Laboratory Techniques for Full-Arch TRINIA® Prostheses

The unique benefits of a full arch TRINIA prosthesis are evident for both you and your patients. In order to achieve clinical success, certain techniques must be followed in the lab. This video provides an overview of those critical techniques. Use only three or four appropriately spaced implants to facilitate the fabrication of the prosthesis. Five or more implants unnecessarily complicates the prosthesis. If possible, place three implants while there are still teeth present and then extract them when the final prosthesis is being inserted. These teeth will provide the technician with significant landmarks for fabricating the TRINIA prosthesis. If necessary, open the bite to achieve at least 11 millimeters of clearance from ridge to opposing occlusion for sufficient prosthetic space. If the bite, the vertical dimension of occlusion, cannot be opened, then the universal abutment and retentive coping can be reduced. The coping can be retentive even as a three millimeter ring. Low-profile universal abutments should not be used for full-arch TRINIA prostheses. Standard profile or taller universal abutments should be used with their shoulder at least minimally above the soft tissue. In nonaesthetic areas, such as sublingual areas, the shoulder can be significantly higher to facilitate cleaning and mucosal health. Record a gothic arch tracing to facilitate an accurate recording of the patient’s centric relation at the appropriate vertical dimension of occlusion. Fabricate a facial silicone mask of an approved wax teeth arrangement to verify sufficient space for universal abutments, retentive copings, milled prosthetic teeth, and the essential requirement to have two millimeters of TRINIA material over the retentive copings for strength. The universal abutments must have .5 degrees of divergence amongst them at their cervical area to provide for retention. The coronal aspect of a universal abutment may be reduced to facilitate a path of insertion and withdrawal without compromising the retentiveness of the TRINIA prosthesis. Fabricate a one piece light cured resin verification jig with retentive copings to verify that the TRINIA prosthesis will have a path of insertion and withdrawal as well as be retentive. Fabricate one or two light cured resin orientation and seating jigs. These are appropriately numerically marked coinciding with the numerical markings on the master model to indicate the sequencing for inserting each universal abutment into the corresponding well of the patient’s implant. Most often, the abutments are loosely placed into the seating jig for transport and seating into well of the implants. In certain situations, some angled abutments need to be loosely seated into the implant well and subsequently positioned by placing the jig onto it. An arrow on the model and jig can indicate this need to the clinician. Initially, digitally design and mill an inexpensive plastic substructure to manually and visually evaluate its appropriateness. If necessary, modify it prior to scanning it for the fabrication of the permanent TRINIA substructure. The blue color in the graphic shows example modifications. Note the milled TRINIA substructure from the scan of a modified plastic substructure. The prep teeth design facilitates the fabrication of digitally milled crowns which will be cemented onto the TRINIA substructure. You can enhance the aesthetics of the TRINIA substructure and the milled polyceramic crowns by cutting back their facial aspect and applying indirect polyceramic materials.