Skip to main content
+ 1 (418)-527-0388     [email protected]

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.


Articulation Set-up

There are some criteria to have in mind for Articulation building up.
We will be using the elements: White plaster, Artifix – 200g and distilled water – 66g.
The elastic band is located on the incisal plane to help setting up the models in the right position for later placing of the bite registration. We also prepare the soft tissue.

Vlad_case_13
Vlad_case_06
Vlad_case_07
Vlad_case_07
Vlad_case_13
Vlad_case_13

Processing pins

Processing pins for dental prostheses involves some crucial steps, including the removal of existing MK1 Attachments and their replacement with MK1 Acrylic. This transition enhances the overall quality and functionality of dental prostheses. The steps to follow are: Unlock the MK1 Attachments, fit the Double Structure bar on the Primary Bar and familiarize with the unscrewing tool and the processing pins.

Vlad_case_14
Vlad_case_15
Vlad_case_16
Vlad_case_17

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.


Landmarks & Waxing up

Vlad_case_26
Vlad_case_27
Lower bar
Lower analogs
Lower bar

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.

Vlad_case_29
Vlad_case_30
Vlad_case_31

4. Removing the mandibular wax set-up and placing the analogs helps in the investing process giving support for the bar.

Vlad_case_13
Vlad_case_32
Vlad_case_07

Investing

Vlad_case_33
Vlad_case_33
Vlad_case_34

Flasking

It is important to keep flask’s margins clean for perfect closing. Preserve the white plaster and cleaning the margings and smooth the undercuts without forget to wax channels. After, apply plaster separator with a brush and silicon over set-up to cover all retentive parts. Create retention in silicon for better grip and leave the incisal and occlusal edges uncovered to stay fixed in the plaster.

Flasks closed and locked. Injection channels are blocked to keep the plaster inside the flask. Fill up the flask with plaster, let them rest for 2 hours. Vibrations will eliminate the air bubbles. Place the flasks in boiled water for 8 minutes and then will be ready to be opened.

Vlad_case_35
Vlad_case_37
Vlad_case_38
Vlad_case_39
Vlad_case_40

Dewaxing

It is important to know that any residual wax will contaminate the acrylic resin and will prevent bonding between teeth and the denture base.

Vlad_case_35
Vlad_case_37
Vlad_case_38
Vlad_case_39
Vlad_case_40

Injection

Vlad_case_35
Vlad_case_37

Deflasking

Vlad_case_35
Vlad_case_37
Vlad_case_13
Vlad_case_32
Vlad_case_07

Cut back

Trimmed back as much as possible from teeth and acrylic gingiva, in order to made room for layering composite.

Vlad_case_06
Vlad_case_13
Vlad_case_07
Vlad_case_13
Vlad_case_07
Vlad_case_13

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.

Vlad_case_06
Vlad_case_13
Vlad_case_07

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.

Vlad_case_06
Vlad_case_13
Vlad_case_07

Layering & Staining pink

1. Anaxgum red paint.
2. Anaxgum cream paint.
3. GC Gradia blue.
4. VITA G1 G2 G3
5. Twiny red flow.
6. Twiny Yamakin MultiPrimer paste white and preparing Mk 1 attachments to be layered with pink.
7. Composite sandblasted.

Vlad_case_35
Vlad_case_37

Final result

Thank you, Vlad Atanasoaie, DT


Materials and settings

Articulator:
Artex CR (Amann Girrbach)
Upper Teeth:
Vitapan Excell (VITA) – Size: O39 / 23L
Lower Teeth:

Vitapan Lingoform (VITA) – Size: L39 / 23L

Condyle Settings:
Left and right condyles was set at 30°
Incisal Guidance:
Was set at 0°
Protrusion:
Was set at 0°
Bennett Angle:
Was set at 15°


Get technical content delivered straight to your inbox

By clicking on “Submit”, you agree to our Privacy Policy and to receive Panthera’s latest news and promotional emails.

NEED MORE INFORMATION?

Canada (HQ)


9105 rue John-Simons
Quebec, QC Canada,
G2B 0S6
+ 1 (418) 527-0388

USA


22343 La Palma Ave, Ste 128
Yorba Linda, CA
USA 92887
+ 1 (418) 527-0388

France


38 rue Jean Mermoz
78600 Maisons-Laffitte
France,
+ 1 (418) 527-0388

Newsletter

By clicking on “Submit”, you agree to our Privacy Policy and to receive Panthera’s latest news and promotional emails.

+ 1 (418)-527-0388      [email protected]


Newsletter


By clicking on “Submit”, you agree to our Privacy Policy and to receive Panthera’s
latest news and promotional emails.

Panthera Dental