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ePaper created 2016-10-04, 09:33:57 | version 1.38.0
| ce article fixed and removable implant restorations 28 CAD/CAM 3 2016 included an implant verification jig, custom final impression, and provisional implant prosthesis. Theseextrameasuresweretakentomakeabsolutely certainthatthedefinitiveprostheticdesignwasac- curate before milling the final restoration from monolithic zirconia. The implant verification jig was attached to the im- plants so a precise final impression could be taken (Figs. 17a–c). 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 provisional implant prosthesis could be produced. The final lower appliance was fabricated on the master cast and included recess wells in which metal housings with overdenture caps would be cured chairside (Figs. 18a & b). These denture caps provide retention and stabilise the prosthesis by seating over the Locator attachments and keeping the appliance in place during function. A new master cast of the maxilla was produced based on the custom open-tray final impression. The new master cast and final-approved wax setup were scanned. A virtual model was generated upon whichthefixedmonolithicprosthesiswasdesigned using CAD software (Figs. 19a & b). Because this digital model was based on the final impression containing the verification jig, screw access holes werecreatedinprecisealignmentwiththepositions of the maxillary implants. The CAD design was used to mill a provisional im- plant prosthesis from poly(methyl methacrylate) (PMMA) (Figs. 20a & b). 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,assignificantadjustmentscannotbemade to the final restoration once it has been milled from BruxZir Solid Zirconia. Atthefollowingappointment,theInclusiveLocator Implant Overdenture was seated and checked for properfit,functionandsupportfromthesofttissue. Fig. 15a Fig. 15b Fig. 15c Figs. 13a & b: The upper wax rim was screwed into place through the temporary cylinders, while the lower wax rim was seated over Locator impression caps. The jaw relationship was recorded and a bite registration taken. Fig. 14: A VPS wash impression was made of the mandibular arch, capturing the positions of the Locator attachments as well as the gingival contours and vestibules. Figs. 15a–c: The lab produced wax setups for try-in. The upper included temporary cylinders so the setup could be attached to the implants during evaluation. The lower setup included recess wells so it could be seated over the Locator attachments and onto the soft tissue. Fig. 13a Fig. 13b Fig. 14 32016