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ePaper created 2016-10-04, 09:33:57 | version 1.38.0
The patient returned after three and a half months ofhealingsothestabilityoftheimplantsandhealth of the soft tissue could be evaluated. Removal of the temporary appliances revealed excellent tissue health around the healing abutments of the man- dible and multi-unit abutments of the maxilla (Figs. 10a & b). Vinyl polysiloxane (VPS) impressions were taken to begin the restorative process (Figs. 11a–c). Because multi-unit abutments and healing abutments were placed on the day of surgery, the restorative process began above the tissue level, withoutanyneedforsecondarysurgeryoranesthe- tisation. The restorative protocol for both prostheses in- cluded wax rims and setups, which the lab pro- duced on the working casts fabricated from the impressions (Figs. 12a & b). The maxillary wax rim incorporated temporary cylinders through which screws could connect to the dental implants. The lower wax rim was designed to seat over Locator attachments. At the next appointment, the wax rims were seated, the jaw relationship was recorded using conven- tional denture technique, and a bite registration was taken (Figs. 13a & b). A VPS “wash” impression of the mandibular arch was also taken with the wax rims and Locator impression caps in place (Fig. 14). This would aid the lab in designing an overdenture thatfullyrestsonthetissueinsteadoftheimplants. The case was returned to the lab, and wax setups were produced (Figs. 15a–c). During the try-in appointment, the wax setups were evaluated to confirm the vertical dimension of occlusion, inter- occlusalrelationship,phonetics,aesthetics,midline, teeth arrangement, tooth colour and shape, incisal edges, and function (Figs. 16a–c). After final approval of the wax setups, the restor- ative protocols for the two prostheses diverged, as thelabmoveddirectlytothefinalimplantoverden- ture from the approved wax setup, while the pro- cess for the BruxZir Full-Arch Implant Prosthesis fixed and removable implant restorations ce article | 27 CAD/CAM 3 2016 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. Note the temporary cylinders attaching the provisional maxillary denture to the implants. Figs. 10a & b: The patient returned 14 weeks after implant surgery, and healing of the peri-implant tissue had progressed nicely. Figs. 11a–c: 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. Figs. 12a & b: For the recording of jaw relations, the lower wax rim was designed to seat over the Locator attachments, while a screw-down wax rim was created for the upper. Fig. 11a Fig. 11b Fig. 11c Fig. 12a Fig. 12b Fig. 9 Fig. 10a Fig. 10b 32016