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ePaper created 2017-05-10, 16:12:25 | version 1.38.0
| case report restoration of the edentulous maxilla Figs. 5 & 6: Completed final impression using the custom tray and light body and medium body PVS, as well as rigid bite registration material around the impression copings to eliminate any movement of the copings. Fig. 5 Fig. 6 sible up to 30 degrees. Two major requirements are necessary: the dentist must make an accurate, im- plant-level impression and a scan must be made of either an approved denture set-up or of a completed denture to be retro-fitted. The Atlantis Conus Abut- ments are then designed to be positioned optimally within the denture confines. The fixed yet removable prosthesis offers the advantages of excellent chewing function, improved aesthetics and fracture resistance (as no screw access holes are present) and optimally facial supporting contours, without compromising cleaning by the patient. Case report A 73-year-old woman with a history of 11 years of complete edentulism of the maxilla and mandible, and five endosseous implants in the anterior mandi- ble, presented with a chief complaint of a non-reten- tive and unstable lower denture. The implants were standard diameter, externally hexed, Brånemark fix- tures. She had moderate resorption of both the max- illary and mandibular residual ridges (Fig. 1). The patient had bone loss involving the implant bod- ies but comparing the radiographic evidence available, documenting her condition through the years, it ap- pears the bone loss occurred soon after implant place- ment and no appreciable change was seen thereafter. During those 11 years, her treatment history in- cluded initial restoration of the implants with a com- plete denture retained by the LOCATOR Attachment System (Zest Dental Solutions); and the maxilla was restored with a complete denture. She advised that the result was unsatisfactory as the lower denture displaced during function. Her history further reveals that the Locators were replaced with PRECI-CLIX attachments (Ceka Attachments) with no demonstrable improvement. The patient was later retreated by the author, with new maxillary and mandibular complete dentures and new Locator attachments used to retain the lower prosthesis. The attachment male components were secured intraorally using auto-polymerising resin to eliminate the possibility of laboratory error. The patient continued to experience problems with the lower denture coming loose during function and required frequent replacement of the nylon male inserts; replacement with Extended Range inserts did Fig. 7: Design images showing the contour and tooth position of the duplicate denture and proposed design of the Atlantis Conus Abutments. Fig. 7 12 CAD/CAM 2 2017