1. ANTOANELA GARBACEA, DDS, MSD
USE OF DIGITAL DENTURES IN IMMEDIATE OCCLUSAL FUNCTIONAL LOADING OF DENTAL IMPLATS
ANTOANELA GARBACEA, DDS, MSD

2. Outline DIGITAL DENTURES VS. CONVENTIONAL COMPLETE DENTURES
GUIDED SURGERY FOR IMPLANT PLACEMENT
IMMEDIATE LOADING AND DENTURE CONVERSION USING CAD/CAM MILLED DENTURES
Outline

3. Outline 1. INTRODUCTION 2. TECHNIQUE DESCRIPTION
3. PATIENT TREATMENT SEQUENCE
4. ADVANTAGES
5. CONCLUSIONS

4. Immediate Loading Consensus
Immediate/early loading of dental implants: A report from the Sociedad Espanola de Implantes World Congress consensus meeting in Barcelona, Spain, Aparicio C, Rangert B, Sennerby L.
Clin Implant Dent Relat Res. 2003;5(1):57-60.
The First Consensus Conference on IL made a distinction between “immediate occlusal (functional) loading,” and “immediate provisionalization” or “immediate nonocclusal (nonfunctional) loading.”

5. immediate
‘non-occluding’ loading
Immediate ‘occlusal’ loading

6. Acrylic provisional restorations comprising any sort of metal reinforcement
Tarnow et al. 1997; Horiuchi et al. 2000; Chow et al. 2001; Ganeles et al ; Grunder 2001; Malo´ et al. 2003a, 2003b; Nikellis et al ; Testori et al. 2004; Degidi et al.2006a, 2006b

7. 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

8. Technique Description
Goodacre et al 2011, 2012

9. 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 .

10. Technique Description
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.

11. Technique Description
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.
Transfer the coordinates of the implant planning software to AvaDent software and overlay the denture geometry with the implant placement guide. 
Calculate the extent of the posterior cantilever based on AP spread.

12. Treatment Sequence

13. Existing Complete Dentures

14. Poly (vinyl siloxane) casts made by pressing putty into existing dentures

15. Immerse AvaDent tray in 160° F water
Press softened tray onto PVS cast

16. Border molding with areas of tray showing through the impression material, indicating they need to be relieved before making wash impression

17. Final maxillary and mandibular impressions

18. 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.

19. The maxillary lip support can be adjusted using the anterior hex screw

20. Three different sizes of clear plastic overlays are available to help identify the best size of the teeth

21. Adhesive and registration material applied
to maxillary and mandibular AMD
Completion of a gothic arch tracing

22. An Occlusal Plane Orientation Ruler is Provided To Align The Occlusal Plane With The Interpupillary Line

23. Use the ruler to seat the maxillary AMD so it is aligned with the interpupillary line

24. The mandible is moved so the brass pin engages the dimple and holds that position while the registration material is expressed between the AMDs

25. Superimposing the laser scan of the AMD on the scan of the complete arch impression
Laser scanning of the AMD impression

26. Locating the Borders
Setting the teeth and forming the bases

27. Denture base morphology established
Virtual tooth arrangement

30. ATI (Advanced Try-In) Wax Trial Denture

36. Nobel Clinician: virtual planning of the diameters and lengths of the implants and stabilizing pins the to be placed in the mandible.

37. 35º thread shape
Double lead threads
Tapered
TiUnite surface

38. Fabrication of the Nobel Clinician surgical guide.

39. Laboratory steps in fabrication of the mandibular cast

43. The digital denture conversion as mandibular implant provisional screw- retained prosthesis.

45. Prototype converted denture for immediate loading

46. Advantages

47. 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 .

48. 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

49. Conclusions

50. Thank you