This case demonstrates the clinical and laboratory procedures and techniques to replace a 10-year-old O-Ring mandibular overdenture on three O-Ring Abutments with a telescopic prosthesis of TRINIA® and Shofu disc HC, CAD/CAM material, with three milled retentive copings on Universal Abutments in two clinical visits for a 75-year-old woman.
During the first clinical visit, the three O-Ring Abutments were removed from their implants, and three 2.0mm impression posts and corresponding acrylic sleeves were inserted for the making of a full arch implant-level transfer impression. An initial centric occlusal registration was recorded using modified acrylic impression sleeves at the patient’s existing vertical dimension of occlusion with the bite registration material, Capture. While the patient waited, the impressions were poured and the stone models articulated for the fabrication of a maxillary stylus and mandibular tracing plate to facilitate the registration of the patient’s centric relation utilizing the Gothic arch occlusal registration tracing. After recording the patient’s centric relation, the O-Ring Abutments were re-inserted, and the occlusal registration was sent to the dental technician for the fabrication of a telescopic TRINIA® substructure to which three separately milled teeth arrangements of Shofu disc HC material were bonded.
During the second clinical visit, the O-Ring Abutments were removed, and three Universal Abutments were inserted into the implants utilizing a light-cured resin orientation/seating jig, prior to the cementation of three milled retentive copings into the bores of the TRINIA®-HC prosthesis.
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Pre-operative radiograph of three implants and O-Ring Abutments.
2.
Image of patient's o-ring overdenture.
3.
O-Ring Abutment is being grasped by extraction forceps prior to being twisted and pulled from the well of its implant. Alternatively, the handle of the forceps could have been tapped to remove the abutment.
4.
O-Ring Abutment is being removed from the well of its implant.
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Clinical image of three implant sulci.
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Three violet 2.0mm impression posts seated in their implants for the fabrication of an implant-level transfer impression.
7.
Three violet 2.0mm impression posts with red acrylic sleeves seated in their implants.
8.
Impression material is being injected around the three impression posts and their acrylic sleeves.
9.
Three red acrylic sleeves captured in an implant-level transfer impression.
10.
Three violet implant analogs/ impression post assemblages surrounded by soft tissue moulage in a full arch impression.
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Stone model is being poured, incorporating the three implant analogs/impression post assemblages.
12.
Stylus and resin plate on maxillary stone model.
13.
Mandibular model with wax rim and metal tracing plate for recording a Gothic arch tracing.
14.
Metal stylus is being positioned to scribe on plate during random movements of the patient's mandible at a given vertical dimension of occlusion (VDO).
15.
Modified wax rim and metal plate with Gothic arch image drawn by the random movements of the patient's mandible.
16.
Bore of plastic disc positioned over apex of drawn Gothic arch prior to being luted in place with sticky wax.
17.
Stylus positioned in bore of plastic disc for the recording of the patient's centric occlusal relationship.
18.
Bite registration material is being injected around the wax rim for the recording of the centric occlusal relationship while the stylus is positioned in the bore of the plastic disc.
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Mandibular occlusal registration assemblage, which will be used to articulate the master models.
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Articulated models with the Gothic arch positioning device in place.
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Bite registration material facilitating articulation of the master models.
22.
Mandibular wax and Candulor composite teeth arrangement articulated with maxillary stone model teeth.
23.
Silicone mask confirming appropriateness of spacing around selected Universal Abutments.
24.
Universal Abutments in soft tissue moulage on stone model with numerical markings indicating the sequential seating of the abutments.
25.
Digital image of wax and composite teeth arrangement.
26.
Digital image of retentive telescopic copings on Universal Abutments.
27.
Digital image of designed teeth arrangement, which will be milled from a TRINIA® and Shofu HC disc.
28.
Digital image of a substructure framework and an anatomical teeth arrangement superstructure.
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Digital image of designed TRINIA® substructure.
30.
Digital image of designed prosthesis.
31.
Digital image of occlusal view of designed prosthesis.
32.
Shofu HC disc is being milled.
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Three pieces of milled Shofu HC teeth prior to their being bonded onto TRINIA® framework.
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Milled TRINIA® substructure.
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HC teeth arrangement seated on TRINIA® substructure.
36.
Bonding agent is being applied to TRINIA® substructure.
37.
View of aesthetic contouring of the bonded HC teeth arrangement and TRINIA® substructure.
38.
View of prosthesis prior to addition of Ceramage polyceramic material for gingival aesthetics.
39.
View of finished TRINIA® prosthesis with milled Shofu HC disc teeth.
40.
Ridge side view of finished prosthesis.
41.
Ridge side view of finished prosthesis, orientation/seating jig, and verification jig.
42.
Light-cured resin verification jig with three milled retentive copings seated on Universal Abutments to confirm retentivenes and path of insertion of final prosthesis.
43.
Light-cured resin orientation/seating jig seated with numerical markings for the sequential seating of the Universal Abutments.
44.
Orientation/seating jig seated on three Universal Abutments on stone model.
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Retentive copings seated on Universal Abutments on stone model.
46.
View of verification jig and orientation/seating jig.
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Two first-sequenced Universal Abutments seated in the bores of the orientation/seating jig.
48.
Two first-sequenced abutments are being transported to their implant wells.
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Two first-sequenced abutments are being inserted into the well of their implants.
50.
Seating jig is being tapped with an abutment seating tip on a straight driver to seat both abutments simultaneously.
51.
Crown remover instrument is being used to tap the Vaseline-lined seating jig from the first two seated abutments.
52.
Second-sequenced abutment is being transported to its implant well.
53.
Second-sequenced abutment is being inserted into the well of its implant.
54.
Abutment and seating jig are being tapped with an abutment seating tip on a straight driver.
55.
Crown remover instrument is being used to tap the Vaseline-lined seating jig from the three seated abutments.
56.
Each abutment is being definitively tapped.
57.
Verification jig is being used to confirm the path of insertion and retentiveness of the final prosthesis.
58.
Vaseline is being applied to the bore of each retentive coping to facilitate the removal of the prosthesis when the copings are cemented into its bores.
59.
Each Vaseline-lined retentive coping is being definitively seated onto its Universal Abutment with a gentle tap.
60.
View of finished prosthesis.
61.
Vaseline is being applied to the prosthesis to facilitate the removal of any extraneous cement after the cementation of the three retentive copings.
62.
Resin cement is being applied to the bores of the prosthesis for the cementation of the three retentive copings.
63.
View of TRINIA®-HC hybrid telescopic mandibular prosthesis prior to the removal of extraneous cement.
64.
Post-operative radiograph of three implants and a TRINIA®-HC telescopic mandibular prosthesis.
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