Full Lower Screw Retained Implant Bridge

[Al.]

Si senior

Ohhh, Im going to order one of those, I have one but it dosent lock. The diamonds really hold nicely.

 

[Al.]

Ok I forgot to take a pic of the first tissue bake.

Here is the 2nd tissue bake and the final before contouring and glaze.

So that makes it 5 bakes, or 9 total if you include, 1 degass, 2 opaque,1 dentin, 2 enamel, 1 tissue and tooth touch ups, 1 tissue only, glaze.

I almost forgot to take a couple of pics of this stage, you can see where I started to smooth the facial with a diamond.

The occlusion is not as level as I would like it to be. I reduced quite a bit on the oppers and added wax in places. One problem is the lower anteriors had to really reach to meet the uppers and I had already put a ton of wax on the linguals of the uppers.

Ive said it a ton of times but Ill say it again for all the new techs, IMO it is very important to be patient in your builds and layer as exact as you can to keep grinding to minimun.

Tissue porc #3 & 4 and a bit of Incisal #1 in spots on the teeth.
I think that makes 8 different powders, one was a mix so I guess you could add a couple more to be exact.

But for sure I dont like to use anymore different powers than I need to.
Some times I have used several powders in different places and you dont even see them.
I think it is better for me to use 2 or 3 that contrast rather than several that blend in together.

 

[dmonwaxa]

Ohhh, Im going to order one of those, I have one but it dosent lock. The diamonds really hold nicely.

Al. They don't lock per se, but the thumb screw allows the tips to be expanded against the inside of the screw access nice and tight. Just use the tapered diamond tips.

 

[dmonwaxa]

Al. Would you mind documenting and sharing your finishing and texturizing technique?

 

[rkycdt]

Ive said it a ton of times but Ill say it again for all the new techs, IMO it is very important to be patient in your builds and layer as exact as you can to keep grinding to minimun.

Excellent advice................I have been trying to move the weight to the former on the layering/grinding scale of things.

As a new tech I sure appreciate these documented procedures of things. This is invaluble!

 

[dmonwaxa]

Al.

Not knocking your work or the doc's; the restoration so far looks great but, you alluded to the unsatisfactory occlusion. I, myself have been caught in a the same situation many times. My experience with prosthodontist have been fashioned around those in the military, both Army and Air Force. The occlusion were worked out with long term provisionals and the necessary changes were accomplished during this interim period. They also had a technique for checking the accuracy of the mounting prior to the actual fabrication of the frame work. Kinda throws metal support out of the window. From the looks of things in the max arch the occlusion was not worked out or idealzed, so you ended up with what you got. Not ideal in prosthodontist society but serviceable. You could have a tryin of the fmk in the pre metal stage, but would require you to use a resin for your mock up instead of wax. I will be rigid, can be sectioned and re-attached if necessary and the occlusals can be augmented as necessary prior to casting,,,, just a thought. All depends on the doc using an additional appt. IMHO seems like some docs use less appts and expect the same results. There are NO SHORTCUTS in cases like these or it will come back and bite you.

 

[Al.]

As a new tech I sure appreciate these documented procedures of things. This is invaluble!

Sure neighbor, your pretty much left on your own after school.
Some techs share info and techniques but most dont for competitve reasons or their too busy, also it makes you vunerable to anal exams.

I see alot of real world class work but most dont show you how they got there. But a few do. One thing I see alot of is real beautiful work but only 1 or mabey 2 pics and only at the most flattering angles. Often they are photoshopped, the colors are enhanced and borders and lines etc are used and they are put in collages (sp) of really small pics.

 

[dmonwaxa]

Sure neighbor, your pretty much left on your own after school.
Some techs share info and techniques but most dont for competitve reasons or their too busy, also it makes you vunerable to anal exams.

I see alot of real world class work but most dont show you how they got there. But a few do. One thing I see alot of is real beautiful work but only 1 or mabey 2 pics and only at the most flattering angles. Often they are photoshopped, the colors are enhanced and borders and lines etc are used and they are put in collages (sp) of really small pics.

LOL........ Quit talking about me Al.

So true though. Keep preaching. You've been coming out of your shell the last few months; dont think I havent noticed.popcorn

 

[Al.]

Al.

Not knocking your work or the doc's; the restoration so far looks great but, you alluded to the unsatisfactory occlusion. I, myself have been caught in a the same situation many times. My experience with prosthodontist have been fashioned around those in the military, both Army and Air Force. The occlusion were worked out with long term provisionals and the necessary changes were accomplished during this interim period. They also had a technique for checking the accuracy of the mounting prior to the actual fabrication of the frame work. Kinda throws metal support out of the window. From the looks of things in the max arch the occlusion was not worked out or idealzed, so you ended up with what you got. Not ideal in prosthodontist society but serviceable. You could have a tryin of the fmk in the pre metal stage, but would require you to use a resin for your mock up instead of wax. I will be rigid, can be sectioned and re-attached if necessary and the occlusals can be augmented as necessary prior to casting,,,, just a thought. All depends on the doc using an additional appt. IMHO seems like some docs use less appts and expect the same results. There are NO SHORTCUTS in cases like these or it will come back and bite you.

Yeah its a disaster if it was off much with $1500 of metal.
The Dr did all the model work and mounting and used a mock up lower denture for the bite but Im sure it is easy to shift around and probably didnt fit well on the model.

Thats a really good idea.
Any recommendations on a rigid material I can use for frame, one that will burn out?

 

[Al.]

Al. Would you mind documenting and sharing your finishing and texturizing technique?

Im pretty methodical about finishing so I dont miss areas or have to change burs alot.

These are what I prefer to use and in order from L to R.

 

[dmonwaxa]

Yeah its a disaster if it was off much with $1500 of metal.
The Dr did all the model work and mounting and used a mock up lower denture for the bite but Im sure it is easy to shift around and probably didnt fit well on the model.

Any recommendations on a rigid material I can use for frame, one that will burn out?

I use GC pattern resin and primogel(primotec) ask for Chris and tell him I referred you.

GC resin is a powder/liquid that is self curing. Can be ground shaped and layered with wax.

Primo gel is a light cured material, kinda expensive and rquires a light curing unit; but works nicely. Surface finish is smooth smooth smooth so wax does not stick readily unless its roughned.

 

[Al.]

Yeah its a disaster if it was off much with $1500 of metal.
The Dr did all the model work and mounting and used a mock up lower denture for the bite but Im sure it is easy to shift around and probably didnt fit well on the model.

Thats a really good idea.
Any recommendations on a rigid material I can use for frame, one that will burn out?

Troy would I need an extra appt? If the resin frame fits the mouth and the model and then the casting fits the analogs is there a need to do a metal frame try in?

For peice of mind it would be good to do a metal try in, to know Im not layering it for nothing.

 

[Al.]

I use GC pattern resin and primogel(primotec) ask for Chris and tell him I referred you.

GC resin is a powder/liquid that is self curing. Can be ground shaped and layered with wax.

Primo gel is a light cured material, kinda expensive and rquires a light curing unit; but works nicely. Surface finish is smooth smooth smooth so wax does not stick readily unless its roughned.

Ok thanks, does the gel burn out cleanly?

For the resin do you use some plastic rods and connect them to the abuttments? Or do you free hand the whole thing, making it thick and forming it?

 

[dmonwaxa]

Troy would I need an extra appt? If the resin frame fits the mouth and the model and then the casting fits the analogs is there a need to do a metal frame try in?

For peice of mind it would be good to do a metal try in, to know Im not layering it for nothing.

As I suggested, I would highly recommend it. Its up to the doc being willing to accomadate this. They dont teach this in school but from my experience and the newage materials why not, its only insurance and it can be modified easily before casting. And thats 1500 in metal not accounting for components. Very expensive and very stressful. As I said before casting something like this is my biggest stressor.

Al. rest assured though once you have established a working relationship and familiarity with each other both your confidences will grow and he will know exactly what you need and his fees can reflect the need for additional appts if necessary. Ive seen my share of young docs have to eat some when theyre just starting out, not taking these things into consideration.

Almost forgot your question with regards to metal tryin. Assuming the resin framework is rigid and undistorted, ie using a single screw on the most mesial or distal connection there will be no discernable lifting of the framework at the point farthest from the screw on the model. This can be verified intraorally using an xray. If totally satisfied, proceed with casting, if it fits the same as prior to casting then a metal tryin may not be necessary but wouldnt hurt...docs call. I prefer the resin tryin cause it serves as a verification jig and can be modified for accuracy if necessary.

 

[dmonwaxa]

Ok thanks, does the gel burn out cleanly?

For the resin do you use some plastic rods and connect them to the abuttments? Or do you free hand the whole thing, making it thick and forming it?

Al. reread previous post since it has been edited.

Yes it burns out cleanly, no probs. You can use plastic rods but I would consider the difference in burnout and expansion.

I make my own rods with the same material so theyre readily available. And just build in the pontics with the same.

Another technique from the "OLDSCHOOL" is to use floss and weave in a figure 8 pattern around the abutments(plastic chimneys) snugly not tightly and flow the resin along the woven area. Allow to set; section between abts to relieve stresses; and reattach 1 area at a time to control contraction in the resin. This is one of the reasons I like my premade resin rods. Saves a lot of time and I dont have to worry about contraction as much.

 

[Al.]

Ok slicked up, glazed and in the mail.

I think it came out pretty decent.
Kind of risky for me to start this thread with out finishing the case first, mabey dumb because it could have come out terrible.

This was my first large screw retained implant bridge. My one regret is not having the buccal wall of the tube on #21 higher to support the porc on the lingual of 21 but it is a non functional cusp.

 

[Mike2]

Very Nice

General question, sorry if already asked but why screw retained? Easier to repair etc.? Also I have heard of some clinicians now touting screw retained over the cementable because of the ability to re-tighten. Anyhow, any input would be appreciated, we are casting a 4 unit screw retained as I type.

 

[rkm rdt]

I like the fact that it is 2 sections.This makes alot of sense since the md can flex.

Screw retained is the way to go....way to go Al.

 

[paulg100]

another great result.

and for those having trouble finding decent grips for all-ceramics:

https://www.bredent.co.uk/products/products.php?category=105057

Have used these for years, all you have is a tiny point touching the outer surface of the crown and i couldnt live without em.

Sure you can get em in the US also.

 

[dmonwaxa]

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.