When To Choose Smart1® Implant Bar-Supported Dentures

D. Evaluation Process 

1. What is needed to support facial esthetics and lip support? If the patient has lost a significant amount of bone, the restoration will require a denture flange to provide support for the lip and facial esthetics.

2. What is the available vertical clearance? One of the most important evaluations to make is how much vertical clearance is available. This will affect surgical choices as well as restorative options, so it is essential to collect and analyze this information before working up a treatment plan.

3. Evaluation of the smile line will determine if you need pink tissue built into the restoration, or whether you will need to prescribe a bone reduction as part of the surgical procedures.

Tools to use in evaluating treatment directions and instructions for the lab to use in fabricating prosthetics.

Bite Blocks

Start with bite blocks, making sure that each arch bite block is the thickness required of the desired prostheses, plus 1.5 mm thickness per arch. If you are not planning on opening vertical, you can also use an existing denture or a duplicate of that denture, but always do a reline impression. Ask the lab to add 2 centrals to the bite-block, in the approximate place where they may go. You can use those to establish actual incisal edge positions and occlusal plane.

Important: Mark the bite block with mid-line and the smile line in order to facilitate a more accurate tooth set-up.

Wax-Up Try-In With Teeth

1. Measure what effect the flange of the denture set-up has on the lips. Is the flange of the denture adding necessary lip support?

2. Where is the tissue display within the smile? Check to see If the transition from the restoration to natural tissue is within the smile line. Adjust set-up to fit in the smile.

Measure the Thickness of the Wax Set-up

Take measurements of the wax set-up from several perspectives. You will want to know the thickness in the approximate position of where you would like to place the implants. Measure a couple of posterior positions on the right and left, and at least two in the anterior quadrant as well. Measure the thickness from the center of the position of the proposed implant to the buccal and lingual surfaces of the wax set-up and the occlusal space from the surface of the implant to opposing occlusion. Refer to the “Implant Prosthetic Dimensional Requirement Chart” below for appropriate measurements.