Replacing an Implant-Retained Overdenture with Four Locator Abutments with a Handcrafted Polyceramic TRINIA® Telescopic Prosthesis on Four Universal Abutments with Four Milled Retentive Copings in Only Two Restorative Visits
This treatment demonstrates the clinical and laboratory aspects for the fabrication and insertion of a handcrafted polyceramic TRINIA® telescopic restoration on four unmodified Universal Abutments with four milled retentive copings to replace an implant-retained overdenture with four Locator Abutments for an eighty-four-year-old man, who was not satisfied with his Locator retained prosthesis. During the first clinical visit, after the clinical evaluation and consult, the patient’s four Locator abutments were removed and a full arch implant-level transfer impression was made along with a tooth shade and an initial occlusal registration, for the fabrication of a Gothic Arch plate and stylus. Subsequent to the fabrication of the Gothic Arch devices, a second occlusal registration was made and the patient’s existing Locator abutments were reinserted prior to reinserting his existing overdenture. During the second clinical visit, the Locator abutments were removed and four unmodified Universal Abutments were inserted using two light-cured resin orientation and seating jigs as sequenced according to the technician’s numerical markings on the master soft tissue model. Once the abutments were properly seated and the four milled retentive copings were passively fitted to the handcrafted polyceramic TRINIA® prosthesis, the copings were cemented with a resin cement into the bores of the TRINIA® framework, prior to delivering the new telescopic prosthesis to the patient.
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First Restorative Visit - Pre-operative radiograph.
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Pre-operative clinical image of mandibular overdenture and maxillary porcelain-fused-to-metal prostheses.
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Clinical image of four Locator abutments.
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Locator abutment is being grasped with an extraction forceps prior to the handle of the forceps being tapped to remove the abutment from the well of its Bicon implant.
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Handle of extraction forceps is being tapped to remove the Locator abutment from the well of the implant.
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Locator abutment is being removed prior to inserting green 3.0mm impression post.
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Clinical image of four Bicon implant sulci after the removal of their Locator abutments prior to making an implant-level transfer impression.
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Mirrored image revealing the wells of the locking taper implants.
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A second green 3.0mm impression post is being inserted into its implant well.
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A third impression post is being inserted into its implant well.
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A third green acrylic impression sleeve is being inserted onto its metal impression post.
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Impression material is being injected around two green acrylic impression sleeves.
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Four acrylic impression sleeves within a full arch implant-level transfer impression.
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Recording an arbitrary distance between nose and chin to establish a preliminary vertical dimension of occlusion.
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Bite registration material is being injected to record an initial occlusal registration.
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Initial occlusal registration is being recorded.
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Four acrylic impression sleeves within occlusal registration material.
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Tooth shade is being recorded.
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FIRST LABORATORY PHASE - Four green implant analog / impression post assemblages surrounded by soft tissue moulage in a full arch impression prior to pouring a stone model.
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Master mandibular soft tissue stone model.
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Mandibular model with wax rim and metal plate blackened with marking ink for recording Gothic Arch tracing.
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Tracing plate attached to wax rim with one impression post for stability is being inserted into well of an implant
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Metal stylus attached to acrylic plate is being inserted on palate.
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Metal stylus is being positioned to scribe on blackened plate during the random movements of the patient's mandible at a given vertical dimension of occlusion (VDO).
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Plate with an image of an arch drawn by the random movements of the patient's mandible against the stylus in the maxillary plate.
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Mandibular wax rim with plastic disc with its hole centered over the apex of the drawn arch, and luted with sticky wax, is being inserted to position the stylus in the hole during the recording of the occlusal relationship at the vertical dimension of the adjustable stylus.
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Occlusal relationship is being recorded while the stylus is positioned in the hole of the plastic disc.
28.
Mandibular occlusal registration assemblage, which will be used to articulate the two models.
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Locator abutment is being reinserted prior to discharging patient with his existing overdenture.
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SECOND LABORATORY PHASE - Models prior to being articulated with gothic arch positioning device.
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Articulated models with gothic arch positioning device in place.
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Verification jig with four milled retentive copings was used to confirm the retentiveness and path of insertion of the chosen abutments and milled copings of the final prosthesis.
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Verification jig on model with four unmodified Universal Abutments, prior to being used to confirm both the appropriate retentiveness and path of insertion of the intended prosthesis.
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Two orientation and seating jigs numerically marked to indicate the sequence of inserting the abutments.
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Digital image of scanned waxed teeth arrangement.
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Digital image of designed TRINIA® framework.
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Digital image of proposed TRINIA® framework.
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Occlusal view of milled TRINIA® framework in disc.
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Undersurface of milled TRINIA® framework with four bores for retentive copings.
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Milled TRINIA® framework on model prior to application of polyceramic material.
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View of initial application of polyceramic material to TRINIA® framework.
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View of continuing build-up of handcrafted polyceramic teeth.
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View of aesthetic contouring of polyceramic teeth.
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Occluso-facial view of finished polyceramic handcrafted teeth bonded to a TRINIA® substructure.
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Undersurface of finished prosthesis.
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Facial view of finished, handcrafted polyceramic teeth bonded to TRINIA® framework on model.
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Lingual view of handcrafted polyceramic teeth bonded to TRINIA® framework on model.
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SECOND RESTORATIVE VISIT - Pre-operative clinical image of mandibular overdenture and maxillary porcelain-fused-to-metal prosthesis prior to the insertion of four Universal Abutments and TRINIA® telescopic prosthesis with four milled copings.
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Locator abutment is being removed prior to inserting a Universal Abutment.
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Clinical image of four Bicon implant sulci after the removal of their Locator abutments prior to inserting four Universal Abutments with the aid of two seating jigs.
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Vaseline is being applied to the bore of the seating jig to facilitate its removal from the seated abutments
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Abutment is being loosely inserted into the Vaseline-lined bore of the first sequenced seating jig.
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The two first sequenced abutments are being transported to their implant wells.
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The seating jig is being tapped with an abutment seating tip on a straight driver to definitively seat both abutments simultaneously.
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The anterior abutment is being definitively seated by being directly tapped with a seating tip.
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The posterior abutment is being definitively seated by being directly tapped with a seating tip.
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A crown remover device is being used to tap the seating jig from the two definitively seated abutments.
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Anterior unmodified Universal Abutment is being tapped with an abutment seating tip attached to a straight driver.
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Posterior unmodified Universal Abutment is being tapped with an abutment seating tip attached to a straight driver.
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Vaseline is being applied to the bore of the second sequenced seating jig.
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Unmodified Universal Abutment is being seated in second sequenced seating jig.
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Second sequenced abutments are being transported to their implant wells.
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Second sequenced seating jig is being tapped with an abutment seating tip on a straight driver to definitively seat both abutments simultaneously.
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The anterior abutment is being definitively seated by being directly tapped with a seating tip.
65.
The posterior abutment is being definitively seated by being directly tapped with a seating tip.
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A crown remover device is being used to tap the seating jig from the two definitively seated abutments.
67.
Tall profile Universal Abutment is being definitively seated.
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Standard profile Universal Abutment is being definitively seated.
69.
Clinical view of four definitively seated Universal Abutments.
70.
TRINIA® prosthesis is being seated directly onto four unmodified Universal Abutments to ensure a passive fit.
71.
Blanching of tissue under seated TRINIA® prosthesis indicates the need to reduce the TRINIA® framework.
72.
Prosthesis is being removed to make necessary adjustments.
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Black marking indicates interference with the abutment. Functionally, it is better NOT to cover titanium abutments on copings for aesthetic reasons.
74.
Point of interference is being adjusted with a carbide finishing bur.
75.
Vaseline is being applied to the bore of milled retentive coping to facilitate the removal of the prosthesis when the copings are cemented into its bores.
76.
Vaseline-lined retentive coping is being definitively seated onto Universal Abutment with a gentle tap of an abutment seating tip with a straight driver.
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Alcohol swab is being used to remove Vaseline from retentive coping.
78.
Four purple retentive copings prior to their being cemented into the bores of the TRINIA® framework.
79.
TRINIA® prosthesis is being seated onto the four milled copings to ensure a passive fit.
80.
Radiograph indicates retentive copings not being fully seated.
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Prosthesis is being removed to modify any points of interference.
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Point of interference with milled retentive coping is being modified with carbide finishing bur.
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Red marking ink reveals hyperocclusion caused by incomplete seating of the prosthesis.
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Blue marking paper is being used to reveal areas of tissue contact preventing complete seating of the prosthesis.
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Ridge side of prosthesis is being modified with carbide finishing bur.
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Pink silicone wheel is being used to polish ridge side of prosthesis.
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Upofix brush is being used to polish ridge side of prosthesis.
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Bristle brush with diamond paste.
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Bristle brush with diamond paste is being used to polish ridge side of prosthesis.
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Rag wheel is being used to polish ridge side of prosthesis.
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Vaseline is being applied to ridge side of prosthesis to facilitate the removal of extraneous resin cement after the cementation of the copings into the bores of the prosthesis.
92.
Alcohol swab is being used to remove Vaseline from bore of prosthesis prior to its cementation to coping.
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Resin cement is being injected into bore of TRINIA® telescopic prosthesis.
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Cotton rolls are being used in occlusion with TRINIA® telescopic prosthesis for cementation of copings in the bores of the prosthesis.
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A crown remover device is being used to free the prosthesis with copings from the abutments.
96.
Ridge side view of four milled retentive copings cemented in the bores of the prosthesis.
97.
Excess cement is being removed from around a coping.
98.
Carbide finishing bur is being used to make final incisal adjustments.
99.
Ridge side view of TRINIA® telescopic prosthesis with four milled retentive copings.
100.
Vaseline is being applied to bore of coping to initially facilitate the patient's ability to remove the prosthesis for hygienic purposes.
101.
Post-insertion clinical image of TRINIA® telescopic prosthesis with four milled retentive copings on four Universal Abutments. The abutments were intentionally not covered for meaningless aesthetic purposes.
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