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Smile Makeover: Mandibular Implant Case Study

Mandibular Procera Implant Bridge (PIB) with an Upper Denture

View step-by-step how we helped the doctor give this patient back her smile! The patient presented as fully edentulous. After wearing dentures for a number of years, she had issues with her ill-fitting lower denture and desired a fixed alternative. Upon delivery of a Procera lower implant bridge with a new upper denture, the patient was thrilled, proclaiming ”I now feel like I have my natural teeth back”.


Pictured above: “Before” picture of patient’s existing dentures


Pictured above: At this point the surgeon has placed the implants and allowed them to heal. On top of the implants are the impression posts. The two in the back are old implants (silver) and the four in the front are new implants (gold).


Pictured above: The final impression including impression posts which stay with the impression.


Pictured above: The verification jig on the model is used to verify the accuracy of the model as compared to intraorally.


Pictured above: Zirconia framework on the model


Pictured above: Zirconia framework try-in


Pictured above: Occlusal view of Zirconia framework try-in


Pictured above: X-ray of the framework in the mouth which is used to confirm the prosthesis is fully seated.


Pictured above: The final prosthetic on the model. The technician applied porcelain to the framework with pink gingival porcelain for aesthetics.


Pictured above: Occlusal view of the final prosthetic on the model


Pictured above: The final denture and Procera implant bridge delivered


Pictured above: Occlusal view of the delivered Procera implant bridge


Pictured above: Patient’s new upper denture opposing the PIB


Pictured above: Happy patient

Count on New Image to be a resource for your next implant case!

Implant Abutments. So Many, How Do I Choose?

New Image is proud of our implant knowledge and expertise. From single-unit cases to cutting edge, state-of-the-art, full mouth reconstruction, trust the laboratory with 30 years of clinical success in restoring implants.

New Image currently produces 80% of our abutments through CAD/CAM.

CAD/CAM CUSTOM ABUTMENT

These abutments are created by scanning the model and then custom digitally designed by our technicians. New Image is able to follow the tissue contour, give proper emergence profile, correct the angulation and customize the size and shape. They are designed according to the patient’s space, tissue and doctor’s preferences.

Titanium Abutment
Preferred for strength. Ideal for use in the posterior.
Gold Hue (Titanium Abutment With a Gold Nitrite Coating)
This material combines strength with aesthetics. The gold coating helps to impart warm, lifelike aesthetics to both the tissue and the implant crown vs. a gray underlying color.
Zirconia Abutment
The tissue reacts well with zirconia and lessens the grayish undertones of titanium abutments. This material is best used for anterior aesthetic cases.
Please be aware that Zirconia abutments are ONLY recommended for standard diameter implants. Not indicated for small diameter implants.
Pictured above: Zirconia, Gold Hue and Titanium CAD/CAM Custom Abutments.

BIOMET 3i ENCODE ROBO DRILL

The Biomet 3i Encode Healing Abutment eliminates the need for implant level impressions. The doctor takes an impression with the Encode Healing Cap in place which simplifies the process as there are no transfer copings. Once the models are poured, New Image sends them to Biomet 3i to be robotically drilled and for placement of the analog. Through the grooves and notches in the healing cap, the robot is able to identify the exact size and placement of the implant. From there, New Image is able to fabricate the abutment of your choice.

Encode is very appealing to many of our doctors as there is no inventory of impression posts and the impression is simplified so less chairtime is required.

Pictured above: healing cap, impression of a healing cap, poured model of a healing cap.

CUSTOM CAST ABUTMENT

Custom cast abutments are fabricated using a UCLA abutment. UCLA abutments have a metal base (usually a gold or titanium alloy) with a plastic top that can be cast to. The top of the abutment is designed by hand-waxing the shape of the abutment which is then cast with either a yellow gold alloy for anterior teeth, or noble alloy for posterior teeth. A custom cast abutment should be used if the implant placement is not ideal and neither stock abutments nor CAD/CAM custom abutments will work. Many times doctors are supplied this kind of abutment by an implant sales representative or their oral surgeon.

Steps for creating a Custom Cast Abutment:

Pictured above in order from left to right: UCLA abutment, abutment with wax (blue) hand-designed,abutments prepared to be cast, abutments after casting, finished abutment in place on model.

STOCK ABUTMENT

Stock abutments can be used when the implant is in an ideal placement situation and most commonly on posterior cases. If the doctor supplies the parts, this is the most cost effective option. This option should be used depending on the implant size and angulation. Stock abutments are not recommended on all cases, especially cases in need of angle correction or those in the aesthetic zone that need to follow the contour of the tissue.

Milled Stock Titanium Abutment
This type of abutment can be used anywhere in the mouth and is best with ideal placement. The angle can be off up to 10 degrees. Preferred and primarily used in the posterior.

Milled Stock Zirconia Abutment (Not recommended by New Image based on our history of breakage)
This abutment is milled using a coarse diamond burr with abundant water to prevent microfractures. Milled stock abutments are used in cases where implant placement is ideal and with crowns that will not have a great deal of lateral forces. They are used primarily on aesthetic cases such as young patients and patients with a high smile line.

Pictured above: diagram showing the difference between stock and custom abutments, two titanium abutments, with and without angle correction.

For assistance with choosing the right abutment(s) for your next implant case, call New Image Dental Laboratory at 1.800.233.6785. We can simplify the implant process for you!

Case Study: Porcelain Veneers

Hand-Layered & Pressed

Esthetic porcelain veneers can be used in a variety of situations. Take a look at this unique case New Image Dental Laboratory fabricated in partnership with Dr. Kenneth Murphy of Atlanta. The case is fully documented below.

This complex restorative case combined Empress Esthetic veneers and IPS e.max crowns.  The centrals were a challenging combination of a Zirconia abutment and e.max crown for #8 along with an e.max crown on #9. The implant crown is very slightly out of occlusion for functional purposes. Empress Esthetic veneers on teeth # 5, 6, 7, 10 , 11, and 12 completed the total maxillary transformation.

BEFORE                               AFTER

Presurgical/Diagnostic: The patient presented with a history of childhood trauma for teeth #8 and 9. Tooth #9 had a previous crown restoration. Tooth #8 failed due to external resorption.

Treatment Objectives: The patient was interested in correcting his midline discrepancy and improving anterior esthetics.

Treatment Plan: Dr. Murphy advised the patient of the need to extract tooth #8 and replace with an implant/crown. He also suggested orthodontic treatment with which the patient complied.  A provisional was placed  on tooth #9 during the orthodontic treatment.

Esthetic Planning: New Image Dental Laboratory fabricated a diagnostic wax-up to finalize desired esthetics.  The patient reviewed and accepted the wax-up.

Surgical: The oral surgeon placed a Nobel Active 4.3mm at tooth #8.

Challenge: The patient had some difficulty with his provisionals as he was not very careful with his chewing and a few had to be replaced.

Outcome: The patient was very happy with his new smile. He said he will have to relearn how to smile.  From the looks of the photos, mission accomplished!

The Process Through New Image Dental Laboratory:

Diagnostic wax up:

Soft tissue model with implant analog:

Custom zirconia abutment:

Zirconia abutment on soft tissue model (Note the ideal shoulder preparations):

Finished e.max crowns #8, 9 and Empress Esthetic veneers
on # 5, 6, 7, 10, 11, 12:

The transformation:

BEFORE                                   AFTER

*Photos used with express written permission of patient in compliance with all HIPAA laws.

Contact New Image Dental Laboratory today to get started on your complex case!

Technical Tip – Diagnostic Wax-ups

A diagnostic wax-up is a mock example of the technician’s understanding of his/her treatment plan. It is provided to replicate the outcome before the patient is in the chair.

To get the most accurate diagnostic wax-up, the technician needs a full description of what is expected; items can include the following:

  • Is the goal to match existing teeth, mirror opposite side or correct teeth esthetically?
  • Will the case be veneers or crowns?
  • If the centrals are is involved, the technician needs to know the expected length of the centrals.
  • Shapes vary and any type of description of expected shape would be helpful. (ex: square, square oval, oval as found in “The Smile Styles; The Smile Guide”, or wants teeth to appear more feminine)
  • Many times Doctors will add a note that asks the technician to call for instructions. The advantage of descriptive written instructions is to expedite the completion of the diagnostic wax-up. Further, without descriptive written instructions, the technician may feel his information is complete and creates the diagnostic wax-up with the information given. Full descriptive disclosure of the expected outcome will prevent frustration on the part of both the Doctor and technician.

- Steve Bates, CDT, Specialty Ceramist

Technical Tip – Shade Taking

For best shade matching results, take the patient’s shade first, before you prep or impress. Once teeth dehydrate, it can take 6 hours or longer to rehydrate causing teeth to appear several shades lighter.

- Taffy Crofts, CDT, Ceramist