Replacement of a Failed Full-Arch Maxillary PFM Prosthesis with a TRINIA® Full-Arch Prosthesis Supported on Six Bicon SHORT® Implants Using Fixed-Detachable Universal Abutments and Digital Prosthetic Techniques
This case demonstrates both the surgical and prosthetic treatments, which provided a seventy-five-year-old professional male patient (who travels frequently) with the comfort of having a fixed maxillary prosthesis throughout his three years of treatment. Initially, a single molar implant was placed with an internal sinus lift procedure, which after its integration provided stability for a fixed transitional prosthesis. Immediately following the extraction of two right premolar teeth and a left molar and their replacement with implants, a transitional prosthesis was inserted.
After the integration of the three additional implants, his remaining teeth were removed, and a second transitional TRINIA® prosthesis was inserted onto four Fixed-Detachable Universal Abutments (FDUAs), which provided aesthetics and comfortable functioning during the healing of a significant anterior bone grafting procedure utilizing SynthoGraft® with a titanium mesh membrane and osseointegration of two additional implants. Subsequent to the osseointegration of the newly placed implants and the removal of the failed left posterior implant, a digital abutment-level scan or impression was made for the fabrication of a permanent screw-retained TRINIA® prosthesis on five implants with FDUAs and Copings. A sixth implant abutment, which was too facially positioned is being initially used as a rest and will be replaced with an angled FDUA and retrofitted chairside with a Coping to a more palatal position after further maturation of the significant anterior bone graft.
An occlusal registration was made using conventional material between the mandibular teeth and the palate and alveolar ridge areas of the maxilla. Unfortunately, since the digital abutment-level full-arch intraoral scan was apparently not precisely accurate, an abutment-level conventional open tray impression was made. The screw-retained Impression Copings were joined with an injectable resin material to assure their relative positioning within the impression material. Using the new stone model, the FDUA Copings were repositioned in the TRINIA® prosthesis, which was subsequently successfully seated intraorally. Once the final TRINIA® prosthesis with five FDUA Copings was passively seated on the six implants, it was fastened in place with different standard lengths of retention screws, whose lengths were shortened so that they were slightly below the occlusal surface of the prosthesis. The spaces between the Vaseline-coated retention screws and the TRINIA bores were filled with an injectable resin, which facilitated the removal of the prosthesis for the removal of any extraneous resin cement prior to being refastened with retention screws, which were aesthetically covered with a composite resin.
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Clinical view of three maxillary right implant sulci, prior to the insertion of three Fixed-Detachable Universal Abutments (FDUAs) nine months after the anterior implants were placed.
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Insertion of third FDUA.
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Three seated FDUAs.
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FDUA on maxillary left posterior implant.
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Stone model with four FDUA Copings and 10.0mm Hex Coping Screws for the fabrication of a TRINIA® transitional prosthesis.
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Transitional TRINIA® prosthesis with four FDUA copings.
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Transitional TRINIA® prosthesis with four FDUA copings.
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Periotome being used to facilitate the removal of maxillary canine.
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Clinical view after the removal of maxillary anterior teeth and failed fixed porcelain fused to metal prosthesis.
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Clinical view of seated transitional TRINIA® prosthesis on four FDUA.
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Post-insertion radiograph of fastened titanium mesh and SynthoGraft® material beneath transitional TRINIA® prosthesis.
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Radiograph after insertion of the implants, which were placed into the grafted SynthoGraft® site after the removal of the titanium mesh membrane.
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Post-insertion radiograph.
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Clinical view of four FDUA prior to the uncovering of three newly placed implants.
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Guide Pin being removed from well of implant and two Guide Pins seated in the well of two implants.
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Scannable Temporary Abutment being inserted.
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Radiograph of transitional TRINIA® prosthesis supported by four FDUA with three newly uncovered implants with Scannable Temporary Abutments, one of which is not engaged in the well of its implant.
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Clinical view of six FDUA after the removal of the failed leftmost posterior implant
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White Scan Body being fastened to FDUA.
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Scan Bodies fastened to FDUAs.
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Scan Bodies being digitally scanned for a full-arch abutment-level transfer impression.
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Digital view of maxillary arch with Scan Bodies.
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Digital view of maxillary arch with Scan Bodies using a different software program.
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Digital view of implants with FDUA Copings.
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Digital view of implants with Analogs.
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Digital view of Implant Analog wells.
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View of six FDUAs after removal of transitional TRINIA® prosthesis.
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Hex Retention Screw being inserted into FDUA, which will be used as a rest for the final prosthesis until the grafted bone of its implant has matured further.
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Final TRINIA® prosthesis with five FDUA Copings is being inserted onto the five FDUAs.
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5.0mm Hex Coping Screw being removed since, unfortunately, the prosthesis did not fit precisely onto the FDUAs.
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FDUA Transfer Coping with 5.0mm Hex Coping Screw attached being inserted onto FDUA for the making of a conventional impression, since the intraoral digital impression was apparently not accurate.
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Second FDUA Transfer Coping being fastened with a 5.0mm Hex Coping Screw.
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Third FDUA Transfer Coping with 5.0mm Hex Coping Screw attached being inserted onto FDUA.
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Third FDUA Transfer Coping being fastened with a 5.0mm Hex Coping Screw.
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Resin cement being injected around Transfer Copings to stabilize their relative positions prior to the making of a conventional open tray impression.
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View of two resin splints around Transfer Copings.
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Seated open tray prior to the making of a conventional impression.
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TRINIA® prosthesis with repositioned Final Titanium Copings on stone model.
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TRINIA® prosthesis with repositioned Final Titanium Copings.
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Occlusal view of TRINIA® prosthesis with repositioned Final Titanium Copings.
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TRINIA® prosthesis with repositioned Final Titanium Copings being seated onto implants with FDUAs.
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5.0mm Hex Coping Screw being inserted into right posterior FDUA.
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Hex Retention Screw being inserted into FDUA.
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View of final TRINIA® prosthesis fastened with five retentive screws and resting on one straight FDUA until the abutment can be replaced chairside with an angled FDUA and retained with a FDUA Coping and a Hex Retention Screw.
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Vaseline being applied to facilitate the removal of impression material which will be applied to temporarily cover the hex screws until the prosthesis is definitively fastened.
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Impression material covering four hex screws.
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Panoramic radiograph of TRINIA® prosthesis fastened with five hex screws and resting temporarily on left anterior straight FDUA, which is too facially positioned and will be replaced with an angled abutment and fastened chairside with a coping and a hex screw after further maturation of its implant.
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Prosthesis being unfastened to confirm its appropriateness to the mucosa.
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View of six FDUA and healthy mucosa prior to the permanent fastening of the TRINIA® prosthesis.
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View of five FDUA copings within TRINIA® prosthesis.
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View of TRINIA® prosthesis with five access bores for fastening the prosthesis.
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Prosthesis being inserted onto five FDUA Copings.
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A shortened 10.0mm Hex Coping Screw is being inserted into a FDUA molar site.
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A shortened 10.0mm Hex Coping Screw is being inserted into a FDUA bicuspid site.
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A shortened 5.0mm Hex Coping Screw is being inserted into a FDUA canine site.
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A shortened 5.0mm Hex Coping Screw is being inserted into a FDUA bicuspid site.
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TRINIA® prosthesis fastened with five hex screws, which were shortened to be slightly below the occlusal surface.
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Vaseline being applied to the hex bore within the screw to prevent resin from entering the bore.
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