BruxZir Screw-Retained Hybrid Bridge
Clinical Case
Patient and product photographed is an actual BruxZir Hybrid Clinical Case.
Dentistry performed by Mark McOmie, DMD Chattanooga, TN
Spring 2014
www.oralartsdental.com
800-354-2075
Restoring the fully or partially edentulous patient using a
BruxZir Solid Zirconia Screw-Retained Hybrid
Written by Matt Winstead, CDT, Vice President Clinical Dentistry by Dr. Mark McOmie, DMD, Chattanooga, TN
Photos 1 & 2: Before-Severe decay under an existing fractured PFM bridge Photo 3: X-ray of patient’s existing PFM Bridge Photo 4: All underlying teeth were extracted and implants were placed in the existing root sockets of #5, 6 and #11, 12
Product Overview:
Currently there are many options for restoring mastication to the fully or partially edentulous patient. For patients with the financial resources to allow, an implant supported or retained solution is always the best option. A recently new development in restoring an edentulous patient with implants is a product we’ve coined the “BruxZir Solid Zirconia Screw-Retained Hybrid Bridge”. The BruxZir Hybrid is a full round-house restoration that is computer designed and milled from a solid disk of shaded BruxZir zirconia. After sintering the zirconia, our lab techs add pink porcelain around the necks of the teeth to create a labial gingival flange. Titanium inserts are then cemented into the intaglio surface of the zirconia at each implant site to provide a sturdy platform against the existing implants.
Appointment 1
(Preliminary Impression): After several months of implant healing, the patient was appointed for an implant level impression using a stock tray and closed tray impression copings as well as an opposing impression. This was sent to the lab to create an implant verification jig using an initial model.
Shown is an example of closed tray impression copings for an implant level impression.
Shown is an example of a sectioned and numbered implant verification jig and open custom tray for taking the second impression to do a screw retained hybrid.
Appointment 2
(Final Impression & Bite Rim): The precision of the final prosthesis requires that a verified model be used prior to fabrication of any screw-retained prosthesis. If the impression is distorted by as little as a tenth of a millimeter the final bridge will not seat or may fail catastrophically. This phase of the treatment is CRITICAL to future appointment success. The implant verification jig is made in the lab using a light cure material around titanium temporary cylinders and long screws. The jig is sectioned and numbered and sent to the doctor in two or more pieces. A bite rim was also sent to establish the Vertical Dimension of Occlusion and Midline. The bite rim and verification jig was returned to the doctor in 3 working days. The doctor then individually screws each section of the jig into the implants, making sure that the temporary cylinders are fully seated onto the implants. We highly suggest that you take an X-Ray of the cylinders so that we are 100% sure the cylinders are fully seated. Next, lute the sections together using a light-cured acrylic material of your choice. Using the open tray custom impression, take an impression of the jig, unscrewing all the cylinders after the material is set so that you pick-up the jig in the tray.
Shown is an example of a sectioned implant verification jig that has been luted together intra-orally using a light cure material.
Shown is an example of an open custom tray being used to pick up the verification jig.
Appointment 3
(Denture Setup & Wax Try-In): Using the verified model and bite rim, the lab does a denture tooth wax setup and try-in to verify the midline and esthetics of the tooth arrangement as well as the bite. After the try-in is approved it is returned to the lab. The denture setup was returned to the doctor in 3 working days.
Appointment 4
(Screw-Retained PMMA Temporary Bridge): Next, the denture tooth try-in was scanned in the lab using a computerized laser scanner. Once scanned, the technician can “copy design� the denture tooth setup. A screw-retained PMMA temporary bridge was chosen as an interim prosthesis for the patient to wear to ensure the occlusion, phonetics, and esthetics are correct prior to proceeding with the final zirconia bridge. This step is not required but was chosen by Dr. McOmie and the patient as a way to ensure long-term patient satisfaction.
Appointment 5
(Final Screw-Retained BruxZir Solid Zirconia Hybrid): Multi-unit abutments are placed onto three of four implants to direct screw access holes to the lingual.
Once designed, the bridge is milled from a solid disk of Vita shaded Poly Methyl Methacrylate (PMMA) with pink composite gingival labial flange added. Titanium inserts were cemented into the bridge to securely screw the prosthesis onto the implants. The PMMA temp bridge was returned to the doctor in 5 working days. Due to the angulation of 3 out of the 4 implants, multi-unit abutments were used to re-orient the implant screw access holes back towards the occlusal aspect of the prosthesis. These abutments torque directly into the implants. Later the restoration is torqued to the abutment itself instead of the implant. If these abutments were not used the screw access holes would exit the labial portions of the teeth; filling these holes with composite later in the final zirconia restoration and matching the shade would prove difficult to the doctor. Thus, the multi-unit abutments were used to avoid this problem.
Finalizing the case was easy at this point since the lab knew that the digital design of the PMMA bridge was approved by both the doctor and the patient. The next step was simply to re-mill the design file out of BruxZir zirconia instead of PMMA. An anterior cut back could have been performed for an additional $40 per unit to layer porcelain onto the labial surfaces of the anterior teeth; however this option was not needed for this patient. The entire bridge was milled from solid BruxZir Zirconia as shown in the photos. Pink porcelain was applied and the titanium inserts cemented. The final bridge was returned to the doctor in approximately 7 working days. The bridge is then screwed onto the multi-unit abutments at the manufacturers recommended torque values. The screw access holes are then filled with a shade matching light cured acrylic.
Conclusion:
The Screw-Retained BruxZir Solid Zirconia Hybrid is an excellent solution to restoring either a maxillary or mandibular partially or fully edentulous patient. The Solid Zirconia is extremely resistant to fracture or staining. Following the clinical protocol results in a predictable result and precisely fitting implant supported prosthesis.
A temporary screw-retained PMMA Verification Bridge was worn as an interim prosthesis.
The final bridge was milled from solid BruxZir Zirconia, pink porcelain was applied, and the titanium inserts cemented.
Around Oral Arts is proud to support Huntsville’s Community Free Dental Clinic. The clinic has been started and is being supported by a network of volunteers who have connected through faith-based volunteer health work in Huntsville, the United Way’s Leadership Social Services network, and the Huntsville-Madison County Dental Society. Aching to help? Contact AmberMcLeroy@aol.com for volunteer information, or call the clinic at 256-489-1853. Dentists and dental hygienists are especially needed. Volunteers, equipment, and supplies are also needed.
Your Oral Arts Account is Now Available Online!
Visit www.oralartsdental.com and click on the Customer Portal tab to create your online account.
Need help with your account? Call us at 1-800-354-2075 and one of our customer service representatives can walk you through how to set up your account, help you access your account information or reset your password.
Here’s a unique TCS Flexible Partial Case.... the mandibular anteriors were so lingual verted we were unable to clasp the buccal. A little “outside the box” thinking got this one done! Clasped the lingual and strapped the buccal.
Some of UAB’s finest graduating Seniors tour Oral Arts Dental Laboratories after graduation.
All Oral Art’s Screw-Retained Hybrid Dentures are processed using the IvoBase Technique resulting in FAR superior results to conventionally packed acrylic. IvoBase processing eliminates acrylic shrinkage, is much more dense than conventional processing, and results in very neat and accurate screw access holes. You can also RX IvoBase on regular full dentures for the best suction available! Just write IvoBase on your next denture RX!
Matt Winstead, CDT and Vice President of Oral Arts, lectures on the future of dentistry at the District 4 ASDA Meeting in Raleigh, NC.
Tips from the Lab Implant Abutment Placement
When placing your implant abutments check the model for a “dot” located on the buccal of the model. A corresponding “dot” will also be located on the buccal of the implant abutment. When removing the abutments from the model, use these dots to replicate the location and order in the mouth(See photo 1). For cases with multiple abutments, each abutment will have one or more dots showing the order sequence on the model. We also supply a FREE “Abutment Placement Jig” for all abutment cases with two or more abutments. Use the Abutment Placement Jig to aid in seating your abutments with no risk of improper placement. Be sure the “B” on the jig faces the buccal with the “L” facing the lingual(See photo 2 and 3).
How to Make a BruxZir Crown Under an Existing Partial WITHOUT Giving Up the Partial Doctors and Patients hate giving up their partial to have a crown made! BruxZir crowns can easily be made under an existing partial without having to send the lab the partial. You also do NOT need to try to capture the rests and clasps using bite registration material which can be a nightmare to get right. Simply take a good pre-operative impression of the tooth being restored. Send us the impression or a stone pre-operative cast. We will scan your pre-op and “copy mill” the BruxZir crown in the exact contours of the existing tooth prior to your preparation. In this way, the patient keeps the partial, you don’t have to worry with capturing the clasp and rest in PVS or bite registration material, and you get a crown back with the exact contour, undercut, and occlusal rest of the existing natural tooth!
Shown is a Pre-Operative cast scanned with a BruxZir crown in the exact contour and shape as the existing tooth. The BruxZir will be “copy milled” to fit the existing partial.
Panavia™ SA Cement
Panavia™ SA Cement is a self-adhesive, dual-cure fluoride-releasing resin cement available in automix and handmix versions. Oral Arts recommends Panavia SA cement for Crown and Bridge Restorations of the following materials: • PFM • Porcelain Fused to Zirconia • Solid Zirconia • Lithium Disilicate Panavia SA cement is NOT recommended for Veneers or Maryland Bridges. To order yours today call Oral Arts at 800-354-2075 or visit www.oralartsdental.com/supplies
BruxZir crown shown under existing cast partial using the pre-operative model technique where patient keeps partial and lab “copy mills” existing contours.