Laboratory and Restorative Techniques

Laboratory and Restorative Techniques Implant dentistry is primarily a restorative treatment with a surgical component. In its simplest form, an impression of a seated Bicon abutment is made and the fabricated crown is cemented onto the seated abutment as though it were a prepared natural tooth. This fundamental technique is known to every dental student without the need for any implant training. Bicon’s locking taper abutment to implant connection with three sixty degrees of positioning provides for unmatched clinical capabilities. Please note that one such capability is the extraoral cementing of a crown, eliminating the potential of extraneous cement to initiate inflammation. A significant material for providing these revolutionary capabilities is TRINIA, the metal free, fiber reinforced, hybrid resin CAD/CAM material. Impression techniques and abutment selection. Implant level impressions. Conventional implant level impression with metal post and acrylic sleeve simulated on model. Insert color coded impression post with finger pressure or with a very gentle tap prior to inserting acrylic sleeve onto post. Making an intraoral impression simulated on model. Seating impression post and implant analog into acrylic sleeve within conventional impression. Abutment level impressions. Universal abutments and components. Universal abutment measurement guide. Series is comparable to the millimeter diameter abutments. Profile indicates the height of implant shoulder to reflect thickness of mucosa. Four and five series universal abutments. Six and seven series universal abutments. Universal abutment prosthetic components. Tall shaft components used for deeply positioned implants to avoid unnecessary removal of crestal bone with a sulcus former if an abutment with a standard length shaft were used. Indirect universal abutment level impression. On the left is a simulated image of universal abutments, and on the right is a simulated image of universal abutment components. Indirect universal abutment level impression master model. Seen here are both universal abutment impression sleeves and transfer dies. Clinically selecting and seating universal abutments for indirect level impression. For ideal aesthetics, abutment shoulder height should be one millimeter below or at the level of the gingival crest. Digital impressions. Digital abutment level and implant level impression. On the left are scannable components, and on the right is a simulated intraoral digital impression. Digital implant level impression with scan post. Digital implant level impression with scannable temporary abutments, digital indirect abutment level impression of fixed detachable abutments with scan bodies, Bicon millable abutment blanks. Millable abutment technique for ideally and less than ideally positioned implants. Digital implant level impression and millable abutment blanks. Extra orally cemented crown on millable abutment blank, Custom cast titanium abutments. Custom abutments for less than ideally positioned implants. Custom tall shaft abutment for deeply positioned implant. The first image at the top is of a modified tall shaft abutment in implant analog. The top middle image is of a tall shaft abutment with milled or cast titanium grade five coping. The top right image is of a custom coping cemented on a tall shaft abutment. The bottom left image is of an opaque hybrid composite being applied to a coping. The bottom middle image is of a coping with hybrid composite cemented on a tall shaft abutment with milled or cast titanium grade five coping. The final image is of the finished layered composite crown on model. Custom abutment for shallowly positioned implant. The top left image is a red two point zero millimeter impression post seated in the implant analog within the stone model. The top middle image is a twenty five degree angled stealth abutment in the implant analog. The top right image is a modified abutment in the implant analog. The bottom left image shows a custom waxed coping on a stone model. The bottom middle image is a custom cast titanium grade five coping cemented on a modified twenty five degree angled abutment. The final image is a finished layered hybrid composite crown on a stone model. Custom abutment for less than ideally mesiodistally positioned implant. The top left image shows a two point five millimeter and a three point zero millimeter impression post in implant analog. The top middle image is an emergence profile being marked. The top right image shows the modified abutments. The bottom left image is of custom cast titanium grade five copings cemented on modified abutments. The bottom middle image is of the finished layered hybrid composite crowns. The final image shows the finished layered hybrid composite crowns on the model. Crown fabrication and comparison of materials. Use material of your choice for extraorally cemented crowns. Seen here are extraorally cemented crowns using layered hybrid composite, porcelain fused to metal, milled hybrid composite, milled zirconia, layered zirconia, and milled lithium disilicate. An aesthetic comparison of materials. From left to right, layered composite, metal porcelain, and layered zirconia. Some examples of different materials. Milled lithium disilicate. It is both translucent and durable for use when opposing ceramic restorations. Please note that it should be avoided when opposing natural teeth or gold restorations. Mill zirconia. It is both translucent and durable. It provides for white shades. Use when opposing ceramic restorations. Please note that it should be avoided when opposing natural teeth or gold restorations. It is prone to chipping, is difficult to adjust, and impossible to repair. Defining anatomy. External staining. Milled hybrid composite. Use opposing natural teeth or gold restorations. Facilitates interproximal and occlusal adjustments and aesthetic modifications. Stains less than layered hybrid composite. Extra oral cementing. Finishing surface. Texturing surface. Polishing surface. Layered hybrid composite crown. Use opposing natural teeth or gold restorations, facilitates interproximal and occlusal adjustments and aesthetic modifications. Aesthetic translucency is readily achieved. However, it is more prone to staining than milled hybrid composite. Diagnostic wax up and silicone mask. Marking and modifying emergence profile. Removal of abutment from holder and insertion into an implant analog to confirm adequate space with silicone mask. Red wax used to protect post from sandblasting. Silane and opaque being applied. Opaque dentin being applied. Dentin composite being applied. Hybrid composite being applied to the mamelons. Translucent composite being applied. Oxygen barrier being applied prior to light curing. Interproximal contacts being adjusted. Surface being polished with silicone rubber. Surface being polished with silicone brush. Surface being polished with bristle brush and diamond paste. Finished layered composite crown being inserted into implant analog. Thermoplastic orientation jig being fabricated on model. Thermoplastic seating jig being fabricated on alignment device to facilitate seating force in long axis of implant. Radiographic and clinical images of hybrid composite crown. Layered hybrid composite crown at insertion, ten months post insertion, and two years post insertion. Layered composite crown can be intraorally modified. The crown was modified after eight years in function. Intraoral polishing after eight years in function. Polished hybrid composite restorations after eight years in function. Prosthetic bridge fabrication. Bicon bridges. On the left are Bicon cemented bridges, and on the right are Bicon screw retained bridges. Wax up and silicone mask. Removal of impression posts for try in of diagnostic milled wax up and fabrication of silicone mask. On the left, a Bicon plastic diagnostic bridge, and on the right, a Bicon PMMA transitional bridge. Modifying silicone mask to facilitate selecting appropriate abutments. Contour of emergence profile being marked. Abutment contouring. Insertion of marked abutment into abutment holder. Marked abutment being modified with a carborundum disc. Tungsten comet burs for wet milling at six to seven thousand revolutions per minute. Universal abutment being milled with a two degree comet bur. From left to right, the shoulder is defined using a zero degree tungsten comet bur. The abutment wall is being defined using a two degree tungsten comet bur, and the abutment groove is being defined using a two millimeter zero degree tungsten comet bur. Bridge insertion. Seating jigs. Resin seating jig being fabricated. Resin jig being relined, Resin seating jig being cured. Metal framework being used to orient and seat abutments. Cast metal framework being used to orient and seat abutments. Vaseline being applied to the metal framework to facilitate its removal after the abutments have been seated. Metal porcelain bridges. The first image shows a metal framework being used. The second image shows the definitive seating of the abutment. The third image shows the framework within the impression material. The fourth image shows the definitively seated abutments. Finally, the last image shows the seated metal porcelain bridge. Milled zirconia bridge. Staining of a milled zirconia three unit bridge. On the right is the finished milled zirconia bridge. Screw retained bridges. Here are four examples of screw retained bridges. A TRINIA framework with hybrid composite bridge, a milled zirconia bridge, a metal porcelain bridge, and a layered zirconia bridge. Prosthetic components for screw retained bridges. Screw retained hybrid composite bridge. Measuring the depth and position of the implants for selecting fixed detachable universal abutments of appropriate length and angle. Inserting fixed detachable universal abutments of appropriate length and angle. Inserting and fastening titanium copings on abutments and try in of TRINIA framework. Resin cementing of TRINIA framework onto copings. Unfastening the cemented copings in TRINIA framework. Applying silane and bonding liquid to TRINIA framework. Hybrid composite layering. TRINIA composite bridge with composite covering screws. Screw retained bridges. On the left is a milled metal bridge, and on the right is a milled zirconia bridge. Screw retained milled zirconia bridge. Applying external stain. Screw retained layered zirconia bridge. Full arch TRINIA prosthesis. Full arch TRINIA protocol. Examples of full arch TRINIA prostheses include a cemented TRINIA bar, a screw retained metal bar, retentive copings, a telescopic bar with retentive copings, telescopic and cemented TRINIA prosthesis, as well as screw retained TRINIA prosthesis. Freeway space of ten millimeters is necessary. Both the height of abutment and coping can be reduced and still be retentive. Silicone mask confirms space for abutments and framework. TRINIA’s strength requires two millimeters of thickness. Abutments may be modified for aesthetic reasons. However, it is better to have metal showing above the mucosa to facilitate fabrication and for hygiene of the prosthesis. Abutments may be modified to facilitate path of insertion. To achieve path of insertion, it is better to modify an abutment than to use a fifteen degree angled abutment. Verification and orientation with a seating jig. A two piece seating jig may be preferable. Angled abutments often need to be loosely inserted into an implant prior to being oriented by the seating jig. Ten degree angled abutments. Often, angled abutments need to be loosely inserted into an implant prior to being oriented by the seating jig. Retentiveness of copings. Reducing the height of a coping does not decrease its retentiveness. Crimping a retentive coping can increase its retentiveness. Customized cast copings with Si-Tec attachments. Custom copings are often necessary when an implant is not ideally positioned under the intended prosthetic tooth. Customized cast copings for attachments. How to change SiTech attachments? Digital process for plastic diagnostic framework. Fabrication of telescopic TRINIA prosthesis with milled crowns. Digital process for TRINIA framework. Milled TRINIA framework. Milling strategy is specific to machine and burs. Strategy for PMMA usually works well. Milled hybrid composite crowns and TRINIA framework. Bonding and cementation of milled crowns. Light cured resin seating jigs. The image on the left shows two custom copings and two retentive copings, one of which has been reduced. The image on the right shows the passive fit of the prosthesis being confirmed. Intraoral cementing of retentive copings to TRINIA framework. The image on the left shows the bonding agent being applied. The image on the right shows the resin cement being applied. TRINIA telescopic prosthesis supported by four implants. TRINIA prosthesis with pressed hybrid composite. In the first image, we can see a waxed teeth arrangement with both a transparent and silicone mask. The second image is that of a digitally designed framework and prosthesis. The last image is a milled TRINIA framework. The top left image shows the application of silane and bonding agent. The top middle image shows the application of dentin composite. The top right image shows the dentin composite to transparent mask. The bottom left image shows the dentin composite being pressed. The bottom middle image is a view of the pressed dentin. The final image shows the surfaces being reduced. From the top left, we can see the labial clearance being confirmed. In the top middle image, we see the stain being applied. The top right image shows the incisal composite being pressed. The bottom row shows gingival contouring as well as three color variations, dark pink, light pink, and translucent. Screw retained metal bar with pressed hybrid composite protocol. From left to right is a waxed teeth arrangement, a silicone mask, and abutment selection. From left to right is a waxed bar, a cast or milled bar, and a duplicated bar. From left to right is a waxed framework, a waxed framework dictated by silicone mask, and a cast or milled metal framework. From left to right is a screw retained bar, a metal prosthetic framework, and a metal prosthetic framework. Comprehensive protocol for full arch telescopic TRINIA prosthesis. On the left is a conventional implant level impression, and on the right is a pouring master model. Recording occlusal registration with gothic arch. Waxed teeth arrangements. Impression post stabilizing teeth arrangement for occlusal registration, silicone masks to confirm spacing for abutments, and prosthesis. Confirming one to two degrees of divergence among the abutments. Verification jig with retentive copings confirms path of insertion and retentiveness for the prosthesis. Light cured resin jigs. Bores of resin jigs being relined for better adaptation to the abutments. Here, we see two digitally designed images. On the left is a TRINIA framework, and on the right is a TRINIA framework with the intended prosthesis. Silicone masks of waxed teeth arrangements. Light cured resin facilitates achieving the thickest TRINIA framework, which must be greater than two point zero millimeters. TRINIA discs with milled frameworks. Milling strategy is specific to both the machine and burs. Strategy for PMMA usually works well. Bonding of composite denture teeth to a TRINIA framework. Silicone mask facilitates the resin bonding of composite denture teeth to a TRINIA framework. Removal of extraneous resin around anterior denture teeth. Digitally designed and milled posterior teeth. Bonding of milled posterior crowns onto a TRINIA framework, occlusally stained posterior teeth. Protocol for transporting and seating abutments for TRINIA telescopic prosthesis. Vaseline is applied to the bore seating jig. Cotton pliers are used to facilitate the removal of abutments. The abutment is inserted into the seating jig. Finally, the abutments are shown being transported to the implants. Abutments being transported and inserted with seating jig. Vaseline being applied prior to gently tapping copings onto abutments. Vaseline facilitates the removal of the prosthesis, initial placement of TRINIA prosthesis to confirm passive seating. TRINIA interference being relieved with a finishing bur. Cementation of TRINIA prosthesis to retentive copings. Marked interference is removed. Vaseline is then applied to facilitate the removal of extraneous cement. Finally, resin cement is applied. Resin cementation of TRINIA prosthesis to retentive copings. Here, we can see the TRINIA prosthesis after the removal of extraneous resin cement and occlusal markings on the TRINIA prosthesis. Clinical and radiographic images of the finished prosthesis. Three years post insertion. Comparison of a screw retained TRINIA prosthesis with a metal bar and prosthetic framework. Screw retained metal bar and metal framework. Seen here is a diagnostic teeth arrangement. Teeth arrangement and confirmation of appropriate spacing for metal bar. Protocol for fixed detachable abutments. On the left, three 10 degree angled fixed detachable abutments with groove. On the right, you can see titanium copings placed on the fixed detachable abutments. Digitally scanned bar and digitally scanned teeth arrangement. Here you can see a milled plastic bar, a sprued plastic bar, a sprued metal bar, and a cast metal bar. The top image is that of a waxed framework, while the images on the bottom row are of a sprued waxed framework and a cast metal framework. On the top row, you can see an opaque metal framework, and on the bottom row, a silicone mask facilitates the bonding of the denture teeth to the metal framework. Finished hybrid composite prosthesis with metal framework. Screw retained milled trinia bar and framework. Seen here is a milled trinia bar and prosthetic framework. The top image shows a silicone mask for bonding denture teeth to the TRINIA prosthetic framework, while the bottom two images show denture teeth bonded to a TRINIA framework. Finished TRINIA hybrid composite prosthesis with retentive attachments. Seating fixed detachable abutments with titanium copings. On the top row, we can see the seating jig being fastened to the fixed detachable abutments and the fixed detachable abutments being transported to the implants. The images on the bottom row show the fixed detachable abutments being definitively seated. Unfastening and removal of seating jig with copings from fixed detachable abutments. The top two images show the hex screws being removed, while the bottom two images show the seating jig being removed. Here we see the insertion and fastening of a TRINIA bar and the insertion and fastening of a metal bar. A fastened screw retained TRINIA bar and a fastened screw retained metal bar. And finally, the insertion of a prosthesis with a TRINIA framework and the insertion of a prosthesis with a metal framework. In a side by side weight comparison between a prosthesis with a TRINIA framework and a prosthesis with a metal framework, TRINIA is fifty five percent lighter than the metal alternative. Subscribe to the Bicon Bulletin at www.bicon.com/bulletin.