PIB FABRICATION

Block out over the analogs on the model to allow some room for the healing abutments protruding through the tissue. Fabricate baseplate and wax rim on master model.  
1.
Order appropriate non hexed temporary cylinders from the pertinent manufacturer to make a verification index. Screw non hexed temporary cylinders on to analogs in the model.  Verify the cylinders are seated properly. Lute the cylinders together with  Pattern Resin™ LS (GC) or Triad® (Dentsply Trubyte) light cure acrylic.
2.
Relive any acrylic impinging on the soft tissue mulange.  Remove the soft tissue mulange from the model and tighten just one screw in one of the terminal cylinders to confirm passive fit of the verification index. Send base and bite and verification index to the doctors office for try in.
3.
Upon return of the verification index, base and bite mount the working models on a semi adjustable articulator. If the verification index was sectioned and reluted together by the doctor during try in, remove and reattach the misaligned analog to the model, using the verification index as a positioning aide.
4.
Set teeth in wax for try in.
5.
After the wax try in is approved for esthetics and vertical dimension, remount the models and make a putty index of the set up. Extend the matrix over the occlusal of the denture teeth.
6.
Remove the matrix and teeth set up from the working model and apply a double layer of pink base plate wax to the tissue area of the stone model. Clear away the pink wax around the analogs.
7.
Reattach the verification index on to the model. Position  number 8 gage wax sprues in to the screw access channel of the temp cylinders in the verification index. The wax sprues should extend about 3mm from the top of the cylinders.
8.
Reposition the matrix on to the working model and back fill the matrix with cold cure acrylic and place in pressure pot.
9.
After the acrylic has cured remove the matrix and wax sprues. Mount the case back on the articulator and adjust the occlusion of the mock up to compensate for any distortion.  Make any adjustments necessary for proper vertical height and lateral balanced group function. Shorten the distal aspect according to the AP spread.
10.
Detach the pink acrylic denture from the stone model and reduce the "teeth" as if they were natural teeth prepped for cementable crowns. Remove the flanges and create space for the future pink tissue material utilizing the matrix to guide reduction.
11.
Following the reduction, confirm the mock up frame still seats passively on to the working model and adequate reduction for the future crowns and pink acrylic festooning was created. Send the model and mock up to a CAD CAM milling center.
11a.
Virtual frame work
12.
Confirm the titanium frame seats passively on to the working model. Refine and adjust the frame as needed.
13.
Block out any undercuts with pink wax and fill the screw access holes with Blu-Mousse® (Parkell Inc.).
14.
Duplicate the titanium frame in die stone.
15.
Pin, base, cut and trim the duplicated frame.
16.
Wax up individual copings for porcelain fused to metal crowns or scan the dies for zirconia copings.
17.
Seat the copings on to the respective preps on the titanium framework.
Authors note: Implants in area of 20 and 29 failed in the meantime and patient elected to continue treatment albeit with a shortened distal extension of the prosthesis.
18.
Apply "bake on" or "press to" porcelain according to the coping material.
19.
To avoid a dark line later on in the pink acrylic festooning material at the crown pink acrylic material junction it is crucial to reduce the facial and lingual chamfer or shelf of the preps on the titanium frame. Essentially creating crowns with overhanging or overextended margins.
20.
Sand blast or Rocatec™(3M™ ESPE™) the portion of the titanium frame to receive pink acrylic. Silane and opaque the frame with pink opaquer. Festoon the crowns and frame with GRADIA® GUM (GC).