Clinical Group

Journal of Dental Problems and Solutions

ISSN: 2394-8418 DOI CC By

Gregor-Georg Zafiropoulos1*,
Evangelos Sotiropoulos2, Tae Ho Case Report
Yoon3 and Moosa Abuzayda3
The use of a customized mounting guide
1
Private practice limited in Periodontology,
Duesseldorf, Germany
2
Senior Dental Technician, Dental Laboratory, College
for Implant-Prosthetic Restoration of
of Dental Medicine, MBRU, Dubai
3
Associate Professor, Dept. of Prosthodontics, the Fully Edentulous Arch
College of Dental Medicine, MBRU, Dubai

Dates: Received: 09 June, 2017; Accepted: 11 July,

2017; Published: 12 July, 2017
Abstract
*Corresponding author: Gregor-Georg Zafiropoulos,
Reconstruction of fully edentulous arches with implant-retained dentures requires thorough planning
Luegallee 70, 40545 Duesseldorf, Germany, E-mail:
and precise registration of the interocclusal relationship, to achieve a successful treatment outcome.
This technical report describes three representative approaches from a cohort of 89 fully edentulous
Keywords: Dental implants; Dentures; Mounting arches in 69 patients who were treated with the described mounting guide technique. A technique of
guide; Implant prosthodontic using a duplicated denture as a guide is described, which allows for the accurate transfer of the occlusal
relationship and vertical dimensions, while facilitating the full-arch restoration process with implant-
https://www.peertechz.com
retained fixed or removable dentures and reducing the number of required in-oce sessions.

Introduction denture were taken with an alginate material (Alginat-

rosa; Omnident, Rodgau, Germany). Interim dentures were
The reconstruction of the fully edentulous arch with fabricated, and were inserted on the day of extraction to
implant-retained dentures requires thorough planning that
it should provide the correct vertical height and the maxilla-
mandibular relationship (MMR), while being esthetically
acceptable [1,2]. This process of restoration would represent a
major challenge for the clinicians [3].

The aim of this report was to describe an uncomplicated

as well as accurate technique to obtain MMR transfer, occlusal
relationship, and maintain (or keeping) initial esthetics. By
this way, it enables the production of a full denture initially
that can serve as a template for reconstruction of the final fixed
or removable implant-retained full-arch restoration.

Cases
Between January 2001 and December 2014, a total of 89
fully edentulous arches (54 maxillae and 35 mandibles) of 69
patients (37 females and 32 males; mean age: 56.6 9.2 years,
age range: 3875 years) were treated in the private office by
one of the authors with the technique described herein (Figure
1). All patients who had been referred for multiple tooth
extractions due to advanced periodontal disease and implant
treatment were nonsmokers and in good general health. Three
representative cases were selected for detailed presentation
here. The surgical procedures are not described in the present
report.
Figure 1: Characteristics (% distribution) of the 89 rehabilitated arches n 69
patients. 1A: %-Distribution of the prosthetic rehabilitation arts; 1B: %- Distribution
Diagnostic impressions for the fabrication of an interim
of the used surgical procedures.
054

Citation: Zafiropoulos GG, Sotiropoulos E, Yoon TH, Abuzayda M (2017) The use of a customized mounting guide for Implant-Prosthetic Restoration of the Fully
Edentulous Arch. J Dent Probl Solut 4(3): 054-057. DOI: http://doi.org/10.17352/2394-8418.000049
restore the esthetics and function. Implants were placed eleven thick, AGC Galvanogold; Wieland) [2,6-8], as well as a metal
(11) months after teeth extractions and bone regeneration or framework and a t-FD (as above described) were fabricated as
lateral augmentation in accordance with a two-stage protocol. above described. The customized abutments served as primary
Implants were uncovered and loaded four months later [4,5]. telescopes, and the AGCs as secondary telescopes (Figure 5
All definitive impressions for definitive casts fabrication were B-D).
made using a polyether material (Impregum Penta Soft; 3M
ESPE, Neuss, Germany) with an open-tray technique. Surgical The abutments were transferred, positioned on the
techniques are not described in this report. implants, torqued to 35 Ncm using a resin transfer key (Pattern
Resin, GC, Alsip, IL, USA), and were not removed this point
Case 1 (Fixed case) forward, to avoid any possible inaccuracies. The AGCs were
placed on the implant abutments and the framework was
For the reconstruction and rehabilitation of the maxilla, six
placed over the AGCs (Figure 6). A definitive impression with
screw-cylinder and two provisional implants (for provisional
a polyether impression material was taken (Impregum Penta
denture stabilization) were placed (Figure 2). During the
Soft; 3M ESPE, Neuss, Germany) with AGCs and framework in
healing period, the patients denture was adjusted to manage
place and used for the fabrication of a new master cast. After
complications, and the function and esthetics of the denture
the impression, the t-FD was fixed on the abutments using
was optimized by relining it as is needed (Figure 3A). After
then, the adjusted denture was duplicated (DentDu) using clear
resin (Paladur, Heraeus, Hanau, Germany) and fitted after
implants uncovering (Figure 3B).

System specific ball attachments (BATT) with their

retention elements were mounted on selected three implants.
Access windows were created on the buccal side of the DentDu
in the areas of the BATT and the retention elements fixed to
the DentDu using modeling resin (Pattern Resin; GC, Alsip, IL,
USA). Occlusal records were taken in centric occlusion (Figure
3C). Definitive impression is taken and BATT were positioned
on the implant analogs of the master cast. Subsequently, the Figure 2: Case 1. Orthopantomograph after implant placement.
DentDu was retained on the master cast and articulated under
the guidance of the DentDu and occlusal records (Figure 3D).
The framework of the final restoration (fixed denture, FD) was
fabricated by milling CrCo alloy type 3 (ZENOTEC NP, Wieland).
Additionally, a provisional FD (t-FD) from colored poly-methyl
methacrylate (PMMA; Zenotec; Wieland, Pforzheim, Germany)
was milled.

One week later, two temporary implants were removed and

the abutments were mounted on the implants, torqued to 35
Ncm and were not removed thereafter to avoid introducing
any inaccuracies. The framework was tried-in and another
definitive impression was taken with the metal framework
in place to fabrication of a new master cast. Meanwhile the
t-FD was fixed on the abutments with temporary cement
(TempBond; Kerr, CA, USA; Figure 4A). The metal framework
was veneered with metal bond porcelain (Vintage MP; Shofu,
San Marcos, CA, USA) and replaced t-FD that it was fixed on Figure 3: Case 1. A: interim denture in situ, B: fitting of the DentDu, C: DentDu
the abutments with provisional cement (ImpProv; Alvelogro retained on ball attachments in occlusion, D: Articulated master cast using the
Inc., Snoqualmie, WA, USA; Figure 4B). ball attachments and the DentDu.

Case 2 (Double crowns, removable)

A removable denture using double crowns (telescopic

crowns) was planned to restore the forms and esthetics in
case of severe resorptions in the maxilla (horizontal atrophy
= 1.4 cm; distance from the incisal edge of the mandibular
anterior teeth to the edge of the maxillary alveolar ridge = 1.6
cm; Figure 5A). All clinical records and laboratory steps were
performed as described for case 1. Aditionally to the customized
Figure 4: Case 1. A: Implant retained temporary restoration, B: Final restoration in
abutments, electroformed gold copings (AGCs; 0.25-mm-
situ - left view.
055

Citation: Zafiropoulos GG, Sotiropoulos E, Yoon TH, Abuzayda M (2017) The use of a customized mounting guide for Implant-Prosthetic Restoration of the Fully
Edentulous Arch. J Dent Probl Solut 4(3): 054-057. DOI: http://doi.org/10.17352/2394-8418.000049
temporary cement (TempBond, Kerr, Orange, CA), and it was
left in place until the delivery of the final restoration (Figure 7).

The new master cast was articulated with the help of the
AGCs and of the framework. The veneering of the framework
was made using a light-cured indirect ceramic polymer
(Ceramage, Shofu, Menlo Park, CA). The AGCs were fixed in the
framework using a self-curing compomer cement (AGC Cem,
Wieland, Pforzheim, Germany) (Figure 8).
Figure 7: Case 2. Temporary restoration in situ.
Case 3 (Bar, retained removable)

The presented mandible had been treated with by a

removable denture using two implants (#22 and 27) six years
before and showed an advanced peri-implantitis. A bar-
retained removable denture was planned, and it was mounted
on four implants after surgery. All clinical and laboratory steps
were performed as described above, except that gold copings
were not used (Figure 9A). The bar was milled of CrCo alloy
type 3 (ZENOTEC NP; Wieland) and a metal base housing was
Figure 8: Case 2. A: Final restoration in situ. Right view, B: palatal view.
constructed (Figure 9B). Elastic plastic clips were used to
retaining the base over the bar (Preci Matrice, CEKA, Waregem,
Belgium; Figure 9C). During the next clinical session, the bar
was definitively mounted on the implants and was not removed
after anymore. The metal housing with wax rim was fitted in for
occlusal record and esthetic try in later on. Subsequently, the
denture was finished with an auto-polymerizing acrylic resin
base (PalaXpress Ultra; Heraeus Kulzer, Hanau, Germany) and
delivered to the patient same day (Figure 9D).

Figure 9: Case 3. A: articulation of the DentDu using ball attachments, B: bar in situ,
C: denture in site: use of clips for retention on the bar, D: final restorations in situ.

Discussion
The purpose of the present report was to describe a new and
easy technique with reproducible results and not to compare
different techniques. Three cases were presented to treat with
different types of restorations. This method can be used for
rehabilitation of one arch or both arches simultaneously.
Figure 5: Case 2. A: Articulated master cast, B: customized abutments, C: AGCs,
D: framework. The DentDu is an effective method to be used to obtain
the occlusal records, to guide the mounting process, and to
record and transfer the MMR. This technique allows faster
process by reducing (or eliminating) certain clinical steps.
It is recommended that the DentDu be produced at the end
of the healing period after all denture adjustments and its
improvements have been made.

Three to four BATT are necessary to attain optimal

stabilization of the DentDu without any wobble. Placing open
windows on the buccal side of the DentDu not only provides
Figure 6: Case 2. A: mounted abutments, B: positioned AGCs. good access, but also allows visual checking during treatment.

056

Citation: Zafiropoulos GG, Sotiropoulos E, Yoon TH, Abuzayda M (2017) The use of a customized mounting guide for Implant-Prosthetic Restoration of the Fully
Edentulous Arch. J Dent Probl Solut 4(3): 054-057. DOI: http://doi.org/10.17352/2394-8418.000049
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Copyright: 2017 Zafiropoulos GG, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits
unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

057

Citation: Zafiropoulos GG, Sotiropoulos E, Yoon TH, Abuzayda M (2017) The use of a customized mounting guide for Implant-Prosthetic Restoration of the Fully
Edentulous Arch. J Dent Probl Solut 4(3): 054-057. DOI: http://doi.org/10.17352/2394-8418.000049