Intraoral connection of individual abutment attachments an osseointegrated implant-supported prosthesis John McCartney,
for
DDSa
Tripler Army Medical Center, Honolulu, Hawaii A technique is demonstrated for simultaneous verification of abutment replica positions and accurate adaptation of the prosthesis framework to the abutments. separate procedure to verify abutment replica positions, as well as potential soldering of the framework for long-span castings, is avoided. (J PROSTHET DENT 1991;66:799-803.)
The views or opinions expressed herein are those of the author and do not necessarily reflect those of the United States Army. %olonel, U.S. Army, DC; Chief of Prosthodontics and Maxillofacial Prosthetics. 10/l/31028
Fig. 1. Mandibular
denture teeth are indexed on upper
member of articulator.
Fig. 2. Antirotation-retention
loops are added to abut-
ment waxing sleeves.
THE JOURNAL OF PROSTHETIC DENTISTRY
A
A
passive, accurate adaptation of framework to the abutments is essentia1.l tive conventional fabrication procedures in the accurate positioning of the abutment
the prosthesis Prior to definithe laboratory, replicas on the
Fig. 3. Vertical height of abutment waxing sleeves is adjusted to clear denture teeth at pin contact.
Fig. 4. Body of framework is sculpted around individual cast abutment sleeve attachments.
MCCARTNEY
Fig. 5. A, Only center abutment sleeveattachment is connected to framework body with autopolymerizing acrylic resin on master cast. B, Lack of abutment sleeve attachment interference with tooth position is verified on articulator. C, Lingual clearance is also confirmed.
Fig. 6. Center abutment sleeve attachment and connetted framework body is stabilized intraorally with retentive screw.
Fig. ‘7. After stabilization with their respective retentive screws, remaining abutment sleeve attachments are connetted to framework body with autopolymerizing acrylic resin.
working cast must be verified.” Large framework castings are difficult to cast accurately in one piece, and soldering is sometimes necessary to achieve the desired fit of the casting.” The direct framework assembly with cement4 has
been suggestedas an alternative method to compensate for casting inaccuracies. The fabrication sequenceis expedited and the accuracy of subsequent procedures is ensured if the abutment rep-
AUTOPOLYMERIZED
ATTACHMENT
CONNECTION
Fig. 8. Abutment replicas to each side of center abutment are removed from master cast, retained in position on framework, and framework seated on center abutment in preparation for corrected cast modifications.
Fig. 9. W ith screw accesshole spacers in position, denture teeth are released from index and positioned on framework.
Fig. 10. Remaining denture teeth are transferred to framework. Spacers are reduced to vertical height compatible with prosthesis contours.
Fig. 11. Framework with spacers in place after investment and boil-out procedures.
lica positions and the passive, accurate adaptation of the prosthesis framework can be simultaneously verified. The following technique addressesthe simultaneous direct verification of the fit of the implant framework and related procedures in the prosthesis fabrication. TECHNIQUE 1. After the wax trial fitting of all denture teeth, make an occlusal index and fix the teeth in position (Fig. 1). 2. Add retentive, antirotational wax rings to the individual abutment waxing sleeves (Fig. 2). 3. Adjust the abutment waxing sleevesin height so as to clear the denture teeth (Fig. 3). 4. Invest and cast the abutment waxing sleeves,forming individual abutment sleeve attachments. Then sculpt the body of the prosthesis framework around the abutment sleeve attachments (Fig. 4). 5. Connect the cast framework body on the master cast to THE
JOURNAL
OF PROSTHETIC
DENTISTRY
Fig. 12. Finished prosthesis with screw accesshole spacers removed. ,r -. ou*
MCCARTNEY
Fig. 13. A, Finished
prosthesis (facial view). B, Finished underside). C, Finished prosthesis seated intraorally.
Fig. 14. Intraoral occlusal adjustment before occlusal reconstruction
prosthesis
(viewed from
Fig. 15. Prosthesis after obturation of screw access holes.
of screw access holes.
the center abutment sleeve attachment with autopolymerizing acrylic resin, still clearing the indexed denture teeth at pin contact (Fig. 5). 6. Seat the framework intraorally (Fig. 6) and directly connect the remaining abutment sleeve attachments to
the framework body with autopolymerizing acrylic resin (Fig. 7). 7. Correct the master cast to reflect the verified positions of those abutment replicas to each side of the center abutment (Fig. 8).
AUTOPOLYMERIZED
ATTACHMENT
CONNECTION
8. Place sprue formers in the individual abutment sleeve attachments to create spacers for screw access holes and arrange the denture teeth around them (Fig. 9). 9. Adjust the screw accesshole spacers to be compatible with the occlusal surfaces and complete the arrangement of the denture teeth (Fig. 10). 10. Invest and boil out the framework (Fig. 11). 11. After processing, remove the accesshole spacers (Fig. 12), and finish and polish the prosthesis (Fig. 13). 12. Make final occlusal adjustments intraorally (Fig. 14) and fill the access holes with appropriate shades of acrylic resin (Fig. 15). SUMMARY
vealed no indication of structural fatigue or fracture associated with the acrylic resin framework interface. REFERENCES 1. Worthington P, Bolender CL, Taylor TD. The Swedish system of osseointegrated implants: problems and complications encountered around a I-year trial period. Int J Oral Maxillofac Implants 1984;2:7784. 2. Knudson R, Williams E, Kemple K. Implant transfer coping verification jig. J PROSTHET DENT 1989$X:601-2. 3. Branemark P-I, Zarb GA, Albrektsson T. Tissue-integrated prostheses. Osseointegrationin clinical dentistry. Chicago: QuintessencePublishing Co, 19%x303. 4. Sellers G. Direct assemblyframework for osseointegratedprosthesis. J PROSTHET DENT 19%$62:662-S.
Reprint requests to:
A technique has been demonstrated for direct simultaneous verification of the abutment replica positions and passive,accurate adaptation of the prosthesis framework to the intraoral abutments. Follow-up observations have re-
DR. JOHN W. MCCARTNEY USA AREA DENTAL LABORATORY WALTER REED ARMY MEDICAL CENTER WASHINGTON. DC 20307-5200
Bound volumes available
to subscribers
Bound volumes of THE JOURNAL OF PROSTHETIC DENTISTRY are available to subscribers (only) for the 1991 issues from the publisher at a cost of $50.00 ($63.00 international) for Vol. 65 (January-June) and Vol. 66 (July-December). Shipping chargesare included. Each bound volume contains a subject and author index, and all advertising is removed. Copies are shipped within 30 days after publication of the last issue in the volume. The binding is durable buckram with the journal name, volume number, and year stamped in gold on the spine. Volumes 63 and 64 are also available. Payment must accompany all orders. Contact Mosby-Year Book, Inc., Subscription Services, 11830 Westline Industrial Drive, St. Louis, MO 63146-3318,USA; phone (800) 325-4177,ext. 4351. Subscriptions must be in force to qualify. Bound volumes are not available in place of a regular JOURNAL subscription.
THE
JOURNAL
OF PROSTHETIC
DENTISTRY
803
for
DDSa
Tripler Army Medical Center, Honolulu, Hawaii A technique is demonstrated for simultaneous verification of abutment replica positions and accurate adaptation of the prosthesis framework to the abutments. separate procedure to verify abutment replica positions, as well as potential soldering of the framework for long-span castings, is avoided. (J PROSTHET DENT 1991;66:799-803.)
The views or opinions expressed herein are those of the author and do not necessarily reflect those of the United States Army. %olonel, U.S. Army, DC; Chief of Prosthodontics and Maxillofacial Prosthetics. 10/l/31028
Fig. 1. Mandibular
denture teeth are indexed on upper
member of articulator.
Fig. 2. Antirotation-retention
loops are added to abut-
ment waxing sleeves.
THE JOURNAL OF PROSTHETIC DENTISTRY
A
A
passive, accurate adaptation of framework to the abutments is essentia1.l tive conventional fabrication procedures in the accurate positioning of the abutment
the prosthesis Prior to definithe laboratory, replicas on the
Fig. 3. Vertical height of abutment waxing sleeves is adjusted to clear denture teeth at pin contact.
Fig. 4. Body of framework is sculpted around individual cast abutment sleeve attachments.
MCCARTNEY
Fig. 5. A, Only center abutment sleeveattachment is connected to framework body with autopolymerizing acrylic resin on master cast. B, Lack of abutment sleeve attachment interference with tooth position is verified on articulator. C, Lingual clearance is also confirmed.
Fig. 6. Center abutment sleeve attachment and connetted framework body is stabilized intraorally with retentive screw.
Fig. ‘7. After stabilization with their respective retentive screws, remaining abutment sleeve attachments are connetted to framework body with autopolymerizing acrylic resin.
working cast must be verified.” Large framework castings are difficult to cast accurately in one piece, and soldering is sometimes necessary to achieve the desired fit of the casting.” The direct framework assembly with cement4 has
been suggestedas an alternative method to compensate for casting inaccuracies. The fabrication sequenceis expedited and the accuracy of subsequent procedures is ensured if the abutment rep-
AUTOPOLYMERIZED
ATTACHMENT
CONNECTION
Fig. 8. Abutment replicas to each side of center abutment are removed from master cast, retained in position on framework, and framework seated on center abutment in preparation for corrected cast modifications.
Fig. 9. W ith screw accesshole spacers in position, denture teeth are released from index and positioned on framework.
Fig. 10. Remaining denture teeth are transferred to framework. Spacers are reduced to vertical height compatible with prosthesis contours.
Fig. 11. Framework with spacers in place after investment and boil-out procedures.
lica positions and the passive, accurate adaptation of the prosthesis framework can be simultaneously verified. The following technique addressesthe simultaneous direct verification of the fit of the implant framework and related procedures in the prosthesis fabrication. TECHNIQUE 1. After the wax trial fitting of all denture teeth, make an occlusal index and fix the teeth in position (Fig. 1). 2. Add retentive, antirotational wax rings to the individual abutment waxing sleeves (Fig. 2). 3. Adjust the abutment waxing sleevesin height so as to clear the denture teeth (Fig. 3). 4. Invest and cast the abutment waxing sleeves,forming individual abutment sleeve attachments. Then sculpt the body of the prosthesis framework around the abutment sleeve attachments (Fig. 4). 5. Connect the cast framework body on the master cast to THE
JOURNAL
OF PROSTHETIC
DENTISTRY
Fig. 12. Finished prosthesis with screw accesshole spacers removed. ,r -. ou*
MCCARTNEY
Fig. 13. A, Finished
prosthesis (facial view). B, Finished underside). C, Finished prosthesis seated intraorally.
Fig. 14. Intraoral occlusal adjustment before occlusal reconstruction
prosthesis
(viewed from
Fig. 15. Prosthesis after obturation of screw access holes.
of screw access holes.
the center abutment sleeve attachment with autopolymerizing acrylic resin, still clearing the indexed denture teeth at pin contact (Fig. 5). 6. Seat the framework intraorally (Fig. 6) and directly connect the remaining abutment sleeve attachments to
the framework body with autopolymerizing acrylic resin (Fig. 7). 7. Correct the master cast to reflect the verified positions of those abutment replicas to each side of the center abutment (Fig. 8).
AUTOPOLYMERIZED
ATTACHMENT
CONNECTION
8. Place sprue formers in the individual abutment sleeve attachments to create spacers for screw access holes and arrange the denture teeth around them (Fig. 9). 9. Adjust the screw accesshole spacers to be compatible with the occlusal surfaces and complete the arrangement of the denture teeth (Fig. 10). 10. Invest and boil out the framework (Fig. 11). 11. After processing, remove the accesshole spacers (Fig. 12), and finish and polish the prosthesis (Fig. 13). 12. Make final occlusal adjustments intraorally (Fig. 14) and fill the access holes with appropriate shades of acrylic resin (Fig. 15). SUMMARY
vealed no indication of structural fatigue or fracture associated with the acrylic resin framework interface. REFERENCES 1. Worthington P, Bolender CL, Taylor TD. The Swedish system of osseointegrated implants: problems and complications encountered around a I-year trial period. Int J Oral Maxillofac Implants 1984;2:7784. 2. Knudson R, Williams E, Kemple K. Implant transfer coping verification jig. J PROSTHET DENT 1989$X:601-2. 3. Branemark P-I, Zarb GA, Albrektsson T. Tissue-integrated prostheses. Osseointegrationin clinical dentistry. Chicago: QuintessencePublishing Co, 19%x303. 4. Sellers G. Direct assemblyframework for osseointegratedprosthesis. J PROSTHET DENT 19%$62:662-S.
Reprint requests to:
A technique has been demonstrated for direct simultaneous verification of the abutment replica positions and passive,accurate adaptation of the prosthesis framework to the intraoral abutments. Follow-up observations have re-
DR. JOHN W. MCCARTNEY USA AREA DENTAL LABORATORY WALTER REED ARMY MEDICAL CENTER WASHINGTON. DC 20307-5200
Bound volumes available
to subscribers
Bound volumes of THE JOURNAL OF PROSTHETIC DENTISTRY are available to subscribers (only) for the 1991 issues from the publisher at a cost of $50.00 ($63.00 international) for Vol. 65 (January-June) and Vol. 66 (July-December). Shipping chargesare included. Each bound volume contains a subject and author index, and all advertising is removed. Copies are shipped within 30 days after publication of the last issue in the volume. The binding is durable buckram with the journal name, volume number, and year stamped in gold on the spine. Volumes 63 and 64 are also available. Payment must accompany all orders. Contact Mosby-Year Book, Inc., Subscription Services, 11830 Westline Industrial Drive, St. Louis, MO 63146-3318,USA; phone (800) 325-4177,ext. 4351. Subscriptions must be in force to qualify. Bound volumes are not available in place of a regular JOURNAL subscription.
THE
JOURNAL
OF PROSTHETIC
DENTISTRY
803
