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ePaper created 2017-12-06, 12:03:50 | version 1.38.0
Definitive prosthetic rehabilitation Four months after surgery, the mandibular implants were uncovered and, after evalua- tion of the cuff height, two Sphero Blocks with normal-size spheres (Rhein’83) were screwed on (Fig. 5). At the upper arch level, four OT Equa- tor attachments (Rhein’83, Fig. 6) were screwed on to the implants, and an alginate impression was taken to produce the individual impression trays. The individual impression tray was adequately edged with thermoplastic paste (ISO FUNCTIONAL, GC) and functionalised. Subsequently, polyether precision impressions (3M ESPE) were taken, using the appropriate pick-up impression coping for the maxil- lary OT Equator attachments and for the mandibular spheres. After pouring of the pink silicone into the impres- sions to reproduce the gingival portions, the master model was poured in extra-hard plaster (Class IV). The dental technician then made a wax rim with a resin base in order to determine the maxillary rela- tionship with the facial arch (Artex, Amann Girrbach). The correct height of the maxillary wax rim in the frontal area and the parallelism with the ala-tragal line (corresponding to the occlusal plane) and with the bi-pupillary plane were determined using the Fox plane (Candulor). The wax rim was held firmly by three retentive caps that were connected to the low-profile attachments in order to facilitate masti- catory detection, median line recording, smile show and canine position without using an adhesive paste. The rim, once returned to the laboratory, allowed setting up of the models in the articulator. After the references had been taken with the wax rims, the tooth set-up was done (Acry Plus EVO, Ruthinium). An aesthetic try-in was then done, paying particular attention to phonetics. | industry Fig. 3 Fig. 3: Dental panoramic tomogram after seating of the temporary prosthesis. Fig. 4: All teeth except for #33 and #43 were removed. Fig. 5: Two implants were inserted in regions #32 and 42 and two spherical attachments were inserted to support and anchor a removable prosthesis. Fig. 6: At the upper arch level, the cuff height was evaluated and the correct OT Equator low-profile attachments were screwed on. avoid a regenerative maxillary sinus lift. Furthermore, owing to the peculiar connection of the Co-Axis im- plants, it was possible to handle the prostheses as if these implants were placed parallel. On the same day of the provisional prosthesis delivery, the mandibular teeth were extracted. Only #33 and #43 were pre- served because they were found to be stable and to exhibit no caries or periodontal pathologies (Fig. 4). A removable prosthesis, anchored with wire hooks to the mandibular canines, was delivered to the pa- tient as a temporary prosthesis during osseointegra- tion time and healing of the hard- and soft-tissue. After a few weeks, two cylindrical implants were in- serted in regions #32 and 42 (PrimaConnex, Keystone Dental) and were left covered by the soft tissue for four months. During this period, the two mandibular canines were endodontically treated, sectioned at the gingival level to reduce the crown–root ratio, and two titanium pivots with normal-size spheres (Pivot Block, Rhein’83) were cemented in order to improve retention of the temporary prosthesis and, later, of the definitive prosthesis. Fig. 4 Fig. 5 22 implants 4 2017 Fig. 6