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Dental Tribune Middle East & Africa No. 4, 2016

Dental Tribune Middle East & Africa Edition | 4/2016 12 mCME relationship was checked (Figs. 22a, 22b). Minor occlusal adjustments were made directly to the maxillary provisional implant prosthesis, as PMMAiseasilymodified. Slight alterations were also made to the lower implant overdenture. Then, blockout shims and the reten- tive overdenture caps were seated over the Locator attachments (Figs. 23a, 23b). Quick Up self-cure mate- rial (VOCO America; Indian Land, S.C.) was added to the recess wells of the overdenture before seating the appliance over the metal hous- ings. After letting the material set for approximately three minutes, the overdenture was removed, picking up the denture caps in the prosthe- sis.Theminorvoidssurroundingthe denture caps were then filled with Quick Up light-cured pink compos- ite(Fig.24).Theappropriateretentive inserts, which are available in a vari- ety of strengths depending on the functional capabilities of the patient and the number of implants, were swapped into the metal housings (Fig. 25). The implant overdenture Figures 17a–17c:The individual sections of the implant verification jig were seated and luted together before being picked up in the open-tray final impression, which was made usingacustom trayandCapture®VPSmaterial(GlidewellDirect). Figures 18a, 18b: The final lower implant overdenture was designed to seat over Locator attachment analogs situated in the mandibular cast.This would allow the overdenture caps that engage the Locator attachments to bepickedupchairside. Figures 19a, 19b: Dental CAD software was used to design the definitive prosthesis for the patient’s maxilla based on the final impression and approved wax setup. Screw access holes were created in the precise posi- tionsneededforapassivefit. Figures 20a, 20b:The provisional implant prosthesis was milled and seated on the master cast to verify a proper fit aswellas theinterocclusalrelationshipwith theopposingimplant overdenture. Figures22a,22b:Theinterocclusalrelationshipwasverifiedwiththefinallowerandprovisionalupperappliances inplace. Figures23a,23b:Themetalhousingsof theoverdenturecapswereseatedover theLocatorattachments. Figure 25: The black processing inserts were replaced with the appropriate retentive caps, whicharecolor-codedaccording tostrength. Figures 21a, 21b: After seating the final lower implant overdenture, the maxillary provisional implant pros- thesiswas triedin toverifyfit,formandfunction. Figure 24: Quick Up cold-cure acrylic was used to pick up the metal housings in the over- denture and fill in the minor voids between the denture caps and recess wells of the prosthesis. NOTE: In many cases,thedoctorelectstohave the overdenture caps pro- cessedby thelab. Figure 26: Patient with the final Locator overdenture and theupperprovisionalimplant prosthesisinplace. Figure 27:The definitive maxillary restoration was milled from BruxZir Solid Zirconia, incorporating the slight adjustments that were made to the PMMAprovisionalappliance. Figures 28a, 28b: The final BruxZir Full-Arch Implant Prosthesis completed a dramatic oral reconstruction for a patient whopresentedwith terminaldentition,restoringform,functionandqualityoflife. was reseated, providing excellent retention, stability and function for thepatient. With the final mandibular restora- tion in place, the patient wore the provisional full-arch implant pros- thesis for a trial period of two weeks (Fig. 26). This opportunity to wear the appliance during actual day-to- day function instilled a high degree of confidence in the prosthetic de- sign for the patient and doctor alike. Following patient approval, the pro- visional implant prosthesis was re- turned to the lab so it could serve as theblueprintforthefinalrestoration and the minor adjustments made to the appliance could be included in thedefinitiveprostheticdesign. The final BruxZir Full-Arch Implant Prosthesis was digitally fabricated with precision (Fig. 27). As an exact reproduction of the test-driven pro- visional, the definitive prosthesis fit perfectly and offered the esthetics and function the patient had come to expect (Figs. 28a, 28b). The final restoration effectively addressed the unique circumstances of the case, providing the most durable, stable prosthesis possible for his upper, and a lower restoration that greatly improves prosthetic retention and can be upgraded to a fixed prosthe- sis should the patient’s situation change. Conclusion Practitioners now have the clinical flexibility to offer patients a wide range of treatment options, from entry-level, economical restorations like the Inclusive Locator Implant Overdenture, to the fixed, highly durable BruxZir Full-Arch Implant Prosthesis.Thereisaviablemeansof treating nearly all patients, whatever their oral health, needs and finances. Provided the life-changing benefits of implant therapy and the straight- forward restorative protocols of to- day, this service should be offered to all patients confronting the chal- lenges presented by complete eden- tulism. References 1. Yunus N, Masood M, Saub R, Al- HashediAA,TaiyebAliTB,Thomason JM. Impact of mandibular implant prostheses onthe oralhealth-related quality of life in partially and com- pletely edentulous patients. Clin OralImplantsRes.2015Jul14. Paresh B. Patel, DDS, has graduated from theUniversityofNorthCarolinaatChapel HillSchoolofDentistryin1996.Hegradu- atedfromtheMedicalCollegeofGeorgia/ American Academy of Implant Dentistry MaxiCourse in 2009. He has been in pri- vate practices in Lenoir and Mooresville, N.C.,from1996throughthepresent.Patel is a founding member and on the edito- rial board of Journal of the International Academy of Mini Dental Implants. He is a clinical instructor at the Reconstruc- tive Dentistry Institute and a diplomat of American Academy of Small Diameter Implants.PatelwaspresidentoftheIredell County Dental Society in 2012; is a mem- ber of the American Dental Association, theNorthCarolinaDentalSocietyandthe American Academy of Implant Dentistry; and is a clinical consultant on dental im- plantsandprosthetics. 2. Martín-Ares M, Barona-Dorado C, Guisado-Moya B, Martínez-Rod- ríguez N, Cortés-Bretón-Brinkmann J, Martínez-González JM. Prosthetic hygiene and functional efficacy in completely edentulous patients: sat- isfaction and quality of life during a 5-year follow-up. Clin Oral Implants Res.2015Apr20. ◊Page11

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