看到一点点
enhance redness in the area 增强该区域的红色
And for me, as a restorative dentist 对我来说，作为一个修复牙医
I would be concerned about the amount of bone that's in this 我担心的是里面有多少骨头
area with that labile implant placement with labial inclination 不稳定种植体植入区域有唇倾斜度
But the final result can be very reasonable 但是最终的结果是非常合理的
It could be screwed, retained, or 它可以是螺纹的，固定的，或者
uh from a lingual set screw or cemented 嗯从舌侧固定螺钉或水泥
Based on your long term comfort zone 基于你长期的舒适区
with this case 关于这个案子
multi unit above and 上面有多个单元和
is a progression from some of the 是从一些
the esthetic abundance 审美的丰富性
the conical developments we used years ago 我们多年前采用的锥形发展
The advantage is being that it's a lower profile 优点是它是一个较低的形象
You only need about 4.5millimeters 你只需要4.5毫米
So very close to the ucla involvement 离加州大学洛杉矶分校很近
but still a millimeter more 但还有一毫米
in terms of final restoration 在最终修复方面
the restoration can draw over the top of the apartment 修葺工程可以把公寓的顶部修平
up up to40° 高达40 °
so If you have two implants with a40° 所以如果你有两个40度的植入物
uh male positioning or intentional positioning 男性定位或故意定位
that's40°off 偏离了40度
the restoration will still draw 修复工程还会继续
There is no hex or engaging component beneath the multi unit development 在多单元开发的下面没有六角形或啮合部件
so It's only used for bridges, and that's a key component 所以它只用于桥梁，这是一个关键的组成部分
The department screw is strengthened 部门螺丝加强了
There's angled versions 有倾斜的版本
that are very useful 是非常有用的
There certainly are advantages for these developments 这些发展当然是有好处的
for those that favor titanium 对于那些喜欢钛的人来说
to implant interfaces 去植入界面
uh reduces the degree of subchangeable work required by the restorative dentist UH减少了修复牙医所需的可替代工作的程度
It may be simpler for them 对他们来说可能更简单
To you learn a technique that doesn't require removing 学习一种不需要移动的技术
healing apartments all the way to the head of the implant 从治疗室一直到植入装置的头部
And for those reasons 因为这些原因
we do um find that some sort of dennis prefer these developments 我们发现有些丹尼斯喜欢这些发展
Now, custom about my substructures 现在，关于我的子结构的习惯
could be a uh a cat camp type, pro sarah 可能是猫营类型的，亲莎拉
but titanium or ceramic 但是钛或者陶瓷
It could be aucla department, a cast development 可能是奥克拉部，一个演职人员的发展
and What these things do 以及这些东西的作用
it allows us to create separate units or linked 它允许我们创建单独的单元或链接
units 单位
that then the final restoration will go over the top 最后的复原将会越过顶端
They could be held in place 它们可以被固定在适当的位置
with a lingual or a palatable screw 有舌侧或可接受的螺丝钉
It could be held in place with cement 它可以用水泥固定
It just depends on the situation 只是看情况而定
The indications for these are misaligned implant fixtures 其适应症为种植固定物错位
uh elimination of a screw access hole through an aesthetic zone or the occlusive surface 通过美观区域或闭合表面的螺钉进入孔的消除
uh control of the thickness of the metal and the porcelain in an anterior restoration 在前牙修复中控制金属和瓷的厚度
so It gives greater uh flexibility to the restorative dentist in the laboratory 因此，这给实验室里的修复牙医带来了更大的灵活性
and It develops the proper emergence profiles 并且它开发了正确的涌现轮廓
which also can be very useful and advantage 这也可以是非常有用和有利的
On this case, we reviews the lingal set screw 在这个案例中，我们回顾了术语固定螺钉
but I as i've said, easily, this case could be cemented 但是我已经说过了这个案子很容易就能定下来
There's no need for a lingo set screw 不需要专门的固定螺丝
Unless you feel that there might be a future 除非你觉得会有未来
of value and easier retrieval ability than having to cut the restoration off 比必须切断恢复更有价值和更容易检索的能力
um Each apartment on a separate apartment substructure is that it's designed to engage 每个独立的公寓底层结构上的每一个公寓都被设计成
the head of the implant. So it's non rotational 植入物的头部。 所以它是非旋转的
so We can't use a non engaging environment to do this so uh 所以我们不能用一个不吸引人的环境来做这个，所以
and engaging ucla above and and engaging pro sarah 并参与加州大学洛杉矶分校和亲萨拉
and engaging preferable above, it would also all be 更好的是，它也会是
useful ways of managing this this situation 管理这种情况的有用方法
Here, a linked substructure gives other advantages 在这里，连接子结构具有其它优点
A one advantage is that 一个好处是
since we know 因为我们知道
the fit of the restoration to the linked substructure 对连接子结构的修复拟合
it always fits into orally 它总是适合口服的
The biggest challenge was separate 最大的挑战是分开的
Single units is if your impression is slightly off 单一的单位是如果您的印象是略有偏差
your master model isn't 你的主模不是
accurate as it needs to be 准确到了必要的程度
When you go to see your final restoration 当你去看你的最后修复
it doesn't fit the way you expected to 它不符合你期望的方式
with a linked substructure 有连接的子结构
The fit of the final restoration is always exactly the same intro orally as it is 最终修复的配合总是完全相同的介绍，因为它是口头
in the laboratory 在实验室里
and That's a great advantage 这是一个很大的优势
The only limitation might be a pontik 唯一的限制可能是一个教皇
that presses on soft tissue 会压迫软组织
and If you have trouble 如果你有困难
extraordinarily and seating it all the way because of that pressure 在那种压力下，他们会格外地坐在那里
you may have difficulty getting the restoration seated, but 你可能很难让修复师坐好，但是
you should know that and then take appropriate steps to get that uh pontiac area seated 你应该知道这一点，然后采取适当的措施让庞蒂亚克地区坐好
so I like the length substructures because 所以我喜欢长度的子结构，因为
I know if that 我知道如果
length substructure is fitting accurately against the implants 长度的子结构精确地与植入物配合
i'm sharing the load more. Predictably 我分担更多的负担。 不出所料
I don't have to wonder if I have an accurate fit of the restoration 我不需要怀疑我是否有一个准确适合的修复
When we have a length substructure 当我们有一个长的子结构
there's less chance of loosening of the apartment screws 公寓螺钉松动的可能性较小
that admittedly, as we've improved 无可否认，随着我们的进步
our implants has become less of an issue 我们的植入已经不再是问题了
Here's just an example of a case 这里只是一个例子的案件
where we see screw retained restorations on the patient left 我们看到病人左边有螺钉固定的修复体
but a length substructure on the patient, right 但在病人身上有一个长的子结构，对吧
Or with a full contour wax up 或者用全轮廓蜡
we realize we really need to create this link substructure to change some angulation issues 我们意识到我们真的需要创建这种连接子结构来改变一些成角问题
And then we can make the final restoration really ideal in terms of the buckling dimension 然后我们可以使最终的恢复真正理想的屈曲尺寸
The emergence profile, and the, other issues 突发事件概况，以及其他问题
the value of the length substructure 子结构长度的值
instead of separate crowns 而不是分开的皇冠
is that it will share the load more predictably 它将更有预见性地分担负载
We can also 我们也可以
hopefully plan for and execute 希望计划和执行
ideal hygienic spaces 理想的卫生空间
to allow the patient to clean these things more easily 让病人更容易清洗这些东西
just because we have a length substructure 就因为我们有一个长的子结构
that's not a license to go ahead and totally impinge on hygiene space 这不是一个许可证去进行和完全侵犯卫生空间
or to eliminate the patient's ability to clean these cases 或者消除病人清理这些病例的能力
Now, as I look at restorative implant dentistry 现在，当我看着修复种植牙
for me 对我来说
the keys are number one that 钥匙是第一位的
the uh surgeon and I work well together 外科医生和我合作得很好
that the surgeon understands my limitations, restorative 医生了解我的缺陷，恢复精力
They help uh communicate to the patient what those limitations might be 它们可以帮助病人了解这些限制是什么
and then I execute 我就会执行
this 这个
near ideal implant placement 接近理想的植入位置
or hopefully the ideal implant placement 或者希望是理想的植入位置
that allows me to achieve the result I want to have 这使我能够实现我想要的结果
so Number one is certainly is this surgical 所以第一名肯定是外科医生
biological understanding of where the implant needs to be 对植入位置的生物学理解
The next key for the restorative dentist is making an accurate model 修复牙医的下一个关键是制作一个精确的模型
I think one of the biggest mistakes that that's occurred in implant dentistry over the last few years 我认为最大的错误之一，这是发生在种植牙在过去几年
is an attempt to 是企图
what I called dumb down implant dentistry of the point that it's so simple 我所谓的“哑牙种植牙科”就是这么简单
Anybody can do it without thinking 任何人都可以不假思索地做这件事
well The problem with that is that we end up with 问题是我们最终得到的是
inaccurate impressions 印象不准确
that potentiates itself in in accurate master models 在精确的主模型中发挥作用
We make frame works and even into individual crowns that don't fit the same on the model as in the mouth 我们使框架工程，甚至到个别不适合模型相同的牙冠，因为在嘴里
As we started, dennis As we started, dennis
we we have that uncomfortable feeling of trying to make something fit or work 我们有一种不舒服的感觉，我们试图使一些适合或工作
We adjust restorations for hours trying to get them seated 我们调整恢复数小时，试图让他们坐下来
It is an uncomfortable situation and we start to dread it 这是一个不舒服的情况，我们开始害怕它
I can tell you quite honestly that once I realized how 我可以诚实地告诉你一旦我意识到
important the master model was to the whole restorative experience 重要的是掌握模式是整个修复经验
once I had the skills to achieve an accurate master model 有一次我掌握了准确掌握模型的技巧
implant dentistry was the thing we looked forward to 植牙是我们所期待的
When we see on our schedules that oh good, great 当我们看到我们的时间表，哦很好，很好
We got three implant cases coming in today 今天我们有三个植入病例
were much more relaxed and relieved than we are if we've got a prep 如果我们有准备的话会比现在放松得多
And that is a great transition 这是一个伟大的转变
and that's what we should all look for 这就是我们应该寻找的
So we need to examine impression techniques and we're gonna start at the beginning 所以我们需要检查下印象技巧我们要从头开始
And then i'll give you the skills so that you can take anywhere from 然后我会给你一些技巧，这样你就可以从
2to8to10to12 implants in one arch 2至8至10至12个种植体形成一个牙弓
and have the predictability that any restoration that fits that master model 并且具有任何适合该主模型的恢复的可预测性
will fit predictably in the mouth 会像预料的那样塞进嘴里
so For me 所以对我来说
the ability to make a predictable 使可预测的能力
accurate final impression is the key 准确的最终印象是关键
to making implant dentistry easy, predictable 使种植牙更容易，可预测
and successful 也很成功
There's no reason to make it hard 没有理由让事情变得困难
But sometimes 但有时
making it too simple, makes it much harder 太简单了，会让事情变得更难
And that's not our goal 那不是我们的目标
The first terminology and really understanding implants is also 第一个术语和真正理解植入也是
uh the ability to learn a new language uh 学习一门新语言的能力
to learn a new language of the 学习一种新的语言
components 组成部分
that we need to utilize 我们需要利用它
and There are different terms that are that are thrown about 有很多不同的术语被扔来扔去
One is an analog one is a replica 一个是模拟的一个是复制品
whatever it is, whatever we're taking 不管是什么，不管我们拿的是什么
the impression of extraordinarily we need and 我们非常需要的印象
analog of that component, a replica of that component 模拟该组件，复制该组件
so We can achieve our master model 这样我们才能实现我们的主模式
It might be at the involvement level 可能是参与的程度
It might be at the implant level 可能在植入水平上
A button analog we need, uh 我们需要一个按钮模拟，呃
whatever type of apartment we're using a multi unit development 不管我们用的是什么类型的公寓
uh A 呃A
easy above and a snappy above and 上面很容易，上面很有活力
We need the exact 我们需要准确的
intro, oral involvement 介绍，口头参与
analogue or replica to match with that 与之匹配的模拟或复制
For the fixture analog 夹具模拟
picture, meaning the implant for the implant analog 图片，表示用于植入模拟的植入
We need the same thing 我们需要同样的东西
We need an analog that matches the head of the implant 我们需要一种与植入物头部相匹配的类似物
It needs the same functionality 它需要同样的功能
The same retentive components are engaging components 相同的保持部件是接合部件
whether it's a hex or an internal try channel 无论是十六进制还是内部尝试通道
whatever it might be 不管是什么
we need those replicated 我们需要那些复制品
in the analog 在模拟世界里
When we have those things 当我们有了这些东西
we can generate a very accurate model 我们可以生成非常精确的模型
that will predictably allow us to achieve that restoration that will fit the same on the model 可以预见的是，这将使我们能够实现与模型相符的恢复
as it does in the in the mouth 就像在嘴里一样
Now 现在
we need to think about ways that we can transfer the 我们需要想办法把
relationship of the uh implant intro orally or the apartment intro orally 口腔种植介绍与口腔公寓介绍的关系
into our model 在我们的模型里
To do that 去做那些事
we use impression coping is probably the standard term 我们使用的印象处理可能是标准术语
We can take impressions with these coppings at the involvement level 我们可以从参与的层面来了解这些配料的效果
If we choose to use a multi unit development or a snappy above and replace them into orally 如果我们选择使用多单元开发或上面的snappy并将其替换为口头形式
we Then they need to take an impression at the development level 我们然后他们需要在发展水平上采取一个印象
Many times though uh just to get a little bit ahead of myself 很多次只是为了超前一点
My preference is to take an implant level impression 我的选择是采取植入水平的印象
I don't like to look at a patient and guess what kind of apartment would best serve that patient 我不喜欢看着病人猜什么样的公寓最适合那个病人
Sometimes it is straightforward 有时是直截了当的
but many times on our challenging aesthetic cases 但很多次在我们富有挑战性的美学案例中
it's very difficult to predict exactly what development would be ideal 很难准确预测什么样的发展是理想的
so When we take the impression at the implant or fixture level 所以当我们在植入物或固定物的层面上观察印模时
were able to in the laboratory examine all the options to get input from 我们能够在实验室中检查所有输入选项
various experts sources 各类专家来源
so that we can achieve the best restoration for the patient 以便我们能为病人实现最好的恢复
The other thing and it's really not another category, but 另一件事其实不是另一个类别，但是
a way to achieve the highest level of impression accuracy 实现最高水平的印象准确性的方法
is to use what we call linked impression coping 就是使用我们所说的关联印象处理
linked impression coping 相关的印象处理
Give us the predictability and the accuracy required 给我们所需要的可预测性和准确性
to have a master model 拥有一个大师的模型
that will allow us to create the restoration we're striving to create 这将使我们能够创造我们正在努力创造的复原
So in impression coping 所以在处理印象方面
uh let's begin at the bottom level can be open or closed tray 我们从最底层开始，可以打开或者关闭托盘
The open tray coping is required and opening in the tray 需要打开托盘顶盖，并在托盘中打开
so some part of the impression coping will stick 所以印象中的某些部分会粘在一起
through the tree 穿过那棵树
allowing us to access that after the impression is set 允许我们在设置好印象之后访问它
I'm screwing that 我要搞砸了
and so We can remove the impression 所以我们可以去除这个印象
the other type of impression coping 另一种类型的印象处理
is The 是什么
Closed ray impression coping 封闭射线压痕顶盖
This allows us to screw an impression coping directly to the head of the implant 这允许我们将印模顶盖直接拧到植入体的头部
And then we use a close tray or a stock tray 然后我们使用一个封闭的托盘或一个库存托盘
take an impression, snap the impression out of the mouth 取一个印子，把印子从嘴里取出来
and then transfer the close trade impression 然后转移紧密的贸易印象
coping into the impression 与印象相符
for two basic different types 两种基本的不同类型
and We need a different type of impression coping for every different type of development that we run into 我们需要一种不同类型的印象来应对我们遇到的每种不同的发展类型
so Just as i've been talking 就像我一直在说的
you can start to pick out the meaning with these terms that we use to refer to these types of impression coping 你可以开始找出这些术语的含义，我们用这些术语来指这些类型的印象处理
A close tray impression coping means 一种封闭托盘压顶装置
that there's no aspect of that coping that requires loosening while the trays in place 当托盘放在适当的位置时，没有需要放松的方面
Basically, we screw on the coping, take an impression 基本上，我们在顶部拧，采取一种印象
the impression out 印象消失了
and then access the coping. So a closed tray 然后进入到顶部。 所以是个封闭的盘子
A closed tray coping requires transferring after the impression is made, we must unscrew it from the mouth 封闭的托盘顶盖需要在印模完成后进行转移，我们必须将其从口腔中旋出
and transfer it into the impression 把它转换成印象
The shape of the coping needs to be non retentive 顶部的形状需要是非保持性的
tapered 锥形
so that we can pop the impression over the top of it without tearing or breaking the impression 这样我们就可以在不撕裂或破坏印痕的情况下将印痕从它的顶部弹出
so Those are the classic terminology is used to describe this type of impression coping 所以这些是用来描述这种类型的印象处理的经典术语
Close tray 关闭托盘
We transfer the coping 我们转移了顶盖
It's usually of a taper shape 它通常是锥形的
Here's an example of a case, kind of a classic case 这是一个案例，有点像经典案例
I'm choosing a case with apartments that are actually super changeable 我选择的是一套公寓实际上是超级多变的
Just so you could see everything more clearly 只是为了让你看得更清楚
The patients come in, the apartments are in place 病人进来了，公寓也准备好了
We remove healing caps 我们移除治疗帽
we connect these 我们把这些连接起来
close tray and pressure and coping 关闭托盘、压力和顶盖
After they're connected 在联系上之后
we can use any a last american pressure material 我们可以使用任何最后的美国施压材料
On this case 在这个案子上
just for kind of a diagnostic model we're using alginate 作为一种诊断模型，我们使用藻酸盐
The alginate needs to be well adapted around the coping 藻酸盐需要很好地适应周围的顶部
We snap the allerout of the mouth 我们把嘴巴里的过敏原去掉
We carefully 我们很小心
unscrew each of the 拧开每个
closed ray impression copings and connected for to an analogue 闭合射线印模复制并连接到类似物上
for that individual apartment 为了那个公寓
Once it's connected, the analog serves as a handle 一旦连接上，模拟机就成了手柄
to slowly snap each of those impression copings into place 慢慢地将这些印象拷贝按到位
and then We can pour 然后我们就可以倒了
a model that's admittedly not perfectly accurate 一个不完全准确的模型
There's a lot of places where air can occur 有很多地方会有空气
especially using alginate 尤其是用藻酸盐
But it gives us an a model that's probably more accurate than you expect 但它给了我们一个比你想象中更精确的模型
Now, the second type of impression coping 现在，第二种类型的印象处理
requires an opening in the tray 需要在托盘中打开
so that this retaining screw to the coping 所以这个螺丝固定在顶盖上
it will extend above it or allow access 其将在其上方延伸或允许访问
to the coping after the impression is set 给人留下印象后的应对
so This is what we refer to as an open tray impression coping 这就是我们所说的开放式托盘印象顶部
The coping 应对之道
becomes locked into the impression. So it's 就会给人留下印象。 所以
picked up 捡起来
the only way it can be picked up 唯一能把它捡起来的方法
But this type of coping is to remove the screw or loosen the screw. Once the screw is loosened 但是这种类型的顶盖是用来拆卸螺钉或松开螺钉的。 一旦螺丝松开
It can be picked up 它可以被捡起来
It never leaves the impression 从来不会留下印象
Its shape must be square or in some way 它的形状必须是方形或以某种方式
So it gets locked into the impression 所以它被锁定在印象中
So I even like to think of them as locking, impression 所以我甚至喜欢把它们看作是锁，印象
coping 应对
because because, it becomes locked into the impression 因为，它被锁在印象里
so Again, from a descriptive point of view 所以，再一次，从描述的角度
we require an open tray 我们需要一个开放的托盘
They need to be picked up 他们需要被抓起来
And their shape needs to be 它们的形状需要
locking or squared so that it will lock into the impression 锁住或弄方，以便锁住印痕
Here's an example of that sort of impression 这里有一个这样印象的例子
where we will take the uh squared or open tray impression coping 我们会把方型或开放式托盘的顶部
connect them to our apartments intro orally 把他们和我们的公寓联系起来
They're held in place with a separate guide pin 它们由一个单独的导向销固定
We see our custom tray or even a plastic stock tray that has holes cut into it 我们看到我们的定制托盘，甚至是塑料原料托盘，上面有很多洞
over the top 太过分了
And we all have that moment of anxiety where we make sure that we can find 我们都有过这样的焦虑时刻，我们确信我们能找到
each of the retaining screws 每个固定螺钉
to make sure that we can actually remove the impression afterwards 以确保我们能在事后真正消除这种印象
After the impression is set 在印痕形成后
we carefully loosen all the retaining screws 我们小心地松开所有固定螺钉
We lift our impression out of the mouth and we can see the inferior border 我们把嘴上的印子取出来,就可以看到下边的边界
of the impression coping that has become picked up 给人的印象越来越深刻
indoor impression or locked 室内印痕或锁痕
into the impression 给人的印象
and Then we can connect analog 然后我们可以连接模拟
and eventually poor and accurate model 最终很差很精确的模型
But the question remains with these. How accurate is it 但问题仍然是这些。 它有多准确
All right 好吧
Not to confuse the issue but an important distinction to make 不是为了混淆问题，而是为了做出一个重要的区别
is that there is 1 type of coping 有一种应对方式
that is essentially a closed rate 这基本上是一个封闭的利率
Coping 应对
But it behaves as a pickup coping 但它的表现就像是一个拾荒者
and That's the coping that we use for our 这就是我们用来应对我们的
easy involvement or snappy about men 容易卷入或对男人粗暴
Or we can snap a plastic coping in place over the top of the apartment 或者我们可以在公寓的顶部折断一个塑料顶盖
inject impression material inject impression material
use a closed tray and then pick it up 使用一个封闭的托盘，然后拿起它
So to run through this impression copenhagen 所以在哥本哈根的印象中
we see the apartment in place 我们看到公寓就在那里
We can snap on the coping 我们可以按一下顶部
and We make sure that it is fully seated on the embodiment 并且我们确保它完全位于该实施例之上
without regard to how far subchangeable it is, but ideally 不管它有多大的可替代性，但理想的情况是
it should only be a millimeter, at most subchangeable 它应该只有一毫米，最多是可互换的
We then inject the, impression material 我们然后注入，印模材料
Once the the tray, the closed tray is seated 一旦托盘就位，封闭的托盘就就位
Once it's set 一旦设定好
we can pop the impression out of the mouth and we notice that we've picked up 我们可以从口中弹出印象，我们注意到我们已经学会了
the margin of the apartment 公寓的边缘
into that restoration 参与修复工作
We can then take an analog 然后我们可以用类似的
snap it into our impression 给我们留下印象
and poor and accurate 又穷又准
Final model 最终型号
so This is the only example of a 所以这是唯一的一个例子
close tray pick up 关闭托盘接收
coping, so not to confuse things 为了不把事情搞混
Now, the next level that i'd like to talk about 现在，我想谈的下一个层次是
is the fixture level or the implant level to me 对我来说是固定水平还是植入水平
This is one thing that every restored of dennis needs to master 这是每一个丹尼斯修复需要掌握的一件事
to be able to use a cad cam type restoration to be able to make a custom restoration 能够使用cad cam型修复器能够进行自定义修复
This is the way to proceed 这就是前进的道路
If you have an idea that you can put apartments in the mouth and then prep them in the mouth 如果你有一个想法，你可以把公寓放在嘴里，然后准备他们在嘴里
you're really missing the 你真的错过了
and making implant dentistry so much more difficult 使得种植牙科更加困难
And maybe 或许
not achieving the best possible result 没有达到最好的结果
The key here is that we're making the impression directly to the fixture 这里的关键是我们的印象直接到夹具
There is no apartment in place and that's the only thing we need to know 没有合适的公寓，这是我们唯一需要知道的事情
I prefer 我更喜欢
whenever we're connecting 不管我们什么时候联系
especially an impression coping substantially 尤其是基本的印象处理
that we take an x ray 我们要拍一张x光片
Many people say that you know with some of these new uh 很多人说你知道一些新的
implants or the newer types of implants 植入物或更新类型的植入物
there's no need for that 没必要那样做
But 但是
I can guarantee to you sooner or later 我迟早可以向你保证
they'll be an issue that the impression coping isn't fully seated. So I think there's value there 这将是一个印象应对不完全到位的问题。 所以我觉得有价值
The coping, as we've discussed, the same terminology applies 正如我们所讨论的，应对也适用于同样的术语
can be open or closed tray 可打开或关闭托盘
uh This impression will achieve a implant level of model 这个印象可以达到植入模型的水平
that will allow us to use a canned camp type restoration 这将使我们能够使用罐装的营地类型修复
aucla apartment type restoration aucla apartment type restoration
whatever custom development or custom substructure 无论是习俗发展或习俗的基础
we're hoping to achieve 我们希望实现
so First, let's look at a fixture level, close tray 所以，首先，让我们看看一个夹具的水平，关闭托盘
and The first thing you might notice 你可能会注意到的第一件事
is that there is a 2 piece 就是有一个2块的
impression coping, even though it's a closed tray 印象处理，即使是一个封闭的托盘
Once it's assembled 一旦组装好
it looks very much like the taper impression coping 它看起来非常像锥度压顶
There's no locking components to the 没有锁定组件到
to the coping 为了应对
We realize we need the 2 pieces, because 我们意识到我们需要两件，因为
ideally, we should engage 理想情况下，我们应该参与进来
the components on the head of the implant that are non rotational 植入物的头部上的非旋转的部件
so A hex headed implant 所以一个六角头植入物
We need to engage the hex, a replace implant 我们需要使用六角，一种替代植入物
We need to engage the try channel 我们需要启动试播频道
The only way we can do that is to have a 2 piece apartment 我们唯一能做的就是有一个两件套的公寓
so The shape allows it to stay in the mouth 所以它的形状使它能留在口中
We can use a closed tray 我们可以用一个封闭的盘子
We can snap the impression out 我们可以消除这种印象
but we we need to have a 2 piece impression coping to do that to allow registration 但我们需要有一个2件的印象处理，这样才能让注册
We can also use some components 我们也可以使用一些组件
uh impression coping is that don't engage 呃，印象处理就是不要太投入
the head of the implant 植入物的头部
But these are limited in its use 但这些在其使用中是有限的
and will only allow us to do bridges 只允许我们建造桥梁
And from a laboratory point of view, sometimes 从实验室的角度来看，有时
give us gives us problems 会给我们带来麻烦
So 所以
we rarely will use that sort of above and 我们很少会使用这种上面和
kind of a flow here 有点像在流动
We have a 我们有一个
fixture level impression coping, seated 固定装置级压痕顶盖，就坐
We notice that there's a screw coming out of that coping 我们注意到顶盖上有个螺丝钉
So we realize it's an open tray 所以我们意识到这是一个开放的托盘
When we seed our tray 当我们播种我们的托盘
we will have an impression coping 我们会有一个印象处理
that needs to have access to this screw 必须能接触到这个螺丝钉
to remove it from the mouth 把它从嘴里取出来
Once it's removed 一旦被移除
we can add our analog and we can pour an accurate master model 我们可以添加我们的模拟，我们可以倒一个准确的主模型
uh Here's another example of a case 这是另一个案例
Quite often we begin with the healing involvement in place 我们通常从治疗开始
We remove the healing above and and connect 我们移除上面的愈合和连接
our fixture level 我们的比赛水平
open tray, impression coping 打开托盘，压印器
Take an x ray to verify its seat 照一张X光片来确定它的位置
uh Once it's set as an impression, we undo the screw 一旦它被设置成一个印记，我们就可以拧开螺丝了
we lifted out of the mouth 我们把他从嘴里救出来
and We notice that we've picked up the impression coping into our impression 我们注意到我们已经把印象融入了我们的印象
and then we can proceed to add the analog and hopefully pour an accurate master model 然后我们可以继续添加模拟，并有希望建立一个准确的主模型
Now, and that's really 现在，那真是
hopefully is the key term there 希望是这里的关键术语
especially uh for one implant 尤其是一个植入物
literally a closed technique and open technique 一种封闭的技术和开放的技术
will give you a very reasonable and very workable master model 将给你一个非常合理和非常可行的主模型
But as we progress to anything more than one 但随着我们的进步
questions exist on how accurate that relationship is 人们对这种关系的准确性存在疑问
We could use every skill that we have we could see 我们可以利用我们所掌握的所有技能
transfer, impression coping or, close to impression coping 转移、印象处理或接近印象处理
We can have the laboratories split them together extra extra early in the impression 我们可以让实验室在印象中很早就把它们分开
uh to keep any expansion of the impression material from moving them or vibration, causing them to shift 以防止印模材料的任何膨胀，使其移动或振动，导致其移动
We can achieve a master model 我们可以实现一个主模型
But i'm gonna tell you that probably the most accurate 但我要告诉你这可能是最准确的
technique will only give you maybe a 75% accuracy 技术只会给你75%的准确率
that would allow you to have the exact representation of 它能让你准确地描绘出
what we have intro orally 我们的口头介绍
And that's probably being generous 这可能是很慷慨的
so There's an unknown 所以有个未知数
yeah You say, 3/4 of the time. That's a great model 是的，你说，四分之三的时间。 很棒的模特
But when is it great 但什么时候才是最棒的
Now it requires a certain amount of unpredictability 现在它需要一定程度的不可预测性
So that when they restarted, dennis goes to the mouth 所以当他们重新开始，丹尼斯去嘴
they have to ask, will my 他们一定会问，我的
crowns fit 牙冠配合
Even if I have interproximal contacts 即使我有邻间接触
well they'd be heavy or open 它们要么很重要么是开着的
I have unknown I don't like unknown 我有未知我不喜欢未知
If i'm doing a bridge, will I have to solder 如果我做一座桥，我必须焊接
well I have to separate that unit 我得把那个小组分开
and That's a great 这是一个伟大的
Sometimes difficulty in terms of evaluating that 有时很难对其进行评估
How do we know that the master models accurate 我们如何知道主模型是否准确
You might say 你可能会说
well let's use closed trait that should be more accurate 那么让我们使用封闭的特征，应该更准确
Yes, it should be 是的，应该是
but there's still literally hundreds of points 但还是有几百个点
where we can have air 在那里我们可以呼吸空气
and So 所以
Closed 关闭
tray and open trade both 托盘和开放贸易都有
sometimes end up with about the same error rates 有时会出现相同的错误率
You could make an argument that an open trade 你可能会说一个开放的交易
is slightly more accurate 更精确一些
but still there's the unknown and the lack of predictability 但还是有未知的和不可预测的
For many years, we used to um 很多年来，我们
teach the need to do 教导做事情的需要
a soldering to go into the mouth with separate units 用单独的单元焊接到嘴中
link them together 把他们联系在一起
And then soldering is not a perfect science 焊接不是一门完美的科学
and there's certainly certainly air that comes from soldering 焊接时肯定会产生空气
It also adds a great deal of chair time 它也增加了大量的主持时间
and more unpredictability 更多的不可预测性
so My goal is not to solder and wonder if I can make it fit 所以我的目标是不焊接和不知道如果我可以使它适合
Let's make an accurate master model 让我们做一个精确的主模型
How should we do it? And that's the key 我们该怎么做？ 关键就在这里
We can go back to the original brand of mark lectures 我们可以回到马克讲座的原始品牌
that talked about using a mass of derylade to link the copings together 他们说要用大量的derylade来把这些拷贝联系在一起
Our only issue with that is really maybe the material do we have a more accurate material 我们唯一的问题是，我们是否有更精确的材料
and using a massive acrylic all at once 同时使用大量的丙烯酸
has a certain amount of shrinkage 有一定的收缩量
and linking them together in that way is probably not ideal 以这种方式把它们联系在一起可能并不理想
so Could we come up with some some techniques 所以我们能不能想出一些技巧
Maybe a technique first that's more efficient from a chair side point of view 从椅子的角度来看，可能先有一种更有效的技术
so that we can link the coatings together with the minimum amount of chair side 这样我们就可以用最少量的椅面将涂层连接在一起
with the most accurate type of restoration 最精确的修复方式
Finally, out coming 总算出来了
so Let's look at this fairly simple flow here 让我们看看这个相当简单的流程
I call this linked coping's uh technique one 我把这个叫做关联应对技巧一
Link coping is one 链接应对是其中之一
Again, i'm choosing a case that is super changeable 再说一次，我选择的是一个变化多端的案子
super tangible apartments just so that you can see everything that's occurring very easily 超级有形的公寓只是让你可以看到一切发生的非常容易
what the same technique could be done at the implant level 同样的技术可以在植入水平上做什么
And that's quite honestly where i'm usually doing this 老实说，我通常都是这么做的
Here we see very simply 在这里我们看到很简单
we've added on some closed tray impression coping 我们增加了一些封闭的托盘
You can realize that just from the shape of them 你可以从它们的形状上认识到
there is no separate component that would allow them to be unscrewed 没有单独的部件允许它们被拧松
After you see the impression tray 在你看到印像托盘之后
we see it an impression 我们认为这是一种印象
This happens to be an allergen it's something 这碰巧是一种过敏原它的东西
just quick and easy 又快又简单
uh We can then remove 然后我们可以移除
the impression coping's from the mouth 印象是从嘴巴来的
transfer them into the impression 把它们转换成印象
by connecting them first to an analog 通过将它们首先连接到模拟
and then we can generate a model 然后我们可以生成一个模型
If you look at this 如果你看看这个
basically we've invested maybe 5 minutes 基本上我们已经投入了5分钟
maybe 10 minutes of chair side time 可能需要10分钟的椅子时间
So this is a quick and easy 所以这是一个快速简单的
It gives us a good model 它给了我们一个很好的模型
especially if we're doing an existalist case 尤其是当我们在做一个存在主义的案子
we have the landmarks, we need the retro molar pads 我们有地标，我们需要后臼齿护垫
We have lingual and buckle extension 我们有舌形和带扣延长
We have the ability to create an accurate custom tray 我们有能力创造一个准确的定制托盘
and We have a reasonable idea where all the implants are 我们有一个合理的想法，所有的植入物都在哪里
This model will allow us to 这个模型将允许我们
create an accurate custom tray 创建精确的自定义托盘
We'll remove the 我们会把
transfer copings from that model 从模型中转移拷贝
We will connect the open trade, coping 我们将连接开放贸易，应对
We'll go ahead and 我们继续
link them together on this model 在这个模型上把它们联系起来
and I often use just triad material 我经常用三合会的材料
link them together very quickly 很快就把它们联系在一起
And then the key here with this technique 然后这个技术的关键
is that you section them apart 你把它们分开
So when you go to the mouth 所以当你到嘴边
there's a very small junction between each one of these customized 在这些定制的每一个之间有一个非常小的连接
open tray, impression coping 打开托盘，压印器
I like to number them so that when I carry them to the mouth 我喜欢给它们编号，这样当我把它们送到嘴边的时候
I know where each one of them goes 我知道他们每个人去哪
We go to the mouth 我们到了嘴边
and The key here is that as we tighten them 这里的关键是当我们收紧时
there should be a space between each of the coping 每个顶盖之间应该有一个间隔
Because if they're touching 因为如果他们在接触
we realize that there is no confidence 我们认识到没有信心
that they're seated completely 他们完全坐好了
After they're seated 在他们坐下来之后
there's a space between each one 每个人之间都有一个空间
Hopefully the space is very small 希望空间很小
Essentially, the thickness of a business card 基本上，名片的厚度
We then loop them together or link them together 然后我们将它们循环在一起或将它们链接在一起
Quite often, uh today 很常见，呃今天
my um medium of choice is gc pattern resin 我选择的um介质是gc型树脂
You could use flow of all like your composite 你可以使用所有像你的合成流
You could use a sinopec material 你可以用中石化的材料
whatever works best in your office 任何在你办公室最有效的方法
Now i'm gonna show you and 现在我要给你看
and adjacent technique to this 以及与此相关的技术
If you have doubts about your laboratories ability to generate an accurate model 如果你怀疑你的实验室有能力生成一个精确的模型
what you might do is take these linked coping 你要做的就是把这些联系起来
We'll take them out of the mouth 我们要把它们从嘴里取出来
and will pour a registration of this index 并将此索引进行登记
so that we can later evaluate our master model to make sure that there wasn't some sort of laboratory error 以便我们可以稍后评估我们的主模型，以确保不存在某种实验室错误
that led to an inaccurate master model 这导致了一个不准确的主模型
So 所以
Chair side will disconnect 椅面将断开
these linked copings 把这些联系起来
But since they're just held in place by these guide pins 但是因为它们是由这些导向销固定的
we can undo the pins 我们可以松开别针
remove it from the mouth 把它从嘴里拿出来
connect them to an analog that matches that case 将它们连接到与该情况匹配的模拟
run into the lab 去实验室看看
and We can pour 我们可以倒酒
this registration, and I like to use intro, oral plaster 这个注册，我喜欢用介绍，口腔膏药
I'm not using it intro orally 我不会用口头介绍的
I'm just using it in the laboratory because it sets 我只是在实验室里用它因为它会凝固
And basically about 5 minutes 基本上就是5分钟
So it's intro, oral plaster type two 所以是第二类口腔石膏
not laboratory quickset that takes about 30 minutes 不是需要30分钟的实验室速成
but intro oil plaster type two 但介绍油膏类型二
We now have this 我们现在有了这个
uh registration of my exact position of the implants 我植入位置的准确记录
So later I can evaluate my master model 所以以后我可以评估我的主模型
I'll tell you honestly that I don't do this component anymore, because I have such confidence in my laboratory 老实告诉你，我不再做这个部件了，因为我对我的实验室很有信心
but It's up to you to evaluate that 但这取决于你的评估
within 内部
place this linked coping back in the mouth 把这个相连的顶盖放回嘴里
While the registration is setting 当登记开始的时候
i'm quite honestly borderline in my tray 老实说，我在我的托盘边界
I'm ready to take the impression I fill it with 我准备好接受我的印象了
See it 去看看吧
One other little technique thing is make sure that that coping is dry 另一个小技巧是确保顶部是干燥的
blow air on it 在上面吹气
so that when you put your impression material on it 所以当你把你的印象材料放在上面
you have a good 你做得很好
tight interface between the impression material 印模材料之间的紧密界面
and the coping 以及应对方式
After the material is set 在材料凝固之后
you need to loosen each of the screws 你需要松开每个螺丝
You lift the impression out of the mouth, you turn it over 你从嘴巴里拿出牙印，把它翻过来
and You can actually see the 实际上你可以看到
the underside of each coping and you evaluate to be sure no impression material was between the coping 每个顶盖的底面，并确保顶盖之间没有印模材料
and the involvement or the implant 以及介入或植入
If there is, that implies 如果有，那就意味着
but that coping wasn't fully seated and you really should reject this 但是你的应对并没有完全到位你真的应该拒绝这个
uh impression 呃印象
We then can go ahead and take analogue 然后我们就可以进行模拟了
Now, it is important 现在，这很重要
that the laboratory use good analog that you evaluate the analog 实验室使用良好的模拟，你评估模拟
that you've already evaluated your impression material 你已经评估了你的印象材料
Your impression are coping to be sure that they're not damaged 你的印象是为了确保它们没有被破坏
so that you can um 所以你可以
connect these components together accurately without any problems 准确无误地将这些部件连接在一起
Once they're connected 一旦他们有了联系
uh carefully 呃，小心点
we can go ahead and pour the model 我们可以继续做这个模型
and Now I can tell you in our experience 现在我可以用我们的经验告诉你
we've generated a master model 我们已经生成了一个主模型
that has always given us 一直给予我们的
a final restoration that fit exactly in the mouth 完全适合口腔的最终修复
The way that it did, um yeah 就像它那样，嗯是的
In the model 在模型里
the situation 形势
we can also have a proof 我们还可以有证据
an index of that registration so that we can evaluate 一个我们可以评估的注册索引
how they uh developed our master model and make sure that it's accurate 他们是如何开发出我们的主模型并确保它是准确的
It took a long time to talk about this technique 谈论这项技术花了很长时间
but if you if you evaluate a chair side time 但如果你评估一下椅子旁边的时间
it was actually quite minimal 实际上是很小的
There was only a very short amount of chair side time 只有很短的时间坐在椅子旁边
less than an hour 不到一小时
to generate a full large model that you're 100% confident 生成一个你100%确信的完整的大型模型
will give you an accurate final restoration 会给你一个精确的最终复原
Okay 好吧
Now 现在
another variation to that technique and let's just be honest 另一种方法，让我们实话实说
there's times we're not perfect. We don't have a 有时候我们并不完美。 我们没有
open trade openings order 开放贸易开放订单
We didn't have time to make linked coping 我们没有时间做相关的应对
Patient comes in and all we have in the office are closed 病人进来了，我们办公室里所有的人都关门了
trade, impression, coping 贸易，印象，应对
And we want to take a final impression 我们想给大家一个最后的印象
We decided to give it a shot 我们决定尝试一下
we Uh 我们呃
Place the uh 把呃
closed train, and pressure, coping 封闭的火车，压力，应对
we could We use a good 我们可以我们用一个好的
accurate impression material like a polyvinyl cyloxine 精确的印模材料就像聚乙烯基氧
We take the impression 我们接受这个印象
we've used good impression copings 我们用了很好的模仿手法
hopefully maybe even new impression coping 希望能有新的应对方式
We know they were a seated. Well 我们知道他们是坐着的。 嗯
We we evaluate our impression to make sure we have good 我们评估我们的印象以确保我们有好的
uh connection between the impression material and the impression coping 印象材料和印象处理之间的联系
After we pop it out of the mouth 在我们把它从嘴里吐出来之后
we make sure no debris gets into all these little impressions of each impression coping 我们要确保没有碎片进入每一个印象的这些小印象中
We transfer them carefully into the impression 我们仔细地把它们转换成印象
We use every impression technique out 我们用所有的印象技巧
preparing that we have. The laboratory is very meticulous 为我们所做的准备。 这个实验室非常细致
We get a model that we think there's a chance we could use 我们得到一个我们认为有机会使用的模型
but I still feel we shouldn't progress on and make a restoration and hope that'll fit 但我仍然觉得我们不应该继续前进，不应该进行修复，也不应该寄希望于它能适合我们
so What I suggest that you do 所以我建议你
is you use the length coping technique 你用的是长度处理技巧
to on the model and then carry it to the mouth 把它放在模型上，然后送到嘴边
to check 去检查一下
that we are accurate 我们是准确的
so on the model where you might use the exact same technique 所以在这个模型中，你可以使用完全相同的技术
We'll put the uh 我们会把
open tray impression copings on the model 模型上的开放式托盘印模
will make a triad material 会成为黑社会的材料
a framework to link them together. It 将它们联系在一起的框架。 信息技术
relink them 把它们重新连接起来
carry it to the mouth 把它送到嘴边
and carefully evaluate the fit 仔细评估是否合适
and The thing I always tell people is that for me 我总是告诉人们，对我来说
if it fits, I know it almost immediately 如果合适，我马上就知道了
If I wonder if it's fitting 如果我想知道它是否合适
if it kind of I have to tighten screws or 如果我得拧紧螺丝或者
twist things or play with it 扭转东西或玩它
It probably is inaccurate 它可能是不准确的
and So quickly, i'll make a decision 这么快，我来做个决定
I'll go ahead and separate this thing into its components 我要把这个东西分成几个部分
and I'll go ahead and use the exact same technique and take a master model 我将使用完全相同的技术来制作一个主模型
But if it fits perfectly 但如果它很合适
in a very few minutes, i'll know that it's accurate 再过几分钟，我就会知道它是准确的
And I can go ahead and trust that master model 我可以继续相信那个大师模型
So I think this is a useful 所以我认为这是一个有用的
satellite technique if you ever have doubts 卫星技术，如果你有怀疑的话
Now my partner doctor parvis for came up with a technique 现在我的搭档帕维斯医生想出了一个技巧
I think that's very interesting and i'd like to share with you 我认为这是非常有趣的，我想与你分享
Here in this technique 在这个技巧里
all you need to begin with is an impression of the healing apartments 你需要做的就是给人留下疗愈公寓的印象
We need to know where the implants are 我们得知道植入物在哪
Before we begin, we don't need 在开始之前，我们不需要
that first preliminary impression, though 不过，第一个初步印象
Here we're gonna make a custom trade that is basically right 在这里我们要做的是一个基本正确的定制贸易
at tissue level 在组织层面
There's no vertical height to it 它没有垂直高度
because we want the impression coping 因为我们要的是应对印象
to stick through the impression trade 坚持通过印象行业
We'll go to the mouth 我们会到嘴边的
will remove the healing apartments and connect, in this case 在这种情况下，将拆除疗愈公寓并连接起来
fix your level or implant level impression coping 固定你的水平或植入水平印象应对
I would suggest that you always take an x ray at this level 我建议你一定要照这个水平的X光片
to make sure that they are fully seated 以确保它们完全就位
Once you're confident of that 一旦你有了信心
We then take that custom tray and we go over the top of this 然后我们拿着定制的托盘，越过这个顶部
because the implants may be at an angle 因为植入物可能有一个角度
it may not draw easily off over the top of these impression coping 它可能不会轻易地越过这些印象的顶部
and so We need to enlarge the access holes 所以我们需要扩大入口
until it will draw easily 直到它将容易地画
We'll also boredom, the tray as is necessary 我们也会觉得无聊，盘子也是必要的
When this is the tricky part, when we take our impression 当这是棘手的部分，当我们采取我们的印象
we need to really wipe the impression material off of the impression coping 我们需要真正地擦掉印象处理中的印象材料
and off of the tray in the area directly surrounding the impression coping 并且离开直接围绕印模顶盖的区域中的托盘
The goal is then to take gc pattern resin 然后，目标是获得GC图案树脂
and with a liquid powder technique in a small brush 在小刷子上用液体粉末技术
to pick up liquid powder, a little 去拿些液体粉末，一点点
a bit of gc pattern resin and make a little dab 一点gc图案树脂，做一点dab
Maybe in the most um 可能在大多数时候
medial portion of the tray 托盘的中间部分
and then we will proceed uh down 然后我们会继续下去
to the opposite end of the uh impression tray 在印模托盘的另一端
and We will achieve 我们将实现
a little dab of gc pattern resident in that way 以这种方式驻留的gc模式的一些dab
and so we'll slowly work back and forth across the impression tray 所以我们会慢慢地在印模托盘上来回移动
until we can link 在我们联系上之前
the impression copings to each other as well as to the tray 印象相互吻合，就像托盘一样
The key here being, you don't take a big mass of gc pattern 这里的关键是，你不需要大量的gc模式
resonance and just stick it on all at once 一次把所有的东西都粘上
because then we have a significant amount of shrinkage 因为这样我们就会有大量的收缩
By the time we're linking them to each other 当我们把他们连在一起的时候
the material has stabilized and doesn't shrink as much 材料已经稳定并且不会收缩太多
After it's fully set the gc pattern resin and we've linked the coping's to the tray 在它完全固化后，我们已经把顶盖和托盘连接起来了
we then carefully remove the screws or loosen the screws 然后小心地拆下螺钉或松开螺钉
lift the impression out of the mouth 把牙印从嘴上取下来
at our analog 在我们的模拟里
And then the laboratory technique for pouring the model is very critical 因此，模型灌注的实验技术是非常关键的
so We have an accurate model and 所以我们有一个精确的模型
This also achieves an accurate model 这也实现了精确的模型
Here's another example of the same technique 这里是另一个相同技术的例子
Here's an example 我举个例子
a unilateral case that did have six implants 一例单侧植入了六枚
We made a fairly general opening in a custom tray 我们在一个定制的托盘上开了一个相当大的口子
Usually I like it a little bit more accurate than this 通常我喜欢它比这个更精确一点
but We went ahead and made a fairly general opening 但我们还是做了一个大致的开场
make sure we can see the tray 一定要让我们看到盘子
took an impression 给人留下了印象
wiped off as much of the impression material as we could 尽可能多的擦掉印痕材料
and then link the coping to the tray 然后把顶盖连接到托盘上
and This was admittedly for me the first time I used the technique 不可否认这是我第一次使用这种技术
After we take the impression we put the healing apartments back in place 在我们接受这个印象后，我们把疗愈公寓放回去了
our our impression we remove, we go to the lab 我们的印象被移除了，我们去了实验室
we connect analog and the laboratory will pour 我们接通模拟机,实验室就会来
this accurate model, usually a soft tissue cast 这种精确的模型,通常是软组织铸型
so that we're not damaging the model just trying to remove the impression coping 这样我们就不会破坏模型，而只是试图消除印象
For me, on this case 对我来说，在这个案子上
I had doubts I had doubts about its accuracy 我怀疑我怀疑它的准确性
so One technique, as we've already described, is to put the 一种技术，正如我们已经描述的，是把
open tray impression coping is on this model 开放式托盘压顶是基于这个模型
And lincoln together 和林肯在一起
and I used a technique here that I actually use into early quite a bit 我用了一种我很早就用到的技术
with the uh floss running between the different coatings 不同的涂层间有不同的牙线
taking just a dab of gc pattern 只采用简单的gc模式
A pattern resident at a time slowly building up this framework of agc pattern resin 一次停留的图案慢慢地建立了agc图案树脂的框架
not a big mass of acrylic all at once 不是一次就有一大块丙烯酸
Once it's said 一旦有人说
and fairly rigidly set so that there's no fletcher in this framework 并且相当严格地设置，使得在这个框架中没有Fletcher
I can carry it to the mouth 我可以把它送到嘴边
and We'll go ahead and evaluate the fit 我们会继续评估是否合适
and Here was a great 这是一个伟大的
feeling for me in the realization that this check 感觉到我意识到这张支票
That's so accurately 你说得太对了
Both from the terms of i've proven my master model 我已经证明了我的主要模型
but also for the technique I used to generate 也是我用来产生的技术
this index 这个索引
to evaluate the fit in the mouth 评估在口腔中的贴合性
now I know I have a lot of different techniques 现在我知道我有很多不同的技术
to have an accurate master model 有一个精确的主模型
and I can utilize what's best for any given patient 我可以利用任何病人的优势
Here's an example of a case 下面是一个案例
With, let's say, multi unit type of apartments 比如，多单元类型的公寓
they'll be a gold cylinder and a restoration above that 它们将会是一个金色的圆柱体和上面的修复体
In your mind, do you feel it's necessary 在你看来，你觉得有必要
to do anything other than put in 除了投入之外做任何事
closed tray, impression and 关闭托盘，印模和
coping and take a quick impression 快速应对并留下印象
and I would tell you, even if you were 即使你是，我也会告诉你
choosing a different kind of involvement in doing cemented crowns 选择一种不同类型的参与做骨水泥冠
separate crowns 分开的牙冠
I would still put a little bit of effort 我还是会付出一点努力
into the master model 变成了主模型
because it'll make everything go faster and more predictably. As we finish the case 因为这会让一切都更快更容易预测。 当我们完成这个案子时
For this sort of case 为了这类案子
I would use open trade impression coping is right in the mouth 我会用开放的贸易印象来应对，正好在嘴边
But instead of taking the impression 但我没有接受你的印象
I'm gonna link them together 我要把他们联系起来
just right in the mouth 就在嘴巴里
i'll use some gcp pattern resin or in this case 我将使用一些gcp图案树脂或在这种情况下
some triad material 一些黑社会的材料
and I'll lick them together, I take them out of the mouth 我把它们舔在一起，从嘴里取出来
I put them in the light of and I cure it even harder 我把它们放在光里治疗它更厉害了
And then section it, bring it back to the mouth 再把它切开，放回嘴里
with separate pieces 分开的几块
But the key is a, very small section 但关键是一个非常小的部分
so I could just put paint on some GC pattern resin 所以我可以把颜料涂在一些GC图案的树脂上
I've linked them together 我把他们联系在一起了
I will usually use a 我通常会用
stock plastic tray, cut some holes in it 准备好塑料托盘，在上面开几个洞
and I'm able to generate a very accurate model 我可以生成一个非常精确的模型
that regardless of my final restoration 不管我最后的修复
whether it's single units 不管是单单元的
whether it's a splendid bridge 不管是一座华丽的桥
I 一
we'll always find the accuracy of fit quite high 我们总是会发现拟合的精度相当高
and My chair time will be greatly reduced and trying to make the restoration fit 而我的椅子时间将大大减少，并试图使恢复适合
so That's my key there 所以那是我的钥匙
I will show you though the technique I'm probably using most commonly today 我将向你们展示我今天最常用的技巧
and That's just going to the mouth with two open tray and brush and coping 那就是用两个打开的盘子、刷子和顶盖往嘴里送
and linking them directly 把它们直接联系起来
Like I alluded to earlier 就像我之前提到的
we could use a flash matrix to help support the GC pattern resin 我们可以使用闪光矩阵来帮助支持GC模式树脂
But quite often with two impression coping 但通常都有两种应对方式
just slowly gabbing at the GC pattern 只是慢慢地在GC模式下喋喋不休
resin really doesn't run 树脂真的不流动
You're able to put a little dabble material on 你可以在上面放一点材料
on each impression coping, slowly 在每个印象中，慢慢地
build it up until we have that 把它建起来，直到我们有
connection between the two that links them together to give the accurate model 两者之间的联系将它们联系在一起以给出精确的模型
Now if, you look at the very first picture here on the left 如果你看看左边的第一张图片
and You see that's alive a kind of coding the impression material 你看，这是活着的一种编码的印象材料
That's my one concern for you 那是我唯一关心你的事
You always need to make sure that you're working in a dry environment 你总是需要确保你在一个干燥的环境中工作
The copings need to be dry 顶盖需要干燥
so you have good adhesion of the pattern resin 所以你对图案树脂有很好的附着力
Or even if you're just taking an impression 或者即使你只是在模仿
that the impression material 印痕的材质
as well adapted to the impression coping 很好地适应了印象处理
It needs to be dry. You need to maintain that dryness 必须是干的。 你需要保持干燥
They have any kind of predictability 他们有任何形式的可预测性
with this technique after you've linked them together and the pattern resin has set 在你把它们连接在一起并且图案树脂已经凝固之后用这个技术
You inject them impression material all around it 你在周围注入印痕材料
You have a custom tray or a stock tray with holes drilled into it 你有一个定制的托盘或股票托盘钻孔到它
to pick up those impression companies 去找那些印象公司
and Now we've achieved an accurate model 现在我们有了一个精确的模型
I've used this technique 我用过这种技术
up to eight, even ten implants 最多8次，甚至10次植入
as long as the implants are fairly close together 只要植入物很靠近就行
If they're significantly spread apart 如果它们明显地分开
like on the all on four technique 就像四项技术一样
really have four implants that might be significantly spread apart 实际上有四个植入体，它们可能会分散开来
For me, it's much easier to have pre made blocks of acrylic 对我来说，它更容易有预制块丙烯酸树脂
that I just need to place in the mouth and then just fill in a small little gap 我只需要把它放在嘴里然后填补一个小缺口
and then still use the impression technique 然后仍然使用印模技术
Now, many of you, I may not have convinced that you think 现在，你们中的许多人，我可能不相信你们认为
oh shoot, it's easy 哦，天啊，很简单的
Most of the time I don't have a problem 大多数时候我没什么问题
I just use uh 我只是用呃
close tray and pressure coping and I make a final restoration 关闭托盘和压力盖，我做了最后的修复
But I guarantee you on a bigger case 但我向你保证一个更大的案子
all it takes is one restoration that doesn't fit 只需要一次不合适的修复
and You have that moral dilemma of whether or not you should proceed on with the final restoration 你面临着道德上的两难选择你是否应该继续最后的修复工作
that really will create a great deal of problems for you and lead to issues in terms of predictability 这确实会给你带来大量的问题，并导致在可预测性方面的问题
so Ii 所以我
strongly suggest 强烈建议
that you find your own technique 你找到了自己的方法
for achieving predictability of the master model 用于实现主模型的可预测性
And when you do that 当你这么做的时候
implant dentistry becomes easy and predictable 种植牙变得容易和可预测
and will give you the results that you want to have 会给你你想要的结果
Thank you very much 非常感谢
thank you Thank you 谢谢谢谢谢谢