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ePaper created 2018-02-16, 11:17:41 | version 1.38.0
| industry report rehabilitation of edentulous maxilla Fig. 19 Fig. 20 Fig. 21 Fig. 22 Fig. 23 Fig. 24 Surgery The medical and dental history did not highlight local pathologies that would contraindicate the use of osteointegrated implants for prosthetic support. The third skeletal class favoured the insertion of the implant fixture with vestibular inclination in line with the major axis of the residual crest. The guiding tem- plate, prepared in the laboratory, was positioned on the lower arch to have an intraoperative reference of the correct implant axis, and four 3.3 mm x 10 mm Straumann Standard Plus implants were inserted, a regenerative with heterologous bone (botiss cera- bone) in the 22, 14 vestibular dehiscence area and in the alveoli of the 23. The bone consistency of D3, how- ever, provided a primary stability of 35 Ncm measured Fig. 25 Fig. 26 Fig. 27 38 CAD/CAM 4 2017 with a dynamometer key. After 12 weeks, the im- plants were revealed, the keratinised tissues were repositioned around the healing screws and the first impression in alginate was taken. Once the models were developed, the individual fenestrated impression trays for the implant transfers were produced and then the definitive impression was taken (Figs. 7–9). Prosthetic part The position impression was developed with a pink silicone and in extra-hard Fujirock optiscan type 4 plaster to simulate the gingiva around the analogues (Figs. 10 & 11). The wax rims with light-curing resin bases were produced in order to simulate the needed volumes for the labial support; its dimensions were of 22 mm height in the front and 20 mm in the back, with a thickness of 2 mm in the front and 4/6 mm in the back. Once tested and adapted the base with the Candulor occlusal fork aligning the upper wax in parallel with the bipupillary line, and laterally in parallel to the Camper plane which proceeds from the lower margin of the trago to the front nasal spine. The labial vesti- bulum volume was adapted to the aesthetic needs. Using the form selector, the shape of the anterior teeth was determined as corresponding to the form B63 SR Phonares II (Ivoclar), while the posterior teeth were determined as the A2 Bonartic (Candulor). The values recorded on the Stratos (Ivoclar) artic- ulator were transferred through the slider of the horizontal plane by first mounting the upper and consequently the lower antagonist model. The teeth were assembled, which was then tested in the oral cavity for the patient by performing phonetic tests and extraoral evaluations.