The Implant Bar Adventure
This documentation showcase the solutions and challenges of solving 63-year old female patient ill-fitting dentures with the help of implants and implant bars on both arches.
The patient
The patient is a 63-year-old female who has been wearing dentures for many years. She was tired of having constant problems with ill-fitting dentures. She had 5 implants placed in the upper arch and 4 implants in the lower arch. She has good oral hygiene so a compromise between fixed and removable was decided for this patient. Patient has requested a natural looking appearance.
Implant bars
The upper dental implant bar is a Double Structure milled implant bar. Incorporating MK1 and CM Loc attachments offering the patient a combination of fixed and removable prosthesis. The case will be done on 5 Zimmer ACTR implants. The lower is a fixed Wrap-Around milled implant bar. The case will be done on 4 NobelBiocare Multi-Unit RP implants.
After all elements are in place and before shading and molding. Is key to create the duplicate of the bite registration, processing the pin that is fixed on the bar and secure the occlusal plane and the incisal pin, which is the point in between midline and the occlusal plane.
Shade and Mould
Objectives: To secure mid, smile and canine lines, as well as, the occlusal plane. To set the bite registration marks for maxilary central spacing to 12mm (zoom in) and intercanine spacing to 48mm and finally to create a bite registration mark from midline to canine of 24mm. Reasons to have chosen these Vita teeth shades: The idea was to deliver a natural smile for a 62 years old female. So, the shape selected was ovoid and the shade was decided as not too white.
CM LOC processing insert
In order to protect and preserve the space for the final CM LOC retention Insert. It is important to place the inserts on the Double Structure bar. The insert (grey piece) has zero retention, meaning it will be easy to remove at the moment of wax set-up.
The landmarks process allows to establish an accurate result on patient needs. These are the elements to consider:
1. Canine key of occlusion – Class I. Mesial incline of maxillary canine overlaps distal incline of mandibular canine.
2. Occlusal plane should be at 2/3 the height of retromolar pad.
3. Molar key of occlusion – Class I. the mesio-buccal cusp of the maxillary 1st molars should coincide with the mesio-buccal groove of the mandibular molar.
4. Overjet 2mm / Overbite 2mm.
5. Wax Set up.
Removing the wax set-up
1. Unscrewing the processing pins.
2. Removing the wax set-up.
3. Replacing the processing pins.
4. Removing the mandibular wax set-up and placing the analogs helps in the investing process giving support for the bar.
Cut back
Trimmed back as much as possible from teeth and acrylic gingiva, in order to made room for layering composite.
Layering
1. A layer of repair liquid has been applied all over, then is light cured it for 1 minute to make the surface sticky again and
ready for layering the composite.
2. Orange composite layer.
3. As much acrylic as possible has been removed for a natural look, this also will bring the gingiva lower.
4. Cracks are made with disk and bur and filled with orange flow.
5. Orange flow composite.
6. White opaque composite.
7. Layered mesial and distal
with Twiny bleach dentine
and white enamel.
8. Layered the gingiva with Twiny bleach dentine for a lighter pink.
9. Layered mesial and distal with Twiny blue flow.
10. Layered the incisal with Twiny orange flow – aged teeth no mamelons.
11. Layered the cervical area with Twiny opaque dentine A2 to define the root/cervical line.
12. To create a better morphology the occlusal has been layered with Twiny bleach dentine.
13. The incisal third has been layered with Twiny Transpa Glass Clear.
14. In order to create a natural look on buccal and lingual side, the mesial, distal and occlusal third have been layered with Twiny bleach dentine.
15. Layered (UL side) allows a better occlusal morphology. In comparison with the (UR side) (non layered)
16. In order to create a natural feeling for the palatal morphology. It has been layered with bleach dentine Twiny composite.
Trimming and shaping
All over the teeth the Twiny Enamel E2 Clear has been layered. It was also trimmed and shaped with diamond bur. Finally, occlusion and lateral movements (Canine guidance) were established.
Final result
Panthera products used
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