implants - international magazine of oral implantology

industry report I and particularly to the cervical gingival area of the in- tended teeth. If necessary, the resin bar may be modi- fiedbyaddingwaxorbyreducingitwithabur.Priorto its being sprayed and digitally scanned, the space be- tweentheresinbarandtheridgeareabetweenthepen- cil lines on the model is filled with a putty material, so that the milled framework can be in contact with the softtissueoftheedentulousridge(Fig.6). Afterthemodelwiththemilledabutmentsandthe resin bar were separately sprayed and scanned, the Triniafiberresinbarwasdigitallydesignedonthecom- puter with a minimum thickness of 7.0 mm through- out, an abutment clearance of 30 microns for cement andwithamaximumcantileverextensionof21.0mm. Ifnecessary,themilledTriniaframeworkmayhavebeen judiciouslyreducedmanually. After cleaning the milled Trinia framework with al- cohol,itwasplacedontothemilledabutmentstoeval- uateand,ifnecessary,modifythemarginaladaptation oftheframeworktotheabutmentsandtothealveolar ridge of the model. The ridge side of the framework should be convex without any concavities. Addition- ally,theTriniaframeworkwasusedtoconfirmboththe pathofinsertionoftheprosthesisandthesequenceof insertion of the milled abutments on the model. After thesequenceandpathofinsertionwereconfirmed,the facial,occlusalandlingualmaskswererepositionedon the model and attached together with cyanoacrylate glue(Fig.7). A thin mix of denture resin was poured into the sil- iconeflaskthroughtheanteriorcutawayoraperturein the lingual mask. Final polymerization was achieved whilethesiliconeflaskandmodelswereunderhotwa- ter,withanairpressureof3bars.Afterpolymerization, the Trinia prosthesis was removed from its silicone flask, then finished and polished in a conventional manner. Clinically, after the removal of the temporary abutments from the implant wells, at least two milled abutments were incompletely inserted into the pros- thesis. If necessary, they were stabilized with an appli- cation of Vaseline, prior to their being transported to the mouth and inserted into the well of their implant (Fig. 8). The loosely fitting abutment facilitated its in- sertion into the well of the implant (Fig. 9). Once the abutment was initially seated, the prosthesis was re- moved for the definitive seating by tapping directly onto the titanium abutment. This seating process was continued until all of the abutments were definitively seated(Figs.10to12). Alternatively,anabutmentcouldhavebeeninitially belooselyseatedinthewelloftheimplant,priortothe prosthesis being used to orient and seat the abutment inthewelloftheimplant.Finalortemporarycementa- tion was achieved by first applying Vaseline over the ridgeareaoftheprosthesistofacilitatetheremovalof any extraneous cement. Only a minimum of cement wasappliedtotheboresintheTriniaframeworkbefore inserting the prosthesis in the mouth. The extraneous cementwasblownawaywithanapplicationofairun- dertheprosthesis.Theocclusionwasevaluatedandad- justed(Figs.13&14). _Conclusion Regardlessofwhichtypeofmaterialwillultimately be used to cover the Trinia framework, it was essential to have an anterior diagnostic positioning, wax rim, or arrangementoftheintendedteethpriortothefabrica- tionoftheTriniaCAD/CAMframework. Inourclinicalcase,Meyorcompositedentureteeth wereusedforthefinalprosthetictoassureagoodbio- mechanicalforcedistributionaroundthefourSHORT® implants. The follow-ups of our patients treated with the described technique was showing a good gingival response and no marginal bone loss around the plat- form switched implant neck of the SHORT® or ULTRA SHORT® implants (Bicon Dental Implants) used in our casepresentationandin60othercasestreatedinthree differentImplantDentistryCenters. This technique of a fixed prosthesis on only four shortimplantsdeservesaclinical,longterm,evidence- basedstudybecauseofitslowcostsandreducedtreat- ment time with minimum morbidity and good patient response._ Editorial note: A complete list of references is available fromthepublisher. I 31implants3_2012 Prof Dr Mauro Marincola Via dei Gracchi,285 I-00192 Roma,Italy mmarincola@gmail.com _contact implants Fig. 14