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USE OF DIGITAL DENTURES IN IMMEDIATE OCCLUSAL FUNCTIONAL LOADING OF DENTAL IMPLATS ANTOANELA GARBACEA, DDS, MSD
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• DIGITAL DENTURES VS.
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CONVENTIONAL COMPLETE DENTURES
Outlin e
• GUIDED SURGERY FOR IMPLANT PLACEMENT • IMMEDIATE LOADING AND DENTURE CONVERSION USING CAD/CAM MILLED DENTURES Implant Dentistry
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Immediate Loading Consensus •
Immediate/early loading of dental implants: A report from the Sociedad Espanola de Implantes World Congress consensus meeting in Barcelona, Spain, 2002. Aparicio C, Rangert B, Sennerby L. Clin Implant Dent Relat Res. 2003;5(1):5760.
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immediate ‘non-occluding’ loading
Immediate ‘occlusal’ loading
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Acrylic provisional restorations comprising any sort of metal reinforcement Tarnow et al. 1997; Horiuchi et al. 2000; Chow et al. 2001; Ganeles et al. 2001; Grunder 2001; Malo´ et al. 2003a, 2003b; Nikellis et al. 2004; Testori et al. 2004; Degidi et al.2006a, 2006b
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Entirely acrylic, metal-free restorations can be considered as an alternative Schnitman et al. 1990; Cooper et al. 2002; Kammeyer et al. 2002; Becker et al. 2003; Chee & Jivraj 2003; Wolfinger et al. 2003; Misch 2004; Balshi et al. 2005; Malo´ et al. 2006
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Technique Description
Goodacre et al 2011, 2012
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AvaDent™ Digital Dentures It is a system by which impressions, interocclusal records, and tooth selection can be completed in one appointment and the dentures fabricated using CAD/CAM technology .
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Technique Description
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1. Maxillary and mandibular impressions using Avadent system. 2.Fabrication of Avadent Digital Dentures. 3.Fiduciary markers in the Avadent already milled dentures as required by the Nobel Guide Clinician protocol. 4. Dual CBCT Scan.
Avadent Digital Dentures and
Patient wearing dentures.
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Technique Description
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5. Virtual Implant Treatment Plan using Nobel Clinician Software . 6. Fabrication of the Nobel Clinician surgical guide. 7. Guided Surgery 8. Immediate Loading of Implants using Avadent Digital Dentures as provisional prosthesis. Implant Dentistry
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Treatment Sequence
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Existing Complete Dentures
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Poly (vinyl siloxane) casts made by pressing putty into existing dentures
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Immerse AvaDent tray in 160째 F water
Press softened tray onto PVS cast
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Border molding with areas of tray showing through the impression material, indicating they need to be relieved
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before making wash impression
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Final maxillary and mandibular impressions
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Anatomical Measuring Device used to adjust and hold OVD, serve as a
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gothic arch tracing device, and also provide upper lip support adjustment
Brass gothic arch tracing pin is adjustable using the side hex screw.
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The maxillary lip support can be adjusted using the anterior hex screw
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Three different sizes of clear plastic overlays are available to help identify the
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Adhesive and registration material applied Completion of a gothic arch tracin to maxillary and mandibular AMD
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An Occlusal Plane Orientation Ruler is Provided To Align The Occlusal Plane With The Interpupillary Line
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Use the ruler to seat the maxillary AMD so it is aligned with the interpupillary line
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The mandible is moved so the brass pin engages the dimple and holds that position while the registration material is expressed between the AMDs
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Superimposing the laser scan of the AMD on the
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scan of the complete arch impression
Laser scanning of the AMD impression
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Locating the Borders
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Setting the teeth and forming the base
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Denture base morphology established
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Virtual tooth arrangement
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ATI (Advanced Try-In) Wax Trial Denture
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Nobel Clinician: virtual planning of the diameters and lengths of the
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implants and stabilizing pins the to be placed in the mandible.
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35ยบ thread shape Double lead threads Tapered TiUnite surface Implant Dentistry
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Fabrication of the Nobel Clinician surgical guide.
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Laboratory steps in fabrication of the mandibular cast
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The digital denture conversion as mandibular implant provisional screw-retained prosthesis.
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Prototype converted denture for immediate loading
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Advantages
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•
It is possible to record all the clinical information for complete dentures in one appointment (1-2 hours) and have the dentures ready for the second appointment .
•
Less clinical chair time provides the opportunity for a more cost-effective set of appropriately accurate complete dentures .
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•
There is a repository of digital data that allows for more rapid fabrication of a replacement or spare denture
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The denture base fit is superior to that of conventionally processed bases
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Research indicates some favorable properties of the PREpolymerized resin
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Conclusions
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Thank you
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