Here is a case that I have been working on for a bit. Patient wanted Upper and Lower Hybrids. He was unhappy with the set up of his denture so we made him a new one. You will see that everything in both the Guided Surgery and the Hybrids centers around the Radiographic Guide, so we want to make sure we nail the teeth position before we even pick up a hand piece. The dentures were processed and one duplicate Radiographic Guide was affixed to the SICAT bite plate. The other duplicate was saved for scanning in CEREC
I had previously done the lower free hand, took me two hours. The upper duplicate was powdered in the Blu Cam and incorporated in the scan.
The Patient was scanned, note the radio opaque flange to help in pin position
When planning the pins I like to be 45 degrees on all pins to the occlusal table. The central pins are straight with the midline. The Lateral pins are at 45 degrees to the mesial to avoid the cheeks.
Pins placed. I use the Nobel pins which seem to be the industry default. If your kit does not have them, just specify them in Galaxis like an implant and buy them for nobel. Make sure you also buy the drill as the stop is at 20mm and when using pins you are usually in bone close to Anatomy.
Very easy and boring uneventful surgery. I used the Nobel Guided kit with Implant Direct Implants.
After healing, its time to take impressions for a hybrid and when I say impressions I mean I always take two. The first is an in-exact closed, open whatever impression to just get a custom tray and a set of Triad resin jigs that we lute in the mouth.
You can see from the break how inaccurate typical impressions are. This is Triad light cured flowable. I like this stuff better than GC resin.
A more accurate custom tray is used to make a pick up impression of the jigs. Remember the set of duplicate dentures we made? These are then used for the bite, to mount the case and to design the bars.
The duplicate is powdered up and scanned with a 3shape lab scanner and is used as a matrix for the bar design. We used an I bar wrap around hybrid as you can see in the cross section.
Wax up over the bars
Final case on the models
Very beautiful and very slender hybrids can be made. This awesome lab work was from Mark Jackson from Precision Ceramics.
The hybrids were screwed in. I know the recommendations are to torque these down to 30. I have done that and could not get the screws out later for cleaning, so I just hand tighten. Played with Anaxgum composite some more and got the color figured out
Screwed down, Endo sponge over screws.
I like the paste better than the flowable for screw holes.
So here we are. Long time planning and working out the bite but we got it done. This was an early case so I did not affix titanium cylinders to the case and that gave me trouble when ironing out the bite. Currently I screw down the duplicate dentures rather than just having them rest. But the bite in the end was great and the patient was happy with the tooth display. These cases are fun, but make sure you charge enough as they are a lot of work!!!