Implant superstructures
Implants can basically be used in the same manner as natural teeth for supporting all types of dental restorations (single crowns, bridges, fixed-removable restorations, overdentures). A respective restoration is called a superstructure. It can be designed as removable, fixed/removable or only fixed.
Full upper and lower dentures (fitting surface with ball sockets)
Ball attachment
A superstructure can be purely implant-supported or supported both on teeth and implants. Particularly with bridges the term used is hybrid or tooth/implant-borne.
Implant-borne metal-ceramic crowns
Cemented superstructures are differentiated between provisional (temporary), definitive (permanent) and semi-permanent cementation. The latter should enable secure retention and at the same time removal of the superstructure by the dentist, if necessary. This is referred to as an operator-removable (i.e. fixed for the patient) superstructure and also includes screw-retained superstructures.
Both types of retention have advantages and disadvantages:
Screw retention creates gaps, which can be colonised by bacteria. To prevent this special gels, intended to remain effective in the long-term, are supplied for applying in the interior of the implant. If superstructures are screw-retained, they can also fail due to loosening, overloading or fracturing.
As implants are not self-mobile and are anchored rigidly in the alveolar bone the aim is always to ensure a passive fit of the superstructure. With screw-retained superstructures the passive fit can be checked on a minimum of two abutments using the Sheffield test (gap-free fit when tightening any individual screw). Procedures for intraoral bonding (such as adhesive bonding) of components of the superstructure and/or digital fabrication (e.g. milling, sintering) are used to fabricate stress-free frameworks.
To avoid inaccessible excess cement, which could result in peri-implantitis and implant failure, the restoration margin of cemented superstructures should always terminate in the region of the gingival margin. This allows fabrication of implant platforms mainly at bone level with corresponding (if necessary, custom-fabricated) abutments.
Abutments are used as a connection between implants and superstructure. Angled abutments enable parallelisation to produce a common path of insertion with superstructures on several abutments. Abutments can either copy the form of a tooth preparation or include a component of a connector (e.g. press-stud systems, ball abutment, bars, magnets). In these cases the superstructure incorporates the respective complementary components.
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piston release | Kolbenentriegelung |
Wax build-up technique Wax build-up technique The various anatomical structures (such as cusp tips and slopes as well as marginal ridges) are usually built up one after another by adding small portions of wax (often using differently coloured waxes for didactic purposes). The firm, special waxes first have to be melted at room temperature. This can be carried out by warming small portions on differently shaped working tips of hand instruments in an open flame (such as a gas burner) or using electrically heated instruments which provide for more accurate temperature control and avoid contamination (e.g. electric wax-knife, induction heaters, wax dipping units). The wax is applied drop-by-drop to ensure that the warmer molten wax added last fuses seamlessly with the firm, cooler material. After hardening, the wax pattern can be reduced by sculpting, milling guidance surfaces or drilling to add retainers. Modern procedures include flexible, occlusal preforms for adding contours to soft wax. In addition, wax preforms, such as for occlusal surfaces or bridge pontics, are available in various shapes and sizes. Recently, irreversible, light-curing materials have been introduced for use instead of reversible thermoplastic waxes. Wax preforms To ensure that the wax pattern can be released without being damaged, model surfaces, opposing dentition and preparations must be hardened/sealed with special lacquer (applied by spraying, brushing or dipping). These waxes are mostly relatively rigid/elastic after cooling. Attaching wax sprues to a removable framework supported on double crowns using a hand instrument When employing the lost wax technique, prefabricated wax sprues, bars and reservoirs are attached to the patterns. Once the pattern has been released and its sprues waxed onto the crucible former, it is invested in a casting ring with refractory investment material. The wax can then be burnt out residue-free and casting completed. Unlike standard wax build-up techniques, a diagnostic wax-up is not intended for fabricating an indirect restoration, but rather for simulating the appearance and/or external contouring for producing orientation templates. |