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Lab Tribune Asia Pacific No.1, 2017

Lab Tribune Asia Pacific Edition | 12/2017 TRENDS & APPLICATIONS 23 21a 21b 22a 22b 23a 23b 25 26 24 Figs. 21a & b: After seating of the inal mandibular implant overdenture, the maxillary provisional implant prosthesis was tried in to verify it, form and function.—Figs. 22a & b: The interocclusal relationship was veriied with the inal mandibular and provisional maxillary appliances in place.—Figs. 23a & b: The metal housings of the overdenture caps were seated over the Locator attachments.—Fig. 24: Quick Up self-curing acrylic was used to pick up the metal housings in the overdenture and ill in the minor voids between the denture caps and recess wells of the prosthesis. Note that, in many cases, the dentist elects to have the overdenture caps processed by the laboratory.—Fig. 25: The black processing inserts were replaced with the appropriate retentive caps, which are colour-coded according to strength.—Fig. 26: The patient with the inal Locator overdenture and the maxillary provisional implant prosthesis in place.—Fig. 27: The deinitive maxillary restoration was milled from BruxZir Solid Zirconia, incorporating the slight adjustments that were made to the PMMA provisional appliance.—Figs. 28a & b: The inal BruxZir Full-Arch Implant Prosthesis completed a dramatic oral reconstruc- tion for a patient who presented with terminal dentition, restoring form, function and quality of life. thesis by seating over the Locator attachments and keeping the ap- pliance in place during function. A new master cast of the max- illa was produced based on the custom open-tray inal impres- sion. The new master cast and inal approved wax set-up were scanned. A virtual model was gen- erated, upon which the ixed mon- olithic prosthesis was designed using CAD software (Figs. 19a & b). Because this digital model was based on the inal impression with the veriication jig, screw access holes were created in precise alignment with the positions of the maxillary implants. The re- sulting design was used to mill a provisional implant prosthesis from polymethyl methacrylate (PMMA; Figs. 20a & b). This appli- ance was tried in and worn for a trial period, thus ensuring an ac- curate prosthetic design. The provisional implant pros- thesis is an essential element of the restorative process, as signii- cant adjustments cannot be made to the inal restoration once it has been milled from BruxZir Solid Zirconia. At the following appoint- ment, the Inclusive Locator Im- plant Overdenture was seated and checked for proper it, function and support from the soft tissue. The provisional implant prosthe- sis was then screwed into place, and its tooth positioning, func- tion and aesthetics were veriied (Figs. 21 a & b). With both appli- ances in place, the interocclu- sal relationship was checked (Figs. 22a & b). Minor occlusal ad- justments were made directly to the maxillary provisional implant prosthesis, as PMMA is easily mod- iied. Slight alterations were also made to the mandibular implant overdenture. Block-out shims and the retentive overdenture caps were then seated over the Locator attachments (Figs. 23a & b). Quick Up self-curing material (VOCO America) was added to the recess wells of the overdenture before seating the appliance over the metal housings. After allowing the material to set for approximately 3 minutes, the over denture was re- moved, picking up the denture caps in the prosthesis. The minor voids surrounding the denture caps were then illed with Quick Up light-cured pink composite (Fig. 24). The appropriate retentive inserts, which are available in a va- riety of strengths, depending on the functional capabilities of the patient and the number of im- plants, were swapped into the metal housings (Fig. 25). The im- plant overdenture was reseated, providing excellent retention, sta- bility and function for the patient. With the inal mandibular res- toration in place, the patient wore the provisional full-arch implant prosthesis for a trial period of two weeks (Fig. 26). This opportunity to wear the appliance during actual day-to-day function instilled a high degree of conidence in the prosthetic design for the patient and dentist alike. After patient ap- proval, the provisional implant prosthesis was returned to the lab- oratory so that it could serve as the blueprint for the inal restoration and the minor adjustments made to the appliance could be included in the deinitive prosthetic design. The inal BruxZir Full-Arch Implant Prosthesis was digitally fabricated with precision (Fig. 27). As an exact reproduction of the test-driven provisional, the deini- tive prosthesis itted perfectly and offered the aesthetics and func- tion the patient had come to ex- pect (Figs. 28a & b). The inal resto- ration effectively addressed the unique circumstances of the case, providing the most durable, stable prosthesis possible for his maxilla and a mandibular restoration that greatly improved prosthetic retention and could be upgraded to a ixed prosthesis should the patient’s situation change. Conclusion Practitioners now have the clinical lexibility to offer patients a wide range of treatment options, from entry-level, economical res- torations like the Inclusive Locator Implant Overdenture to the ixed, highly durable BruxZir Full-Arch Implant Prosthesis. There is a via- ble means of treating nearly all pa- tients, whatever their oral health, needs and inances. Given the life-changing beneits of implant therapy and the straightforward restorative protocols of today, all patients should be offered this ser- vice to confront the challenges pre- sented by complete edentulism. Editorial note: This article was irst pub- lished in CAD/CAM international maga- zine of digital dentistry No. 2/17. A list of references is available from the publisher. Dr Paresh B. Patel is a co-founder of the American Academy of Small Di- ameter Implants and has worked as a lecturer and clinical consultant on den- tal implants for various companies. He has been in private practice in Lenoir and Mooresville in North Carolina in the US since 1996 and can be contacted at 27 28a 28b

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