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Case Presentation
In 2011, a 41-year old female presented with a worn, ill-fitting, broken
maxillary removable implant bar overdenture prosthesis. She desired
that it be replaced with a durable fixed prosthesis. Additionally, she requested replacement of her missing mandibular posterior teeth with
fixed implant restorations. She had been utilizing a Kennedy class I removable partial denture. Smile enhancement was also one of her goals.
Implant Overdenture
Retreatment with
Advanced Design
Hybrid Prosthesis
Treatment Plan
For the maxilla, the patient’s goals were met by fabricating an advanced
design screw retained “fixed detachable” or “hybrid” prosthesis that utilized ceramic crowns luted to individual crown preparations on a metal
framework. The gingival material was a composite resin that allowed
for customized shading and pigmentation. Treatment was complicated
because the company that purchased the manufacturer of the implants,
Nobel Biocare, no longer made components for them. Fortunately, another biomedical device manufacturer, Lifecore, had a complete line of
components that was compatible.Unfortunately, the abutments were
not supported by any of the virtual cad milling facilities that routinely
create titanium frameworks for implant prostheses. It was necessary
to cast and laser weld a ceramogold framework. Mandibular treatment
was accomplished in a routine manner by placing two implants bilaterally and fabricating titanium custom abutments for cement retained fixed
partial dentures.
Past Dental History
Review of dental history revealed that her maxillary dentition was extracted at age 16. She functioned with a conventional maxillary complete
denture for 15 years. In 2001, six Sterioss Hex Lock implants were
placed, a fixture level gold bar with locator attachments was fabricated
to retain and support an overdenture. Subsequently, four overdentures
were fabricated. None of them met her esthetic or functional criteria. All
had premature wear and breakage issues.
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Initial Clinical Procedures
The overdenture bar was removed, five Lifecore SD conical abutments
and one Nobel Biocare multiunit abutment were placed and torqued
appropriately. Next, the overdenture that the patient felt had the best
esthetics was converted to a temporary hybrid prosthesis at the same
appointment utilizing non-hexed titanium temporary abutment sleeves
and a rapid setting acrylic resin. Fortunately, both centric and vertical
dimension of occlusion were reasonable. Next, a transfer impression
was made to generate a maxillary cast. At the following appointment,
the temporary hybrid prosthesis was screwed to place on the master
cast and the case was mounted on a semi-adjustable articulator. Next,
a series of denture-making appointments enabled establishment of the
maxillary teeth arrangement.