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Optical Impressions and Full-Arch Implant Restorations
ridge and scanning abutments to increase contrast (Fig. 7),
the IOS FastScan, with its large scan field, was used to capture
an optical impression of the arch (Fig. 8).
Attention then turned to the jaw relationship. (Note that the
vertical dimension established by the temporary overdenture
was marked and measured earlier in the appointment
[Fig. 9].) To begin, PVS putty bite registration material was
inserted in the anterior segment, and the patient was guided
into a centric relation (CR) position using bimanual manipulation
at the previously established vertical dimension.
The position was maintained until the material had set. This
position was then repeated and verified. With the bite registration
in place to hold the vertical dimension, the posterior
segments were optically scanned to provide the laboratory
with a CR record (Fig. 10). After bilaterally scanning the posterior
quadrants, support was established on the posterior
regions, and the anterior support was removed to permit
scanning of the anterior segment. Accuracy of the CR record
was later confirmed with the provisional restoration.
Figure 6: Abutment seating was verified with an explorer. NOTE: Radiopaque
abutments allow radiographic verification of complete seating.
The prescription and digital impression were then electronically
submitted to the laboratory — a completely model-less
and paperless transaction. Based on the optical impression
and the trial denture, the laboratory milled seven Inclusive ®
Custom Abutments (Glidewell Laboratories; Newport Beach,
Calif.) from titanium with margins slightly subgingival. These
computer-designed abutments provide exceptional control
of emergence profiles. The custom abutments were received
from the lab, along with a trial framework (Fig. 11) and an
acrylic provisional. The lab also printed a polymer working
model of the arch with the custom abutments in place.
Second Appointment
Figure 7: The edentulous ridge and scanning abutments were lightly coated
with an opaque powder to facilitate a more precise data capture.
At the second appointment, the titanium custom abutments
were placed on the implants and the abutment screws were
torqued to 35 Ncm (Fig. 12). The trial framework fit extremely
well and seated passively. The acrylic provisional (Fig.
13) was seated on the custom abutments to evaluate occlusion,
esthetics and phonetics. The patient, pleased with
the function and esthetics of the provisional, accepted and
wore the provisional for several weeks without the need for
modifications.
Third Appointment
At the third and final appointment, the final metal-ceramic
prosthesis was delivered (Fig. 14). Fitting without adjustment,
the bridge was harmonious with the soft tissue formation
and facial symmetry (Fig. 15). But best of all was the
effect on the patient. Going from a removable denture to a
fixed prosthesis with excellent esthetics was “life-changing”
Figure 8: The IOS FastScan intraoral scanner was used to scan the
patient’s maxillary arch with scanning abutments in place.
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