Suggested Techniques
- Accelerated Technique for a Single Denture
- Accelerated Technique for a Upper & Lower Dentures
- Pouring Master Models
- Pulling Crowns
- Restoring a Conventional Denture Opposing an Implant Overdenture
- Restoring a Maxillary or Mandibular Overdenture Restoration
- Restoring Hybrid Restoration on Endosseous Implants
- Restoring Overdenture on Endosseous Implants
- Restoring Hybrid Prothesis on Immediate Implants
- Restoring a Conventional Denture & Opposing Implant Overdenture with Locator Attachment
- To Help Us in Fabricating Stents
- Take an alginate impression of the opposing arch.
- Take a reline impression inside the existing denture. Use no adhesive.
- Verify your bite and make a centric occlusion registration.
- Pour your alginate impression and reline impression. Trim the models around the dentures but do not separate the denture from the model.
- Using your bite, mount the case on an articulator and make sure your incisal guide pin is set.
- Remove the denture from the model and make a vertical bite between the endentulous model and the opposing.
- Remove the impression material from inside the denture and make a study model of the denture.
- Return the denture to the patient and send all mounting and records to the lab.
- Take a reline impression inside the existing dentures. Use no adhesive.
- Verify your bite and make a centric occlusion registration.
- Pour your reline impressions.
- Trim the models around the dentures but do not separate the dentures from the models.
- Use your bite; mount the case on an articulator. Make sure your incisal guide pin is set.
- Remove only the lower denture from the model. Use putty and take a bite on the articulator between the lower edentulous model and the upper denture recording the incisal of the anterior and the occlusal of the posterior teeth and your bite.
- Remove the upper denture from the model and make a putty bite between the upper and lower edentulous models.
- Remove the impression material from inside the dentures and make study models of both upper and lower.
- Return dentures to patient and records to lab.
- Sprinkle dry plaster into the wet impression and wash out immediately to displace any blood and saliva in the fresh impression.
- Use compressed air to dry impression. (A wet impression would dilute the die stone, resulting in a "soft" model.)
- Use a thick mixture of die stone. (A thick mixture will stick to the spatula when you turn a scoop upside down.)
- Vibrate the stone into the dry impression very slowly to avoid trapping air bubbles.
Please mix 1/3 Vaseline with your temporary cement. Place mixture inside crowns and seat them. The temporary cement will set up to a chalky consistency. This will hold the crowns in place during the impression but will allow the impression material to pull them. Even if crowns seem very tight orally, they will lift 90% of the time without temporary cement to hold them in place. After you withdraw the impression please inspect the inside of the crowns for impression material. If there is impression material inside the crowns they either do not fit or have moved during the impression.
- 1st Appointment: Take upper and lower alginate impressions. The implant impression will have the healing abutments in place. Lab: Construct upper and lower custom trays.
- 2nd Appointment: Dr. will remove healing abutments and screw in impression transfer posts. Please take and x-ray to ensure proper seating and make the final impression. Please send the x-ray with the case. Lab: Review x-rays, attach analog to impression transfer posts and pour master model with soft tissue around implant analogs. Construct upper and lower occlusal rims. The implant occlusal rim will be fabricated to the model with the healing abutments.
- 3rd Appointment: Dr. will use the occlusal rims to make centric records and communicate with lab on how teeth should be set. Lab: The implant model with the healing abutments will be mounted with occlusal rim and teeth set in wax for the try in.
- 4th Appointment: Tooth try in and advise lab of any changes. If there are changes another try in may be needed. Lab: If the try in is successful, the lab will transfer set ups to the soft tissue master model and make a labial index so the bar can be cast exactly to the individual set up. At this time the Dr. can opt to try in the bar assembly or continue with the cast RPD framework (if maxillary) and transfer teeth to that cast RPD framework for a try in.
- 5th Appointment: Final try-in of bar assembly and teeth in wax on framework. Advise lab if changes need to be made. Lab: Process case.
- 6th Appointment: Insert case.
- DOCTOR: Take alginate impression of the healing abutments. Take impression of opposing. LAB: Pour impressions. Fabricate base plate and rims. Fabricate custom tray for final impression. Check status of implant impression posts.
- DOCTOR: Take bite with wax rim over healing abutments. Unscrew healing abutments, place impression posts and take a final impression with the custom tray. Replace healing abutments. LAB: Pour master model. Mount healing cap model with wax rims. Fabricate set up on healing abutment model.
- DOCTOR: Try in setup, if good return to lab or take a new bite and return. LAB: Remount if required or take a check bite of the good setup and opposing. Transfer setup to master model and mount to opposing.Make labial index. Fabricate Bar. Remove bar and place setup on master model to set the pin at the correct vertical. Replace Bar Keep pin set on articulator. Block out and duplicate a setup model and a process model. Place blocked out master model back on the same articulator and take a bite. Mount setup model to opposing. Transfer setup to a blocked out setup model. Send final try in and bar try in to the Doctor.
- DOCTOR: Try in bar. Try in setup over bar. If good, return to lab or take bite and return for adjustments. LAB: If good, mount process model and transfer setup to process model. Process and deliver case.
- 1st Appointment: Take alginate impressions with healing abutments in place. Lab will construct a custom tray from the alginate impression and an occlusal rim, which will fit over the healing abutments.
- 2nd Appointment: Doctor will use the occlusal rims to make centric records and communicate with the lab on how the teeth should be set. Also at this appointment the Doctor will remove healing abutment and screw in impression transfer posts, take an X-ray for proper seating and take the final impression. Lab will review X-rays, attach analog to impression transfer posts and pour master model with soft tissue around implant analogs. The model with healing abutments will be mounted with occlusal rim and teeth set in wax for the try in.
- 3rd Appointment: Tooth try-in and advise lab of any changes. Lab will transfer set ups to the soft tissue master model and make a labial index so the bar can be cast exactly to the individual set up. At this time the Doctor can opt to try in the bar assembly or try the bar assembly with the teeth in wax.
- 4th Appointment: Final try in of bar assembly and teeth in wax on framework. Advise lab if changes need to be made. Lab will process case.
- 5th Appointment: Insert case.
- 1st Appointment: Take alginate impressions with healing abutments in place. Lab will construct a custom tray from the alginate impression and an occlusal rim, which will fit over the healing abutments.
- 2nd Appointment: Doctor will use the occlusal rims to make centric records and communicate with the lab on how the teeth should be set. Also at this appointment the Doctor will remove healing abutment and screw in impression transfer posts, take an X-ray for proper seating and take the final impression. Lab will review X-rays, attach analog to impression transfer posts and pour master model with soft tissue around implant analogs. The model with healing abutments will be mounted with occlusal rim and teeth set in wax for the try in.
- 3rd Appointment: Tooth try-in and advise lab of any changes. Lab will transfer set ups to the soft tissue master model and make a labial index so the bar can be cast exactly to the individual set up. At this time the Doctor can opt to try in the bar assembly or try the bar assembly with the teeth in wax.
- 4th Appointment: Final try in of bar assembly and teeth in wax on framework. Advise lab if changes need to be made. Lab will process case.
- 5th Appointment: Insert case.
Prior to implants being placed:
Dentist:
- Restoring dentist will make impression, centric records, and tooth try ins.
- Lab will process to completion the upper and lower dentures, grind out the tissue side, and make a surgical stent and custom tray to accommodate implant impression posts at the designated implant sites.
Surgeon:
- Will place implants.
- Make an immediate impression of implants with implant impression posts.
- Place 2nd phase healing abutments.
- Lute upper and lower denture together and make a wash impression inside the lower denture with Blu-Mousse or polysiloxane putty recording the healing abutments. Surgeon will need the patient to close to the proper vertical. Send case to the lab with healing abutments used.
Lab:
- Will pour implant models.
- Pour and remount model inside the upper denture.
- Place the healing abutments on the lower implant model.
- Mount the case on a semi- adjustable articulator.
- Make indexes.
- Fabricate a cast base.
- Transfer the lower denture to the base and reline the denture to the base.
- Return the case to the restoring dentist for upper and lower insertion.
- 1st Appointment: Take upper and lower alginate impressions. The implant impression will have healing abutments in place. Unscrew healing abutments one at a time and measure from the implant platform to the crest of the tissue so you will know cuff height when ordering your locator attachments. Replace healing abutments.
- LAB: Construct upper and lower custom trays.
- 2nd Appointment: Dr. will remove each healing abutment and screw in the locator attachment one at a time. Place the transfer posts onto the locator attachments and make final impression. Please make your upper final impression using your custom tray. You may want to soft line the denture to fit the locator.
- LAB: Will attach analog to impression transfer posts and pour master model with soft tissue around implant analogs. Construct upper and lower occlusal rims. The implant occlusal rim will be fabricated to the model with the locator abutments.
- 3rd Appointment: Dr. will use the occlusal rims to make centric records and communicate with lab on how teeth should be set.
- LAB: The implant model with the healing abutments will be mounted with occlusal rim and teeth set in wax for the try in.
- 4th Appointment: Tooth try in and advise lab of any changes. If there are changes, another try in may be needed.
- LAB: If the try in is successful, the lab will process the case. If a cast metal substructure or horseshoe palate is needed; it will be made at this time.
- 5th Appointment: Insert case.
To Help Us in Fabricating Implant Stents, We Will Need The Following:
- Upper and lower models with a bite registration and a panorex.
- Restorative plan.
- Over-denture Bar with attachments.
- Fixed / Removable Hybrid prosthesis.
- Cementable PFM.
- Screw retained PFM.
- Desired locations of implant placement, type of implant system and diameter size.
- If area of placement has resorbtion, will a bone or tissue graft be planned for better esthetics or implant stability?
- Please let us know if ridge reduction is planned due to inter-occlusal space or a narrow ridge.
- Surgery date and time. We will need at least 10 working days in the lab to fabricate implant stents.
Using Calton Implant Stents: Use the hole in the stent for the pilot bur and parallel the hand piece with the lingual paralleling pin. After pilot hole is complete, cut the plastic guide hole area away and utilize the lingual paralleling pin for the rest of your sizing burs. I am told that once you pass through the cancellous bone and into the megullary bone, the hand piece can change angles. The guide pin will help you keep the hand piece at the original angle.