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ePaper created 2016-06-01, 10:23:49 | version 1.38.0
I 11implants 2_2016 C.E. article_ fixed and removable implant restorations I were produced (Figs. 15a–15c). During the try-in appointment, the wax setups were evaluated to confirm the vertical dimension of occlusion, inte- rocclusal relationship, phonetics, esthetics, midline, teeth arrangement, tooth color and shape, incisal edges, and function (Figs. 16a–16c). After final approval of the wax setups, the re- storative protocols for the two prostheses diverged, as the lab moved directly to the final implant over- denture from the approved wax setup, while the process for the BruxZir Full-Arch Implant Prosthesis included an implant verification jig, custom final impression, and provisional implant prosthesis. Theseextrameasuresweretakentomakeabsolutely certain that the definitive prosthetic design was accurate before milling the final restoration from monolithic zirconia. The implant verification jig was attached to the implants so a precise final impression could be taken (Figs. 17a–17c). The custom tray provided by the lab was filled with VPS material and seated over the implant verification jig. As the VPS material set, the relative positions of the implants represented by the verification jig remained fixed, ensuring an extremely accurate final impression. The approved wax setups and final maxillary impression were returned to the lab so the final mandibular implant overdenture and maxillary pro- visional implant prosthesis could be produced. The final lower appliance was fabricated on the master cast and included recess wells in which metal hous- ingswithoverdenturecapswouldbecuredchairside (Figs.18a,18b).Thesedenturecapsprovideretention andstabilizetheprosthesisbyseatingovertheLoca- tor attachments and keeping the appliance in place during function. A new master cast of the maxilla was produced basedonthecustomopen-trayfinalimpression.The newmastercastandfinal-approvedwaxsetupwere scanned.Avirtualmodelwasgenerateduponwhich the fixed monolithic prosthesis was designed using CAD software (Figs. 19a, 19b). Because this digital modelwasbasedonthefinalimpressioncontaining the verification jig, screw access holes were created inprecisealignmentwiththepositionsofthemaxil- lary implants. The CAD design was used to mill a provisional implant prosthesis from poly(methyl methacrylate) (PMMA) (Figs. 20a, 20b). This appliance was tried in and worn for a trial period, thus ensuring an ac- curate prosthetic design. The provisional implant prosthesis is an essential element of the restorative process, as significant adjustments cannot be made to the final restoration once it has been milled from BruxZir Solid Zirconia. Atthefollowingappointment,theInclusiveLoca- torImplantOverdenturewasseatedandcheckedfor properfit,functionandsupportfromthesofttissue. Thentheprovisionalimplantprosthesiswasscrewed into place, and its teeth positioning, function and Figs. 8a, 8b_Note the dramatic change in the appearance of the patient, who left with chairside- converted dentures in place on the same day as surgery, including a screw-retained, fixed provisional for his upper arch. Fig. 9_Postoperative panoramic radiograph illustrates All-on-4 configuration of maxillary implants and axial placement of the mandibular implants, which would facilitate a passive fit of the lower overdenture. Figs. 10a, 10b_The patient returned 14 weeks after implant surgery, and healing of the peri-implant tissue had progressed nicely. Figs. 11a–11c_Transfer copings were attached to the maxillary multi- unit abutments, and an open-tray impression was made to serve as the basis for the working cast the lab would use to begin designing the restoration. Note that a closed-tray impression was taken for the lower implant overdenture. Fig. 8a Fig. 8b Fig. 10a Fig. 10b Fig. 9 Fig. 11a Fig. 11b Fig. 11c