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Production Workflow A single package that includes laboratory services helps to maximize clinical efficiency, reduce chair time and minimize remakes and chairside adjustments. The advantages of this treatment protocol are best explained by following a Screw- Retained Hybrid Denture (Fig. 1) as it moves through the various phases of laboratory production. All-in-One Package Screw-Retained Hybrid Dentures are typically indicated for edentulous patients desiring a replacement for removable prostheses. The Inclusive Tooth Replacement System package simplifies tray setup and eliminates the hassle of selecting components and arranging laboratory services as doctors move from one phase of treatment to the next. A complete case includes: • 6 tapered implants • Final surgical drill • 6 titanium healing abutments • 6 impression copings • 6 analogs • Model work • Implant verification jig • CAD/CAM milled titanium bar • Final denture with premium denture teeth The Process Step 1: Fabrication of Implant Verification Jig and Custom Tray After placement of the implants and completion of the healing phase, the laboratory receives the preliminary impression taken by the doctor. A preliminary cast is poured from this implant-level impression, which, along with the impression copings it contains, conveys the patient’s tissue level, gingival contours and position of the implants to the laboratory. The processing of the preliminary impression for overdentures is efficient and predictable because cases are planned from the beginning with the same interfacing components and restorative-driven approach in mind. Based on the preliminary impression, the laboratory technician fabricates the implant verification jig and custom impression tray. The verification jig is sectioned and numbered on the preliminary model (Fig. 2) — each section containing a non-engaging titanium cylinder — and sent to the clinician along with the custom impression tray so the final impression can be made. To maximize clinical flexibility and efficiency, the laboratory will fabricate the bite block at this stage if requested. Step 2: Fabrication of Master Cast and Bite Block Next, the laboratory fabricates the master cast and bite block. Note that the final impression contains the implant verification jig, which conveys the exact orientation of the implants to the laboratory and ensures a precise fit of the CAD/CAM milled titanium framework that will be designed and milled after denture try-in and approval. The master cast incorporates implant analogs in the same orientation as the implants placed by the surgeon. The bite block is fabricated onto the master cast (Fig. 3) and articulated with the opposing cast. In cases where the bite block was distributed with the implant verification jig, the base plate is adjusted to fit the master cast. The laboratory technician incorporates two screw-retained temporary cylinders that will be used to retain the bite block when jaw relations are recorded during the next clinical appointment. Step 3: Articulation of Casts and Setting of Denture Teeth in Wax Once the laboratory receives the jaw relation records, opposing impression, bite registration and working cast, the models are articulated and the technician carefully sets the premium denture teeth according to the instructions provided by the doctor in the prescription (Fig. 4). The mounted denture setup is sent to the doctor for try-in and evaluation of centric relation, VDO, esthetics, phonetics, tooth arrangement, shade and occlusion. Step 4: Fabrication of Titanium Framework Once the denture setup is approved, the model and setup are scanned, and the titanium bar is fabricated. The titanium framework is designed by the lab technician using CAD/CAM technology to achieve a precise fit of less than 20 microns (Fig. 5). The bar is then milled and the denture setup is transferred onto the framework before being sent to the doctor for final try-in. By following a predictable, restorative-driven workflow, the laboratory produces a well-fitting titanium bar that typically exhibits a passive fit upon initial seating, minimizing remakes and adjustments. This simplifies and makes for a smoother clinical process that enhances the chair time experience and maximizes the restorative result for the patient. Step 5: Processing of Acrylic and Denture Teeth to the Framework After a final try-in and approval of the combination titanium bar and transfer setup, the laboratory completes the final denture by processing the framework and setup into acrylic (Figs. 6–8). The resulting final prosthesis is accurate, esthetic 74 – www.inclusivemagazine.com –
Figure 1: The Screw-Retained Hybrid Denture package includes all of the surgical and restorative components and laboratory services required to complete a fully edentulous case. Figure 5: CAD/CAM software is used to design the titanium framework. Figure 2: Implant verification jig sectioned and numbered on a working model. Figure 6: The denture teeth are arranged in a denture processing flask for conversion of the setup into acrylic. Figure 3: Bite block fabricated onto the master cast. Figure 7: The titanium bar is prepared for incorporation into the final denture. Adding an extra layer of acrylic prevents the framework from showing through the final prosthesis. Figure 4: The lab technician arranges the denture teeth to be set in wax. Figure 8: Acrylic is poured into the denture processing flask. The resulting denture incorporates the titanium framework and denture teeth into the final prosthesis. – All Together Now: Inclusive Tooth Replacement System Removables – 75
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Inclusive Restorative Driven Implan
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Contents 9 20 29 36 Implant Q&A: An
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Letter from the Editor This issue o
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■ JACK A. HAHN, DDS Dr. Jack Hahn
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Online Exclusive R&D CORNER “Digi
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Implant& Q A: Go online for in-dept
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DC: We often hear that endodontics
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markets have been highly penetrated
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get fibrous encapsulation. By going
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type they were. And what was wrong?
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The young dental professionals of t
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Go online for in-depth content Mini
Page 25: Courtesy of Christopher P. Travis,
Page 28: When I reached out to Dr. James, he
Page 32 and 33: the clinical advantages of custom A
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Page 48 and 49: System-specific intraoral workflow
Page 51 and 52: Go online for in-depth content BRID
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Page 55 and 56: Figure 21: A polyvinyl siloxane imp
Page 57 and 58: Clinical Case Report Go online for
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Page 61 and 62: Figure 13: Inclusive Custom Tempora
Page 63 and 64: A panoramic radiograph was taken wi
Page 65 and 66: Discussion Several types of technol
Page 69 and 70: Optical Impressions and Full-Arch I
Page 71 and 72: The final restoration was fabricate
Page 73 and 74: Figure 9: The VDO was measured prev
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