Dr.
Mahmoud Rabie
Assistant Professor of Prosthodontics
Faculty of Dentistry
Qassim University
General laboratory procedures in implant
dentistry:
Describing fabrication of radiographic template.
Describe fabrication of surgical guide.
Describe fabrication of master cast with
embedded implant analogue, gingival index and
removable die.
Describe fabrication of attachments in implant
overdenture.
Radiographic Guides
Radiographic Guide
• The radiographic template is a sort of prosthesis used to assist treatment
planning by estimating the fixture position.
• The radiographic template should contain a radiographic marker (i.e;
having radio-opaque characteristics).
• This markers could be in the form of metallic balls or rods of known
diameters or by metallic rings or may paint the clear template using
radio-opaque paste.
• Some companies provide customers by clear sheet template with pre-
drawn fixtures to estimate their size.
Used for partially edentulous
Used for completely edentulous
Clear template
Radiographic Guide
• There are several configurations depending on the type of implant
prosthesis that is planned.
• These balls could added by sticky wax before radiographing or embedded
during dough stage of the template.
• In partially edentulous situations the radiographic guide is constructed
over mounted casts with diagnostic setup.
• These templates are processed in clear acrylic which will be carried over
the incisal edges of the remaining teeth.
• These templates could be converted later on to be used as a surgical guide.
Surgical Guides
Surgical Guides
• Surgical guides are templates that transfer information
regarding tooth position to the surgeon prior to implant
placement.
• After the treatment plan has been determined, surgical guides
may be made from diagnostic casts, wax patterns and/or
preexisting prostheses.
• Surgical guides may be fabricated from vacuum/heat-formed
plastics or from chemically, light or heat cured acrylic resin.
Chemically-cured clear template Transparent vacuum-formed template
Light cured resin
surgical guide
Surgical guide
• Surgical guide in not useful for determining the proper positioning and orientation of
the fixture during surgery but also used as a reference for fixture position in second
stage surgery when delayed loading protocol is intended.
• There are a lot of technique used to prepare surgical guides according the edentulous
situation and position.
• Surgical guide not only support the functional aspect determining the proper fixture
position but also for a successful esthetic aspects.
• In order to get a real parallelism between sleeves and later on fixtures dental surveyor
may be used.
Drill positions according to radiographic data Dowel pins and plastic sleeves are
placed on the lubricated cast.
material is adapted to a six millimeter height around plastic sleeves and to the occlusal surface of
posterior teeth.
Drilling
followed by
pins with
plastic
sleeves
added
Posterior
surgical
guide
with
teeth
support
is
finished
and
polished
The use of surveyor to get parallelism
Fully edentulous guide stent with maximum opening apparatus
Mounted Occlusal blocks
casts and after addition
stent in whether by light or
place chemical curing
Using patient denture after duplication
Computer Generated Guides
• This type of guides is based on using the virtual 3D model constructed from images of CT scans
of the dental arches.
• The models constructed by special softwares that provide a lot of tools used for planning
interactively and determining the precise position and dimensions of the needed dental implants.
• These guides could be tooth, bone or mucosa-supported.
Computer Generated Guides
• These guides could be constructed by special devices (3D printers)
that have the ability to transfer 3D data of the guide from computer
to a physical part in your hand.
• To prepare such type of surgical guides you need to prepare radio-
opaque radiographic guide prepared from duplicate of the waxed
up or the denture of the patient.
• The radiographic guide is duplicated by the conventional method
but using radio-opaque resin (clear resin mixed with barium
sulphate 15%).
Software
plateform
Virtual surgical guide
Physical Physical
model of model of
the digital
mandible Surgical
guide
Master model preparation with
implant analogue
Master
model :
•laboratory guide pin •fixation screw
•impression coping •Abutment
Transfer coping
•implant fixture
•fixture replica
Implant analogue
The prosthetic kit implant analogue, transfer coping and coping pins if
include found these components differ according to the
system used and technique applied.
•impression coping
Transfer coping
Laboratory guide pin
Transfer coping
Transfer/analogue assembly
Implant analogue
Master model
• The prosthetic kit include implant analogue, transfer coping and coping pins if
found these components differ according to the system used and technique applied.
• After impression is made whatever the technique used, the negative replica of the
abutment holding the transfer coping or the transfer cap is inspected.
• The implant analogue is screwed or attached to transfer coping inside the
impression.
Master model
• The gingival mask is shaped by injecting silicone around the
implant analogue neck and wait until setting.
gingival mask
Fabrication of Master Cast (Implant Analogs)
After the impression material polymerized, the impression
coping screws were unscrewed with the large posterior hex driver,
and the impression was removed. The pick up implant
impression copings remained inside the impression .
Implant lab analogs were selected, attached to the
apical surfaces of the pick-up implant impression
copings, and screwed into place from the occlusal
aspect of the impression tray
• The gingival mask
Because the implant restorative platforms were sub-gingival, the
peri-implant soft tissues around the implant lab analogs in the
master cast were made with a resilient material. In this case, a
separator was placed around the impression copings/implant
analogs prior to injecting polyvinyl siloxane impression material in
and around the implant analog/impression coping connections .
Care was taken not to allow any of the impression material into the
inter-proximal contact areas. The impression was now ready to be
poured in Type IV dental stone to fabricate the master cast
Laboratory Work Order for
Fabrication of a Verification
Index
1.After the master cast has been made,
remove the impression copings from the
impression.
2.Place the impression copings back onto
the implant lab analogs in the master cast.
Make sure that you visualize metal-to-
metal contact between all of the
impression copings and the implant
analogs.
• 3.Mix RelateAcrylicResin and place
theres in around each of the impression
copings, making sure to engage the
undercuts of the impression copings.
• 4.Allow the resin to polymerize
overnight.
• 5.Section the verification index into
individual segments with a fine separating
disc.
• 6.Return the master cast and verification
index for tryin
Using a verification index
can ensure that these
positional and spatial
relationships have been
recorded in the impression
and transferred to the
master cast
Laboratory Procedures For Implant
Overdenture
IMPLANT OVERDENTURE
• Overdenture is an economic replacement for hybrid
prosthesis when quantity of bone resorption and hygienic
status of the patient interfere with this line of treatment.
• Overdenture require mesostructure in the form of attachment
element to add retention to the selected design.
• These attachment may be in the form of bar, ball (stud) or
locator.
Ball attachment Restoration
Female portion
(housing)
Male portion ( ball )
Bar overdenture restoration
Bars may be pre-formed metal bar that are soldered to
the copings covering the abutment teeth or it may be in
form of plastic bars which are attached to the waxed up
copings to be cast in metal.
Seat the matrix on the working cast
to verify clearance between the Design the framework pattern
modified screws and the suspended
prosthetic teeth
Adjust the fixation screws to the desired height, then adjust the plastic sheeths
The length of acceptable distal
cantilevers is 1.5 times the distance Support the distal ends of the
between the most anterior and the cantilevers with wax.
most posterior abutments, as
measured along the midline
Reinforce the framework Sprue the framework pattern
pattern with inlay wax
Cast the framework in
nobel metal The polished bar
Attach retentive clips, then block out the Fabricate a triad baseplate over the
remaining exposed bar with soft material blocked out bar, engaging the clips
Process the retentive clips in the triad Retentive clips in place after boil-out
baseplate
Sky implant system
3D-BarAbutment
THANK YOU
