loma linda university implant dentistry use of digital dentures in immediate occlusal functional...

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Implant Dentistry

USE OF DIGITAL DENTURES IN IMMEDIATE OCCLUSAL

FUNCTIONAL LOADING OF DENTAL IMPLATS

ANTOANELA GARBACEA, DDS, MSD

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Implant Dentistry

Outline

• DIGITAL DENTURES VS. CONVENTIONAL

COMPLETE DENTURES

• GUIDED SURGERY FOR IMPLANT

PLACEMENT

• IMMEDIATE LOADING AND DENTURE

CONVERSION USING CAD/CAM MILLED

DENTURES

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Implant Dentistry

Immediate Loading Consensus

• Immediate/early loading of dental

implants: A report from the Sociedad

Espanola de Implantes World Congress

consensus meeting in Barcelona, Spain,

2002.

Aparicio C, Rangert B, Sennerby L.

Clin Implant Dent Relat Res.

2003;5(1):57-60.

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Implant Dentistry

immediate ‘non-occluding’ loading

Immediate ‘occlusal’ loading

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Implant Dentistry

Acrylic provisional restorations comprising any sort of metal reinforcement

Tarnow et al. 1997; Horiuchi et al. 2000; Chow et al. 2001;

Ganeles et al. 2001; Grunder 2001; Malo´ et al. 2003a,

2003b; Nikellis et al. 2004; Testori et al. 2004; Degidi et

al.2006a, 2006b

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Entirely acrylic, metal-free restorations can be considered as an alternative

Schnitman et al. 1990; Cooper et al. 2002; Kammeyer et al.

2002; Becker et al. 2003; Chee & Jivraj 2003; Wolfinger et

al. 2003; Misch 2004; Balshi et al. 2005; Malo´ et al. 2006

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Technique Description

Goodacre et al 2011, 2012

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AvaDent™ Digital Dentures

It is a system by which impressions,

interocclusal records, and tooth

selection can be completed in one

appointment and the dentures

fabricated using CAD/CAM

technology .

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1. Maxillary and mandibular impressions using

Avadent system.

2.Fabrication of Avadent Digital Dentures.

3.Fiduciary markers in the Avadent already

milled dentures as

required by the Nobel Guide Clinician protocol.

4. Dual CBCT Scan. Avadent Digital Dentures

and Patient wearing dentures.

Technique Description

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5. Virtual Implant Treatment Plan using Nobel

Clinician Software .

6. Fabrication of the Nobel Clinician surgical

guide.

7. Guided Surgery

8. Immediate Loading of Implants using Avadent

Digital Dentures as provisional prosthesis.

Technique Description

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Treatment Sequence

Existing Complete Dentures

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Poly (vinyl siloxane) casts made by pressing putty into

existing dentures

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Immerse AvaDent tray in 160° F water Press softened tray onto PVS cast

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Border molding with areas of tray showing through the impression material, indicating they

need to be relieved before making wash impression

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Final maxillary and mandibular impressions

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Anatomical Measuring Device used to adjust and hold

OVD, serve as a

gothic arch tracing device, and also provide upper lip

support adjustment

Brass gothic arch tracing pin is

adjustable using the side hex

screw.

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The maxillary lip support can be

adjusted using the anterior

hex screw

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Three different sizes of clear plastic

overlays are available to help identify the

best size of the teeth

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Adhesive and registration material applied to maxillary and mandibular AMD

Completion of a gothic arch tracing

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An Occlusal Plane Orientation Ruler is Provided To Align The

Occlusal Plane With The Interpupillary Line

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Use the ruler to seat the

maxillary AMD so it is aligned

with the interpupillary line

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The mandible is moved so the brass pin engages the dimple and holds that position while the registration material is expressed between the AMDs

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Laser scanning of the

AMD impression

Superimposing the laser

scan of the AMD on the

scan of the complete

arch impression

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Locating the Borders

Setting the teeth and forming the bases

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Virtual tooth arrangement

Denture base morphology established

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ATI (Advanced Try-In) Wax Trial Denture

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Nobel Clinician: virtual planning of the diameters and

lengths of the

implants and stabilizing pins the to be placed in the

mandible.

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35º thread shapeDouble lead threadsTaperedTiUnite surface

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Fabrication of the Nobel Clinician surgical guide.

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Laboratory steps in fabrication of the mandibular cast

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The digital denture conversion as mandibular implant

provisional screw-retained prosthesis.

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Prototype converted denture for immediate

loading

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Advantages

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• It is possible to record all the clinical information for

complete dentures in one appointment (1-2 hours) and

have the dentures ready for the second appointment .

• Less clinical chair time provides the opportunity for a

more cost-effective set of appropriately accurate

complete dentures .

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• There is a repository of digital data that allows for more

rapid fabrication of a replacement or spare denture

• The denture base fit is superior to that of conventionally

processed bases

• Research indicates some favorable properties of the

PRE-polymerized resin

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Conclusions

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Thank you