Implant Laboratory Procedures (eBook)

Implant Laboratory Procedures: A Step-by-Step Guide 1
Contents 9
Foreword 15
Preface 17
Acknowledgments 19
Notice for Readers 21
Registered Trademarks 23
Chapter 1: Introduction to Implant Dentistry 27
INTRODUCTION 27
LOADING PROTOCOLS 27
Traditional, Two-Stage, Unloaded Healing 27
Single-Stage, Unloaded Healing 27
Immediate Occlusal Loading 27
Immediate Nonocclusal Loading 27
ABUTMENTS 28
ABUTMENT SELECTION 30
SURGICAL GUIDES 31
Conventional 31
Computer Generated 33
Chapter 2: Mandibular Two-Implant Overdenture 35
INTRODUCTION 35
CLINICAL PATIENT PRESENTATION 36
DIAGNOSIS 36
ASSESSMENT 36
DIAGNOSTIC CASTS 38
CUSTOM IMPRESSION TRAYS 39
DEFINITIVE INTRAORAL IMPRESSION 40
MASTER CAST 40
RECORD BASES 41
ARTICULATOR MOUNTING 42
WAX DENTURES 42
PROCESSING 45
INSERTION 48
Chapter 3: Immediate Occlusal Loading—Maxillary Hybrid Prosthesis with Cast Metal Framework (The Columbus Bridge Protocol) 51
INTRODUCTION 51
CLINICAL PATIENT PRESENTATION 52
DIAGNOSES 54
ASSESSMENT 54
DIAGNOSTICS 55
ARTICULATOR MOUNTING 57
SURGICAL GUIDE 57
SURGERY/IMPLANT PLACEMENT 64
ABUTMENT PLACEMENT 66
ABUTMENT IMPRESSION 68
JAW RELATION RECORDS 70
MASTER CAST 71
ARTICULATOR MOUNTING 72
FABRICATION OF INTERIM SCREW-RETAINED IMPLANT PROSTHESIS 73
Construction of the Cast Metal Framework 73
Construction of the Hybrid Prosthesis 75
INSERTION 78
ONE-WEEK POST-INSERTION CLINICAL VISIT 80
Chapter 4: Robot Analog Placement and CAD/CAM Abutments 85
INTRODUCTION 85
THE ENCODE COMPLETE RESTORATIVE SYSTEM 88
CLINICAL PATIENT PRESENTATION 91
DIAGNOSIS 91
ASSESSMENT 96
DIAGNOSTIC CASTS/SURGICAL GUIDE 96
IMPLANT SURGERY 97
PLACEMENT OF HEALING ABUTMENT 97
PLACEMENT OF ENCODE HEALING ABUTMENT AND ENCODE HEALING ABUTMENT IMPRESSION 98
MASTER CAST 100
ARTICULATOR MOUNTING 101
ENCODE COMPLETE WORK ORDER 101
SCANNING 103
ABUTMENT DESIGN/MILLING 104
ROBOTIC PLACEMENT OF LAB ANALOG INTO CAST (ROBOCAST) 105
FABRICATION OF PORCELAIN-FUSED-TO-METAL CROWN 109
CLINICAL INSERTION 110
Chapter 5: Maxillary Implant-Retained Primary Bar ( CAM Struct SURE Precision Milled Copy Milled Bar Framework) with Secondary Casting Maxillary Overdenture Mandibular CAM Struct SURE Precision Milled Bar for Mandibular Hybrid Screw-Retained Prosthesis
INTRODUCTION 117
CLINICAL PATIENT PRESENTATION 117
DIAGNOSES 119
ASSESSMENT 119
DIAGNOSTIC CASTS/SURGICAL GUIDE 120
IMPLANT SURGERY 120
IMPLANT-LEVEL IMPRESSION—LABORATORY PROCEDURES 122
MASTER CAST 122
RECORD BASES/JAW RELATION RECORDS 124
ARTICULATOR MOUNTING/WAX DENTURES/VERIFICATION INDEX 126
OVERVIEW OF THE DESIGN/CONSTRUCTION OF CAD/CAM FRAMEWORKS 128
Maxillary Copy Milled Bar 129
Electroformed Bar Sleeves 132
Tertiary Casting 133
Mandibular CAM Struct SURE Precision Milled Bar 135
Silicoating 137
DENTURE SETUP ON CAD/CAM FRAMEWORKS 138
CLINICAL TRY-IN APPOINTMENT 138
PROCESSING 140
INSERTION 145
Chapter 6: Computed Tomography (CT)-Guided Surgery/Immediate Occlusal Loading with a Full-Arch Prosthesis in the Edentulous Mandible 151
IMMEDIATE OCCLUSAL LOADING 151
TILTED IMPLANTS 151
DIAGNOSTIC IMAGING 151
COMPUTED TOMOGRAPHY (CT) 154
INTERACTIVE CT (ICT) 155
INTERACTIVE COMPUTER SOFTWARE 156
SURGICAL GUIDES 156
MASTER TUBES 157
PROSTHETIC LABORATORY KIT—IMPLANT ANALOG MOUNTS 157
SURGICAL KIT COMPONENTS 158
FABRICATION OF A MASTER CAST FOR AN IMMEDIATE, FIXED PROVISIONAL PROSTHESIS 159
ABUTMENT SELECTION FOR FIXED, SCREW-RETAINED PROVISIONAL PROSTHESES 160
FABRICATION OF A SCREW-RETAINED PROVISIONAL PROSTHESIS 161
CLINICAL PATIENT PRESENTATION 163
RADIOGRAPHS 165
DIAGNOSIS 165
ASSESSMENT 166
TREATMENT PLAN 166
CONSTRUCTION OF WAX DENTURES 166
CLINICAL TRY-IN OF THE WAX DENTURES 169
FABRICATION OF CT SCANNING APPLIANCE 170
INTRAORAL CT SCAN 171
FABRICATION OF THE MASTER CAST WITH IMPLANT ANALOGS 174
LABORATORY ABUTMENT SELECTION AND PLACEMENT 177
FRAMEWORK FABRICATION (PROVISIONAL PROSTHESIS) 178
PROVISIONAL PROSTHESIS 179
SURGICAL IMPLANT PLACEMENT 181
CLINICAL ABUTMENT PLACEMENT 182
INSERTION OF PROVISIONAL PROSTHESIS 185
POSTOPERATIVE VISIT 186
Chapter 7: Three-Unit Implant-Retained Porcelain-Fused-to-Metal Fixed Partial Denture with Premachined, Fixed Collar Height Titanium Abutments 189
INTRODUCTION 189
CLINICAL PATIENT PRESENTATION 192
DIAGNOSIS 192
ASSESSMENT 192
ABUTMENT SELECTION 193
DIAGNOSTICS 193
SURGERY 193
ABUTMENT IMPRESSION 196
MASTER CAST WITH ABUTMENT ANALOGS 197
WAXING SLEEVES 198
DEFINITIVE PROSTHESIS 199
INSERTION 202
AESTHETIC EVALUATION 202
Chapter 8: Multiple CAD/CAM Abutments with Implant-Retained Porcelain Metal Crowns (The Encode® Complete Protocol) 205
INTRODUCTION 205
THE ENCODE® COMPLETE RESTORATIVE SYSTEM 208
CLINICAL PATIENT PRESENTATION 211
DIAGNOSIS 215
ASSESSMENT 215
DIAGNOSTIC CASTS/SURGICAL GUIDE 216
IMPLANT SURGERY 216
PLACEMENT OF HEALING ABUTMENTS 217
PLACEMENT OF ENCODE HEALING ABUTMENTS AND ENCODE HEALING ABUTMENT IMPRESSION 218
MASTER CAST 220
ARTICULATOR MOUNTING 221
ENCODE COMPLETE WORK ORDER 222
SCANNING 222
ABUTMENT DESIGN/MILLING 224
ROBOTIC PLACEMENT OF LAB ANALOGS INTO CAST (ROBOCAST) 225
FABRICATION OF PORCELAIN-FUSED-TO-METAL CROWNS 226
CLINICAL INSERTION 230
Chapter 9: Single-Unit Implant-Retained Porcelain Crown with Computer-Aided Design/Computer-Aided Manufacturing (CAD/CAM) Ceramic Abutment (Encode Zirconia Abutment) 237
INTRODUCTION 237
CAD/CAM PROTOCOL—THE ENCODE® COMPLETE RESTORATIVE SYSTEM 243
CLINICAL PATIENT PRESENTATION 247
DIAGNOSIS 249
ASSESSMENT 249
DIAGNOSTIC CASTS/SURGICAL GUIDE 251
IMPLANT SURGERY 252
PLACEMENT OF ENCODE HEALING ABUTMENT 252
MASTER CAST 256
ARTICULATOR MOUNTING 256
ENCODE COMPLETE WORK ORDER 257
SCANNING 259
ROBOTIC PLACEMENT OF LAB ANALOG INTO CAST (ROBOCAST) 260
ABUTMENT DESIGN/MILLING 264
FABRICATION OF PORCELAIN CROWN 267
CLINICAL INSERTION 271
Chapter 10: Computed Tomography (CT)-Guided Surgery/Immediate Occlusal Loading with a Full-Arch Prosthesis in Edentulous Maxillae 277
INTRODUCTION 277
TILTED IMPLANTS 278
COMPUTED TOMOGRAPHY (CT) 279
CBCT 279
INTERACTIVE CT 280
ACCURACY IN CT TREATMENT PLANNING 280
PREOPERATIVE PLANNING 281
CLINICAL PATIENT PRESENTATION 281
RADIOGRAPHS 282
DIAGNOSIS 283
ASSESSMENT 283
TREATMENT PLAN 283
CONSTRUCTION OF MAXILLARY WAX DENTURE 283
CLINICAL TRY-IN OF THE MAXILLARY WAX DENTURE 286
FABRICATION OF THE SCANNING APPLIANCE 286
INTRAORAL CT SCAN 288
FABRICATION OF THE MASTER CAST WITH IMPLANT ANALOGS 289
LABORATORY ABUTMENT SELECTION AND PLACEMENT 294
FRAMEWORK FABRICATION (PROVISIONAL PROSTHESIS) 297
PROVISIONAL PROSTHESIS 300
SURGICAL IMPLANT PLACEMENT 302
CLINICAL ABUTMENT PLACEMENT 302
INSERTION OF PROVISIONAL PROSTHESIS 304
POSTOPERATIVE VISIT 307
Chapter 11: Replacement of Denture Teeth and Denture Base for a Preexisting Mandibular Fixed/Detachable Prosthesis 311
INTRODUCTION 311
CLINICAL PATIENT PRESENTATION 313
DIAGNOSIS 314
ASSESSMENT 315
APPOINTMENT SEQUENCE 315
DIAGNOSTIC CASTS 316
CUSTOM MAXILLARY IMPRESSION TRAY AND DEFINITIVE MAXILLARY IMPRESSION 317
MAXILLARY MASTER CAST 318
MAXILLARY RECORD BASE AND WAX OCCLUSION RIM 318
CLINICAL JAW RELATION RECORDS 321
FIRST ARTICULATOR MOUNTING 322
MAXILLARY WAX DENTURE 322
MANDIBULAR MASTER CAST 325
SECOND ARTICULATOR MOUNTING—MANDIBULAR MASTER CAST 326
MANDIBULAR WAX DENTURE 326
SILICOATING 328
PROCESSING 330
INSERTION 332
Index 337