All posts by CM Prosthetics

CM Prosthetics is the ultimate resource for providing patients with premium implant prosthodontics. Utilizing state of the art CAD/CAM technology, superlative materials and the skilled oversight of master technicians, the CM prosthesis is one of the most natural looking and patient friendly restorations in the world. CM Prosthetics is a comprehensive laboratory service focusing on the edentulous patient, but it is much more than just the delivery of an extraordinary product. President and CEO, Stephen Balshi, uses his Masters Degree in Biomedical Engineering and his expertise in the immediate loading of dental implants to offer his national clientele consultation for the planning, design and total treatment of the most challenging cases. CM Prosthetics is unique to the dental profession. Built upon a rich history of scientific research and committed to unparalleled professional collegiality and customer service, partnership with CM Prosthetics is a giant step to ensure patient satisfaction.

Connect and Collaborate with the ACP Dental Technician Alliance

JDT FEATURE
By Stephen Balshi, MBE

Prosthodontists are the driving force behind comprehensive care for patients seeking complex dental rehabilitations. As a member of the Dental Technician Alliance of the American College of Prosthodontists (ACP), I collaborate with these leaders in restorative dentistry in delivering that care.

Membership in the ACP Dental Technician Alliance gives us exposure to this prestigious specialty through access to networking opportunities, research and continuing education, much of which is focused on the technology that we use in our laboratories. The ACP is rare among dental specialties in that we, as technicians, are truly a part of the organization.

Pictured Above:
Dental Technicians and Prosthodontists attend “The Laboratory Connection: Techniques, Innovations, and Pearls from the Experts” at the 2015 ACP Annual Session in Orlando.

Pictured Below:
Stephen Balshi addresses technicians and members of the ACP Board of Directors at the Dental Technician Alliance
Breakfast held at the 2015 ACP Annual Session.

Stephen Balshi addresses technicians and members of the ACP Board of Directors at the Dental Technician Alliance Breakfast held at the 2015 ACP Annual Session.

ACP Dental Technician Alliance members receive a listing in the printed membership directory and the ACP’s online “Find a Dental Tech” search. ACP prosthodontists use this search to locate Dental Alliance Technician members by name or location. Those two features alone have brought my dental laboratory not only new business, but business we technicians desire. Quality record taking leads to quality restorations.

I was fortunate to serve as the President of an ACP Section, the Pennsylvania Prosthodontic Association, where I worked with local prosthodontic leaders to plan our annual meeting. This included organizing the scientific program and acquiring corporate sponsorships. Previously, only prosthodontist members were permitted to serve as state section officers but the ACP voted to update their bylaws to give members of the Dental Technician Alliance the opportunity to lead as well. My experience as Section President provided great exposure to all the prosthodontists in the state.

When we convene for the Annual Session, Dental Technician Alliance members have access to some of the best educational sessions in dentistry, as well as the very latest advances in technology. There is also a breakout scientific session for laboratory technicians, often focused on the critical communication between technician and prosthodontist. The ACP Annual Session is the one meeting I am sure to attend every year as it is an opportunity to learn side-by-side with prosthodontic practitioners and educators. Should you attend the ACP Annual Session, don’t miss the breakfast for dental technicians on Friday, October 7.

The 46th ACP Annual Session will be held in San Diego on Oct. 5-8. If you are interested in attending the meeting and learning more about the Dental Technician Alliance, you can contact the ACP membership department at (312) 573-8799 or visit Prosthodontics.org.

About the Author:
Stephen Balshi, MBE, is the owner of CM Prosthetics, Inc. in Fort Washington, Pa., and currently serves as Chair of the ACP Dental Technician Alliance Committee.


Journal of Dental Technology June/July 2016 Special Reprint | © 2016, National Association of Dental Laboratories | www.jdtunbound.com

ACP_JDT_Article_2016 in PDF Format

The Retread: A Retrospective Analysis of 205 Implant-Supported Fixed Hybrid Prostheses

Article PDF: The Retread: A Retrospective Analysis of 205 Implant-Supported Fixed Hybrid Prostheses

The International Journal of Prosthodontics, March/April 2016 – Vol. 29 Issue 2, 126-131 

Thomas J. Balshi, DDS, PhD, Glenn J. Wolfinger, DMD, Stephen G. Alfano, DDS, Stephen F. Balshi, MBE

Purpose:
Acrylic resin teeth on fixed implant prostheses are subject to time-dependent wear. The purpose of this retrospective analysis is to evaluate and describe the management of such wear in the context of selected variables-patient gender and age, dental arch location, and opposing dentition. The clinical and dental laboratory process to replace the worn teeth is defined as a retread.

Materials and Methods:
A retrospective database review from a single private prosthodontic practice was carried out on all patients who had undergone a retread procedure. The patient pool included 205 arches in 194 patients (70 in men, 135 in women) with a mean age of 57.4 years (range: 19.9 to 80.5 years). The retread procedure is described.

Results:
The mean time between final prosthesis delivery and retread was 7.8 years  (range: 1.1 to 22.9 years). Statistical analysis was significant according to dental arch and opposing dentition. A statistical
difference was also noted in patients undergoing multiple retread procedures, with a reduction in time between the subsequent procedures.

Conclusion:
Acrylic resin components of implant-
supported hybrid prostheses wear over time and are influenced by a combination of the nature of the opposing dentition and patient habits. The dental laboratory process to retread the implant-
supported framework is important for long-term patient care and maintenance of an appropriate vertical dimension of occlusion . lnt J Prosthodont 2016;29126-131. doi: 10.11607/r1p.4277.

A Long-term Retrospective Analysis of Survival Rates of Implants in the Mandible

Balshi TJ, Wolfinger GJ, Stein BE, Balshi SF.

Int J Oral Maxillofac Implants. 2015 Nov-Dec;30(6):1348-54. doi: 10.11607/jomi.3910.

Abstract

PURPOSE:

To retrospectively analyze the survival rate of endosseous dental implants placed in the edentulous or partially edentulous mandible over a long-term follow-up period of 10 years or more.

MATERIALS AND METHODS:

The charts of patients who underwent mandibular implant placement at a private prosthodontics practice and received follow-up care for 10 years or more were included in this study. Implants were examined according to the following study variables: patient sex, patient age, degree of edentulism (fully vs partially edentulous), implant location, time of loading (delayed vs immediate), implant size and type, bone quality, prosthesis type, and the presence of other implants during placement.

RESULTS:

The study sample was composed of 2,394 implants placed in 470 patients with 10 to 27 years of follow-up. Of these 2,394 implants, 176 failed, resulting in an overall cumulative survival rate (CSR) of 92.6%. A total of 1,482 implants were placed in edentulous mandibles, and 912 implants were placed in partially edentulous mandibles, with CSRs of 92.6% and 92.7%, respectively. Comparisons of the study variables with respect to CSR were largely nonsignificant. However, there were significant differences in CSRs between anterior vs posterior locations and rough- vs smooth-surfaced implants in addition to some prosthesis types, ages, and bone qualities. The overall CSR of 92.6% in the present study is high and comparable to survival rates observed in previous long-term analyses of mandibular implants. The significant differences observed between implant locations, patient age groups, bone qualities, and prostheses were not suggestive of any remarkable trends.

CONCLUSION:

Patient sex, age, degree of edentulism, implant location, time of loading, implant size and type, bone quality, prosthesis type, and the presence of multiple implants did not result in any significant effect on long-term implant survival. The CSR observed after 10 to 27 years of follow-up in a single private prosthodontic center was high (92.6%) and supports the use of endosseous dental implants as a long-term treatment option for the rehabilitation of the edentulous and partially edentulous mandible.

A Long-term Retrospective Analysis of Survival Rates of Implants in the Mandible in PDF Format

Fabricating an Accurate Implant Master Cast: A Technique Report

Journal of Prosthodontics 24 (2015) 654–660 C _ 2015 by the American College of Prosthodontists

Thomas J. Balshi, DDS, PhD, FACP, Glenn J. Wolfinger, DMD, FACP, Stephen G. Alfano, DDS, MS, FACP, Jeannine N. Cacovean, BS, & Stephen F. Balshi, MBE

Pi Dental Center, Institute for Facial Esthetics, Fort Washington, PA
CM Prosthetics, Inc., Fort Washington, PA

The article is associated with the American College of Prosthodontists’ journal-based continuing education program. It is accompanied by an online continuing education activity worth 1 credit. Please visit www.wileyhealthlearning.com/jopr to complete the activity and earn credit.

Correspondence
Stephen F. Balshi, Pi Dental Center, Institute for Facial Esthetics, 467 Pennsylvania Ave, Ste 201, Fort Washington, PA 19034.
E-mail: stephen.balshi@cmprosthetics.com

Abstract
The technique for fabricating an accurate implant master cast following the 12-week healing period after Teeth in a Day R _ dental implant surgery is detailed. The clinical, functional, and esthetic details captured during the final master impression are vital to creating an accurate master cast. This technique uses the properties of the allacrylic resin interim prosthesis to capture these details. This impression captures the relationship between the remodeled soft tissue and the interim prosthesis. This provides the laboratory technician with an accurate orientation of the implant replicas in the master cast with which a passive fitting restoration can be fabricated.

Fabricating Accurate Implant Master Cast in PDF Format

Life Expectancy of a Fixed Complete Denture

ACP Messenger, Fall 2015, IN THE LAB

BY STEPHEN F. BALSHI, MBE

Patient education for prosthetic maintenance comes from years of collaboration between prosthodontists and dental laboratory technicians.


Screw-retained complete-arch dental implant rehabilitations have existed for over 50 years.  From the beginning, Professor Brånemark restored his patients with a fixed denture or hybrid prosthesis.  This prosthesis consisted of manufacturer’s denture teeth processed to a cast metal framework with acrylic resin.  In today’s marketplace, there are many different options for restoring a complete-arch of dental implants, including various ceramic materials.  However, with the All-on-4® treatment concept becoming so popular over the last handful of years as an economic solution, the screw-retained acrylic-veneered hybrid continues to be one of the more popular solutions as a definitive prosthesis.

While the implant-supported acrylic-veneered hybrid has been a long-standing solution for the fully edentulous patient, it does require prosthodontic maintenance and can also experience prosthodontic complications.  Denture tooth fracture or debonding from the acrylic resin base are probably the two most common complications experienced with these restorations.  All patients who function with an implant-supported acrylic hybrid will experience occlusal wear to the denture teeth over time.  It is a built-in buffer to a rigid system that works quite favorably from a biomechanics standpoint.   However, as the teeth wear, patients experience alteration of the occlusal scheme, guidances in excursive movements, and the loss of vertical dimension of occlusion.

The dental laboratory process to replace the worn teeth and acrylic resin base is called a “Retread.”  In a manuscript authored by Balshi et al and accepted for publication in the International Journal of Prosthodontics, a retread is defined as, “the removal of worn veneering material on an implant-supported framework followed by the replacement of new veneering material at a desired vertical dimension of occlusion on the same implant-supported framework.”  The results of this manuscript indicate that it takes an average of seven (7) years for the patient to wear down acrylic denture teeth to the point at which they need replacement.  This data is based on a sample of 205 arches.  An example of a worn implant-supported hybrid prosthesis is illustrated in Figure 1.  Following the retread procedure in the dental laboratory, the same framework is illustrated in Figure 2.

Digital dentistry has recently invaded the hybrid prosthesis market.  The same retread procedure that we’ve been performing for years can now also be done as a fully milled acrylic resin veneer where there are no individual denture teeth.  This is a “game-changer” for the hybrid prosthesis because it will dramatically reduce the number of prosthetic complications that are seen with this type of restoration.  Once the desired vertical dimension of occlusion is established, it is optically scanned and a new digital tooth setup is made (Figures 3a-c).  The technology can be applied to frameworks that are “wrap-around” style (Figure 4a-b) or cases that have polished metal on the intaglio and/or lingual surfaces (Figure 5a-b).  Early unpublished results show a complication rate less than one percent (1%).

It is expected that the fully milled resin veneer will wear at the same rate or even a little slower than manufacturer’s denture teeth.  In other words, the biomechanical “buffer” that exists with a traditional hybrid prosthesis still exists with the fully milled acrylic resin hybrid.  A digital record of the case is stored when the next retread procedure is needed in the future.

Prosthodontists would be wise to discuss wear factors and retread procedures with patients at the initiation of implant prosthodontic treatment.  It would be beneficial for this information to be included in the written informed consent for treatment.  This prior patient education will inevitably avoid surprises and confrontations between the patient and the prosthodontist when retreads are required.

Life Expectancy Of The Fixed Complete Denture in PDF Format

Oral Rehabilitation and Psychosocial Eval of a Patient with Bulimia Nervosa Following Teeth in a Day®

Oral Rehabilitation and Psychosocial Evaluation of a Patient with Bulimia Nervosa Following Teeth in a Day® Immediate Loading Protocol.

Thomas J. Balshi, DDS, PhD, FACP; Glenn J. Wolfinger, DMD, FACP; Stephen G. Alfano, DDS, MS, FACP; J. Neil Della Croce, DMD, MS; and Stephen F. Balshi, MBE.

Link to article: Compendium April 2015, Volume 36, Issue 4.

PURPOSE: The purpose of this patient report is to accurately portray the clinical experience of treating an active bulimic patient by employing an immediately loaded dental implant protocol to provide the patient with an expedited esthetic and functional result. Implementation of a psychometric component statistically quantifies the psychological effects of the oral rehabilitation.

MATERIALS AND METHODS: A 34-year-old woman presented with severe dental perimolysis (erosion) resulting from a 28-year history of bulimic behaviors. Clinical and radiographic evaluation of the existing dentition indicated advanced dental erosion and previous restoration attempts in a state of failure. The patient’s existing teeth were extracted and treated with full maxillary and mandibular implant-supported prostheses, following the Teeth in a Day® (TIAD) immediate functional loading protocol. Psychometric assessment was conducted through administration of a 20-item questionnaire, as seen in previous literature.

RESULTS: Radiographic and clinical analysis suggested all implant fixtures to be viable and accompanied by normal levels of alveolar bone 7 months into treatment. Questionnaire results at the new-patient presentation (T1) resulted in a composite score of 4.0 (SD = 2.9; P = 0.004), indicating severe body-image dysphoria. At 3 months postoperative (T2), the questionnaire score was 0.4 (SD = -1.7; P = 0.09). The final psychometric questionnaire at 7 months (T3) resulted in a score of 0.5 (SD = -1.5; P = 0.12). The patient was followed for a total of 7 years following implant placement.

CONCLUSION: In this patient report, oral rehabilitation using the TIAD protocol provided an expedited and predictable alternative method for restoring functional abilities, esthetics, and self-esteem to a severely depressed bulimic patient. Psychometrically, at the postoperative (T2) and final testing period (T3), the patient’s body image profile was no longer considered to be significantly different from established normative values.

Complete Oral Rehabilitation With Implants Using CAD/CAM Technology, Stereolithography, and Conoscopic Holography

Robert M. Bentz, DMD, and Stephen F. Balshi, MBE

Implant Dentistry, Volume 21 • Number 1.

A 64-year-old totally edentulous female initially presented with ill fitting removable prostheses. A comprehensive treatment plan with dental implants was accepted by the patient. Clinical and laboratory procedures were executed using various computer technologies including computed tomography, rapid prototyping, and optical scanning using conoscopic holography. A review of the patient’s treatment and various modalities used are the focus of this patient report.

Article in PDF

Oral Rehabilitation and Psychosocial Evaluation of a Patient with Bulimia Nervosa Following Teeth in a Day® Immediate Loading Protocol

Thomas J. Balshi, DDS, PhD, FACP; Glenn J. Wolfinger, DMD, FACP; Stephen G. Alfano, DDS, MS, FACP; J. Neil Della Croce, DMD, MS; and Stephen F. Balshi, MBE

Compendium, April 2015, Volume 36, Issue 4 – Published by AEGIS Communications

PURPOSE: The purpose of this patient report is to accurately portray the clinical experience of treating an active bulimic patient by employing an immediately loaded dental implant protocol to provide the patient with an expedited esthetic and functional result. Implementation of a psychometric component statistically quantifies the psychological effects of the oral rehabilitation.
MATERIALS AND METHODS: A 34-year-old woman presented with severe dental perimolysis (erosion) resulting from a 28-year history of bulimic behaviors. Clinical and radiographic evaluation of the existing dentition indicated advanced dental erosion and previous restoration attempts in a state of failure. The patient’s existing teeth were extracted and treated with full maxillary and mandibular implant-supported prostheses, following the Teeth in a Day® (TIAD) immediate functional loading protocol. Psychometric assessment was conducted through administration of a 20-item questionnaire, as seen in previous literature.
RESULTS: Radiographic and clinical analysis suggested all implant fixtures to be viable and accompanied by normal levels of alveolar bone 7 months into treatment. Questionnaire results at the new-patient presentation (T1) resulted in a composite score of 4.0 (SD = 2.9; P = 0.004), indicating severe body-image dysphoria. At 3 months postoperative (T2), the questionnaire score was 0.4 (SD = -1.7; P = 0.09). The final psychometric questionnaire at 7 months (T3) resulted in a score of 0.5 (SD = -1.5; P = 0.12). The patient was followed for a total of 7 years following implant placement. CONCLUSION: In this patient report, oral rehabilitation using the TIAD protocol provided an expedited and predictable alternative method for restoring functional abilities, esthetics, and self-esteem to a severely depressed bulimic patient. Psychometrically, at the postoperative (T2) and final testing period (T3), the patient’s body image profile was no longer considered to be significantly different from established normative values.

Article in PDF

Management of Soft Tissue Irritation Around Exposed Zygomatic Implant in a Hemimaxillectomy Patient: A Technical Report

Int J Oral Maxillofac Implants. 2014 Dec 5. doi: 10.11607/jomi.3615. [Epub ahead of print]

Balshi TJ, Wolfinger GJ, Balshi SF.

Patients missing portions or all of the maxillary alveolar bone who are restored with zygomatic implants frequently have threads exposed that can be a mucosal irritant. If such irritation is reported, covering the threads with a highly polished titanium sleeve is recommended. The technique of placing said custom sleeve is described. This adjunctive treatment method has eliminated mucosal irritation.

Article in PDF

Zygomatic implants as a rehabilitation approach for a severely deficient maxilla

Al-Thobity AM, Wolfinger GJ, Balshi SF, Flinton RJ, Balshi TJ.

Int J Oral Maxillofac Implants. 2014 Nov-Dec;29(6):e283-9. doi: 10.11607/jomi.3662. Epub 2014 Aug 20.

Abstract: A gunshot injury is one of the main trauma injuries that affect the head and neck region. Severe esthetic, functional, and psychologic deficiencies are consequences of gunshot injuries. The use of implants anchored in the zygomatic bone has been advocated as an approach to the prosthetic rehabilitation of a severely deficient maxilla. This approach provides the patient with an immediate, high-quality, esthetic, and functional complete fixed prosthesis and eliminates the need for bone grafting. In this case report, a patient with a severely deficient maxilla caused by a gunshot injury was rehabilitated by placement of  four zygomatic and two pterygomaxillary implants, which were immediately loaded with a complete fixed all-acrylic resin interim prosthesis. The definitive CM Prosthesis (CM Prosthetics) was constructed using computer-aided design/computer-assisted manufacture (CAD/CAM) technology.

Article in PDF