Fabrication and Insertion of a Four-Implant Mandibular Full Arch TRINIA™ Telescopic Prosthesis with Two Lithium Disilicate Crowns to Resist Abrasion of Composite Denture Teeth Against Opposing Maxillary Porcelain Restorations
This case demonstrates the fabrication of a four-implant mandibular full arch TRINIA™ telescopic prosthesis, beginning with the making of an implant-level transfer impression and bite registration, followed by the laboratory fabrication of a soft tissue model with four Universal abutments prosthetic posts with two to three degrees of parallelism; a light-cured resin verification jig with milled retentive copings to confirm both a path of insertion and retentiveness of the intended TRINIA™ prosthesis; a light-cured resin seating jig to facilitate the orientation and initial seating of the four Universal abutments intra-orally; and two lithium disilicate molar crowns to preserve the patient’s vertical dimension of the occlusion, by resisting the abrasion of the composite denture teeth against the patient’s maxillary porcelain restorations. Finally, three red retentive copings and one metallic non-retentive coping, which were seated on the Universal abutments, were intra-orally cemented into the bores of the mandibular full arch TRINIA™ prosthesis to provide the patient with a functionally stable and aesthetic restoration.
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Wax bite registrations with acrylic sleeves for articulating models. Preferably, a polysiloxane material.
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Initial waxed teeth arrangement.
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Stone incisor teeth being removed.
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Full arch arrangement of teeth.
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Articulated models in Class II occlusion.
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Articulated models in Class II occlusion.
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Silicone mask of composite denture teeth arrangement.
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Denture teeth attached with Cyanoacrylic glue to silicone mask.
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Measuring to achieve 1 to 3 degrees of divergence among the Universal Abutments.
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Confirming 1 to 3 degrees of divergence among the Universal Abutments.
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Fabricated light-cured resin abutment seating jig with enlarged abutment orifices to facilitate their relining with pattern resin.
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Relined seating jig with numerical markings indicating the sequence for seating the abutments. Initially, the two most parallel are marked Number 1.
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Three red retentive and one metallic non-retentive coping on Universal Abutments for fabrication of verification jig.
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Light-cured verification jig with enlarged orifices prior to being luted to copings.
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Light-cured, flowable pattern resin being injected around copings in verification jig.
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Flowable pattern resin being light-cured to retain copings in verification jig.
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Verification jig with three retentive and one non-retentive coping.
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Verification jig on master model to confirm both the path of insertion and retentiveness of the intended telescopic prosthesis.
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Articulating paper being used to confirm adequate space between composite denture teeth and copings seated on Universal Abutments.
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Blue marking indicates interference with copings.
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Areas of interference with copings being adjusted.
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Virtual image of scanned components.
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Scanned image of model with copings on Universal Abutments.
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Lingual view of virtual image of designed framework.
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Labial view of designed bar showing a minimum of 2.0 mm of TRINIA™ material over copings and 3.0 mm projections of TRINIAª to enhance retention of composite denture teeth.
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Virtual lingual view of components with 3.0 mm retentive projections of TRINIA™ material into the composite teeth.
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Milled bar nested in TRINIA™ disc after two hours of milling.
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Occlusal view of TRINIA™ bar showing 3.0 mm projections to enhance denture teeth retention.
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Ridge view of TRINIA™ bar showing four bores for retaining copings with resin cement.
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Cervical view of composite teeth with bores for retention in silicone mask.
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Composite teeth seated on TRINIA™ bar on model to confirm adequate spacing.
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Bonding agent being applied to composite teeth for light-cured bonding of teeth to TRINIA™ bar.
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Light-cured bonding agent applied prior to attachment with polyceramic material to TRINIA™ bar.
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Composite teeth bonded to cream-colored TRINIA™ bar on model.
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TRINIA™ prosthesis with distal molars prepared for lithium disilicate crowns to maintain vertical dimension of occlusion since the opposing dentition is porcelain, which is more abrasive than the composite teeth.
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Two waxed molar crowns prior to being invested.
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Waxed crowns ready for investment.
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Wax crowns being invested. Alternatively, crowns could have been milled.
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Prosthesis being finished with two lithium disilicate crowns to preserve vertical dimension of occlusion.
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Prosthesis with surface being textured.
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Textured surface being confirmed with blue ink markings from articulating paper.
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Lithium disilicate crown being fitted.
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Occlusion being adjusted.
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Glazed lithium disilicate crowns prior to being cemented to TRINIA™ bar.
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Prosthesis being polished with gray rubber wheel.
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Prosthesis being polished with Upofix brush.
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Prosthesis being polished with bristle brush and diamond paste.
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Final buffing with rag wheel.
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Staining sulci for aesthetics.
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Etching lithium disilicate crowns prior to their cementation.
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Bonding agent being applied to TRINIA™ crown preps.
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Bonding agent being applied to TRINIA™ crown preps.
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Resin cement being applied to lithium disilicate crown.
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Oxygen barrier being applied for light curing of resin cement.
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Polishing with Upofix brush.
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Finished TRINIA™ prosthesis on articulated model.
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Finished TRINIA™ prosthesis on articulated model.
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View of convexed ridge of TRINIA™ prosthesis with three retentive and one non-retentive coping fitted into it.
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Occlusal view of TRINIA™ prosthesis with composite denture teeth and two lithium disilicate molar crowns to resist abrasion from opposing porcelain teeth.
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Post-extraction site prior to insertion of TRINIA™ prosthesis during patient's second restorative visit.
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Sutured site prior to removal of temporary abutments and insertion of four Universal Abutments.
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View of ridge side of seating jig with two loosely seated Universal Abutments, which will be the first abutments to be seated since they were the two most parallel abutments.
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Seating jig being tapped to engage the definitive seating of the first two Universal Abutments.
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Temporary abutment being removed.
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Vaseline being applied to Universal Abutments to facilitate the removal of the copings once they have been cemented into the TRINIA™ prosthesis.
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Resin cement being applied to the bores of the TRINIA™ prosthesis to retain the four copings.
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TRINIA™ prosthesisbeing cemented onto four copings seated on Universal Abutments.
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TRINIA™ prosthesis cemented onto three retentive and one non- retentive coping
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View of four Universal Abutments after removal of TRINIA™ telescopic restoration.
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Finished telescopic TRINIA™ prosthesis with four copings on four Universal Abutments.
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Patient's smile with mandibular TRINIA™ prosthesis.
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Six-month clinical view of TRINIA™ telescopic prosthesis prior to being relined.
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Six-month occlusal view of TRINIA™ telescopic prosthesis with staining.
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Six-month clinical view of four Universal Abutments.
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Six-month ridge view of TRINIA™ prosthesis with calculus and staining.
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Prosthesis being cleaned with air abrasion prior to being relined.
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Cleaned prosthesis prior to being relined.
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Silene being applied to ridge surface prior to being relined.
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Bonding agent being applied to ridge side of prosthesis prior to prosthesis being intra-orally relined with light-cured polyceramic material.
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Polyceramic paste addedto prosthesis prior to being inserted for a chairside reline.
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Polyceramic paste being contoured prior to being light-cured.
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Initial light-curing of polyceramic paste.
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Relined prosthesis prior to being removed for additional light-curing.
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Oxygen barrier being applied prior to final light-curing.
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Relined prosthesis being contoured.
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Relined prosthesis being polished with rubber cone.
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Relined prosthesis being polished with Upofix brush.
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Relined prosthesis being polished with bristle brush and diamond paste.
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