AMSJI for total maxillary reconstruction in case of ... · AMSJI for total maxillary reconstruction in case of extreme atrophy ... - radiopaque base plate ... lingual and occlusal

AMSJI for total maxillary reconstruction in case of extreme atrophy

2 AMSJIs with robotic milled positive connectors

Double structure in a cleft maxilla

Hybrid bridge with separated gum and dental arch

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Dental part 1 Choice between removable double structure or screw-fixed hybrid bridge, depending on the bone height/intercrestal space, phonetics and lip contour. Manufacturing of a wax trial with the following requirements:: - dental stone (type III) for upper and lower model

- radiopaque base plate (eg Selexion LC tray plate – light-cured) is recommended (better segmentation of gums)

- Confection tooth arrangement with color, shape and occlusion as desired by practitioner and patient. Wax of the wax-trial is of the type that does not flow at body temperature ("wax rim bite rim") - choice between Locator or CM Loc or Dalbo X (4 our sufficient) when a double structure overdenture is chosen All info (wax trial and models) is given to the patient for the surgeon.

Surgical Part 1 Impression of the occluding teeth with hard plastic standard tray or Alfa Triple Tray. The impression material is alginate or silicone (eg AlgiNot, Kerr Dental). Impression of the wax-trial in the mouth with alginate in a plastic standard tray or Alfa Triple tray. The wax-trial is removed from the impression. The buccal, lingual and occlusal surfaces of the teeth in the wax-trial are brushed with radiopaque silicone varnish (X-resin flow, Bredent).

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Manufacture or have manufactured, a CT or CBCT of the maxillo-facial complex with the wax-trial (+ radiopaquer) in situ. The scan includes the lower dental arch, the upper dental arch, the upper jaw to the infra-orbital rim. Dorsally, the TMJ is included within the field. The scanning is done in CO/MI. High resolution CT scan of the impressions (impression of the wax-trial without radiopaquer and of the occluding dental arch) or of the models manufactured thereof; or an optical scan of the impressions or models. CADskills Segmentation of the CT or CBCT - jawbone - gingiva - varnish Superimposition of the occluding dental arch Design of subperiosteal implants Design of suprastructure Print of the implants and suprastructure (for hybrid bridge or overdenture) For a hybrid bridge a provisional bar is made. A 3D print of the denture fits over it.

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The primary structure of a double structure overdenture is provisionally fitted with a 3D print denture. De secondary structure is printed along and given to the dentist to have the permanent denture fabricated.

3D print of a temporary denture in MFH C&B van Nexdent.

Manufacturing of an SLA skull model as an occludator (optional, when a temporary prosthesis in the dental laboratory is manufactured in an analogous way). The skull will cost € 1,000. It works perfectly without. Producing a 3D printed model of the upper jaw, to verify the fit of the AMSJIs. Surgical Part 2 General or local anesthesia Subperiosteal flap preparation (crestal incision 1 mm caudal to the mucogingival border, relaxation incisions in the gingiva at the height of the connectors) Left and right fitting of the AMSJIs

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Connection to the primary structure (hexagon screwdriver 0.5 "- 1.26 mm for Straumann Cross-fit screws) Fitting of the prosthesis on the primary structure and in occlusion Screw fixation of the AMSJi with 2.3 mm Surgi-Tec screws (length of the screw can be indicated) Adjustments can at two levels: between AMSJI and the bone surface; between the denture and the suprastructure. Multi Link Hybrid Abutment forms a UV-cured hard adhesion. CoeSoft is preferred (reduced load on the implants for 2 months, adjustment for gum contour is possible - phonetics). Coepack wound dressing (optional) Dental lab Alternatively, for the temporary prosthesis, instead of Nextdent 3D print dental arch. Making the prosthesis in the SLA model - Reducing the base where interferences with secondary structure - Connecting the secondary structure with the dental arch Dental part 2 hybrid bridge The final prosthesis may be manufactured 2 months later, on the basis of the final suprastructure. This prosthesis can be made in a conventional manner. The titanium suprastructure can also be ordered by the dentist in a second session on the basis of an impression with impression-copings, or already ordered in the surgical session by the surgeon, and then produced on the basis of the virtual design.

double structure In an overdenture the dentist should already specify at the beginning how retention will be created (Locators, Dalbo). The double structure is printed right away. It cannot be manufactured in a second phase.

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(Recommended workflow by M. Mommaerts, MD, DMD, PhD, FEBOMS)