Clinical Report Summary

REFERENCES

Some patients who are fully edentulous prefer fixed instead of removable prostheses. Current choices for full arch frameworks for implant-supported fixed

prostheses are conventional cast metal, CADCAM milled titanium and CADCAM milled zirconia. This clinical report describes the steps involved in the

fabrication of implant-supported milled zirconia fixed complete dentures for a patient with both a fully edentulous maxilla and a fully edentulous mandible.

1. Vagkopoulou T, Koutayas SO, Koidis P, Strub JR. Zirconia in dentistry: Part 1. Discovering the nature of an upcoming bioceramic. Eur J Esthet Dent. 2009 Summer;4(2):130-51.

2. Dunn DB. The use of a zirconia custom implant-supported fixed partial denture prosthesis to treat implant failure in the anterior maxilla. J Prosthet Dent. 2009; 100: 415421"

3. Sadan A, Blatz MB, Lang B. Clinical considerations for densely sintered alumina and zirconia restorations: Part 1. Int J Periodontics Restorative Dent 2005; 25:213 - 9

Fabrication of Milled Zirconia Screw-Retained Fixed Maxillary and Mandibular Complete Dentures: Clinical and Laboratory Procedures

Baldwin W. Marchack, DDS, Shoko Sato, DDS, Tomikazu Tada, RDT,MDC UNIVERSITY OF SOUTHERN CALIFORNIA SCHOOL OF DENTISTRY; SHOWA UNIVERSITY SCHOOL OF DENTISTRY.

The screw access channels are sealed with composite resin, rendering them easily retrievable without destroying the prostheses. There are no concerns with

subgingival cement retention since they are screw retained. Use of gingival colored porcelain avoids multiple surgical grafting procedures. The posterior

occlusion is first developed in group function, then the cuspids are designed for immediate disclusion. Should wear occur on the cuspids the group function will already have been prepared. In summary, a procedure for screw-retained implant-

supported full dentures has been described.

Initial Radiographs Maxillary Implants Mandibular Implants

Maxillary and mandibular resin patterns duplicating existing removable full dentures

Resin patterns cut back to create space for veneering porcelain

Maxillary and mandibular resin patterns completed to full contour

Resin patterns are scanned and milled zirconia frameworks are fabricated

Try-in of milled zirconia frameworks, changes marked, and centric relation registration confirmed

Radiographs to confirm fit of the milled zirconia frameworks

Wax is applied directly to the zirconia frameworks as a mock-up. Patient appproval is obtained.

The wax-up is duplicated, and models are fabricated as a guide for the ceramist. Wax is removed & zirconia steam cleaned.

Bisque bake try-in. Occlusion is finalized. Access for cleaning is confirmed

Completed prostheses attached with new abutment screws torqued to 35Ncm. Screw access channels are sealed with composite resin.

Tooth display and lip position upon spontaneous smiling