Clinical protocol ao4 dif 140701

Clinical Protocol for AvaDent®on 4 Fixed-Detachable Dentures

Dentate - Immediate Load - Freehand

Preliminary Appointment Diagnostic Evaluation: Diagnostic treatment plan and gather signed informed consent including CBCT. Fig.1

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2. The AvaDent® records will be scanned, teeth digitally removed and adequate bone digitally reduced to provide room for the prosthesis, implants and potential titanium bar. The AvaDent® is designed. (Fig. 6-9)

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3. An AvaDent® fully milled Provisional Denture (APD) will be manufactured which will become the conversion denture. In addition an AvaDent® Bone Reduction Guide (ABRG) will be manufactured from this design. (Fig. 10-12)

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Appointment 1: 1. Make all records needed by following the conventional AvaDent® process for AvaDent® immediate dentures and send to Global Dental Science (GDS) for fabrication. Clearly communicate the intended midline, incisal edge/occlusal plane, OVD and CR. Include photos of patient at rest and smiling. (Fig. 1-5)

4. This guide will provide a reference for the reduction of the alveolar bone. Reduce the anterior labial flange vertically to allow 15mm from the incisal edges of the anterior teeth to the edge of the flange. A lingual slot is made to create a reference to aid implant placement and selection of appropriate abutments. (Straight, 17 or 30 degree)

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Dentate - Immediate Load - Freehand Appointment 2: 1. Extract teeth, flap tissue. Insert the ABRG in the mouth, and perform alveolectomy. Reduce the bone to allow for 15 mm of space from the incisal edges of the central incisors and anterior teeth to the reduced bone. The 15 mm space in the anterior area is required to accommodate a smooth transition area between the resin of the surgical guide and the soft tissue when the lip is animated and will accommodate the bar and teeth for the final restoration. In the posterior area, a minimum of 10 mm is required to accommodate the final restoration. (Fig. 13-17)

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2. Place the implants using the ABRG as a reference. Ensure the implants are placed in correct position to carry the final restoration. 3. The Nobel Multi-unit Abutments are placed at this time. When tilted implants are used posteriorly, angled abutments are used that correct the posterior inclination of the implants. It is important to recognize that the circumferential positioning of the angle-correcting Multi-unit Abutments within the posterior tilted implants will vary slightly depending on where the implant placement was stopped during the final torquing in the osteotomy. (Fig. 18) Abutments are torqued at this time (15NCm for angled abutments and 35NCm for straight abutments).

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4. Place comfort caps over the abutments. Should the posterior comfort caps not be Fig.18 aligned with the anterior caps these are removed, the distal abutment loosened and rotated circumferentially thereby providing the best possible alignment between the anterior and posterior abutments. 5. Relieve the denture over the comfort cap (lubricate) areas and reline the AvaDent速 Provisional Denture (APD) with an auto-polymerizing resin. Remove the denture from the mouth. Drill holes/channels through the transitional denture at the sites of comfort cap indentations. 6. Remove the comfort caps and screw the Temporary Copings (Nobel catalog number 29406) to the abutments. Seat the Provisional Denture (APD) into place with the copings protruding through the holes/ channels in the denture. Some adjustment of the posterior channels within the AvaDent速 Provisional Denture may be required to accommodate the copings. (Fig.19-23)

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息 2014 Global Dental Science, LLC. AvaDent速 is a registered trademark of Global Dental Science, LLC.

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Clinical Protocol for AvaDent®on 4 Fixed-Detachable Dentures

7. Check the occlusion against the opposing dentition. It is possible that the height of the Temporary Copings will contact the opposing denture and prevent closure into the maximum intercuspal position. Therefore, it may be necessary to mark the Temporary Copings, and remove them from the mouth for shortening. 8. Once the AvaDent® Provisional Denture is properly seated over the Temporary Copings, flowable composite resin or auto polymerizing resin is placed between the Temporary Copings and the channels in the AvaDent® Provisional Denture and polymerized. Check and maintain the occlusion against the opposing arch during polymerization. (Fig. 24)

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9. All of the prosthetic screws attaching the Temporary Copings to the Multi-Unit abutments are loosened, the denture removed and the denture shaped to the desired form. (Fig. 25-28)

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10. Affix multi-unit abutment replicas to the AvaDent® Provisional Denture before its final placement in the mouth and embed the replicas in Whip Mix Snap Fig.27 Stone so a cast is made that can be sent to Global Dental Science to construct the AvaDent® Verification Jig (AVJ). Include a putty matrix of the complete conversion denture on the model.

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11. The AvaDent® Provisional Denture is then placed and the screws torque to the recommended level of 15 NCm. The occlusal contacts are rechecked and final refinements made, if needed. 12. The occlusal screw access holes are filled with the clinician’s choice of material (either an impression material so the screw tightness can be re-checked at a post-operative appointment or a definitive resin material). (Fig. 29, 30) Fig.29

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Appointment 3: Prior to this appointment, Global Dental Science will provide an AvaDent® Implant Record Device (AIRD) and AvaDent® Verification Jig (AVJ). (Fig. 31, 32) The resin Verification Jig is designed to fit simultaneously over and around either Impression Copings (Nobel open tray impression copings for Multi-unit Abutments, catalog number 29089) or Temporary Copings (Nobel Temporary Copings for Multi-unit Abutments, catalog number 29406). Either of these copings can be used for the final impression. Fig.31

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Dentate - Immediate Load - Freehand 1. The previously placed AvaDent® Provisional Denture is removed from the abutments and the copings attached to the abutments. 2. The AvaDent® Verification Jig is placed over the copings. (Fig. 33) The channels in the jig may have to be enlarged to fit over the posterior copings as they can have slight variations in their orientation. The AvaDent® Verification Jig is held so it is vertically positioned with a 2-3 mm space between the inferior surface of the jig and the mucosa. It is then secured to the Impression/Temporary Copings by syringing flowable composite resin between the jig and the copings.

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3. The AvaDent® Implant Record Device (AIRD) will have an opening in the denture base that is large enough to fit around the AvaDent® Verification Jig that has been connected to the copings while also resting on the posterior edentulous ridge. The final impression is then made using the AvaDent® Implant Record Device (AIRD) as an impression tray. It is coated with impression adhesive and light-body impression material is placed in the AvaDent® Implant Record Device (AIRD) so it records the posterior edentulous ridges. (Fig. 34, 35) Light-body impression material can Fig.34 Fig.35 be expressed around the connected Copings and underneath the AvaDent® Verification Jig. (Fig. 36, 37) The AvaDent® Implant Record Device (AIRD) is then seated over the AvaDent® Verification Jig. The AvaDent® Implant Record Device (AIRD) scan guide has a slot in its facial surface that extends distal to the most posterior Coping on the right side to a location Fig.36 Fig.37 just distal to the most posterior Coping on the left side. This continuous slot is large enough that the syringe tip from an Ultradent impression syringe can be placed into the slot and light-body impression material flowed around the base of the Copings and underneath the attached AvaDent® Verification Jig. Light-body impression material can also be expressed through the occlusal opening in the AvaDent® Implant Record Device (AIRD). A finger or Q-tip Fig.38 is used to wipe across the occlusal opening in the AvaDent® Implant Record Device (AIRD) to expose the occlusal aspect of the copings so their screws can be located before polymerization of the impression material and subsequently easily accessed for loosening. (Fig. 38) 4. The AvaDent® Implant Record Device (AIRD) is oriented using the occlusion with the opposing dentition. After the impression material is properly polymerized, the screws in the Temporary Copings are loosened and the impression removed. The impression should have recorded the edentulous ridges and contains the AvaDent® Verification Jig with the connected Temporary Copings. Excess impression material that would interfere with occlusal interdigitation of the AvaDent® Implant Record Device (AIRD) with the maxillary denture is removed carefully and the impression reseated and attached with a couple of screws. An interocclusal record is made between the AvaDent® Implant Record Device (AIRD) and the maxillary denture. (Fig. 39) Fig.39

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Clinical Protocol for AvaDent®on 4 Fixed-Detachable Dentures

5. The fixed AvaDent® Provisional Denture (APD) is replaced, the screws tightened, and the access holes sealed with the clinician’s material of choice (typically PVS Impression Material). The final impression made with the AvaDent® Implant Record Device (AIRD) is sent to Global Dental Science along with the interocclusal record for fabrication of the (AHP) AvaDent® Hybrid Prosthesis with incorporated Procera Implant Bar. (Fig. 40-42)

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Appointment 4:

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1. The AvaDent® Provisional Denture is removed. (Fig. 43) 2. AHP definitive prostheses placed. (Fig. 44) New prosthetic screws are used to attach the AHP AvaDent® Hybrid Prosthesis to the Multi-unit Abutments and torqued to 15 NCm. (Fig. 45) The definitive maxillary complete denture is seated with pressure-indicating paste (PIP) to refine its fit to the mucosa and then the occlusal adjusted. The occlusal screw access holes are filled with the clinician’s choice of material (Fig. 46) (either an impression material so the screw tightness can be re-checked at a post-operative appointment or a definitive resin material).

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3. The process is complete. (Fig. 47)

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