Replacement of a Failed Screw-Retained Prosthesis with a Telescopic TRIO-TRINIA® Prosthesis with Milled Hybrid Polyceramic Teeth

Posted on December 27, 2017 in Restorative, SHORT® Implants, Surgical, Telescopic Restorations, Uncovering

This treatment for an 83-year-old woman, who presented with a failed maxillary prosthesis supported by five screw-retained IMZ implants, demonstrates the clinical capabilities of a telescopic TRINIA® prosthesis supported by only three Bicon SHORT® Implants: two 4.5 x 6.0-mm implants with a 3.0-mm well, and one 4.0 x 6.0-mm implant with a 2.5-mm well. The laboratory techniques and procedures of this treatment are also presented. After five months of healing, the implants were uncovered and a telescopic TRIO-TRINIA® prosthesis was fabricated with milled hybrid polyceramic teeth.

Replacement of an O-ring Mandibular Overdenture with a Telescopic TRINIA®-HC Prosthesis Utilizing Gothic Arch Occlusal Registration Tracing

Posted on October 30, 2017 in Overdentures

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.

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

Posted on October 23, 2017 in Uncategorized

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.

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

Posted on August 10, 2017 in Overdentures, Porcelain Fused to Metal

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.

Laboratory and Clinical Aspects of Fabricating and Inserting Four Universal Abutments for the Immediate Insertion of a Milled PMMA Telescopic Transitional Prosthesis and a Permanent Handcrafted Poly-ceramic Telescopic Prosthesis on a TRINIA® Framework with Three Milled Copings and One Custom Cast Chrome Cobalt Coping with an Interchangeable Retentive Attachment

Posted on July 24, 2017 in Telescopic Restorations, Uncovering

This treatment depicts the detailed aspects and nuances of the above-described prostheses in only three clinical restorative visits, which included:
During the first visit, the surgical uncovering of four implants, an implant-level transfer impression, the recording of an initial occlusal relationship, and choosing an aesthetic tooth shade.
During the second visit, the extraction of the four teeth, insertion of three unmodified and one modified Universal Abutment, which was unwisely modified to achieve an unnecessary aesthetic effect by using a custom cast chrome cobalt retentive coping, a second occlusal registration, and the insertion of a milled PMMA telescopic full arch transitional prosthesis, with gingiva-colored Ceramage material added for aesthetics, to confirm the appropriateness of the teeth arrangement as well as a transitional device for function while the extraction sites were healing and the permanent TRINIA® restoration was being fabricated. Alternatively, as a less expensive option, the PMMA prosthesis could have been affixed to the abutments without the telescopic copings.
During the third visit, the insertion of a handcrafted poly-ceramic telescopic restoration on a TRINIA® framework with three cemented milled retentive copings and one custom cast chrome cobalt coping with a yellow SiTec retentive attachment, as well as the intra-oral relining of the prosthesis with Ceramage.

Insertion of a Maxillary Full Arch TRINIA® Telescopic Prosthesis

Posted on July 18, 2017 in Telescopic Restorations

This treatment demonstrates the sequential use of a resin seating jig to facilitate the orientation and seating of four abutments for the insertion of a maxillary full arch TRINIA® telescopic prosthesis with two milled retentive copings and two custom cast chrome cobalt copings on four implants for a 59-year-old woman.

Insertion of a Two-Unit TRINIA® Prosthesis to Replace an Ill-Fitting Prosthesis

Posted on July 10, 2017 in Porcelain Fused to Metal

This treatment demonstrates the insertion of a two-unit TRINIA® prosthesis for maxillary central incisor implants in a 71-year-old male, who presented with an ill-fitting, splinted Porcelain-Fused-to-Metal (PFM) prosthesis.

Immediate Loading of Three Maxillary Implants with a Winged TRINIA® Transitional Prosthesis

Posted on May 27, 2017 in Immediate Placement, Surgical

This treatment demonstrates the technique of immediately loading two 4.0 x 6.0mm implants and one 5.0 x 5.0mm implant by using a winged TRINIA® transitional prosthesis and one existing 4.5 x 8.0mm implant.

Insertion of a TRINIA® Telescopic Prosthesis

Posted on May 15, 2017 in Overdentures, Restorative

This treatment demonstrates the insertion of a TRINIA® telescopic restoration on five non-parallel implants for a 70-year-old woman, who previously had a four-implant-retained o-ring overdenture.

Insertion and Relining of a Maxillary Telescopic TRINIA™ Prosthesis

Posted on January 25, 2017 in Restorative, Telescopic Restorations

This case demonstrates the insertion of a maxillary full arch telescopic restoration with two conventional telescopic copings with yellow retentive inserts and two milled titanium copings on four implants, one of which is badly positioned.