Surgical Guidelines for Mandibular 2 Implant Retained Overdentures

Ectodermal Dysplasia Completed Treatment

This patient presented with a congenital disorder known as Ectodermal Dysplasia.  As a result she was congenitally missing teeth 1, 2, 4, 5, 6, 11, 12, 13, 15, 16, 17-32.  Also, her teeth present were malformed.  Previous dental treatment included PFM crowns on teeth 7, 8, 9, 10; an interim maxillary removable partial denture; and a mandibular complete removable prosthesis.  Her treatment included: extensive grafting in the maxillary edentulous areas; implants in sites 4, 6, 11, 13, 20, 22, 24, 27, and 29; Zirconia crowns on teeth 3 and 14; porcelain fused to zirconia crowns on teeth 7-10; porcelain fused to metal screw retained fixed partial dentures 4-6 and 11-13; and a mandibular metal acrylic five implant retained complete dental prosthesis (hybrid).

Pretreatment Smile

Intra-oral Pretreatment

Post-treatment Smile

Post-treatment Intr-oral

Maxillary Semi-precision RPD with survey crowns and Mandibular two implant assisted Swing-lock RPD

This patient wanted to "fix his my mouth."  While doing so he expressed interest in "saving" as many of his existing teeth as possible and we had to stay within his proposed budget.  Multiple treatment options were provided and he elected to proceed with survey crowns and a semiprecision RDP in his maxilla and a swing-lock implant assisted RDP in the mandible.

Pre-treatment frontal smile photo.

Pre-treatment profile smile photo.

Post-treatment frontal smile photo.

Post-treatment profile smile photos.

Mandibular Hybrid Prosthesis Denture Tooth Location Index and Tranfer to Metal Framework in Wax

The following photos depict the sequence and steps involved with transferring mandibular denture tooth position, determined previously with an intra-oral wax try-in, to mandibular hybrid prosthesis metal framework.

Fabricate a lab plaster occlusal index of the mandibular denture tooth position on  previously (correctly) mounted mandibular cast.  Maintain the same vertical dimension of occlusion with the articulator pin when fabricating the plaster index.  The index needs to cover the mandibular teeth to their height of contour.

Remove all wax from the mandibular denture teeth and re-insert into the plaster index.

Add sticky wax onto the facial/buccal surfaces of the denture teeth to secure their position in the plaster matrix.

Articulator closed with healing caps still present on implant abutment lab analogs.

Mandibular hybrid metal framework in place.  This photo shows properly adjusted mandibular denture teeth that allows closure of the articulator to the proper occlusal vertical dimension with the mandibular hybrid metal framework in place on the master cast.  In order to accomplish this, one must adjust the denture teeth until adequate space is present between the teeth and the metal frame when the articulator pin touches the articulator's pin table at the previously determined occlusal vertical dimension.  

Pre-opaqued mandibular hybrid metal framework.

Air abraded mandibular hybrid metal framework.

 

Opaqued framework on the master cast with indexed mandibular denture teeth in place.

Screw access holes blocked out with cotton prior to adding wax to secure mandibular denture teeth to hybrid framework.

PVS used to finish blocking out the screw access holes prior to securing teeth to the mandibular framework with wax.

Wax applied to the mandibular framework securing the mandibular denture teeth.

Screw access holes drilled through the wax and teeth providing access to the prosthetic screws of the hybrid. 

Festooned and polished mandibular hybrid prosthesis in wax.

Maxillary Implant Rehab Provisional, Index Implant Location

Ectodermal Dysplasia: maxillary rehab (implants and teeth) and mandibular hybrid prosthesis

 This patient has ectodermal dysplasia.  She has never experienced life with teeth.  Her primary concern was to finally "get some teeth."  Her final treatment plan included 6 maxillary PFM crowns on natural teeth, two maxillary implant cantilever FPDs, and a mandibular five implant fixed metal-acylic prosthesis (hybrid).  She was and is one of the most grateful patients I've ever treated.