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Lom
a Lin
da U
niv
ersity
Implant Dentistry
USE OF DIGITAL DENTURES IN IMMEDIATE OCCLUSAL
FUNCTIONAL LOADING OF DENTAL IMPLATS
ANTOANELA GARBACEA, DDS, MSD
Lom
a Lin
da U
niv
ersity
Implant Dentistry
Outline
• DIGITAL DENTURES VS. CONVENTIONAL
COMPLETE DENTURES
• GUIDED SURGERY FOR IMPLANT
PLACEMENT
• IMMEDIATE LOADING AND DENTURE
CONVERSION USING CAD/CAM MILLED
DENTURES
Lom
a Lin
da U
niv
ersity
Implant Dentistry
Immediate Loading Consensus
• Immediate/early loading of dental
implants: A report from the Sociedad
Espanola de Implantes World Congress
consensus meeting in Barcelona, Spain,
2002.
Aparicio C, Rangert B, Sennerby L.
Clin Implant Dent Relat Res.
2003;5(1):57-60.
Lom
a Lin
da U
niv
ersity
Implant Dentistry
immediate ‘non-occluding’ loading
Immediate ‘occlusal’ loading
Lom
a Lin
da U
niv
ersity
Implant Dentistry
Acrylic provisional restorations comprising any sort of metal reinforcement
Tarnow et al. 1997; Horiuchi et al. 2000; Chow et al. 2001;
Ganeles et al. 2001; Grunder 2001; Malo´ et al. 2003a,
2003b; Nikellis et al. 2004; Testori et al. 2004; Degidi et
al.2006a, 2006b
Lom
a Lin
da U
niv
ersity
Implant Dentistry
Entirely acrylic, metal-free restorations can be considered as an alternative
Schnitman et al. 1990; Cooper et al. 2002; Kammeyer et al.
2002; Becker et al. 2003; Chee & Jivraj 2003; Wolfinger et
al. 2003; Misch 2004; Balshi et al. 2005; Malo´ et al. 2006
Lom
a Lin
da U
niv
ersity
Implant Dentistry
Technique Description
Goodacre et al 2011, 2012
Lom
a Lin
da U
niv
ersity
Implant Dentistry
AvaDent™ Digital Dentures
It is a system by which impressions,
interocclusal records, and tooth
selection can be completed in one
appointment and the dentures
fabricated using CAD/CAM
technology .
Lom
a Lin
da U
niv
ersity
Implant Dentistry
1. Maxillary and mandibular impressions using
Avadent system.
2.Fabrication of Avadent Digital Dentures.
3.Fiduciary markers in the Avadent already
milled dentures as
required by the Nobel Guide Clinician protocol.
4. Dual CBCT Scan. Avadent Digital Dentures
and Patient wearing dentures.
Technique Description
Lom
a Lin
da U
niv
ersity
Implant Dentistry
5. Virtual Implant Treatment Plan using Nobel
Clinician Software .
6. Fabrication of the Nobel Clinician surgical
guide.
7. Guided Surgery
8. Immediate Loading of Implants using Avadent
Digital Dentures as provisional prosthesis.
Technique Description
Lom
a Lin
da U
niv
ersity
Implant Dentistry
Treatment Sequence
Existing Complete Dentures
Lom
a Lin
da U
niv
ersity
Implant Dentistry
Poly (vinyl siloxane) casts made by pressing putty into
existing dentures
Lom
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da U
niv
ersity
Implant Dentistry
Immerse AvaDent tray in 160° F water Press softened tray onto PVS cast
Lom
a Lin
da U
niv
ersity
Implant Dentistry
Border molding with areas of tray showing through the impression material, indicating they
need to be relieved before making wash impression
Lom
a Lin
da U
niv
ersity
Implant Dentistry
Final maxillary and mandibular impressions
Lom
a Lin
da U
niv
ersity
Implant Dentistry
Anatomical Measuring Device used to adjust and hold
OVD, serve as a
gothic arch tracing device, and also provide upper lip
support adjustment
Brass gothic arch tracing pin is
adjustable using the side hex
screw.
Lom
a Lin
da U
niv
ersity
Implant Dentistry
The maxillary lip support can be
adjusted using the anterior
hex screw
Lom
a Lin
da U
niv
ersity
Implant Dentistry
Three different sizes of clear plastic
overlays are available to help identify the
best size of the teeth
Lom
a Lin
da U
niv
ersity
Implant Dentistry
Adhesive and registration material applied to maxillary and mandibular AMD
Completion of a gothic arch tracing
Lom
a Lin
da U
niv
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Implant Dentistry
An Occlusal Plane Orientation Ruler is Provided To Align The
Occlusal Plane With The Interpupillary Line
Lom
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da U
niv
ersity
Implant Dentistry
Use the ruler to seat the
maxillary AMD so it is aligned
with the interpupillary line
Lom
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da U
niv
ersity
Implant Dentistry
The mandible is moved so the brass pin engages the dimple and holds that position while the registration material is expressed between the AMDs
Lom
a Lin
da U
niv
ersity
Implant Dentistry
Laser scanning of the
AMD impression
Superimposing the laser
scan of the AMD on the
scan of the complete
arch impression
Lom
a Lin
da U
niv
ersity
Implant Dentistry
Locating the Borders
Setting the teeth and forming the bases
Lom
a Lin
da U
niv
ersity
Implant Dentistry
Virtual tooth arrangement
Denture base morphology established
Lom
a Lin
da U
niv
ersity
Implant Dentistry
Lom
a Lin
da U
niv
ersity
Implant Dentistry
Lom
a Lin
da U
niv
ersity
Implant Dentistry
ATI (Advanced Try-In) Wax Trial Denture
Lom
a Lin
da U
niv
ersity
Implant Dentistry
Lom
a Lin
da U
niv
ersity
Implant Dentistry
Lom
a Lin
da U
niv
ersity
Implant Dentistry
Lom
a Lin
da U
niv
ersity
Implant Dentistry
Lom
a Lin
da U
niv
ersity
Implant Dentistry
Lom
a Lin
da U
niv
ersity
Implant Dentistry
Nobel Clinician: virtual planning of the diameters and
lengths of the
implants and stabilizing pins the to be placed in the
mandible.
Lom
a Lin
da U
niv
ersity
Implant Dentistry
35º thread shapeDouble lead threadsTaperedTiUnite surface
Lom
a Lin
da U
niv
ersity
Implant Dentistry
Fabrication of the Nobel Clinician surgical guide.
Lom
a Lin
da U
niv
ersity
Implant Dentistry
Laboratory steps in fabrication of the mandibular cast
Lom
a Lin
da U
niv
ersity
Implant Dentistry
Lom
a Lin
da U
niv
ersity
Implant Dentistry
Lom
a Lin
da U
niv
ersity
Implant Dentistry
The digital denture conversion as mandibular implant
provisional screw-retained prosthesis.
Lom
a Lin
da U
niv
ersity
Implant Dentistry
Lom
a Lin
da U
niv
ersity
Implant Dentistry
Prototype converted denture for immediate
loading
Lom
a Lin
da U
niv
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Implant Dentistry
Advantages
Lom
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da U
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Implant Dentistry
• It is possible to record all the clinical information for
complete dentures in one appointment (1-2 hours) and
have the dentures ready for the second appointment .
• Less clinical chair time provides the opportunity for a
more cost-effective set of appropriately accurate
complete dentures .
Lom
a Lin
da U
niv
ersity
Implant Dentistry
• There is a repository of digital data that allows for more
rapid fabrication of a replacement or spare denture
• The denture base fit is superior to that of conventionally
processed bases
• Research indicates some favorable properties of the
PRE-polymerized resin
Lom
a Lin
da U
niv
ersity
Implant Dentistry
Conclusions
Lom
a Lin
da U
niv
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Implant Dentistry
Thank you