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ePaper created 2017-05-10, 16:12:25 | version 1.38.0
fixed and removable implant restorations CE article | Figs. 21a & b: After seating the final lower implant overdenture, the max- illary provisional implant prosthesis was tried in to verify fit, form and function. Figs. 22a & b: The interocclusal relationship was verified with the final lower and provisional upper appliances in place. Fig. 21b Figs. 23a & b: The metal housings of the overdenture caps were seated over the Locator attachments. Fig. 21a Fig. 22a Fig. 22b Fig. 23a Fig. 23b 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 set-up were scanned. A virtual model was generated, upon which the fixed monolithic prosthesis was designed using CAD software (Figs. 19a & b). Because this digital model was based on the final impression containing the verification jig, screw access holes were created in precise alignment with the positions of the maxil- lary 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 accurate pros- thetic design. The provisional implant prosthesis is an essential element of the restorative process, as signifi- cant adjustments cannot be made to the final restora- tion once it has been milled from BruxZir Solid Zirconia. At the following appointment, the Inclusive Loca- tor Implant Overdenture was seated and checked for proper fit, function and support from the soft tissue. Then the provisional implant prosthesis was screwed into place, and its teeth positioning, function and aesthetics were verified (Figs. 21a & b). With both appliances in place, the interocclusal relationship was checked (Figs. 22a & b). Minor occlusal adjust- ments were made directly to the maxillary provisional implant prosthesis, as PMMA is easily modified. Slight alterations were also made to the lower implant overdenture. Then, block out shims and the retentive overdenture caps were seated over the Locator attachments (Figs. 23a & b). Quick Up self- cure material (VOCO America) was added to the recess wells of the overdenture before seating the appliance over the metal housings. After letting the material set for approximately 3 minutes, the overdenture was removed, picking up the denture caps in the prosthesis. The minor voids surrounding the denture caps were then filled with Quick Up light-cured pink composite (Fig. 24). The appropriate retentive inserts, which are available in a variety of strengths depending on the functional capabilities of the patient and the number of implants, were swapped into the metal housings (Fig. 25). The implant overdenture was reseated, providing excel- lent retention, stability and function for the patient. CAD/CAM 2 2017 29