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ePaper created 2017-05-10, 16:12:25 | version 1.38.0
| case report restoration of the edentulous maxilla ments on the original working cast; where they have remained since receipt. Each abutment was identified with one, two, three and four black ink dots respec- tively, based on their position on the cast. The clear matrix was seated over the abutments and corre- sponding black dots were drawn on it to line up ex- actly with those on the abutments. The completed mandibular bridge was double-side impressed by the dental technician and an injection-mould copy of clear acrylic resin was made. The patient was scheduled for completion of treat- ment. The Locator abutments were again removed and Teflon tape was placed in the implant excluded from the design. The abutments were seated onto the dental implants (Fig. 12), and the clear matrix was placed to verify that each abutment was correctly orientated by checking that the dots on the matrix superimposed with those on the abutments. Once verified, the abutments were torqued to 20 Ncm, appropriate for the implants involved. The SynCone caps were placed and viewed with magnifi- cation to assure that they were superior to the gingi- val tissues (Fig. 13). The prosthesis was placed over the caps to verify there was no obstruction of complete seating. The prosthesis was removed and vent holes were drilled through the buccal contours of the acrylic resin to relieve hydraulic pressure during cap- ture of the caps. The SynCone caps were lifted and a rubber dam was placed around the abutments to pre- vent pick-up resin from locking into undercuts, and the caps were reseated (Fig. 14). Attachment processing material (Chairside, Zest Dental Solutions) was placed in the reservoirs of the prosthesis and seated over the SynCone caps. The up- per denture was placed and the patient was instructed to gently close into full occlusion and to maintain position for two minutes while setting occurred. After two minutes, the excess flow of pick-up resin was checked for hardness and after an additional minute the prosthesis was ready for removal. Removal was uneventful although retention was considerable; removal of the bridge can only occur following the long axis of the abutments, no tipping or rotating is possible (Figs. 15 & 16). Once removed, the excess pick-up material was re- moved and the bridge was properly polished where needed. The abutments were packed with Teflon tape to within 3 mm of the surface, and the remaining space was filled with flowable composite resin (Fig. 17). The patient was instructed on placement and removal and repeated the exercise until we were satisfied she would experience no difficulties performing this. The clear, duplicate copy of the bridge was seated onto the abut- ments using a chairside soft lining material (Fig. 18). This copy serves as a temporary device for the patient to wear when cleaning the finished bridge or when sleeping to protect the tongue from scraping against the abutments. A panoramic radiograph was taken at completion of treatment (Fig. 19). The patient returned after one week and again after six weeks, and reported at both visits that the lower bridge did not move at all during function and stayed seated until she removed it. She commented on the ease of cleaning the dental abutments, and she reported no discomfort and no food entrapment. Overall, the patient was very pleased with the result (Fig. 20). Fig. 15: Completed bridge with SynCone caps processed in position. Because they have been processed intraorally, there is no error in fit, these caps are extremely retentive allowing only vertical displacement of the prosthesis. Fig. 16: Completed restoration. Note the absence of screw access holes for a prosthesis that looks like a denture yet fits like a bridge. Fig. 17: Atlantis Conus Abutments torqued to specified level, obturated with Teflon tape and composite resin. Fig. 18: Laboratory processed, clear duplicate prosthesis with siliconised reline material to improve retention; to be used as a night-time appliance Fig. 15 Fig. 16 to protect the tongue from the sharper edges of the abutments. Fig. 17 Fig. 18 16 CAD/CAM 2 2017