ZIRMAX M: Implant-Supported Fixed Prosthesis

There is a lot of complexity involved in edentulous cases, and they need to be planned properly. A lack of proper planning makes it difficult to achieve the desired results. The desired outcome can be determined by starting with the end in mind. When evaluating the initial situation, it is crucial to consider the following:

• Examine any issues related to facial esthetics and bone loss.
• Analyze the vertical opening.
• Examine the smile line.

It can be helpful to have a surgical guide to assist in determining the best placement for an implant. From a variety of workflows, Burbank Dental Lab’s guided surgery appliances provide a precise fit. During dental implant surgery, this appliance will ensure the implants are positioned correctly.

1. Take an impression at the implant level, including the palate and tissue.
2. A bite block with screw-retained temporary cylinders is created. It is tried-in at the second appointment.
3. With the bite block tried in, the jaw relationship is recorded.
4. Take impressions of opposing dentition.
5. Duplicate the patient’s current denture to use as a study model.
6. Both tooth and tissue shades can be selected. Specify other issues, such as the shape of the teeth.
7. Using the information from the previous step, a wax setup try-in is conducted.
8. With wax set up in place, evaluate the following and make any necessary changes:

• Esthetics
• Phonetics
• Centric relation
• The vertical dimension of occlusion
• The midline
• The verification jig is an excellent way to ensure a passive fit.
• The final impression should be taken.
• Prosthesis trials can be conducted using a PMMA provisional. This temporary can be worn by the patient while the final restoration is being made so that feedback can be obtained.

Zirconia frameworks provide precise contours for porcelain layering if needed. Ideally, at this stage, the framework should be tried-in, and new bite registration is taken. Upon confirmation of fit, porcelain is layered over the bridge, glazed, and hand-finished.

When placing the bridge, the first step is to remove the healing caps. To properly remove the healing caps, a torque wrench can be used initially to loosen them then a screwdriver is used to remove each one completely. There is no particular order in which these healing caps should be removed. After the healing caps are removed, the following steps should be used to insert the bridge:

• To insert the bridge, align it evenly with the implants.
• Insert the screws and tighten them after the bridge is evenly seated.
• Torque the screws.

In implant cases where a correction is needed due to an angulation issue, a multi-unit abutment is needed. These multi-unit abutments can successfully correct angulation issues of the implants. They are used when the screw access hole placement is angled toward the facial. The use of the multi-unit abutment redirects the access hole to the lingual. The following steps should be used when utilizing multi-unit abutments:

1. Pick and choose the correct cuff height and angle of the Multi-unit abutments to bring the screw access hole for the prosthesis to the optimal angle.
2. Follow standard full arch impression taking modality.
3. Install the bridge on top of the multi-unit abutments by lightly screwing down all screws of the bridge following a criss-cross pattern.
4. In order to hold the bridge properly in place, torque all the screws until they are in their proper positions. (See above image)
5. Adjust the occlusion as necessary at this point.