| The patient is a 65-year-old female, medical history unremarkable, who has been edentulous for 45 years. | |
| 1 (in our office): The patient was examined in our office. Chief complaint was an unstable lower denture. The panoramic radiograph showed a severely resorbed mandible. Treatment plan included the placement of 5 implants to support a fixed complete denture. |
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| 2 (in our office): Five Brĺnemark implants (one 4 x 11.5 mm and four 4
x 10 mm) were placed between the mental foramina. Implant surgery was
uneventful. A radiograph was taken immediately post-operative to rule out jaw
fracture. Healing time: 5 months. |
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3 (in our office): Second stage surgery was uneventful. All fixtures were successfully integrated. |
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| 4 (in our office): Four 3.0 mm high MultiUnit abutments were delivered. Per manufacturer protocol, 20 Ncm torque was applied to the abutment screw. |  |
| 5 (in our office): 5 plastic cover screws were placed on the abutments. The patient is now ready for restoration. |  |
| 6 (General Dentist office): Patient is referred to her General Dentist for soft reline of the denture. The first impression (steps 7-8) can be made at the same appointment. |  |
| 7 (General Dentist office): The cover screws are removed and five tapered
impression copings are placed and hand-tightened.
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| 8 (General Dentist office): An alginate impression is taken. The copings are removed and sent to the lab with the impression. The cover screws are replaced and the patient is dismissed. |  |
| 9 (in the lab): The laboratory technician processes the impression by placing analogs on the copings and pouring a model. The technician fabricates a Triad bar around the five two-piece impression copings, then sections the bar into five pieces. A perforated custom tray is also fabricated (step 15). |  |
| 10 (General Dentist office): Zapit cyanoacrylate glue is used to index the pieces in the patient mouth. Always provide eye protection for the patient as well as the doctor and assistant when using this material. |   |
| 11 (General Dentist office): The cover screws are removed and Vaseline is applied on the abutment heads to help separation. The Triad sections are placed on the abutments. The sections should never contact each other—this is verified by using a Mylar strip. If the strip does not move freely, remove the section and adjust with a finishing bur. All the screws should be tight. |  |
| 12 (General Dentist office): Zapit gel is carried with an explorer or a micropipette. |  |
| 13 (General Dentist office): Zapit catalyst is carried with a cotton pliers or a micropipette. |  |
| 14 (General Dentist office): When all the sections are attached to each other, the indexing bar is removed and inspected. Additional Zapit is applied as needed. The indexing bar is replaced and checked for passive fit (see technique on bar indexing). |  |
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15 (General Dentist office): The perforated custom impression tray is tried in and inspected. |
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| 16 (General Dentist office): An impression is made, using a semi-hard compound such as Impregum. The impression coping screws are removed first, then the tray is removed. Steps 17-19 should follow within a few minutes to prevent distortion. |  |
| 17 (General Dentist office): Analogs are placed in the impression copings. It is critical that the analog is stabilized with two fingers while tightening the coping screw. |  |
| 18 (General Dentist office): A soft acrylic resin is poured around the analogs. |  |
| 19 (General Dentist office): A very thick mix of die stone is prepared and placed on a pad. The model is placed in the stone, allowed to set, then sent to the lab. |   |
| 20 (in the lab): The "master cast" is now achieved and need to kept intact throughout the process. |  |
| 21 (in the lab): A bite block is prepared |  |
| 22 (General Dentist office): The bite and vertical dimension are recorded using conventional complete denture techniques. |  |
| 23 (in the lab): The denture setup is prepared in the lab. |  |
| 24 (General Dentist office): The setup is delivered. Occlusion is checked and adjusted as necessary. |  |
| 25 (General Dentist office): Vertical dimension and lip support are checked and reviewed with the patient. |   |
| 26 (in the lab): The lab fabricates a resin model of the All In One framework. This model is mailed to Procera facility. |  |
| 27 (at Procera): The acrylic model is painted in white and scanned with a laser. |  |
| 28 (at Procera): The framework is milled from a solid piece of titanium. A precision fit of 2 to 3 microns on the master cast is guaranteed. The framework is mailed back to the lab. |  |
| 29 (in the lab): Buccal view of the framework. |  |
| 30 (in the lab): Lingual view of the framework. |  |
| 31 (in the lab): Bottom view of the framework. |  |
| 32 (General Dentist office): The framework is tested for passive fit in the mouth (see technique on bar indexing). Once verified, the framework is returned to the lab. |  |
| 33 (in the lab): The teeth are set and processed on the framework. In this case, resin teeth were used. Ceramic may also be processed on the titanium framework. |  |
| 34 (General Dentist office): The case is delivered and adjusted if necessary. In this case, no adjustments were needed. |  |
| 35 (General Dentist office): Postoperative radiograph |  |
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All of this material is copyrighted and cannot be reproduced nor used for any purpose without the authorization of Drs Gantes and Yamada
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Credits:
Gen Dentist: Dr. Robert Emigh, Long Beach. Lab: Jim Wehrman, Nordent, Long Beach. Surgeon: Dr. Bernard Gantes, Long Beach |