Thursday, November 23rd 2017 2:09AM EST

Laboratory and Clinical Aspects of Fabricating and Inserting Eleven Universal Abutments for an Immediate Insertion of Two Milled PMMA Transitional Prostheses, and the Subsequent Insertion of Two Permanent Telescopic Prostheses with Handcrafted Polyceramic Teeth on TRINIA® Frameworks with Eight Milled Copings and One Custom Cast Chrome Cobalt Coping with an Interchangeable Retentive Attachment

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This presentation depicts the detailed techniques, aspects, and nuances of the laboratory procedures as well as the clinical treatments during the second and third restorative visits for the insertion of PMMA and TRINIA® prostheses. It also shows the increased difficulties and extended clinical time associated with placing more than four implants to support a TRINIA® telescopic prosthesis. A brief outline of the treatment steps is described below:

During the first restorative visit (not shown) and laboratory visit: the surgical uncovering of eleven implants, the fabrication of two implant-level transfer impressions, the recording of an initial occlusal relationship, and the selection of an aesthetic tooth shade. After this restorative visit, the impressions were sent to the laboratory for the fabrication of soft tissue master models; teeth arrangements; digital scans of teeth arrangements; modified and unmodified Universal Abutments; and PMMA (polymethyl methacralate) transitional prostheses.

During the second visit: the extraction of the four mandibular teeth; the insertion of eight unmodified and three modified Universal Abutments; the try-in of two waxed denture teeth arrangements on resin bases to confirm the appropriateness of the teeth arrangements, as well as the insertion of two milled PMMA full arch transitional prostheses (with gingiva-colored Ceramage material added for aesthetics) to function while the permanent TRINIA® restorations were being fabricated. The modified abutments were necessary to compensate for the less than ideal positioning of two maxillary implants and one mandibular implant. The modified mandibular abutment required the use of a custom cast chrome cobalt retentive coping.

During the third visit: The insertion of two handcrafted polyceramic teeth restorations on telescopic TRINIA® frameworks with eight cemented milled retentive copings and one custom cast chrome cobalt coping with a yellow Sci Tec retentive attachment, which provides 500 grams of retention. Two modified Universal Abutments were not used with telescopic copings, since there was sufficient retention with the four retentive copings, indicative of the fact that using more than four implants does not necessarily improve the clinical retention. Using more than four implants will provide some convenience, if an implant were to fail; however, using more than four implants increases the prosthetic complexity of the restoration.

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