IMPLANT PROSTHETICS
FULL MOUTH REHABILITATION(FMR)By, BEST LASER DENTAL CLINIC,
[email protected], www.drmurugavel.in,
[email protected]
INTRODUCTIONABUTMENT PREPARATIONIMPRESSIONJAW RELATIONFRAMEWORK
TRY-INSEMITRIALCEMENTATION
ABUTMENT PREPARATIONTray setup 1.Tungsten carbide bur 2.suction
tip 3.Diamond bur 4.Curved artery forcep. 5.Goggles. 6.Ortho
mirrors.
While doing the abutment preparation for full mouth. The inter
implant distance between upper & lower arch at VDO should be
4mmCheck for the parallellism of the implants, mesio-distally and
labio lingually.
.Look for any undercuts, sharp edges.Always use the tactile
sensation for checking the sharp margins.
IMPRESSIONBridging step between a dentist and lab.
Always air dry the abutments before taking impression.Make sure
that the frenum is recorded in the impression to reproduce proper
midline.After impression ,check under light or with loops/lens for
any air bubbles & proper recording of all implants.
JAW RELATION
Vertical Jaw Relation / Vertical DimensionVertical dimension
refers to the length of the face.
It is maintained either by the occlusion of the teeth or the
balanced tonic contraction of the opening and closing muscles of
mandibular movements
SignificanceProvides optimal separation between maxilla and
mandible.
If not measured accurately, the joint will be strained.
If the VD is altered, severe discomfort to both TMJ and muscles
of mastication.
Two measurable lengths of the face are important guides in
making maxillo -mandibular relation records and are referred to as
:
Vertical dimension of rest or physiologic rest position.
(VDR).
Vertical dimension of occlusion (VDO).
PHYSIOLOGICAL REST POSITION
The position assumed by the mandible when the head is in an
upright position, the muscles are in equilibrium in tonic
contraction and the condyles are in a neutral unstrained position
is the physiologic rest position of the mandible.
Vertical dimension of occlusion (VDO)Vertical separation of the
jaws when the teeth or occlusion rims are in contact.
It is generally considered that the teeth should not be in
contact when the jaws are at the vertical dimension of rest
position. The 2 to 4mm distance between the upper and lower teeth
when the mandible is at physiologic rest position is called
interocclusal distance (IOD) frequently referred to as the Free way
space.
EFFECTS OF ALTERED vdINCREASE IN VDO / DECREASE IN IOD
The chin-nose distance will increase, and then patients will
have an appearance of open mouth.
Clicking, of dentures during speech.
Improper phonetics.
DECREASED VD
Potentially damaging to the TMJ.The normal tongue space is
limited. Facial distortion appears more noticeable with over
closure that with the slightly opened closure because with over
closure the chin appears to be closer to the nose, the commissure
of the lips turns down and the lips lose their fullness. The
muscles of facial expression lose their tonicity and the face
appears flabby instead of firm and full.Over closure of jaws may
lead to angular chelitis
Make the patient sit upright ---OBSERVECheck VD multiple
timesCheck the interarch distance & look for any implants
encroaching(mainly the distal most implants)Place the upper
occlusal rim.
Points to remember
.Place 2 points of reference.Instruct the patient to wipe his
lips with his tongue, to swallow and to drop his shoulders rest
position.Measure - repeat and take average
Speech 2 methods:
1st method : Ask the patient to repeatedly pronounce the letter
M, a certain number of times. Distance is measured immediately
after the patient stops.
2nd method: keep talking to the patient and measure the distance
immediately after the patient stops talking
Phonetics and esthetics.
The dentist asks the pt to speak certain words and then makes
certain observations of the relationship of the occlusion rims to
each other and to the lips.
Using msound: The pt repeats the letter m. When the lip just
touches ask the patient to hold the jaws still. The distance
between tip of the nose and chin is measured (VDR).The occlusion
rims are adjusted and again measured. The second measurement should
be 2-4mm less than the first measurement(VDO)
The ch,s,and j sounds: There should be 1mm space between the
occlusion rims in the anterior area at correct VDO.Using 33 : When
repeating this word there should be enough space for the tip of the
tongue to protrude between the anterior teeth.Using f or v sounds:
The max incisors/occlusion rims should lightly contact the lower
lip at the vermillion border when pt pronounces these words.
SILVERMANS CLOSEST SPEAKING SPACE The 2mm space between the
incisors at correct VDO when pt pronounces words containing S
eg.
ESTHETICS
In normal relaxed position the lips are even anteroposteriorly
and in slight contact. If the face appears strained the vertical
height may be more. If the corners of the mouth droop, making the
chin appear too close to the nose, then vertical dimension may be
too less.
FRAMEWORK TRY-IN
FRAMEWORK TRY-INTray SetupVernier caliperOcclusal sprayLab
micromotor and bursAirotor handpiece with metal cutting
burArticulating papers(8,200)Millers forcepsCadbite/ wax sheet
Light bodyAlginate impressionShade guide.
Problems we face during framework try-in?
1.Improper fitting.2.Rocking of framework
Improper fitting can be because of 1. improper pressure
delivered during impression 2.edges of implant may have chipped off
in the cast
Why rocking? 1.Oversized implants 2.Oversized coping 3.The lab
person may have increased the spacer thickness.
For full arch prosthesis keep the framework in mouth and keep
the fingers on both side molars & check for rocking on either
side,also check mesiodistally.If rocking,use the occlusal spray on
the framework,dry the abutment and repeat the rocking test.
Check for marking on the implantsWhich implant has the marking?
Which aspect(edges/side/top)?Check the framework under bright
light.A fine line/an area of 2-3mm may be scratched off on the
framework trim that area.Try the framework again after air spray,if
no fresh markings, spray tha occlusal spray again and if markings
present trim
If fitting is ok; check the gingival part 1.Blanching
2.framework far from abutment,may be because of shrinkage of tissue
after extraction.Look for the midline .any errors mark the midline
on the framework.
Stabilize the upper and lower frameworks with lightbody.Check
the VD.Smile lineOcclusal plane,Incisal exposureMax-mandibular arch
relation.Canine guidance.Speech.Record the bite at VDO.If required
a new impression can be taken.
Shade selection ,Record photosDiscuss with the patient about the
size and shape of his/her teeth,whether to replicate the previous
teeth size & shape.Send the records along with the preop photos
to the lab.
For further details log on to http://www.drmurugavel.in/
http://www.acdeimplants.org/ For enquiry mail us at
[email protected] [email protected] us at +91-
9171515077 044- 43856017
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