The Traditional Workflow for Edentulous Implant Cases

The initial steps in a digital workflow for an edentulous case are essentially the same as a traditional workflow. There are two possible starting places for any given edentulous implant case. In either situation, the goal of the initial sequence of records is to establish the desired vertical, smile line, tooth position, occlusion, and phonetics.

Duplicate of Current Denture

•  If the current denture meets the essential elements that you will desire in the final prosthetic you can make a duplicate denture that will be used for articulation and as the surgical stent.

Figure 1

Figure 2

New Denture Set-Up

• Requires bite block and set-up try-ins.

Figure 3

Figure 4

In both cases, it is important to take a PVS reline impression in the duplicate denture or new denture set-up.

• Once an ideal denture set-up is established it is then used as the basis for a Surgical Stent. 

Figure 5

• You can also use the ideal denture set-up to fabricate a new denture that has guide holes that are used in surgery as a guide to begin the initial osteotomy pilot hole. 

• Use the surgical stent as a guide to initiate pilot hole osteotomy, then complete the osteotomy freehand.

Figure 6

1. Take a bite with the conversion denture in place. 
2. Pick-up impression of conversion denture, using an open tray technique. (Figure 8)
3. Be sure to thoroughly inject impression material under conversion denture to capture current tissue impression. You may also remove the prosthetic, syringe PVS directly onto tissue, screw the conversion denture down and then take the pick-up impression. 
4. Remove the pick-up impression and attach analogs to the base of the conversion denture and pour a stone model. 
5. Carefully remove conversion denture from the impression, and articulate model and conversion denture to opposing using bite. 
6. Record vertical of the conversion denture on an articulator.
7. Return conversion denture to the patient. 
8. Send articulated model to the lab. 
9. Lab fabricates a wax set-up up for use fabricating the final restoration. 

Figure 8

Final restorations can be fabricated from a scan and copy mill of the tested and approved provisional and can be delivered in a variety of materials for the final restoration. 

1. Full arch monolithic zirconia. (Figure 11)
   

   Figure 11

2. Monolithic composite bonded to a milled Co/Cr substructure. (Burbank Dental Lab’s SmartComposite Hybrid) (Figure 12)
   

   Figure 12

3. Acrylic and denture teeth cured to a metal substructure.  (Figure 13)
   

   Figure 13

4. Porcelain fused to metal hybrid type or C & B type restoration. (Figure 14)
   
   

   Figure 14