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Figure 9 Once the lab and restorative dentist approve the design, the titanium framework is milled in one day and sent to the laboratory for setting teeth and a wax try-in (if NextSmile sets the teeth thereâ€™s a two- to three-day turnaround). The teeth are processed to the framework with Ivoclar Vivadentâ€™s Ivocap Preference Implant resin which creates a strong mechanical bond and eliminates the need for pink opaque since the resin is 80% opaque yet esthetic.
Figure 8 A composite 3D image of the restorative space, denture teeth and titanium framework is developed and the design is emailed to the lab for review in SolidView Lite, free software provided by NextSmile.
Figure 7 The upper and lower casts (with analogs), putty and the 0.020" of stent material are shipped to NextSmile, in San Antonio, TX, to be digitally scanned and then combined into one image. If changes are noted in the tissue and the shape of the healed ridge needs to be recorded, an impression of the soft tissues with healing abutments attached to the implants is made and also sent to NextSmile for scanning. The scan of the healed ridge can accurately be positioned in the same scanned image.
Figure 6 The dentist uses a specially designed articulator with mounting plates that can be moved to a scanner or mill so he controls where the dental casts are in relation to the virtual model; it also eliminates the need for a conventional facebow. All scanning, milling of occlusion and processing can be accomplished on the same cast and plate, eliminating errors and time. The mounted casts are then removed from the articulator and Accurate Set putty is adapted under the provisional prosthesis to capture its shape and eliminate any undercuts. Next, 0.020" of Ellman Internationalâ€™s stent material (Ellman Press Form Sheets) is vacuum formed over the provisional prosthesis and onto the stone cast so the prosthesis can be removed and the stent material replaced on the cast in the exact same position. The provisional restorations are placed back in the patientâ€™s mouth.
Figure 5 The patient wears the upper and lower immediate-load fixed provisional restorations for four months. After the healing phase, the jaw relation records are made by the dentist and the provisional restorations are removed and attached to the master upper and lower casts and mounted.
Figure 4 On the day of surgery, master casts with implant analogs are made by the dentist or a technician trained in the technique.
Figure 3 Computer-generated drill guides are used to place and load the six maxillary and five mandibular implants, both with transfer copings.
Figures 2 Computer-generated drill guides are used to place and load the six maxillary and five mandibular implants, both with transfer copings.
Figure 1 A CT scan of the patientâ€™s head and face is taken to determine the condition of his teeth and facial bones and implant placement. This CT scan shows the patientâ€™s mobile and periodontally hopeless teeth; thereâ€™s little bone on the front of the anterior teeth. Using a CT Byteâ„¢ during the CT scan allows the CT scan to be joined with the model scans and eliminates radiographic scatter, the need for a facebow or a radiographic template.