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ePaper created 2016-01-07, 12:59:38 | version 1.38.0
I industry Figs. 18a & b_The BioTemps prostheses were tried in and fit the patient well. Fig. 19_The interim BioTemps restorations were evaluated for proper occlusion, function and esthetics. Fig. 20_Based on the final-approved BioTemps prostheses, the final PFM restorations were fabricated on the master casts. Fig. 21_Final panoramic radiograph illustrates proper placement and orientation of the dental implants. patient’s immediate dentures in place, providing the labwithatemplateforthedefinitivedesignofthePFM restorations(Fig.11). ThelabpouredworkingcastsfromtheVPSimpres- sionsofthepatient’sedentulousarchesandproduced wax occlusal rims (Fig. 12). After seating the wax rims in the patient’s mouth and tightening the temporary cylinder screws, the jaw relationship records were taken (Fig. 13). Note that the patient’s vertical dimen- sion had virtually collapsed due to the extensive wear tohisteeth.Aftermeasuringthedistancebetweenthe patient’s nose and chin during maximum intercuspa- tion, the lab was instructed to open the patient’s bite by2mm.Next,thelabusedCADsoftwaretodesignIn- clusive® Titanium Custom Abutments (Glidewell Eu- ropeGmbH;Frankfurt/Main,Germany)forbotharches basedonthescannedworkingmodels.TheCAD/CAM- produced custom abutments were seated on the working models so their fit could be verified and they could be used in the development of the definitive prostheses (Figs. 14a & b). Based on the jaw relation- ship records and the impressions of the patient’s im- mediate dentures, the lab prepared a diagnostic wax- up to help determine the initial design for the PFM restorations(Fig.15).Afterfinalisingtheinitialdesign, BioTemps prostheses were fabricated from poly- methylmethacrylate(PMMA)material,whichisversa- tileenoughtoeasilyaccommodateadjustmentsatthe try-inappointment,yetdurableenoughforprovision- alisation (Fig. 16). The working models were sent out along with the custom abutments and BioTemps in- terim restorations for patient evaluation. At the next appointment, the titanium custom abutments were transferredtothepatient’smouthusingtheacrylicde- livery jigs provided by the lab (Fig. 17). The custom abutments achieved a precise fit and were thus tight- enedtotheappropriatetorque,establishingidealsoft- tissue margins and support. Complete seating was verified radiographically, and the screw access holes werecovered. Next,theBioTempsprosthesesweretriedinandex- hibited an accurate fit (Figs. 18a & b). The provisional restorations were attached to the abutments using temporarycement,andthephonetics,aesthetics,bite and function were evaluated (Fig. 19). Minor modifi- cations were made to the BioTemps prostheses, and the patient wore the BioTemps provisionals for an in- terim of four weeks. This trial period was essential in verifying that the patient was happy with the look, comfortandfunctionoftheprostheticdesignsbefore the final PFM restorations were fabricated. After pa- tient approval was provided, alginate impressions weremadeoftheBioTempsprostheses.Modelsofthe final-approvedBioTempsrestorationswerefabricated fromtheimpressions,andanewbitewastakensothe definitive prosthetic designs could be adjusted ac- cordingly. Crown & bridge impressions were taken of thefinalcustomabutmentsinplaceandwouldbeused bythelabtopourmastermodels,uponwhichthefinal PFMprostheseswouldbeproduced.Thegingivalareas forthefinalPFMsweremarkedontothemodelsofthe BioTemps restorations, and the case was returned to the lab along with instructions for final adjustments. The final PFM prostheses were fabricated by layering 36 I implants4_2015 Fig. 19 Fig. 21Fig. 20 Fig. 18a Fig. 18b