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■ When black or white is not the only

solution – a telescopic implant treatment: Part 2 By Ulrich Heker, DTM Educational aims, objectives and outcomes ■ Educational aim: – to illustrate via a real life case study how multiple technologies can be employed to achieve a patient’s desired result ■ CPD outcomes: – to gain an overview of the specific issues that prevented the use of a standard approach to treatment – to illustrate how a team approach to a problem can achieve an ideal solution – to gain an understanding of the practical implications and techniques used to achieve a completely detachable prosthesis based on telescopic implants

Dentists are often faced with situations where black or white, prosthesis or implant, are not the only options. In Part I (April edition of The Technologist), we introduced a case study of a telescope implant treatment (Kennedy Class 1) in the upper jaw of a female patient. Ulrich Heker (Master Dental Technician) continues his description of the treatment of a UK patient with a completely detachable prosthesis based on telescopic implants, combining the best of both technologies to provide an optimal solution for the client, at a reasonable cost.

Introduction

Making the tertiary structure

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Care should be taken when modelling to achieve the optimum distribution of material: thin in the labial region where there is never sufficient room and thicker in the posterior region to afford the necessary strength. The refractory model was made such that the prosthesis could be completely relined in the future, thus avoiding pressure points.

n Part I we were introduced to a patient presenting a unique challenge for the dentist. The 55-year-old female had worn a classical gold/gold telescope prosthesis for many years that had mutated into a full denture, something that she did not want. From an oral surgical point of view, both sides were unsuitable for implants due to the lack of bone material, and the patient had also rejected expensive augmentation of the molar areas. After thorough consideration, the decision fell in favour of a combination of six implants with individual abutments and detachable, bar-free telescope prosthesis. The patient was fitted with regular neck (RN) implants. The primary parts were made from non-precious metal alloy (NEM). The primary parts were milled on RN burnout copings in wax and cast in non-precious alloy. The secondary parts were sandblasted and carefully attached to a Straumann RN Variobase®. The units were then screwed into the master model, milled and polished. For fitting, a 1.5 mm Erkolen® foil was thermoformed over the complete work for positioning. Following small corrections, the try-in was secured using a matrix. We are now ready to make the tertiary structure.

the

As per the patient’s wishes, we were able to avoid any transversal connectors. The procedure for the construction of the tertiary part consisted merely of separating, sandblasting and electrolytic polishing. The framework could be immediately placed on the gold caps without any issues. Another ‘try-in’ of all the metal pieces took place: the base, with the glued primary parts and keys, the gold caps on top and finally the CrCo base. The cast metal structure showed an identical fit on the master model and in the mouth of the patient. It was now ready for completion.

Fig. 1: Blocked master model (fully relineable)

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Fig. 2: Assessment of available space using silicone key/matrix

Back in the laboratory, finishing was carried out in the conventional way after all exterior surfaces had been coated with saline coupling agent and covered with opaquer. Finally all adhesive surfaces were prepared by using aluminium oxide 100


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micron and degreased prior to intraoral cementing. The table at the bottom of this page gives a graphical overview of the entire construction for each implant and the associated primary crown, secondary crown and the CrCo tertiary structure. The dental technician’s role was done.

A note on the final fitting

materials & equipment

In order to prevent stresses, the cementing (of the caps with the frame) should only happen intraorally in pairs. This avoids the accumulation of unwanted stresses. Beginning at the distal end, the secondary crowns were cemented in, in opposing pairs. The remaining 4 and/or 2 stayed on the primary parts.

Fig. 3: Views of the finished tertiary construction

What the patient thought ‘My new denture is pleasant to wear. I am

The happy patient

Fig. 4: Basal view before cementing

b RN Variobase™ abutment

particularly happy that I no longer have bars on the roof of my mouth – that always bothered me about my old denture. I believe that this result was only made possible by the close cooperation between my dentist and the dental technician from the initial planning through to completion.’

c Primary crown

What the dentist thought

Schematic of the entire construction from implant to CrCo tertiary structure

a RN® implant

d RN burn-out coping e Secondary crown, gold cap

The entire prosthetic treatment could be done with relatively few appointments. Trying-in was problem-free although time-consuming as each time the abutments had to be set up and removed.

f CrCo tertiary structure A suitable key can save a lot of ‘trial and error’.

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The acclimatisation phase was extremely short for the patient, as she had already had a telescope denture in the past. The absolute rigidity of teeth implants firmly anchored in the bone, compared with flexibly attached natural teeth, felt unusual at first. It required an even more precise insertion and removal of the prosthesis that became familiar with practice.

Conclusion

Clearly it is possible to treat difficult cases in a truly effective way (here: Kennedy Class I as ‘removable bridge’), by using implants and telescopes together.

Fig. 5: The finished work on the master model

About the author

Choice of non-precious metal alloys led to a durable, high quality product that was cost-effective and resulted in high patient satisfaction. Good communication and information facilitated this solution for the dentist in a case where ‘black OR white was not the only solution’.

Ulrich Heker is the owner-manager of Ulrich Heker Dental Laboratory founded in 1996 with the strap line TEETH ‘R’ US. As a qualified master craftsman (German Master Dental Technician) since 1991, he has over 26 years’ experience, both at the bench and in running a successful business. Ulrich lives in Mülheim on the river Ruhr and is an accomplished ‘western-style’ rider in his spare time. Ulrich is fluent in English and can be contacted at:

Key materials used

the

Product

Manufacturer

Modelling plastic

GC

Contact colour

Tanaka Bite-X

Implants

Straumann RN® Tissue Level

RN Variobase™ abutment with screw

Straumann

Product ID

Patern Resin®

Impression post or pick up impression coping Straumann synOcta®

048.010

RN burn-out coping

Straumann

048.268

RN synOcta® analog

Straumann

048.108

Attachment glue

Goldquadrat Quattro Zem®

Anterior and posterior teeth

Vita

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Physiodens®

Ulrich Heker, D-45130 Essen Corneliastr. 17, T: +49 201 797 955, ulrich@teethrus.de, Video skype: TEETH ARE US, www.german-smile.info.

materials & equipment

This method of implant treatment for edentulous patients offers a really good, stable, yet unobtrusive solution. Complex surgical interference with augmentation can also be avoided.

When black or white is not the only solution Part 2  

Dentists are often faced with situations where black or white, prosthesis or implant, are not the only options. In Part I (April edition of...

When black or white is not the only solution Part 2  

Dentists are often faced with situations where black or white, prosthesis or implant, are not the only options. In Part I (April edition of...

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