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ePaper created 2017-05-10, 16:12:25 | version 1.38.0
| CE article fixed and removable implant restorations 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. Figs. 13a & b: The upper wax rim was screwed into place through the temporary cylinders while the lower wax rim was seated over Locator Fig. 10a Fig. 10b Fig. 11a Fig. 11b Fig. 11c impression caps. Fig. 12a Fig. 12b 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 set-ups for try-in. The upper included temporary cylinders so set-up could be attached to the implants during evaluation. The lower set-up included recess wells so it could be seated over the Locator attachments and soft tissue. attachments would be incorporated in the prosthesis chairside, though it should be noted that many clini- cians elect to have the laboratory handle this step. The surgical phase of treatment called for the ex- traction of the patient’s remaining teeth followed by the immediate placement of eight dental implants. CBCT scans were taken to help determine the optimal placement of the implants within the available bone and away from the patient’s vital oral anatomy. Eval- uation of the CBCT scan determined that there was sufficient height, width and quality of bone to place the implants in the appropriate locations and angu- lations via freehand surgery. Four 3.7 mm Inclusive Tapered Implants (Glidewell Direct) would be placed in each arch to support the fixed maxillary restoration and the removable mandibular prosthesis. At the surgical appointment, the patient’s remain- ing teeth were removed, and a flap was raised to visualise the socket sites and areas of implantation. Bone levelling was performed on the patient’s maxil- lary arch to elevate the patient’s smile transition line above the upper lip. Fig. 13a Fig. 13b Fig. 14 Fig. 15a Fig. 15b Fig. 15c 26 CAD/CAM 2 2017