Assuming a vertical occlusal dimension has (VOD) been established through a bite block and
the relationship of the analogs to each other has been confirmed with a verification
index, teeth need to be set up in wax for try in. |
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1. |
Set teeth in wax for try in with a lingualized, lingual contact
occlusion (Contemporary Complete Denture Occlusion, Lang, Lauciello et
al, Ivoclar Vivadent). Send to Dr.'s office to confirm the bite relationship, esthetics and phonetics. Have Dr. take a new bite with teeth in wax in place.
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2. |
Remount models with new bite if indicated and reset teeth if necessary. Make a putty
matrix of the teeth in wax on the master model. |
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3. |
Remove the matrix and set up from the model and reposition the
matrix to verify adequate space for the substructure is present. |
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4. |
Determine AP spread and length of acceptable cantilever. |
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5. |
The substructure can either be a CAD CAM milled bar or waxed and
cast with non indexed UCLA's. CAD CAM bars can be
outsourced or if in
house technology allows, produced on site. |
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6. |
Verify passive fit of the substructure by tightening one screw in a
terminal abutment. The bar should seat on all analogs without rocking or
lifting. |
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7. |
Reposition soft tissue mulange on master model and seat bar. Ensure
adequate room between bar and tissue exist to allow enough acrylic
thickness. Adjust if necessary. |
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8. |
Replace the matrix on to the master model with the seated bar
substructure to determine sufficient space is available for the denture
teeth and acrylic. |
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9. |
Re set teeth in wax on to the bar, utilizing the matrix. Adjust
denture teeth and or bar as needed. Drill access holes through teeth and
wax to allow access to fixation screws. Send teeth in wax over substructure
for final try in to Dr.'s office if requested. |
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10. |
Refine the hybrid wax up. Three options present themselves in
regards to the extension of the basal design, option one would be a high
water design with 1 to 2mm of space between the acrylic and the tissue,
option two no space between the acrylic and the tissue and option three
would extend the acrylic slightly (0.5mm) to allow the hybriddenture to
displace some tissue once inserted. Keeping in mind all three options
require a egg shaped basal profile and some space immediately next to
the implant to thread superfloss in between. The basal design is Dr.
preference and philosophy dependent. |
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11. |
Remove the wax up from the model and attach a second set of analogs
to each "abutment" of the substructure. |
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12. |
Fill the bottom half of the acrylic processing flask with stone and
set the wax up in to the soft stone. Obturate each screw access hole
with impression material. Apply a plaster separator to the stone and
finish investing the wax up in to the flask. Boil out the wax. |
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13. |
After boiling out the wax up, unscrew the substructure and apply a
acrylic separator to the stone. Sand blast the framework with Rocatec |
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14. |
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Silane the frame and apply opaquer. Stay just shy of the finish line
around each abutment. This will prevent a unsightly gap between the
acrylic and substructure once the acrylic is processed. |
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15. |
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Reattach the opaqued substructure to the analogs in the flask
and obturate the screw access channel with impression material. Process
acrylic. |
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16. |
After the acrylic is cured divest the processed hybriddenture and
remove the impression material from the screw access holes. |
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17. |
Unscrew the analogs from the hybriddenture used during processing
and screw the restoration on to the master model. |
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18. |
Adjust occlusion and lateral contacts according to the lingualised
contact occlusion theory.. |
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19. |
Finish denture in usual manner, taking care not to damage the
abutment/implant interface. Extra analogs can be utilized to protect the
interface during finishing. |
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