Planning a Highly Predictable Workflow:

IMPLANT-SUPPORTED PROSTHESIS

Written by Andrew Sedler, COO

Written by Andrew Sedler, COO

Written by Andrew Sedler, COO

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Implant retained hybrid restorations have become extremely popular with patients, and the demand for these restorative options has shown an exponential increase over the last decade.

An implant-supported hybrid restoration can be life-changing for patients suffering from edentulism. When the procedure follows a planned workflow, the final prosthesis result is predictable. This creates satisfied patients who may ultimately become a source of referrals to the clinician.

In the early days of these treatment plans, the workflows were difficult and required several appointments, and in many instances, with unsatisfactory final results. Today, technology coupled with a planned protocol has made these procedures highly predictable.

There is no question that working on these types of cases requires a team approach. This team consists of the patient, clinician, and of course, Burbank Dental Lab. The key to success lies in the protocol that will take the patient from their initial desired results to the final outcome. The use of technology has dramatically improved the workflow of these cases.

Initial Appointment

One of the essential steps in the process begins with the initial appointment, where the foundation of the case is created. In this phase of the workflow, managing the patient's expectations is critical to overall success. When evaluating what type of restorative option would be best suited or even possible for a specific case, the following three conditions must be considered:

  1. Facial esthetics and lip support should be evaluated. If the patient has lost bone, then the restoration will need to support facial esthetics such as lip support.
  2. Vertical clearance measurements are critical in determining the type of restoration.
  3. The smile line is the third condition to factor into the discussion. This is made by evaluating the natural tissues in the smile relative to the smile line itself.

Denture Evaluation

From these evaluations, the process of a digital workflow can begin. One of the most critical aspects of ensuring a successful case is in the data provided to the laboratory. The first step in providing an implant-supported prosthesis for edentulous patients begins with a denture set up. These cases can start with either an existing denture that the patient is relatively happy with or a completely new denture that can be fabricated.

Denture Evaluation

This step helps to do the following:

  • Establish the vertical
  • Determine tooth positioning
  • Check phonetics
  • Evaluate the smile line
  • Create ideal occlusion

If a current denture can be used, this can be duplicated and used as a scanning guide. If a new denture is required, then bite blocks, and set-up try-ins will be necessary.

Guided Implant Surgery

Using a CT scanning appliance based on the approved denture, a CT scan is obtained to aid in ideal implant placement. The CT scan is then combined with the STL file of the scanned appliance and scanned models, including an STL file of the model with the CT scanning appliance in place.

CT Scanning Appliance - Guided Implant Surgery

This file can then be used for the planning of the implant placement within guided surgery software. This software results in a digital appliance that will be used during surgery to place the implants in ideal positions.

The final appliance can be printed on a 3D printer.  The guided surgery appliance is used to place implants according to the guided surgery plan. A prefabricated conversion denture is used for immediate provisionals following surgery.

Digital Impression for Polymethyl Methacrylate (PMMA)

Here the conversion prosthesis is used as a prototype for the final prosthesis.  Because the patient has been wearing the conversion prosthesis since the time of surgery, any issues or changes can be noted to be implemented in the final restoration.

To provide the lab with the data, the following steps should be followed:

  • Remove the prototype prosthesis
  • Using scan bodies, scan the prosthesis
  • Insert the prosthesis and scan the opposing
  • Scan the bite

After the relative data has been captured, this data can be uploaded to Burbank Dental Lab. In addition, photographs should be taken along with the chosen shade and any other diagnostic information that was discussed.

The Burbank Dental Lab digital team receives this data file and will then merge the scan body STL files, the scan of the appliance, and the model scan to create the PMMA prosthetic.

This PMMA device is designed to encompass the data from the conversion prosthesis and any changes that the patient and clinician request. The patient will then wear this provisional for a set period, and this will be the time to make any changes before final fabrication.

Once approved, the PMMA provisional can be scanned and copy milled to create the final restoration.

Restoration Options

Implant-supported hybrid cases can be restored using composite materials such as Burbank Dental Lab's SmartCompositeporcelain fused to metal, and even acrylic fixed prosthesis. However, one of the most widely prescribed materials is the zirconia hybrid fixed prosthesis (ZIRMAX M).

The decision to use one hybrid type over the other will depend on several factors, but the key elements are:

  • Amount of bone loss
  • Vertical opening
  • Functional issues
  • Patient financial issues
  • Esthetic demands

When occlusal loads are challenging, the ZIRMAX M hybrid prosthetic is the best solution. It offers both strength and esthetics.

There are several different workflow options available for handling these larger edentulous cases.

For the best option, contact Burbank Dental Lab to set up a complete case plan and workflow method.

Our trained staff is available to ensure your case has predictable results and a smooth flow from start to finish.

Chat with us by clicking the blue icon along the bottom right-hand corner or call us at (800) 336-3053 for help with your next implant-supported hybrid prosthesis.

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