How would u handle this case

[prestige.dental]

There are 7 legacy (3.5 Zimmer clones) implant direct implants.

Very divergent 6 and 11 implants.

Impression taken by non engaging splinted impression copings open tray impression technique. So we don't have hex indexing available.

Sam

 

[Marcusthegladiator CDT]

Multi Unit abutments. Their zimmers, so bio horizons connection will fit and you could use the multi abutments.
http://www.biohorizons.com/multi-unit-abutments.aspx
Call bio horizons and they can explain the technique to you. Or call Kent Walton at Vulcan(BioHorizons.)

 

[2thm8kr]

What was prescribed on the Rx?

 

[JKraver]

Just be happy there is space, if that were for a denture you would have like 4mm between the teeth and ridge.

 

[BobCDT]

Multi should work well for a screw retained cast. Custom abutments for cement retained.

 

[ceram1]

This case should be a fixed detachable. Call panthera and get the bar and frame made simultaneously. Hygiene would be a nightmare fixed. Don't forget to make a verification jig. Looks like a fun case.!

Sent from my SAMSUNG-SGH-I537 using Tapatalk

 

[prestige.dental]

Multi should work well for a screw retained cast. Custom abutments for cement retained.

How will it be possible to make custom abutments if the hex of the analogs does not match the hex of implants in the mouth because the impression was taken by splinted non engaging impression copings.

The only way the hex can be transferred is by taking engaging impression copings but then the copings can't be splinted ( or the the impression will get stuck and will not come out from mouth)and has to be a close tray impression which will not be accurate for one piece prosthetic bridge splinted or cemented.

The hex of 6 and 11 in the mouth is not facial so the multi unit makes the axis go distal or medial and not lingual.

 

[JKraver]

That is a legitimate concern you tell the dr to reimpress using engaging on those two, or you could do some kind of transfer jig set up. Looks like quite the bastard of a case for that. I would do interlocking bars, and put an over denture on it look at all that space! A roundhouse would need custom milled angled abutments for 6+11 or ask the dr to give it a little more torque.

 

[prestige.dental]

The patient does not want removable prosthetics.

 

[JKraver]

nice

 

[prestige.dental]

6 and 11 are the most coronal or the most proud implants and using multi unit on them would result in air space and phonetics problems.

 

[zero_zero]

How will it be possible to make custom abutments if the hex of the analogs does not match the hex of implants in the mouth because the impression was taken by splinted non engaging impression copings.

The only way the hex can be transferred is by taking engaging impression copings but then the copings can't be splinted ( or the the impression will get stuck and will not come out from mouth)and has to be a close tray impression which will not be accurate for one piece prosthetic bridge splinted or cemented.

The hex of 6 and 11 in the mouth is not facial so the multi unit makes the axis go distal or medial and not lingual.

Forget about the hexes...the whole thing should be non-engaging anyways... I'd get a one-piece bar made without secondary connections, that would give more freedom for design. First I'd make a wax-up and a verification jig, then work backwards from the approved wax-up. Beautiful mounting BTW...

 

[dmonwaxa]

I agree with zero zero....the " mountain" is a real distraction from offering constructive ideas.

 

[Labwa]

you could do angled screw channel with Dynamic Abutments on 3.5 zimmer/BH wont take up VD and MAY bring access all the way back.
What CAD/CAM do you have access to?
http://dynamicabutment.com/wp-content/uploads/2015/07/EN-CAD-CAM-2015-4.pdf

 

[JohnWilson]

All I see is a 7.5k lab fee case mounted on a 2k articulator with $250 worth of parts and $5 worth of care to the entire procedure.

The foundation to the cases start with pride, this model work is about as bad as I have ever seen for any case let alone a full arch fixed implant restoration.

As to your question,

With this much VD I would make milled free shape bar drilled and tapped to accept a secondary prosthetic.

 

[Labwa]

Some pre planning on the surgical side goes a long way!

 

[prestige.dental]

you could do angled screw channel with Dynamic Abutments on 3.5 zimmer/BH wont take up VD and MAY bring access all the way back.
What CAD/CAM do you have access to?
http://dynamicabutment.com/wp-content/uploads/2015/07/EN-CAD-CAM-2015-4.pdf

I think it's an awesome idea if the scan body on 6 and 11 could mill angles screw channel for the talladium tibase.
I have 3shape, trios, Rolland DWX50, D900L scanner, and Imes I core 450 for tit milling.

I would have to cut the hex though for this tibase or they have non hex tibase too.

I think this is what preat is doing too.

Thanks for the suggestion as 6 and 11 are very coronally placed.

I also have medentibases whose multi unit abutment screw can be tightened at angle too. The package just arrived from medentika.

Guys, you are right, the mounting should look better.

 

[prestige.dental]

All I see is a 7.5k lab fee case mounted on a 2k articulator with $250 worth of parts and $5 worth of care to the entire procedure.

The foundation to the cases start with pride, this model work is about as bad as I have ever seen for any case let alone a full arch fixed implant restoration.

As to your question,

With this much VD I would make milled free shape bar drilled and tapped to accept a secondary prosthetic.

John:

Your advice means a lot. Your suggestions carry lot of weight.

 

[2thm8kr]

See John, diet not necessary. People here appreciate you carrying weight.

 

[cadfan]

The nice thing in the modern digital world you just have to scan it with markers and a provisional line up than you can do what you want screw retained, bar with overdenture or cemented version . The only problem you have is the index transfer if you make a cemented solution because off the high angles two steps more not sure if the doc and patient want that.