Posted February 25, 2013
Some guys like a challenge, I’m not one of them. Here is an interesting Edentulous case on a patient with an existing upper and lower Ball Retained Implant Prosthesis that wanted to convert to Upper and Lower Fixed Detachable (aka Hybrids)
http://www.Digitalenamel.tvPatient had an existing Upper and Lower Ball/Implant Supported Overdenture with a retained root on the upper. I debated weather to bury these Implants or include them. We lost one of the upper Ball/Implants so we ended up keeping the remaining three.
- Patient was scanned with Galileos with a duplicate denture containing two densities of Barium Sulfate. Another copy was scanned in CEREC and then imported into the Galileos scan to better position the pins and the implants relative to the teeth.
Back from Germany. Note the position of the pin channels at 45 degrees to the occlusal. The distal pins are angled 45 degrees to the mesial:
Punches made, then Guides stabilized. Used the Nobel Guided Surgery kit but placed upper and lower Screw Indirects from Implant Direct. We ended up with 5 Upper and a total of 8 lower:
The First Impression is made with a stock tray, you can either use closed or open tray Impression Copings. The lab then fabricated these jigs with GC Resin which are luted, and picked up with a custom tray final impression in the mouth:
The Jigs are luted in the mouth with a light cured GC Resin flowable and a final impression taken. Note the two off angled implants were his old ball attachment implants used in his overdenture. The Duplicate Denture that was scanned in CEREC is attached to a few implants with Titanium Cylinders and a bite is taken. This Duplicate Denture is screwed on to the case and powdered up to be used in the bar fabrication step. This is done by Implant Direct Custom, the new Abutment and Bar Center at Implant Direct:
Here are images from the Delcam software used to make the Bars. The purple is the scanned denture.
Here are the bars tried in. Remember the Shefflield test. One screw only and bounce on the contralateral side to see if there is rocking. These bars were made by Helen and Ron over at Implant Direct
After the bars were verified we sent them over to Mark Jackson and Precision Ceramics. Talk about an incredible lab! Some of the most beautiful spot on work I have seen! Here we are doing the Sheffield test on the wax try in and everything is still golden!
Here is the final processed upper and lower hybrid. The bite required no adjustment and the patient loved them!! Thanks Mark!
We used Anaxgum Composite. I need to use a lighter shade. No adjustment at all on the bite. Thrilled Patient, exhausted dentist!
