14 june 2015
telescopicimplanttreatment
■ When black or white is not the only
solution – a telescopic implant treatment: Part 2 By Ulrich Heker, DTM Educational aims, objectives and outcomes ■ Educational aim: – to illustrate via a real life case study how multiple technologies can be employed to achieve a patient’s desired result ■ CPD outcomes: – to gain an overview of the specific issues that prevented the use of a standard approach to treatment – to illustrate how a team approach to a problem can achieve an ideal solution – to gain an understanding of the practical implications and techniques used to achieve a completely detachable prosthesis based on telescopic implants
Dentists are often faced with situations where black or white, prosthesis or implant, are not the only options. In Part I (April edition of The Technologist), we introduced a case study of a telescope implant treatment (Kennedy Class 1) in the upper jaw of a female patient. Ulrich Heker (Master Dental Technician) continues his description of the treatment of a UK patient with a completely detachable prosthesis based on telescopic implants, combining the best of both technologies to provide an optimal solution for the client, at a reasonable cost.
Introduction
Making the tertiary structure
I
Care should be taken when modelling to achieve the optimum distribution of material: thin in the labial region where there is never sufficient room and thicker in the posterior region to afford the necessary strength. The refractory model was made such that the prosthesis could be completely relined in the future, thus avoiding pressure points.
n Part I we were introduced to a patient presenting a unique challenge for the dentist. The 55-year-old female had worn a classical gold/gold telescope prosthesis for many years that had mutated into a full denture, something that she did not want. From an oral surgical point of view, both sides were unsuitable for implants due to the lack of bone material, and the patient had also rejected expensive augmentation of the molar areas. After thorough consideration, the decision fell in favour of a combination of six implants with individual abutments and detachable, bar-free telescope prosthesis. The patient was fitted with regular neck (RN) implants. The primary parts were made from non-precious metal alloy (NEM). The primary parts were milled on RN burnout copings in wax and cast in non-precious alloy. The secondary parts were sandblasted and carefully attached to a Straumann RN Variobase®. The units were then screwed into the master model, milled and polished. For fitting, a 1.5 mm Erkolen® foil was thermoformed over the complete work for positioning. Following small corrections, the try-in was secured using a matrix. We are now ready to make the tertiary structure.
the
As per the patient’s wishes, we were able to avoid any transversal connectors. The procedure for the construction of the tertiary part consisted merely of separating, sandblasting and electrolytic polishing. The framework could be immediately placed on the gold caps without any issues. Another ‘try-in’ of all the metal pieces took place: the base, with the glued primary parts and keys, the gold caps on top and finally the CrCo base. The cast metal structure showed an identical fit on the master model and in the mouth of the patient. It was now ready for completion.
Fig. 1: Blocked master model (fully relineable)
technologist
Fig. 2: Assessment of available space using silicone key/matrix
Back in the laboratory, finishing was carried out in the conventional way after all exterior surfaces had been coated with saline coupling agent and covered with opaquer. Finally all adhesive surfaces were prepared by using aluminium oxide 100