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ePaper created 2017-12-06, 12:03:50 | version 1.38.0
| industry Fig. 7 Fig. 8 Fig. 9 Fig. 10 Fig. 7: Primary bar anchored to low-profile OT Equator attachments by means of Elastic Seeger rings, whose function is to anchor the structure passively. Fig. 8: The primary bar was assembled with castable material and subsequently cast in cobalt-chromium. Fig. 9: Secondary structure anchored on the primary structure via OT Equator attachments and palatine screws. Fig. 10: Delivery of the prostheses, which showed good harmonisation with the surrounding tissue and good aesthetics. The assembly try-in provided a general appearance that harmonised well with the physiognomy of the patient by providing a proper profile and aesthetics. After the assembly had been correctly done, the pros- thetic volumes were evaluated while searching the available spaces for the reinforcement structure, both for the maxillary fixed prosthesis and the removable mandibular prosthesis. The Double FiRe Bridge proto- col implemented in the present study entailed the construction of a primary bar anchored to low-profile OT Equator attachments using acetal rings called Elastic Seeger (Rhein’83), capable of blocking the whole structure by creating a functional and solid connection with guaranteed passivity.19 Above each attachment, a cover screw was placed to increase the contact of the Elastic Seeger rings on the walls of the bar by improving the anchorage (Fig. 7). On the occlusal surface, the bar had some OT Equator attachments that would allow a superstruc- ture to be anchored if the clinician decided to turn the fixed prosthesis into a removable one. The primary bar, once cast, had two threads at the palatine level to which it was possible to attach the fixing screws for the secondary structure positioned above, thereby transforming the prosthesis into a fixed one (Fig. 8). The overlying secondary structure was precisely fit- ted on the primary bar and assembled according to the dentition tested during aesthetic and phonetic testing (Fig. 9). For the mandible, a cobalt-chromium reinforcement structure was cast, which had to be applied inside the containers on the spherical attach- ments for the retentive caps. The definitive prosthesis was completed and char- acterised with colour stains to mimic the keratinised gingiva and dental discolorations to improve mimicry. In addition, the medial frenulum and the alveolar nerve were formed for a more natural look. The max- illary and mandibular prostheses were then delivered and showed proper harmony with the surrounding tissue and good aesthetics provided both by the fea- tures of the teeth and flange and by the absence of occlusal access holes for the screws, commonly pres- ent in fixed screw-retained prostheses (Fig. 10). The final dental panoramic tomogram showed correct fitting of the prostheses, correct adjustment of the maxillary bar and excellent maintenance of the peri-implant bone. The lateral cephalometric radio- graph showed the close relationship between the base of the prosthetic central incisor and the implant neck to indicate how, in this case, fixed restoration was the best possible solution from an aesthetic and functional point of view (Figs. 11a & b).2, 5 Case 2 In the second case, a 67-year-old patient with mul- tiple caries and periapical lesions of both maxillary and mandibular teeth was treated. The patient had a 24 implants 4 2017