Here is a case we did Guided on the upper and lower. This patient’s bone was really D4 on the upper right, so we were only able to get 4 implants with not a great A/P spread. So we ended up doing an upper Hader Clip Overdenture. The patent was really set on fixed. So we grafted the upper right and later placed two more Screw Indirects and let them sit for 6 months. They “took” so we removed the Hader Bar and started the process for a “Pawn Post” Hybrid.
On any case with a CAD Milled bar, we start is an “in-exact” impression. You don’t even need a tissue model. All this impression is for is to generate these sectioned GC Resin copings and a custom open tray for a more exact impression in which the Hybrid will be made from.
The copings are luted together in the mouth with GC Resin. Let them sit then remove the copings then screw it back in. It should fit passively.
I think this next step is the most important in making any bar or hybrid. Use the Radiographic Guide, or in this case a second duplicate denture. Drill two holes in it and pick up two titanium temporary cylinders in the mouth. You can use acrylic or composite, in this case I just used Luxatemp, its softer in case it locked on. Screw and unscrew this assembly to make sure it can be reattached.
Now take a bite with any bite registration material. When you convert a removable to a fixed its very important that you have a stable bite or you will be doing multiple wax try ins later to get the bite down. Now the lab will have an easy time mounting this case.
The lab ( I used Burbank for this case) will then screw the denture on the model, powder it up and scan it into the bar software. In this case the lab chose to use a Pawn Post design. In this type of Hybrid, extensions come out only where the teeth are. This allows for a very thin substructure that is still strong.
Beautiful Bar! Fits incredible. Remember the Sheffild test. You should be able to screw just one screw in and the bar should not rock when you bounce on the contralateral side.
We got a good A/P spread and was able to cantilever back to the second molars.
One, I said one, wax try in. Bite and esthetics were perfect. The patient wanted to go whiter on the top than the bottom and we may strip the lower later and change out the teeth to match.
The processed hybrid back from the lab. Note how thin the prosthesis is.
We placed endo sponges in the screw holes. Cleaned the lower in the ultrasonic and replaced the composites with Anaxgum from Anaxdent.
Final! Burbank did an incredible job on the upper!! refined the bite in the mouth and again, we may change the lower teeth out later to match the upper. But overall, the smoothest case I have ever done.