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
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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Mandibular soft tissue master model after pouring the implant-level transfer impression during first restorative visit.
2.
Maxillary soft tissue master model with implant analogs.
3.
Resin duplication of patient’s denture with bite registration in capture material facilitating articulation of master models.
4.
Maxillary Candulor composite teeth arrangement articulated with mandibular stone model teeth.
5.
After removal of stone teeth, the mandibular composite teeth are arranged against the existing maxillary composite teeth arrangement.
6.
Silicone mask of mandibular wax composite teeth arrangement.
7.
Silicone mask confirming appropriateness of spacing around selected abutments.
8.
Digital image of wax composite teeth arrangements.
9.
Selected Universal Abutment being modified for custom cast chrome cobalt coping.
10.
Four unmodified posterior Universal Abutments and two modified central incisor Universal Abutments.
11.
Scanned image of waxed arrangements of Candulor composite teeth over abutments.
12.
Digital image of designed PMMA prostheses
13.
Digital image of scanned models with abutments.
14.
Image of milled PMMA, transitional prostheses.
15.
Milled PMMA transitional prostheses with gingival colored polyceramic material applied for aesthetics.
16.
Maxillary model with four unmodified posterior Universal Abutments and two modified anterior abutments.
17.
Three light-cured resin orientation and seating jigs.
18.
Utilizing the fabricated jig to initially seat the two first-sequenced Universal Abutments as indicated on stone model with the numeral one.
19.
Utilizing the resin jig to initially seat the first-sequenced Universal Abutments.
20.
Tapping jig to seat the two first-sequenced abutments in unison.
21.
The anterior abutment being tapped with a seating tip attached to a straight driver to achieve engagement of its locking taper connection.
22.
The posterior abutment being tapped with a seating tip attached to a straight driver.
23.
Crown remover instrument being used to remove the Vaseline-lined seating jig.
24.
Blue 2.5 mm guide pins seated in the anterior implants to receive a 5.0 mm sulcus former to prepare an implant sulcus for the intended 5.0 mm abutment.
25.
A gold 5.0 mm sulcus former being rotated to remove tissue to facilitate the complete seating of a 5.0 mm modified Universal Abutment.
26.
Sulcus former with remnants of tissue, which would have prevented the definitive seating of the abutment.
27.
Removing guide pin with the remnants of tissue, which would have prevented the definitive seating of the abutment.
28.
Two second-sequenced modified Universal Abutments being transported to their implants in Vaseline-lined orientation and seating jig for their initial seating
29.
Modified Universal Abutments being seated with finger pressure.
30.
Modified Universal Abutments after their initial seating.
31.
Second seating jig being tapped with abutment seating tip to engage the abutments in their implants.
32.
Right modified abutment being definitively seated by tapping on a seating tip.
33.
Left modified abutment being definitively seated by tapping on a seating tip.
34.
Crown remover instrument being used to remove the Vaseline-lined seating jig.
35.
Two definitively seated, modified Universal Abutments.
36.
Vaseline being placed into the bores of the jig to hold the abutments while allowing for the jig’s easy separation from seated abutments.
37.
Cotton pliers being used to remove an abutment from an implant analog.
38.
The two third-sequenced abutments being transported to their implants.
39.
Third seating jig being tapped with abutment seating tip to engage the abutments in their implants.
40.
Anterior abutment being definitively seated.
41.
Posterior abutment being definitively seated.
42.
Crown remover instrument being used to remove the Vaseline-lined seating jig.
43.
PMMA transitional prosthesis being transported to abutments.
44.
Mandibular master model with two modified and three unmodified Universal Abutments.
45.
Two light-cured resin orientation and seating jigs on stone model with numerical markings indicating the sequence for seating abutments.
46.
Vaseline being placed into the mandibular jig’s bores to hold the abutment while allowing for easy separation of the jig from the abutments.
47.
Abutment being placed into the Vaseline-lined posterior bore of the first seating jig.
48.
Two of the first-sequenced abutments being transported to their implants.
49.
Two of the first-sequenced abutments being seated into the well of their implants.
50.
First seating jig being tapped with abutment seating tip to engage the abutments in their implants.
51.
Anterior abutment being definitively seated by tapping on a seating tip.
52.
Posterior abutment being definitively seated by tapping on a seating tip.
53.
Crown remover instrument being used to remove the Vaseline-lined seating jig.
54.
Seating jig being used to transport the second-sequenced abutment.
55.
First seating jig being tapped with abutment seating tip to engage all abutments in their implants.
56.
Second-sequenced abutment being definitively seated by tapping on a seating tip.
57.
Crown remover instrument being used to remove the Vaseline-lined seating jig.
58.
Anterior abutment being placed into the Vaseline-lined bore of the second seating jig.
59.
Abutment being loosely placed into the implant prior to utilizing the seating jig for the abutment’s final orientation.
60.
Anterior Universal Abutment being transported in the seating jig.
61.
Second seating jig being used to finally align and seat loosely seated abutments in their implants.
62.
Second seating jig being tapped with abutment seating tip to engage both abutments in their implants.
63.
Posterior abutment being definitively seated by tapping on a seating tip.
64.
Anterior abutment being definitively seated by tapping on a seating tip.
65.
Crown remover instrument being used to remove the Vaseline-lined seating jig.
66.
Further definitive seating of the posterior abutment.
67.
Further definitive seating of the anterior abutment.
68.
PMMA temporary prosthesis prior to being placed on the seated abutments.
69.
PMMA temporary prosthesis prior to being placed on the seated abutments.
70.
PMMA prosthesis being seated with finger pressure to verify accurate seating between prosthesis and abutments.
71.
Blue ink markings indicating occlusal contacts.
72.
Seated PMMA prostheses.
73.
Patient’s smile.
74.
Dental floss indicating the need to modify the midline of the PMMA teeth arrangements.
75.
Modified teeth arrangements on stone model prior to being scanned for fabrication of TRINIA® prostheses.
76.
Modified teeth arrangements on stone model prior to being scanned for fabrication of TRINIA® prostheses.
77.
Modified teeth arrangements on stone model prior to being scanned for fabrication of TRINIA® prostheses.
78.
Vaseline being applied to the bore of a retentive coping to facilitate the removal of the prosthesis when the copings are cemented into the TRINIA® prosthesis.
79.
Vaseline-lined retentive coping being seated onto Universal Abutment prior to being cemented into the TRINIA® prosthesis.
80.
Maxillary TRINIA® prosthesis being seated onto the four retentive copings to confirm a passive fit.
81.
Patient's smile.
82.
Vaseline being applied to the mandibular prosthesis to facilitate the removal of extraneous cement after the cementation of two custom cast chrome cobalt copings.
83.
Resin cement being applied to the bores of the mandibular prosthesis for the cementation of two custom cast chrome cobalt copings.
84.
Vaseline-lined TRINIA® prosthesis being seated onto the abutments for the cementation of two custom cast chrome cobalt copings.
85.
Cotton rolls being used to definitively cement the two custom cast chrome cobalt copings to the TRINIA® prosthesis.
86.
Resin cement applied to the bores of the maxillary prosthesis for the cementation of four retentive copings.
87.
Vaseline-lined TRINIA® prosthesis being seated for the cementation of four retentive copings into the bores of the TRINIA® prosthesis.
88.
View of mandibular TRINIA® telescopic prosthesis with three retentive and two custom cast chrome cobalt copings and maxillary TRINIA® telescopic prosthesis with four retentive copings.
89.
Palatal view of four unmodified and two anterior modified Universal Abutments.
90.
View of three unmodified and two modified Universal Abutments.
91.
Facial view of TRINIA® telescopic prostheses in occlusion.
92.
Palatal view of maxillary TRINIA® telescopic prosthesis.
93.
Occlusal view of mandibular TRINIA® telescopic prosthesis.
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