Full Lower Screw Retained Implant Bridge

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DeVreugd

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Not a dumb thing at all Al. Most would wait until it is finished before venturing to show it. That my friend shows a lot of courage. Once again you have amazed us. Great looking case, and excellent results.

I agree....excellent result Al !
 
JohnWilson

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Hi Al,

Wonderful labwork and photography. I like that you have been so open in sharing these types of cases its a big learning experience for many. I know there is a tremendous amount of stress and pressure on these cases so I didn't want to put any negative thoughts out there so I waited till you finished the case to ask some questions just so I wouldn't skew your creativity and art.

1) Since this is an edontoulous arch that I am sure the patient is wearing a denture and if I remember right the doc "jam mounted" the mounting using the denture ?? How did you determine facial lip support since the patient is used to a flange on the denture? Was it "make it look pretty" and we will hope it works or did you get some info from the Dr. I assume the big class 2 you corrected was due to this fact that the Dr used the denture to mount with and requested a class 1 occlusion???

2) Since I did not see any pictures of the glass work articulated how much ant overlap did you build in? Are you planning to "Fix everything"when you do the upper?

3) Tissue contour looks superb did the client ask for it to be "Tight" to the tissue around the fixtures?

4)Is the client going to modify the Max dentition when he delivers the mand, as far as excursions and ant guidance?

Again I post these questions to stir dialog and not to judge, I have my fair share of FMR cases under my belt and I learn from everyone.

I paid my dues by doing things that came back to bite me in the ass MANY MANY times and I would hope to be able to share from these learning experiences with others.

OK thats enough for now, if this is interesting to others we can take it to the next level and talk about occ schemes and tips and tricks to bullet proof occlusion in these big implant retained/supported cases.
 
Mark Jackson

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Dang, what are you doing in Kentucky? You could make enough in five years out here in Hollywood to RETIRE there Al. You really should be lecturing.

Beautiful, beautiful stuff.
 
dmonwaxa

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Hi Al,

Wonderful labwork and photography. I like that you have been so open in sharing these types of cases its a big learning experience for many. I know there is a tremendous amount of stress and pressure on these cases so I didn't want to put any negative thoughts out there so I waited till you finished the case to ask some questions just so I wouldn't skew your creativity and art.

1) Since this is an edontoulous arch that I am sure the patient is wearing a denture and if I remember right the doc "jam mounted" the mounting using the denture ?? How did you determine facial lip support since the patient is used to a flange on the denture? Was it "make it look pretty" and we will hope it works or did you get some info from the Dr. I assume the big class 2 you corrected was due to this fact that the Dr used the denture to mount with and requested a class 1 occlusion???

2) Since I did not see any pictures of the glass work articulated how much ant overlap did you build in? Are you planning to "Fix everything"when you do the upper?

3) Tissue contour looks superb did the client ask for it to be "Tight" to the tissue around the fixtures?

4)Is the client going to modify the Max dentition when he delivers the mand, as far as excursions and ant guidance?

Again I post these questions to stir dialog and not to judge, I have my fair share of FMR cases under my belt and I learn from everyone.

I paid my dues by doing things that came back to bite me in the ass MANY MANY times and I would hope to be able to share from these learning experiences with others.

OK thats enough for now, if this is interesting to others we can take it to the next level and talk about occ schemes and tips and tricks to bullet proof occlusion in these big implant retained/supported cases.

Pandora's Box.

John I totally share your views on this; been there done that. In situations similar to this if the occlusal scheme is worked out by the doc and dupes are made to be used in fabrication then its a slam dunk. In fairness to Al. like many of us we come in later to bat clean up or in football terms "punt". With regards to tissue support or lack thereof we have to consider the condition of the bone, age of patient and how long a denture was worn , all of which as you well know may have contributed to atrophy. That being said consider the same case done 20 years ago, surely a nobrainer; we have evolved esthetically by leaps and bounds...well some of us. Al. shows a great example of this, I really cant see that amount of support in a case like this using porcelain. Resin perhaps as was suggested earlier but that too has its drawbacks when repairs are necessary as was also stated. Im sure however that old geezer will be glad to have something solid instead of a flip flopping denture, and cant wait to chase the girls. Added benefit,,, he'll have that chiseled Zoolander look.:D
 
Al.

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Hi Al,

Wonderful labwork and photography. I like that you have been so open in sharing these types of cases its a big learning experience for many. I know there is a tremendous amount of stress and pressure on these cases so I didn't want to put any negative thoughts out there so I waited till you finished the case to ask some questions just so I wouldn't skew your creativity and art.

1) Since this is an edontoulous arch that I am sure the patient is wearing a denture and if I remember right the doc "jam mounted" the mounting using the denture ?? How did you determine facial lip support since the patient is used to a flange on the denture? Was it "make it look pretty" and we will hope it works or did you get some info from the Dr. I assume the big class 2 you corrected was due to this fact that the Dr used the denture to mount with and requested a class 1 occlusion???

2) Since I did not see any pictures of the glass work articulated how much ant overlap did you build in? Are you planning to "Fix everything"when you do the upper?

3) Tissue contour looks superb did the client ask for it to be "Tight" to the tissue around the fixtures?

4)Is the client going to modify the Max dentition when he delivers the mand, as far as excursions and ant guidance?

Again I post these questions to stir dialog and not to judge, I have my fair share of FMR cases under my belt and I learn from everyone.

I paid my dues by doing things that came back to bite me in the ass MANY MANY times and I would hope to be able to share from these learning experiences with others.

OK thats enough for now, if this is interesting to others we can take it to the next level and talk about occ schemes and tips and tricks to bullet proof occlusion in these big implant retained/supported cases.

I dont know.

Frankly that is why I am spending $4000 to go to Dr Chasolens in office "Implant Prosthetics" course at the end of March.
Lab Guy is going to be there so I will report back on his misbehavior.

Its fortunate this case came now to help give me a better understanding or prepare me for the course.

Ive been doing work for this client for the last month and a half.
Ive gotten 3 cases from him totaling 38 units. Its a whole different world of dentistry from doing single units.

As far a the facial lip support, I think the entire facial could be brought out more from the incisal edge all the way down.
But to do that I would need to extend the bridges past the ridge (from 1st bi to 1st bi) and the occlusion so far from the implants I would think that would put alot of torque on them.
Hes an old man and his lower arch is smaller than his upper.
 
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TheLabGuy

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I dont know.

Frankly that is why I am spending $4000 to go to Dr Chasolens in office "Implant Prosthetics" course at the end of March.
Lab Guy is going to be there so I will report back on his misbehavior.

Its fortunate this case came now to help give me a better understanding or prepare me for the course.

Ive been doing work for this client for the last month and a half.
Ive gotten 3 cases from him totaling 38 units. Its a whole different world of dentistry.

Easy killer......lol

Great discussion Gents......I wish I had more time (been kinda crazy around these parts lately) but I want to get into more of a dialogue about this case (thanks for posting Al) as well because I've done a few of these, not a pant load like some of the other dinosaurs...oops, I mean dynamo's!!!! lol First off, John, what would you have done differently from your experience. I know from my experience and by the sounds of it, some type of temporary has to be made so you have the right height of contours, tooth placement, occlusal schemes, etc. Maybe even a jig would of been better. Also I know we talked about the GC Gradia Gum, but what are others doing? Ceramics?
 
dmonwaxa

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Zoolander is a great look! And I stand by that.

Seriously though, with this type of prosthesis it would have requirrd massive amount of pink material to plump it up. Porcelain or GC, which would have led to an increase in the CMO design and volume, which probably would lead to food traps and a decrease in ability to clean. The other option would be to do a bar supported /attachment case utilizing an overdenture where you can really plump up those areas an still have the ability to remove for hygiene.
 
JohnWilson

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I dint know.

Frankly that is why I am spending $4000 to go to Dr Chasolens in office "Implant Prosthetics" course at the end of March.
Lab Guy is going to be there so I will report back on his misbehavior.

Its fortunate this case came now to help give me a better understanding or prepare me for the course.

Ive been doing work for this client for the last month and a half.
Ive gotten 3 cases from him totaling 38 units. Its a whole different world of dentistry from doing single units.

As far a the facial lip support, I think the entire facial could be brought out more from the incisal edge all the way down.
But to do that I would need to extend the bridges past the ridge (from 1st bi to 1st bi) and the occlusion so far from the implants I would think that would put alot of torque on them.
Hes an old man and his lower arch is smaller than his upper.

First of Dr Chasolens course will be very very informative. I have not heard him speak but I have seen his posts on DT and the man knows more than most. I was first alternate for that course but I have some other plans that month that prevent me from going. I believe he is having another one in Oct that I may attend. I will hit you and Rob up after the course to ask you guys some questions.

As for this case I always like to hear how the conversations went when you received this case. Of course you are following the directions of the client and assuming the patient wasn't dictating treatment then you probably are fine. On severely reabsorbed arches when they are looking for proper facial support Implant retained/supported appliances are the most difficult to fabricate with out some sort of trade off.

One way to do this case in my opinion would have been to mock the case up with the UCLAS based on your frame wax up in "Full Contour" You could then send this to the client to try in and evaluate the following main criteria for a successful case

1) Verify accuracy of the master model
2) Verify incisal length and plane of occlusion
3) Verify lip support and facial contours
4) Verify CR and VDO

All of this can be done in resin that you can eventually cut back and cast.

When I see cases that go from a denture to a fixed restoration on arches like this even if the VD is correct you will be able to see a nice horizontal crease under the patients lip from lack of support.

Sometimes on these cases where the feeling of a fixed restoration is desired and the need for a buccle flange is necessitated a better appliance is a bar with an over-denture. This will get around the hygiene hurdle of ridge lapping and give all the needed facial support. Off axis load to the fixtures seem to not be as much of a concern here especially with the nice placement this case had.

Like I said Al the case you produced is beautiful all of this discussion is based on "What ifs" all I wanted to do is to create dialog to explore ideas that I know come up on these big cases.
 
araucaria

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1 , thanks for sharing Al.
2, re the lip-support discussion - could a removable flange section have been designed to attach from frontal direction and fix with a simple lock into metal engagement holes ? This would've avoided excessive build of ceramic re CTE issues, and allow an inexpensive chrome/acrylic item. Similar issue to the labial/gingival mask, or swinglock flange ideas.
 
dmonwaxa

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What is CMO ?

CMO : CAST METAL OBJECT

LOL, thats BS, I just reread and thought, Huh? LOL. Sorry for the confusion Al. That was clearly a typo on my part, sent from my droid phone. But my explanation above could work.:D
 
Al.

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Ok, He seated it.
No adjustments, so the new bite was right on.
He seated it Thurs and on Sat. I got a check in the mail cant beat that.

He sent me 3 pics but they are poor quality. His cam is 10 years and only 2 mega pixals.
Ill make the 1 1/2 hour drive and get pics when the upper is finished.

ai46.photobucket.com_albums_f116_CDLAB_tc7.jpg
ai46.photobucket.com_albums_f116_CDLAB_tc8.jpg
ai46.photobucket.com_albums_f116_CDLAB_tc9.jpg
ai46.photobucket.com_albums_f116_CDLAB_tc7.jpg ai46.photobucket.com_albums_f116_CDLAB_tc8.jpg ai46.photobucket.com_albums_f116_CDLAB_tc9.jpg
 
rkm rdt

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The access holes filled in nicely.

Looks great.Can't wait to see the upper.
 
Al.

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Yeah the uppers look pretty nasty. Dr thinks the black may be from crappy metal.
 
TheLabGuy

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I hope that Dentist has a great Periodontist for those uppers, something you might want to mention as well Al to the Dentist. Having the tissue treated and healed will be crucial in your upper restorations.
 
dmonwaxa

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Al. the case looks great in the mouth. Those pics look really different with his camera. I need to get a new cam, looking at the Nikon D7000 perhaps. as for the max arch, I say Emax XL; XL for extra long. The staining could be masked easily with generous preps and your talents. :D
 
Al.

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I hope that Dentist has a great Periodontist for those uppers, something you might want to mention as well Al to the Dentist. Having the tissue treated and healed will be crucial in your upper restorations.

I do know he is waiting for a go ahead from a bone graft before he places the upper implants.
 
JohnWilson

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Slam dunk!

Well done Al
 
Al.

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I just got these pics back.

Full lower implants 2 peices but connected with a attachment.

Im pretty happy with it but I hate the incisal edges of the 4 anteriors, too thick.
I mixed g4 and 0E4 50/50 to get the white blanched tissue color.

ai46.photobucket.com_albums_f116_CDLAB_ro1.jpg
ai46.photobucket.com_albums_f116_CDLAB_ro2.jpg
ai46.photobucket.com_albums_f116_CDLAB_ro3.jpg
ai46.photobucket.com_albums_f116_CDLAB_ro4.jpg
ai46.photobucket.com_albums_f116_CDLAB_ro1.jpg ai46.photobucket.com_albums_f116_CDLAB_ro2.jpg ai46.photobucket.com_albums_f116_CDLAB_ro3.jpg ai46.photobucket.com_albums_f116_CDLAB_ro4.jpg
 
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