Full-Arch Telescopic TRINIA® Prostheses

Hello. My name is Laura Murcko, and I welcome this opportunity of sharing with you our clinical experiences for the restoration of a maxillary and mandibular full arch TRINIA telescopic restoration on four short Bicon implants. Since 2010, we have been using TRINIA, a revolutionary metal free CAD/CAM fiber reinforced material very successfully for the restoration of not only implants but also for natural teeth, both fixed and removable prostheses. Although there are many different ways to restore all types of implants with TRINIA, in this video, we shall present to you the restoration of two edentulous arches on a fifty year old man and only three clinical visits. Telescopic restorations are not common in the United States, yet. However, they are ubiquitous in some European countries. Whether you are familiar with the telescopic restorations or not, hopefully both you and your patients will benefit from these revolutionary materials and techniques that will be presented in the following cases. Treatment for our fifty year old edentulous male patient began with a clinical and a radiographic examination and the subsequent placement of four five point zero millimeter by six point zero millimeter implants in his maxilla and four five point zero millimeter by five point zero millimeter implants in his mandible. After three months of healing, the eight short implants were uncovered and the restorative phase of his treatment was initiated. A maxillary and a mandibular full arch implant level transfer impression was made by inserting eight color coded metal impression posts with only finger pressure into their corresponding implant wells. Color coded acrylic sleeves were then inserted onto the metal posts prior to the making of a full arch impression. After removal of the impression tray, a bite registration material was injected around and between the eight impression posts to record a preliminary positional relationship between the patient’s two dental arches. Eight color coded impression posts and corresponding implant analogs were assembled and inserted into the acrylic impression sleeves within the full arch impressions and a separating medium was applied prior to the injection of a soft tissue moulage around the impression post to simulate mucosa over the implants. The impressions were poured in dental stone and the resulting casts were mounted and articulated with the preliminary bite registration. The two blue and six green color coded impression posts were replaced with appropriate straight or angled universal abutments. Final parallelism was achieved by modifying the universal abutments with two degree comet burs. A pink light cured resin jig was fabricated and numerically labeled to facilitate the appropriate sequential insertion of the parallel abutments into both the implant analogs in the model and the implants intraorally. Preliminary wax teeth arrangements were achieved with Candulor composite teeth on light cured resin bars over the milled parallel abutments. During the second clinical visit, the milled abutments orientation and seating were facilitated with the use of the light cured resin jigs. After the intraoral confirmation of the appropriateness of the teeth arrangements, the milled abutments and waxed teeth arrangements were returned to the dental technician. Labial silicone masks of the wax teeth arrangements were fabricated for the purpose of evaluating the selection and modification of the universal abutments so that there was sufficient space for the mandatory two millimeters of TRINIA material over each abutment. Once the abutments were appropriately modified to provide for adequate spacing, eight telescopic retentive copings were waxed onto the milled abutments, to which retentive Garo Sitek TK frick attachments were then luted. The eight waxed copings were invested and cast in a chrome cobalt alloy. After the chrome cobalt copings were fitted to the milled abutments, they were digitally scanned along with the resin bar. The scanned images were digitally combined and the final TRINIA substructure was designed and milled from a pink TRINIA disc prior to being fitted and seated onto the cast telescopic copings on the models. After removing the buccal wax from the teeth arrangements, secondary silicone masks were fabricated to represent the new cervical waxless contours of the teeth arrangements. These contours were used to shape the application of the tooth colored resin around the buccocervical aspect of the candelor teeth as they were being bonded to the TRINIA bar. The TRINIA bars and Candulor teeth were cleaned of any residual wax with a steam spray prior to their being glued with cyanoacrylate cement to the secondary pair of silicone masks. In their repositioning to the TRINIA substructures, there is only minimal space for the tooth colored acrylic resin to bond the Candulor teeth facially to the TRINIA bar, and for a mucosal shade of Ceramage to bond the teeth lingually to the TRINIA bar. The finished TRINIA prostheses and resin seating jigs with sequential markings were delivered to the dentist for another insertion of the eight parallel milled abutments into the well of the implants and for the fitting and resin cementing of the eight cast chrome telescopic copings into the bores of two full arch CAD/CAM fiber reinforced resin prostheses. Vaseline was applied to the bores of the cast chrome cobalt copings to facilitate their withdrawal from the parallel abutments during their intraoral fitting and cementing to the TRINIA prostheses. A radiographic and clinical evaluation was made after the removal of any extraneous cement. Upon confirmation of both the aesthetics and the function of the prostheses, the patient was given instructions about the use, maintenance, and enjoyment of his new maxillary and mandibular telescopic TRINIA prostheses. Hopefully this video has enhanced your understanding of both the clinical and the laboratory techniques, which will allow you to provide for your patients or dentists telescopic prostheses in only three restorative visits.