2010 QDT (Quintessence of Dental Technology)

 

 

QDT 2010년 모음판입니다. 매 해 이 책이 나올 때 마다 관심있게 사보고 있습니다. 기공이라는 것이 정말 'Technology'라고 늘 느끼게 해주는 책입니다. 특히 올해에는 제가 관심있어하는 무치악환자의 High-strength ceramics and component prosthesis design에 대한 내용이 있어서 좀 더 자세히 그 내용을 review해 볼까 합니다.

 

사진과 원서 느낌을 그대로 전해드리기 위해서 따로 해석하지는 않겠습니다.

 

 

A 59-year-old male presented to the clinic with maxillary and mandibular edentulism and inability to wear conventional proshtetics. A panoramic radiograph revealed an edentulous atrophic maxilla with pneumatized posterior segments and an edentulous mandible with a limited amount of supracanal bone height in the posterior areas.

 

 

Diagnostic casts mounted to display interarch distance. Matrix of diagnostic tooth arrangement to determine available distance for proposed mandibular prosthesis design.

 

 

Radiographic templates with gutta-percha markers for use in creating CT radiographic scans. Proposed surgical sites in the maxilla and mandible.

 

 

Maxillary and mandibular placement guides for implants. Note the initial construction phase to attach the implant replica to the mandibular surgical stent.

 

 

Fabication of master casts, provisional restorations, and an interocclusal registration index to properly position each template during surgery.

 

 

Anchorage of the maxillary sugical template with anchor pins. Interocclusal registration used for implant placement.

 

 

Mandibular implants placed and anchor pins removed. Mandibular conversion prosthesis.

 

Transitional prostheses after implant placement with a mandibular fixed conversion proshesis and maxillary overdenture prosthesis.

 

 

Maxillary and mandibular master casts allow fabrication of verification indices for implant impression transfer.

 

 

Fabrication of verification index with pattern resin on the first master cast. Sectioned units luted together intraorally with additional pattern resin. Polyvinyl siloxane pickup impression of verification index to ensure an accurate master cast.

 

 

Centric relation recording. Trial tooth arrangement after inspection for correct esthetics and phonetics.

 

 

Trial tooth arrangements recorded with siloxane matrices.

 

 

Temporary titanium abutments with wax projections to preserve access to abutment screws.

 

 

Silicone matrix containing injected white-colored resin. Pattern resin after removal of matrices. Both resin casts in centric relation. Mandibular resin cast adaptation with soft tissue simulation removed.

 

 

Resin cast cut back in relation to the silicone matrix. Duplicate of the resin cast after cutback.

 

 

Provisional restorations made form polymethyl methacrylate. Fitting of the mandibular provisional restorations in relation to the opposing occlusal anatomy.

 

 

Depth grooves placed in gingival areas to guide establishment of sufficient dimension for gingival restorative material. Finish lines created for lamination of gingival porcelain.

 

 

Y-TZP framework after redefinition of finish lines and resintering.

 

 

Creation of custom abutments using pattern resin in relation to trial tooth arrangement matrix. Common path of draw between pattern resin abutment.

 

 

 

Tooth probe scanning of the pattern resin to create custom abutment. Zirconia abutments placed on master cast, illustrating common path of draw.

 

 

Duplication of abutments with wax relief to a master cast. Pattern resin abutments on dupulicated cast. Verification of fit to abutment master cast.

 

 

 Cutback of pattern resin in relation to trial tooth arrangement. Further cutback of gingival areas to form gingival ceramic lamination. Dupulication of pattern resin for creation of working cast to fabricate provisional restoration.

 

 

Provisional restorations on cast and verified on the pattern resin.

 

 

Copy-milled Y-TZP zirconia framework returned from the manufacturer. Provisional restorations used to relate the frameworks on the articulator.

 

 

Guide for creating lamination of gingival procelain.

 

 

Lamination of gingival porcelain after firing cycles.

 

 

 

 

Inspection of provisional restorations attached for frameworks to verify centric relation and occlusion.

 

 

Zirconia copings used to fabricate individual restorations. Copings seated on maxillary and mandibular frameworks.

 

 

Full-contoured wax-up over copings in anticipation of pressed fluorapatite glass-based ceramic veneer.

 

 

 

Partial cutback of wax-up to illustrate available space for ceramic.

 

 

Try-in of the pressed restorations on the zirconia framework and adaptation to the surrounding gingival procelain.

 

 

  

 

 

 

 

Staining an glazing fo the restorations and readaptation to the supporting framework.

 

 

 

 

 

 

 

 

 

Finished restorations in maximum intercuspation.

 

 

 

Static and dynamic occlusal relationships of prostheses on the articulator.

 

 

Components of maxillary and mandibular prostheses prior to assembly.

 

 

Hydrofluoric acid etching of gingival ceramic. Phosphoric acid cleaning of zirconia surfaces.

 

 

Cementaion of pontics in the laboratory. Securing abutment screws with torque application.

 

 

Light-cured urethane dimethacrylate placement fig on master cast. Transfering of abutment to mouth with placement jig and securing with torque applicatoin. Computer-aided design/computer-assisted manufacture-generated zirconia abutments ready for sequential luting.

 

 

Intaglio an occlusal surfaces of the maxillary restoration prior to sequential luting.

 

 

Zirconia custom abutment with anodized titanium insert. The abutment in bonded to the prosthesis with the sequential luting technique while the insert facilitates positioning and remains detachable.

 

 

Intaglio surface after sequential luting of all abutments.

 

 

 

 

 

Final results.