Lab Tribune Asia Pacific No. 1, 2017
Ivoclar Vivadent hosts successful Competence in Esthetics symposium / Business / Fixed and removable implant restorations: A solution for every arch
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Lab TRIBUNE
The World’s Event Newspaper · Asia Pacific Edition
www.dental-tribune.asia
PUBLISHED IN HONG KONG
VOL. 15, NO. 12
Ivoclar Vivadent hosts successful
Competence in Esthetics symposium
By DTI
sion of the program is already available and was
shown at the event.
VIENNA, Austria: Digitalisation has changed the dental industry and new technologies have entered dental practices and laboratories faster than predicted.
Following the dynamics of
this development, dental
manufacturer
Ivoclar
Vivadent highlighted this
topic at its Competence in
Esthetics symposium recently held in the Austrian
capital of Vienna.
For the third time, Gernot Schuller, Senior DirecDigitalisation in focus: New state-of-the-art software was introduced at the event.
tor for Austria and Eastern
Europe at Ivoclar Vivadent,
Many speakers at the symposium
and his team succeed in drawing
dental technicians to overcome
were pioneers in terms of digitaliparticipants from all over the
the barriers of time and space was
sation and have used several generworld to the symposium. More
proven by a number of presenters
ations of devices and technologies
who work as a team across differthan 1,400 participants from 36
and shared their experiences via
ent countries, among them Dr Stecountries registered for the event,
numerous clinical cases that they
fan Koubi from France and dental
which is traditionally hosted at the
technician Hilal Kuday from TurAustria Center Vienna conference
treated using either a fully or
key, as well as Dr Florin Cofar from
venue. An additional 100 people
mixed digital approach.
Romania and dental technician
joined as day visitors to attend the
What changed with the advent
Lorant Stumpf from Ireland.
presentations of the 21 speakers.
of CAD/CAM? What are the
In his opening speech, Ivoclar
At the symposium, new statestrengths and weaknesses of this
Vivadent CEO Robert Ganley exof-the-art software was introduced
technology? At the event, there was
plained why it is important for the
that in the future will allow users
a general consensus that CAD/
company to focus on digitalisato see different versions of their
CAM is an intelligent tool rather
tion, a megatrend that has been
restoration in a virtual mirror and
than a solution in itself. That CAD/
predicted by reputable futurolomodify it with a swiping motion,
CAM facilitates day-to-day work
gists and not only for dentistry.
like on a smartphone. A demo verand makes it easier for dentists and
At present, treatment
teams may use mock-ups
that are milled or printed to
give their patients a clearer
sense of what their prospective smiles may look like. Dr
Irena Sailer and dental technician Vincent Fehmer presented a case in which they
offered their patient three
different mock-ups to try-in:
a perfect aesthetic version, a
version with a diastema and
another one in which teeth
#12 and 22 were rotated
around their axes. These
digitally prepared mock-ups
facilitated the conversation with the
patient and made it possible for her
to choose her own prospective
smile. The mock-up of her choice
was then inalised using digital
technology. “This is as easy as
copy and paste,” said Fehmer.
Dental technicians can expand
their digital library with every clinical case by storing scan data. Over
time, this results in an extensive collection of tooth shapes that can be
used in the planning of other cases.
The Cofar–Stumpf team knows how
to use the library to their advantage.
Both team members have studied
the dentition of many patients and
have turned the basics of aesthetics
upside down when it comes to shape
and symmetry: their result proves
that the shape of the face does not
always conform to the shape of the
tooth and some asymmetry may be
present—especially in the case of
smiles that appear natural or beautiful. “It’s all about harmony and individuality and not about perfection
in form and symmetry,” explained
Cofar. When the team members use
their library of nature in the digital
planning process, they blend the anterior and posterior teeth of different cases. In the process, the teeth
are scaled in size but never distorted,
because that would affect the optical
result adversely.
Especially for Ivoclar Vivadent
events and lectures, the company
developed the IV Events app. During the Competence in Esthetics
2017 symposium, the app provided
information about the presentations and speakers, and allowed
users to rate them using the star
system used on social media. The
app also gave participants the opportunity to pose questions to the
presenters, and questions of broad
interest were discussed on stage.
The discussions were moderated
by Drs Thomas Bernhart (scientiic chairman of this year’s event)
and Laurent Schenck (Senior Director of Global Communications
and Strategy at Ivoclar Vivadent).
US dental software provider first to
deliver voice-assisted ordering
NEW YORK, USA: The next step in
artiicial intelligence advancement within dentistry could be
just around the corner. Awrel, the
dental software solution provider
for web, mobile and voice platforms, has recently unveiled their
Awrel Partner Portal. According to
the company, this new technology
enables dental supply companies
and laboratories to supply their
customers with intelligent, voiceguided ordering services for implants, supplies and equipment.
The capabilities of the new
technology reportedly enable companies to extend their order processing capabilities beyond the current paper-, web- and mobile-based
methods to environments that
deliver next-generation, conversational voice experiences. Additionally, companies will be able to custom label their offerings, deine
unique worklows and create company- and product-speciic conversational exchanges.
“We’re very pleased to be the
irst dental software provider to
deliver voice-assisted, hands-free
ordering,” said Dr Arnold Rosen,
Awrel founder and CEO. “With this
technology, dental care providers
will see improved productivity
and quality while suppliers and
labs will accelerate their sales processes. This is a deinite win-win.”
The system is designed so
that the person placing the order
can respond to product-speciic
prompts from a voice-powered
agent or chat-bot. Each subsequent interaction follows an intelligent, protocol-based conversational low. After the order is
completed, it can be sent via
message to the supplier or laboratory, or the system can be customised so that it can low directly into an existing electronic
ordering system.
“We soon realise that dentistry could logically benefit
from next-gen voice assistants.
This is a logical extension of our
offerings,” said Rosen. “As a
prosthodontist, my hands serve
as the tools of my trade. I’d rather
they be working to create a great
smile than typing orders into a
computer or cellphone. With
voice technology, my hands are
free to work and puts my focus
where it belongs—on the patient.”
Companies using
Awrel’s voice capabilities can also
provide their
customers with
Awrel’s readyto-download
texting and
collaboration tool for
HIPAA-compliant sharing
and the storage of messages,
images, documents and scans.
© Screeny/Shutterstock.com
By DTI
[2] =>
BUSINESS
18
Lab Tribune Asia Pacific Edition | 12/2017
© Planmeca
© Messukeskus Helsinki
Stay CALM! Planmeca algorithm
improves imaging quality
1
2
Fig. 1: Planmeca 3-D imaging specialist Mikko Lilja participated in the development of the algorithm. CALM analyses and compensates for patients’ movement during the scanning process, making dental imaging
safer and quicker for patients and dentists alike. —Fig. 2: A Planmeca representative introducing the CALM algorithm at the Finnish Dental Congress and Exhibition in Helsinki in November, were the solution
received a honourable mention.
By DTI
HELSINKI, Finland: Patient movement is among the most signiicant challenges to CBCT imaging, producing artefacts that can
compromise the quality of the
image.
According to Finnish manufacturer Planmeca, an end-user
solution to this problem was in
the company’s sights for some
time and has now inally been addressed with Planmeca CALM.
The algorithm analyses and
compensates for patients’ movement, eliminating the need for retakes and thus improving the
quality of and the time needed for
imaging in dentistry. Recounting
the development process of CALM
(Correction Algorithm for Latent
Movement), Planmeca 3-D imaging specialist Mikko Lilja explained the mechanism of the
solution: “In tomographic reconstruction, the assumption is that
the measurements—in this case
the CBCT x-ray projection im-
ages—are geometrically consistent with one another, but when a
patient moves, the data no longer
adds up, which shows in the reconstruction.”
To avoid these disruptions,
Planmeca CALM restores the consistency of the X-ray measurements by tracking the movement
of the patient. The algorithm
works with all volume and voxel
sizes and adds only between 10
and 60 seconds to the overall reconstruction time, the company
stated. The function can be run either after the scan is complete or
before exposure to ensure that
the volumes are already corrected
when they are accessed in the
Planmeca Romexis software.
“In the past, dentists would
send their unsatisfactory images
to the manufacturer for reconstruction or just redo the entire
scan, but with Planmeca CALM
this is now a thing of the past. We
are proud to be the irst dental
manufacturer to provide a solu-
tion for motion artefact correction to the end-user,” Lilja said.
For dentists, the CALM feature is especially valuable when
imaging restless or livelier patients, such as children, individuals with special needs or elderly
patients. “Even in cases where
you might not typically think
there has been signiicant movement, Planmeca CALM can noticeably enhance the image and
enable seeing more details,” Lilja
concluded.
Western Australia to change restrictive
CBCT ownership regulations for dentists
© Wolfilser/Shutterstock.com
ity of dental practitioners in
Western Australia. However, this
regulatory framework is set to
change, according to the Australian Dental Industry Association
(ADIA).
Although each state and territory takes a different regulatory
approach to owning CBCT equipment, in terms of outcomes, there
is broad alignment across all of
them—with the exception of
Western Australia.
By DTI
PERTH, Australia: CBCT imaging is changing the way dental
practitioners can visualise the
oral and maxillofacial complex,
as well as teeth and the surrounding tissue. Despite being regarded
as beneicial for practitioners and
patients alike, owing to a restrictive licensing policy, the technology is only available to a minor-
“ADIA welcomes news that the
Radiological Council of Western
Australia looks set to remove the
restrictions on CBCT ownership in
that state,” said ADIA CEO Troy
Williams. Owning and operating
CBCT equipment in Western Australia is currently limited to dentists registered with the Australian Health Practitioner Regulation
Agency (AHPRA) in the specialty
of dentomaxillofacial radiology
—a criterion that only very few
dentists fulil. In a senate committee hearing on 9 November, the
ADIA CEO pointed out that, of the
about 1,780 registered dentists in
the state, almost none satisfy the
requirement to own and operate
CBCT equipment.
Once in force, the regulatory
changes will allow AHPRA-registered dentists who have successfully completed a recognised CBCT
course to be eligible for a licence to
own and operate CBCT equipment. According to the ADIA release, the requisite courses are offered by the dental schools at the
University of Queensland and the
University of Adelaide and by a
private provider.
“This outcome is entirely consistent with what ADIA has argued
for over many years. It’s actually
ive years ago this month that
ADIA met with the then Minister
for Health to progress this reform
and we’ve naturally discussed it in
the past with the current Minister,
Roger Cook,” Williams commented.
It has not yet been announced
when the new legislation will be
put into force.
[3] =>
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[4] =>
TRENDS & APPLICATIONS
20
Lab Tribune Asia Pacific Edition | 12/2017
Fixed and removable implant
restorations: A solution for every arch
By Dr Paresh B. Patel, US
1a
1b
2
4b
1c
3
4c
4a
5
Figs. 1a–c: Pre-op condition of the patient. Note the high lip line, severe cervical caries present on the patient’s remaining teeth and lack of gingival support.—Fig. 2: The pre-op panoramic radiograph demonstrated periodontal disease, cervical caries, the terminal state of the patient’s dentition and the compromised state of the surrounding periodontium, which had rendered the teeth mobile.—Fig. 3: Maxillary
implants with parallel pins in place exhibiting the axial placement of the anterior implants and the tilted angulation of the posterior implants.—Fig. 4a: Inclusive Tapered Implant.—Figs. 4b & c: The implants were threaded into place, achieving excellent initial stability.—Fig. 5: Multi-unit abutment with carrier in place illustrates correction of the implant’s angulation to establish a uniform prosthetic platform around the arch.
Introduction
When a patient presents with an
edentulous arch or terminal dentition, implant treatment can be
provided that improves not only
form and function, but also quality of life. For patients desiring
better masticatory capability,
stability, aesthetics and comfort
than a conventional denture can
offer, both removable and ixed
implant restorations are superior
alternatives.1 While the appropriate implant solution can vary de-
pending on the patient’s oral
health, anatomy, quality and quantity of bone, and inancial resources, full-arch prostheses have
progressed to the point where virtually every patient can have his
or her teeth restored.
Although ixed implant-supported restorations offer the
highest levels of stability, function and patient satisfaction, removable overdentures also offer
a dramatic improvement over
conventional complete dentures. 2 Both treatment options
effectively mitigate the bone resorption that occurs after the
loss of teeth, helping to preserve
the oral and facial structures
and, by extension, the self-conidence of the fully edentulous
patient.
Determining which solution
is appropriate requires a careful
evaluation of the individual patient’s circumstances and de-
sires. Even when an implant
overdenture is delivered, the
prosthesis can eventually be
converted to a ixed restoration.
As evidenced by the case that
follows, in which one arch is restored with an implant overdenture and the other with a BruxZir Full-Arch Implant Prosthesis,
practitioners today have a great
deal of clinical lexibility.
Whatever prosthetic approach is adopted, immediate,
life-changing relief can be provided to patients suffering from
terminal dentition or an uncomfortable, poorly functioning conventional denture. Furthermore, the dramatic overhaul of this patient’s oral health
demonstrates the life-changing
capabilities of implant therapy,
which helped him overcome severe functional and aesthetic
challenges that affected practically every facet of his life prior
to treatment.
“Whatever prosthetic approach is adopted, immediate, life-changing
relief can be provided to patients suffering from terminal dentition
or an uncomfortable, poorly functioning conventional denture.”
[5] =>
TRENDS & APPLICATIONS
Lab Tribune Asia Pacific Edition | 12/2017
6
21
7a
7b
8a
8b
9
10a
10b
11a
11b
11c
12a
12b
13a
Fig. 6: Conventional dentures were fabricated in advance of the surgical appointment so that they could be immediately converted to serve as temporary appliances during the healing phase.—Figs. 7a & b:
Same-day conversion of the maxillary denture to an immediate ixed prosthesis was achieved by adding multi-unit temporary cylinders using self-curing acrylic and trimming the appliance into a horseshoe shape.—Figs. 8a & b: Note the dramatic change in the appearance of the patient, who left with chairside-converted dentures in place on the same day as surgery, including a screw-retained ixed
provisional for his upper arch.—Fig. 9: Post-op panoramic radiograph illustrates all-on-4 coniguration of maxillary implants and axial placement of the mandibular implants, which would facilitate a
passive it of the mandibular overdenture.—Figs. 10a & b: The patient returned 14 weeks after implant surgery, and healing of the peri-implant tissue had progressed nicely.—Figs. 11a–c: Transfer copings were attached to the maxillary multi-unit abutments, and an open-tray impression was made to serve as the basis for the working cast the laboratory would use to begin designing the restoration.
Note that a closed-tray impression was taken for the mandibular implant overdenture.—Figs. 12a & b: For the recording of jaw relations, a mandibular wax rim was designed to seat over the Locator
attachments, while a screw-down wax rim was created for the maxilla.—Figs. 13a & b: The maxillary wax rim was screwed into place through the temporary cylinders, while the mandibular wax rim
was seated over the Locator impression caps.
Case presentation
A 47-year-old male presented
with terminal dentition in both
arches resulting from periodontal
disease and severe caries (Figs. 1a–c).
The patient had already lost many
of his teeth, and the dentition that
remained had been rendered unstable by his periodontal condition
(Fig. 2). He had saved up enough
money for a ixed implant restoration for his upper arch, for which
he desired the most functional,
lifelike prosthesis possible. While
he could not afford such a restoration for both arches, he wanted a
retentive appliance for his mandible, with the option of later upgrading to a ixed prosthesis.
from monolithic zirconia would
ensure maximum long-term durability. This was important considering the relatively young age
of the patient, who would not have
to worry about his maxillary prosthesis succumbing to fractures,
chips or stains. His mandibular
appliance would be held in place
by connecting to the implants via
Locator attachments (Zest Dental
Solutions), which are an economical means of improving prosthetic
retention and stability. The overdenture caps that connect to the
Locator attachments would be incorporated in the prosthesis chairside—though it should be noted
that many clinicians elect to have
the laboratory handle this step.
The patient accepted a treatment plan in which his maxilla
would be restored with a BruxZir
Full-Arch Implant Prosthesis and
his mandible with an Inclusive
Locator Implant Overdenture. Fabricating his maxillary restoration
The surgical phase of treatment called for the extraction of
the patient’s remaining teeth, followed by the immediate placement of eight dental implants.
Cone beam computed tomography (CBCT) scans were taken to
help determine the optimal placement of the implants within the
available bone and away from the
patient’s vital oral anatomy. Evaluation of the CBCT scan determined that there was suficient
height, width and quality of bone
to place the implants in the appropriate locations and angulations via freehand surgery. Four
ø 3.7 mm Inclusive Tapered Implants (Glidewell Direct) would be
placed in each arch to support the
ixed maxillary restoration and
the removable mandibular prosthesis. At the surgical appointment, the patient’s remaining
teeth were removed, and a lap
was raised to visualise the socket
sites and areas of implantation.
Bone levelling was performed on
the patient’s upper arch to elevate
the patient’s smile transition line
above the upper lip.
The maxillary osteotomies
were positioned to facilitate an
all-on-4 coniguration, with the
posterior implants tilted to maximise the anterior–posterior spread,
avoid the sinuses and accommodate
the patient’s bone limitations
(Fig. 3). Osteotomies were created
for the placement of four mandibular implants, as opposed to the minimum of two required for a Locator
overdenture. This would enhance
retention of the overdenture while
affording the possibility of upgrading to a ixed restoration at a later
time. After the creation of the osteotomies, the implants were placed
(Figs. 4a & b).
13b
Inclusive Multi-Unit Abutments (Glidewell Direct) were attached to the maxillary implants,
correcting for the divergent angulation of the implants. This would
both position the restorative platform in a manner that would situate the screw access holes of the
eventual prosthesis toward the lingual aspect and allow for a molar–
molar restoration (Fig. 5). Note that
patients with terminal dentition
presenting for treatment are commonly anxious about losing their
teeth and the effect this will have
[6] =>
TRENDS & APPLICATIONS
22
Lab Tribune Asia Pacific Edition | 12/2017
14
15a
15b
15c
16a
16b
16c
17a
17b
17c
18a
18b
Fig. 14: A PVS wash impression was made of the mandibular arch, capturing the positions of the Locator attachments and the gingival contours and vestibules.—Figs. 15a–c: The laboratory produced wax set-ups for
try-in. The maxillary set-up included temporary cylinders so that the set-up could be attached to the implants during evaluation. The mandibular set-up included recess wells so that it could be seated over the Locator attachments and soft tissue.—Figs. 16a–c: The maxillary and mandibular wax set-ups were tried in to evaluate it, aesthetics, occlusion and function.—Figs. 17a–c: Individual sections of the implant veriication
jig were seated and luted together before being picked up in the open-tray inal impression, which was made using a custom tray and Capture PVS material (Glidewell Direct).—Figs. 18a & b: The inal mandibular
implant overdenture was designed to seat over Locator attachment analogues situated in the mandibular cast. This would allow the overdenture caps that engage the Locator attachments to be picked up chairside.
—Figs. 19a & b: CAD software was used to design the deinitive prosthesis for the patient’s maxilla based on the inal impression and approved wax set-up. Access holes were created in the precise positions needed
for passive it.—Figs. 20a & b: The provisional implant prosthesis was milled and seated on the master cast to verify proper it, as well as the interocclusal relationship with the opposing implant overdenture.
on their speech and masticatory
capabilities. For this reason, it is
important to make every effort to
ensure that the patient leaves with
functional appliances in place.
Thus, conventional dentures were
fabricated from preliminary impressions in advance of the surgical appointment for modiication
and delivery after placement of the
implants (Fig. 6).
Suficient primary stability
having been achieved, the Inclusive Tapered Implants placed in
the patient’s maxilla could be immediately loaded. Thus, the maxillary denture was trimmed and
modiied chairside to connect to
the multi-unit abutments through
temporary cylinders (Figs. 7a & b).
This would satisfy the patient’s desire to leave the surgical appointment with a ixed, fully functional
maxillary prosthesis in place.
Note that the two most distal molars were removed to minimise
the cantilevers and the forces
transmitted to the implants during osseointegration. Healing abut-
19a
ments were placed on the mandibular implants to begin developing
the transmucosal passages.
The mandibular immediate
denture was then modiied and
relined to seat over the implants
during healing. This approach
provided the patient with sameday temporary restorations, and
he walked out of the ofice with
properly functioning teeth for the
irst time in many years. The effect this had on the patient’s comfort, function and appearance
was immediate and profound
(Figs. 8a & b). The inal radiograph
taken after seating the temporary
appliances conirmed excellent
positioning of the implants (Fig. 9).
The patient returned after
14 weeks of healing for stability
of the implants and health of
the soft tissue to be evaluated.
Removal of the temporary appliances revealed excellent tissue
health around the healing abutments of the mandible and multi-unit abutments of the maxilla
19b
(Figs. 10 a & b). Polyvinylsiloxane
(PVS) impressions were taken to
begin the restorative process
(Figs. 11a –c).
Because multi-unit abutments
and healing abutments were placed
on the day of surgery, the restorative process began above the tissue
level, without any need for secondary surgery or anaesthesia. The restorative protocol for both prostheses included wax rims and setups, which the laboratory produced
on the working casts fabricated
from the impressions (Figs. 12a & b).
The maxillary wax rim incorporated temporary cylinders
through which screws could connect to the dental implants. The
mandibular wax rim was designed
to seat over Locator attachments.
At the next appointment, the
wax rims were seated, the jaw relationship was recorded using a conventional denture technique and
a bite registration was taken
(Figs. 13a & b). A PVS wash impression of the mandibular arch was
20a
also taken with the wax rims and
Locator impression caps in place
(Fig. 14). This would aid the laboratory in designing an overdenture
that fully rested on the tissue instead of the implants. The case
was returned to the laboratory,
and wax set-ups were produced
(Figs. 15a–c). During the try-in appointment, the wax set-ups were
evaluated to conirm the vertical
dimension of occlusion, interocclusal relationship, phonetics, aesthetics, midline, arrangement of the
teeth, tooth colour and shape, incisal edges and function (Figs. 16a–c).
After inal approval of the wax
set-ups, the restorative protocols
for the two prostheses diverged, as
the laboratory moved directly to
the inal implant overdenture
from the approved wax set-up,
while the process for the BruxZir
Full-Arch Implant Prosthesis included an implant veriication jig,
custom inal impression and provisional implant prosthesis. These
extra measures were taken to
make absolutely certain that the
20b
deinitive prosthetic design was accurate before milling the inal restoration from monolithic zirconia.
The implant veriication jig was attached to the implants so that a
precise inal impression could be
taken (Figs. 17a–c). The custom tray
provided by the laboratory was
illed with PVS material and seated
over the implant veriication jig. As
the PVS material set, the relative
positions of the implants represented by the veriication jig remained ixed, ensuring an extremely accurate inal impression.
The approved wax set-ups and
inal maxillary impression were
returned to the laboratory so that
the inal mandibular implant
overdenture and maxillary provisional implant prosthesis could be
produced. The inal mandibular
appliance was fabricated on the
master cast and included recess
wells in which metal housings
with overdenture caps would be
cured chairside (Figs. 18a & b).
These denture caps provide retention and stabilise the pros-
[7] =>
TRENDS & APPLICATIONS
Lab Tribune Asia Pacific Edition | 12/2017
21a
21b
22a
23a
25
23
22b
23b
26
24
Figs. 21a & b: After seating of the inal mandibular implant overdenture, the maxillary provisional implant prosthesis was tried in to verify it, form and function.—Figs. 22a & b: The interocclusal relationship
was veriied with the inal mandibular and provisional maxillary appliances in place.—Figs. 23a & b: The metal housings of the overdenture caps were seated over the Locator attachments.—Fig. 24:
Quick Up self-curing acrylic was used to pick up the metal housings in the overdenture and ill in the minor voids between the denture caps and recess wells of the prosthesis. Note that, in many cases,
the dentist elects to have the overdenture caps processed by the laboratory.—Fig. 25: The black processing inserts were replaced with the appropriate retentive caps, which are colour-coded according
to strength.—Fig. 26: The patient with the inal Locator overdenture and the maxillary provisional implant prosthesis in place.—Fig. 27: The deinitive maxillary restoration was milled from BruxZir Solid
Zirconia, incorporating the slight adjustments that were made to the PMMA provisional appliance.—Figs. 28a & b: The inal BruxZir Full-Arch Implant Prosthesis completed a dramatic oral reconstruction for a patient who presented with terminal dentition, restoring form, function and quality of life.
thesis by seating over the Locator
attachments and keeping the appliance in place during function.
A new master cast of the maxilla was produced based on the
custom open-tray inal impression. The new master cast and
inal approved wax set-up were
scanned. A virtual model was generated, upon which the ixed monolithic prosthesis was designed
using CAD software (Figs. 19a & b).
Because this digital model was
based on the inal impression with
the veriication jig, screw access
holes were created in precise
alignment with the positions of
the maxillary implants. The resulting design was used to mill a
provisional implant prosthesis
from polymethyl methacrylate
(PMMA; Figs. 20a & b). This appliance was tried in and worn for a
trial period, thus ensuring an accurate prosthetic design.
The provisional implant prosthesis is an essential element of
the restorative process, as signii-
27
cant adjustments cannot be made
to the inal restoration once it has
been milled from BruxZir Solid
Zirconia. At the following appointment, the Inclusive Locator Implant Overdenture was seated and
checked for proper it, function
and support from the soft tissue.
The provisional implant prosthesis was then screwed into place,
and its tooth positioning, function and aesthetics were veriied
(Figs. 21 a & b). With both appliances in place, the interocclusal relationship was checked
(Figs. 22a & b). Minor occlusal adjustments were made directly to
the maxillary provisional implant
prosthesis, as PMMA is easily modiied. Slight alterations were also
made to the mandibular implant
overdenture. Block-out shims and
the retentive overdenture caps
were then seated over the Locator
attachments (Figs. 23a & b). Quick
Up self-curing material (VOCO
America) was added to the recess
wells of the overdenture before
seating the appliance over the
metal housings. After allowing the
28a
material to set for approximately 3
minutes, the overdenture was removed, picking up the denture
caps in the prosthesis. The minor
voids surrounding the denture
caps were then illed with Quick
Up light-cured pink composite
(Fig. 24). The appropriate retentive
inserts, which are available in a variety of strengths, depending on
the functional capabilities of the
patient and the number of implants, were swapped into the
metal housings (Fig. 25). The implant overdenture was reseated,
providing excellent retention, stability and function for the patient.
With the inal mandibular restoration in place, the patient wore
the provisional full-arch implant
prosthesis for a trial period of two
weeks (Fig. 26). This opportunity to
wear the appliance during actual
day-to-day function instilled a
high degree of conidence in the
prosthetic design for the patient
and dentist alike. After patient approval, the provisional implant
prosthesis was returned to the lab-
oratory so that it could serve as the
blueprint for the inal restoration
and the minor adjustments made
to the appliance could be included
in the deinitive prosthetic design.
The inal BruxZir Full-Arch
Implant Prosthesis was digitally
fabricated with precision (Fig. 27).
As an exact reproduction of the
test-driven provisional, the deinitive prosthesis itted perfectly and
offered the aesthetics and function the patient had come to expect (Figs. 28a & b). The inal restoration effectively addressed the
unique circumstances of the case,
providing the most durable, stable
prosthesis possible for his maxilla
and a mandibular restoration
that greatly improved prosthetic
retention and could be upgraded
to a ixed prosthesis should the
patient’s situation change.
Conclusion
Practitioners now have the
clinical lexibility to offer patients
a wide range of treatment options,
28b
from entry-level, economical restorations like the Inclusive Locator
Implant Overdenture to the ixed,
highly durable BruxZir Full-Arch
Implant Prosthesis. There is a viable means of treating nearly all patients, whatever their oral health,
needs and inances. Given the
life-changing beneits of implant
therapy and the straightforward
restorative protocols of today, all
patients should be offered this service to confront the challenges presented by complete edentulism.
Editorial note: This article was irst published in CAD/CAM international magazine of digital dentistry No. 2/17. A list of
references is available from the publisher.
Dr Paresh B. Patel is a co-founder of
the American Academy of Small Diameter Implants and has worked as a
lecturer and clinical consultant on dental implants for various companies. He
has been in private practice in Lenoir
and Mooresville in North Carolina in
the US since 1996 and can be contacted
at pareshpateldds2@gmail.com.
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