Challenges of multiple implant cases with cement retained framework
Posted on 06/23/2011
We recently worked on roundhouse implant case with implants in positions: 4,5,7,8,9,10,12,13. We fabricated custom abutments and a 12 unit bridge (two cantilevers) from 3,4,5,6,7,8,9,10,11,12,13,14. We also fabricated a duralay insertion key to help the doctorinsert the abutments to match the position in the model.
Upon try-in, it was realized that the two distal abutments, 4,13 were not correctly aligned in the model - as such the bridge could not seat correctly in the mouth. Troubleshooting such a case, which is not uncommon in multiple implant restorations, is often a challenge.
After attempts to make a new master model with correct alignment failed to achieve ideal fit, it was decided that the easiest way to fix the issue was to secure the abutments in the mouth, section the bridge as needed, and have the doctor take a pickup impression of the position of the copings as they were seated in the mouth. This approach avoided the recurring error of a second mis transfer to the model and allowed us to adjust the copings and reconnect them. An additional tryin was necessary.
This type of case is no doubt a challenge and frustrating for all parties, but with open communication between techs and doctors, this type of case can be solved and the patient will enjoy a well fitting final bridge.
Upon try-in, it was realized that the two distal abutments, 4,13 were not correctly aligned in the model - as such the bridge could not seat correctly in the mouth. Troubleshooting such a case, which is not uncommon in multiple implant restorations, is often a challenge.
After attempts to make a new master model with correct alignment failed to achieve ideal fit, it was decided that the easiest way to fix the issue was to secure the abutments in the mouth, section the bridge as needed, and have the doctor take a pickup impression of the position of the copings as they were seated in the mouth. This approach avoided the recurring error of a second mis transfer to the model and allowed us to adjust the copings and reconnect them. An additional tryin was necessary.
This type of case is no doubt a challenge and frustrating for all parties, but with open communication between techs and doctors, this type of case can be solved and the patient will enjoy a well fitting final bridge.
