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ePaper created 2018-04-10, 12:30:21 | version 1.38.0
| case report Fig. 18 Fig. 19 Fig. 18: Silicone key recording tooth position. Fig. 19: Occlusal keys and pick-up stone position. Finally, the occlusion was checked, revealing bilateral symmetrical contacts. The patient was instructed on managing and cleaning the complete dentures in the ini- tial days. Follow-up visits were planned at 24 hours and one and two weeks after delivery. The patient reported a rapid adaptation to the new dentures, only a few points of pressure caused ulcerating lesions. Phonetics and sta- bility were improved after the treatment. Control appoint- ments were conducted in the weeks after delivery and excellent levels of adaptation were reported, regarding both aesthetic and phonetic aspects. Fabrication of denture copies The successful adaptation to the temporary dentures confirm that all the parameters (vertical dimension of occlusion, centric relation, aesthetics and phonetics) could be maintained in the definitive restoration. It was decided to fabricate copies of the temporary dentures and to use them as a closed-mouth tray. The tempo- rary bearing bases were rebased with a polysulphide impression material (Permlastic Light). The intermaxillary position was registered using a bite registration silicone 30 1 2018 (Occlufast, Zhermack). The copies were obtained using self-curing transparent resin (ProBase, Ivoclar Vivadent; Figs. 16a & b). Closed-mouth implant impression registration After the implant surgery, a multi-unit abutment was placed. At the impression appointment, pick-up copings were attached to the implant abutments. Denture cop- ies were prepared in order to be positioned with perfect adaptation to the oral mucosa. Finally, definitive impressions were taken with polyether material (Permadyne and Impregum, 3M ESPE). The in- termaxillary position was as registered after removing all of the implant pick-up copings that could determine occlusal interferences. A face-bow was also taken before remov- ing the maxillary impression (Figs. 17a–d). Master mod- els were prepared using a removable soft resin to repro- duce peri-implant tissue. The impressions were poured in Class IV plaster, and the obtained models were placed in the articulator using the face-bow measurements. Before removing the impressions from the master model, a silicone key was prepared in order to record the position of the anterior teeth (Fig. 18). Two occlusal bases were prepared with wax rims in order to verify the inter- maxillary position. Additionally, implant pick-up copings were splinted using stone (Elite Arti, Zhermack; Fig. 19). Implant and inter-arch position check The intermaxillary position was confirmed, but the up- per stone key was fractured during screwing procedure. Thus, it was splinted with stone, and after repositioning the implants, replaced on the model. The implants’ posi- tion was definitely confirmed (Figs. 20a–d). Tooth set-up The tooth set-up was performed according to the infor- mation of the denture copies, using the silicone key. The complete set-up was evaluated with the patient and all occlusal, aesthetic and phonetic aspects confirmed. The tooth set-up approved during the patient try-in was sent to the laboratory for framework design. Fixed or removable? Depending on the discrepancy between the position of the clinical crown and the alveolar ridge contour in the bucco-oral dimension, compensation with the denture base of a removable reconstruction may be necessary.12 However, for a fixed complete denture, the clinical crown should ideally be at the soft tissue level of the alveolar ridge. For this solution, minimal bone resorption and a limited inter-arch space with an optimal tooth–lip relation- ship are required (Fig. 21).13 These parameters, mainly determined by tooth posi- tion and the amount of residual alveolar bone, have to