Case Discussion: Multiple Implant Units
Posted on 07/03/2013
I have decided now to turn some attention to actual cases. I will attempt to choose interesting cases that present specific challenges.
The following case presented a male patient with six mandibular implants (19,20,21 and 29,30,31) and eight maxillary implants (3,4,5,6 and 11,12,13,14). Patient had existing teeth 7,8,9.
Doctor asked for custom abutments and all individual PFM white gold crowns except for 10,11,12 where #10 was a cantilever pontic. We splinted #11,12 to #10.
In this case we were faced with two main challenges
1. Establishing the correct vertical
2. Ensuring implant transfer is correct
In working to establish the bite, the doctor initially gave us a vanilla mouse bite using the anterior remaining teeth. We did not feel we could mount the case, so we returned bite blocks. Doctor proceeded to take a new bite which allowed us to establish the vertical.
Implant transfer has always been an area of art and science. Doctor used standard metal impression copings for Zimmer Screw Vent using the closed tray impression technique. We poured the impression and poured a duplicate without the impression copings in the impression. We then double checked the position of the impression copings against the solid model for verification. We cast the abutments from UCLA abutments and created a duralay key for insertion. Lucky for us, the transfer was correct and all abutments seated in the correct position.
We then proceeded to fabricate individual crowns. We like individual crowns over implants as they offer better eshtetics, future retrieval and easier troubleshooting if the implant position is off.
Doctor tried in the crowns but there was indeed an issue with the left side bite. Crowns were out of occlusion. We asked for a bite over the crowns and a pickup impression of the crowns in the mouth. Doctor left the abutments screwed down.
We then added porcelain and rebuilt the contacts for the individual crowns. Doctor was able to seat and patient left very happy with his new bridge.
Lesson learned from this case is to really verify the mounting before baking porcelain - especially on individual crowns. Adding porcelain and rebuilding contacts is not easy the secong go round:)
Here is a photo of the case. You can click the link below to blow up the picture.
The following case presented a male patient with six mandibular implants (19,20,21 and 29,30,31) and eight maxillary implants (3,4,5,6 and 11,12,13,14). Patient had existing teeth 7,8,9.
Doctor asked for custom abutments and all individual PFM white gold crowns except for 10,11,12 where #10 was a cantilever pontic. We splinted #11,12 to #10.
In this case we were faced with two main challenges
1. Establishing the correct vertical
2. Ensuring implant transfer is correct
In working to establish the bite, the doctor initially gave us a vanilla mouse bite using the anterior remaining teeth. We did not feel we could mount the case, so we returned bite blocks. Doctor proceeded to take a new bite which allowed us to establish the vertical.
Implant transfer has always been an area of art and science. Doctor used standard metal impression copings for Zimmer Screw Vent using the closed tray impression technique. We poured the impression and poured a duplicate without the impression copings in the impression. We then double checked the position of the impression copings against the solid model for verification. We cast the abutments from UCLA abutments and created a duralay key for insertion. Lucky for us, the transfer was correct and all abutments seated in the correct position.
We then proceeded to fabricate individual crowns. We like individual crowns over implants as they offer better eshtetics, future retrieval and easier troubleshooting if the implant position is off.
Doctor tried in the crowns but there was indeed an issue with the left side bite. Crowns were out of occlusion. We asked for a bite over the crowns and a pickup impression of the crowns in the mouth. Doctor left the abutments screwed down.
We then added porcelain and rebuilt the contacts for the individual crowns. Doctor was able to seat and patient left very happy with his new bridge.
Lesson learned from this case is to really verify the mounting before baking porcelain - especially on individual crowns. Adding porcelain and rebuilding contacts is not easy the secong go round:)
Here is a photo of the case. You can click the link below to blow up the picture.
Implants, Zimmer, Abutments, White Gold, PFM
- Abutments and Crowns : http://goo.gl/emwh8
