BRIDGE CONNECTED TO A TITANIUM BAR WITH PASSING OCCLUSAL SCREWS. AN INNOVATIVE SOLUTION FOR EDENTULOUS PATIENTS

Numeri Uno, 24: 16-19, 2016

The entire treatment was completed in 4 months and 8 appointments. The implants used are PRAMA and SHELTA with wide thread of Sweden & Martina and another short implant. The patient was exposed surgery with conscious sedation according to the anxiolytic protocol of the school of Padova. The protocol that Vignato Dentists has developed is composed of an initial phase of clinical information collection and the manufacturing of an articulator which establishes the position of the skeletal basis and the vertical dimension of the mouth. The articulator represents, also in the digital transferring, the reference device on which we manufacture all our prosthetic work starting from the temporary to the final prosthesis. Therefore we proceed with the surgery phase of implant insertion followed by the immediate loading of the prepared temporary within 24-48 hours. This temporary is manufactured on the articulator of the initial case replacing through cross-mounting with the impression technique of the implants just inserted. This type of temporary is called the aesthetic healing bite because during the healing period of the implants it allows us to process the occlusion, evaluate the vertical dimension (VD), evaluate the smile line and guide the healing of the gingiva. The temporary is to be considered a clinical reporting tool. Therefore it must satisfy our functional needs and represent the pre-visualization of the final work for the patient. Once the necessary healing period for the implants integration is over, the next phase provides for the master impression, the control of the implants’ positioning by means of a small arch of passivation and the reset up in the articulator of the temporary functionalized. The virtual planning of the final prosthesis provides for the fabrication of two elements: the prepared titanium bar and the prosthetic overstructure which acts as an aesthetic and functional element. The bar is designed by subtraction within the thickness of the prosthetic artefact obtained from the diagnostic wax-up or from the digital re-elaboration of the temporary functionalized in the mouth during the healing period of the implants. It has two important features: it follows the anatomical changes of the gum and matches passively with the implant bases, eliminating the tensions which may generate from the axis of their insertion or from the presence on the same implant arch with different basis, in this case Prama and Shelta. The final prosthetic structure with holes to allow the passage of the fixation screws to the implants and contains the space to house the prepared bar to be luted. The final result is a unique prosthetic artefact tightened to the implants. The work that we have described in this article is in zirconium and ceramic but with the same procedure we can manufacture a more economic artefact in only composite or integral zirconium.