Posterior Fixed Rehabilitation (limited Space): 2 FPDs, 1 Implant FPD, 4 PFMs

 Patient just completed orthodontic treatment.  Originally the patient was planned for an increase in vertical dimension of occlusion to allow more room for a comprehensive restorative rehabilitation.  Due to personal matters the patient was no longer able to afford the complete rehabilitation and elected to proceed with restoring the posterior teeth only with a full understanding of the limitation of space for adequate esthetics regarding her future restorations.

NOTE: This was a panadent system case, which resulted in minimal insertion adjustments to the crowns.  If accurate mountings, tracings, and most importantly inter-occlusal records are obtained; minimal adjustments should e expected.

Initial patient photo regarding dentition.

AnteriorTooth Screw Retained Implant Provisional Crown with Zimmer Carrier

Initial Intraoral photo

  Diagnostic Mounting with Diagnostic Wax Up

 Surgical Guide for Maxillary implants (use while increasing drill size)

Surgical Guide for Maxillary Implants (location and angulation guide)

Implant Location Index using surgical guide day of implant placement (GC pattern Resin and Zimmer implant carrier)

Original Cast Duplicate with area removed for implant analog placement

Implant index on duplicate cast

Analog in place using low expansion stone.  Abutment on analog.  Abutment fabricated from a Zimmer implant carrier and sand blasted to remove color.

Occlusal View of analog and abutment on cast.  Note: it is important to contour the cast by removing unwanted stone around the abutment to allow for better emergence of the crown.  The emergence may need adjusting after trying it in the mouth.

 Jet acrylic in a matrix placed over the abutment site.  Processed in warm water and a pressure pot.

Untrimmed provisional on cast after pressure pot curing.

Occlusal view

Preliminary trimming of the provisional prior to polishing.  Note: it will most likely be necessary to add appropriate acrylic at the cervical portion of the provisional with it off the cast, cure it again, and trim to proper contours with a bur.  Careful not to touch the burn to the metal abutment.

 Occlusal View

 Patient smiling with provisional crown in place.

Retracted view of provisional crown day of uncover/insertion.

1 month photo of provisional in the mouth.  Note: brush beading acrlyic to the cervical may be necessary to obtain the proper contours for your implant provisional (not done here)

FINAL CROWNS

True Immediate Maxillary Complete Denture and Rotational Path Mandibular RPD

This case was pretty fun.  The patient came in with a need to extract all their maxillary teeth and mandibular anterior teeth due to severe aggressive periodontal disease.  An immediate maxillary complete denture was fabricated in conjunction with a mandibular interim RPD.  Teeth were selected using his natural teeth as a guide for mold selection, shade was selected per the patient's request.  The patient absolutely loved the tooth selection and arrangement of his immediate denture.  Thus after several months of healing and management of the patient with soft liners the maxillary interim denture was re-fitted to his stable maxillary arch with a lab processed hard re-line.  Once that was complete a rotational path RPD was designed, fabricated, and delivered.  The following shows a picture representation of the basic process.

Traditional Rehabilitation - Mandible 2 crowns, 3 FPDs

  Thought I would show the most recent diagnostic wax up I've been working on.  It's for a mandibular fixed rehab.  The patient came in and wanted the spaces "filled" where he is currently missing teeth other that that he is completely satisfied with his teeth.  After a closer examination it was noted that there was insufficient bony anchorage for implants.  So, we discussed the possibilities of restoring his mouth with traditional FPDs and he liked the idea.