GAP Australasian-Dentist-Mar Apr 2019

Category 72 AustrAlAsiAn Dentist lInICal Figure 7. After attaching the prosthesis to the temporary cylinders using a closed mouth technique to assure its position in centric relation, the prosthesis was veneered with composite material (Triad pink fibered) to replicate mucosal and alveolar architecture. The prosthesis was then attached to the abutments using Multibase EV Bridge Screws torqued to 15 Ncm. Figure 8. Following this combined surgical and restorative treatment session, the panoramic radiograph reveals the alveolectomy, relative implant positions, angular correction using the posterior 17 degree Multibase abutment and the general position of the radiolucent prosthesis. Figure 9. After 8 weeks of healing, the relative health of the peri-implant mucosa is revealed. The patient was extremely satisfied with the fit, function and aesthetics of her interim prosthesis. Figure 10. The relatively immature nature of the mucosa and modest inflammation is observed on the alveolar ridge crest. However, the peri- implant mucosa adjacent to the abutments is well adapted to the cylinder margins and free of inflammation. Figure 13. A final impression can be made within the prosthetic guide by attaching the cylinders to the prosthetic guide using Bis-Acryl or flowable composite. The mucosa/prosthesis interface is impressed subsequently by washing the impression with low viscosity VPS impression material. Figure 16. Buccal view of the final monolithic zirconia implant supported fixed prosthesis with veneered gingival ceramic (Lee Culp, Sculpture Studios). Figure 11. A prosthetic guide was printed from the CAD/CAM files used to design the milled PMMA prosthesis. The guide was used during surgery to assess the position of the implants and to help align the nonindexed 17 degree multibase abutments. Note: It is also congruent in orientation with centric relation and the designated vertical dimension of occlusion. Figure 14. After the impression step, the prosthetic guide may be used to record centric relation so the position of the implants, the vertical dimension of occlusion and the centric relation can be accurately transferred to the laboratory. The incorporated tooth position and morphology informs the technician regarding the planned (and desired) tooth position, phonetics and aesthetics Figure 17. Facial view. Note: When proper alveolectomy is performed, the prosthesis is at least 10 mm in height. There should be gingival ceramic displayed beneath the cervical contours of the mandibular teeth. Figure 12. The occlusal view of the prosthetic guide demonstrates the orientation of the cylinders to the proposed prosthesis’ occlusal table and incisal edges. Figure 15. The intaglio surface view of the Multibase EV Pick-up copings picked up in an open-tray impression using a stock dentate impression tray. Figure 18. Oblique view. Note the detail in surface texture and gingival contour. The mirror reveals the bonded titanium cylinders within the monolithic zirconia prosthesis. This is a critical bonding step that must be performed with care.