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Blurred Lines: GPS/Legacy Overdenture Case Saved by SICAT Case Study by: August de Oliveira, DDS

One of the things I love about Sirona's guide lab (SICAT), is that they look at your scans and will let you know if there is a problem. Here is a case where we went through all the right steps, but had some errors along the way and corrected them. Patient wants just a little stability with a lower denture. Not happy with the set up. Tried to talk them into a 4 implant bar supported overdenture but due to finances they just wanted a two implant stud type with GPS attachments. Well I live to serve, so we made a duplicate denture in clear acrylic and Barium Sulfate and had it attached to the Classic Guide bite plate.


Blurred Lines: GPS/Legacy Overdenture Case Saved by SICAT

The big issue was that with the ball attachment on the Galileos the denture kept moving. We tried everything, standing, sitting. Finally, I went all MacGyver on it and nixed the ball attachment and just had her bite on some bite registration using the chin rest. I thought everything was cool and sent it to SICAT, guess not. One thing that is very important in edentulous cases is that the FLANGE of the radiographic guide has Barium Sulfate in it as well. You can see that the denture moved buccal. So abort, abort, which is too bad as these radiographic guides cost about $300 to make. What to do?

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Blurred Lines: GPS/Legacy Overdenture Case Saved by SICAT

We had the patient go back to the lab (Burbank) and they made a second duplicate which was used to make a surgical guide with two pilot sleeves and some Nobel pin channels. I used landmarks on the denture (first pre-molars) to determine where the mental foramen was to place my pins. I also looked at the original scan and drilled on the model to find the ridge. Not nearly as good as CBCT based guides, but in a pinch this worked. The patient was moving to the east coast in 2 weeks so I had to place the implants AND fabricate the overdenture. No rest for the wicked!

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Blurred Lines: GPS/Legacy Overdenture Case Saved by SICAT

I secured the guide with the Nobel 1.5mm pin drill. This drill is 1.5mm wide so if you drop it, you are out of luck as these bend easy (ask me how I know), so buy a few. Nice and secure.

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Blurred Lines: GPS/Legacy Overdenture Case Saved by SICAT

Implants placed with the 2.3mm pilot. These will be 4.2mmD by 13mmL Legacy3s, so all drills after the 2.3mm were non-guided. No worries though as this was D1 bone.

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Blurred Lines: GPS/Legacy Overdenture Case Saved by SICAT

Went up to the 3.8mm drill, took an impression with the closed tray impression copings/fixture mounts with a little cotton and cavit.

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Blurred Lines: GPS/Legacy Overdenture Case Saved by SICAT

Used the guide as the occlusal rim as the lab duplicated the denture and it already had the occlusion and the vertical. I just stabilized with hand pressure. I was hoping the pins would clear the bite so I could have it more stable, but alas no, the pins were in the way.

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Blurred Lines: GPS/Legacy Overdenture Case Saved by SICAT

The lab incorporated the GPS attachments into the waxed up denture for stability. Patient was happy with the arrangement and bite.

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Blurred Lines: GPS/Legacy Overdenture Case Saved by SICAT

GPS attachments torqued down to 30Ncm. I finished the day before she left!

Dr August de Oliveira graduated from dental school in 1997 from the University of Washington and completed his General Practice Residency in Los Angeles in 1998. Dr de Oliveira has been lecturing on 3D technology since 2004, when he started as a CEREC Basic trainer. Since 2008 he has been involved with Implant Direct’s R and D department developing Guided Surgery Software and Hardware and testing their CAD Milled Bars and Substructure Department. Dr de Oliveira has written two books on Implantology: Implants Made Easy and Guided Implantology Made Easy. He has been involved with beta testing Sirona’s Sidexis Program, as well as developing the Opti and CEREC Milled Surgical Guides. Dr de Oliveira lectures nationwide for Sirona on the Galileos Cone Beam system and Sirona Guided Implant Surgery. He also teaches for Implant Direct at their Las Vegas Educational Facility and with the Engel Institute in Charlotte NC. Dr de Oliveira lives and practices in Los Angeles CA.

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Blurred Lines GPS Legacy Overdenture Case Saved By Sicat  

Blurred Lines GPS Legacy Overdenture Case Saved By Sicat

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