The Award contest 2017/ 6 February 2017/

Case 3 | The Award 2017 | Slovenia

Dr./DT Killa Khan

Patient came to me treatment planed for a regular fixed removable plan – #22-#29 fixed and rest removable with a cast base.

ALL CLINICAL CASES

He had a large mandibular torus that the previous dentist referred to an OS for removal. At the time of removal the OS convinced the patient that an implant in the location of #19 would be a real improvement for his prosthesis without consulting with me. So he came back without the torus and with an Ankylos implant. Before the first picture was taken #22 was extracted and #21 was equipped with a FRC post and core. The first plan was to do the exact same thing as was planed from the start but with a locator added to the removable part. We have done that before when the patient did not want to replace the fixed part but wanted to improve the retention of the lower denture, but in this case we wanted to do something better. After a couple of talks with my lab tech we decided upon a fixed telescopic part with a removable overdenture with additional retention elements. The patient did not decide to replace the uppers to this date.

Preop – my only treatment before that was the FRC post on 33 (not thrilled with the ferrule though)

46 is an appendix bridge from 43-45.

Wax up for the provisional.

Old bridgework removed and chairside provisional cemented.

Provisionals in two pieces.

Primary impression for the primary telescopic crowns.

Rough primary crowns and an abuttment for the pickup impression. We usually do these cases in high noble gold, but in this case it would be too expensive. Would add at least a 1000€ in gold alone for the primary and secondary telescopes. That’s why we added additional retention elements that can be replaced if need be.

Try in. Open individual tray for the pickup impression.

Pickup impression. Note the error in the impression – a lot of impregum under the 33 crown. That impression was redone.

Bite registration step.

Polished and parallel crowns and abutment.

Framework tryin.

Additional retention elements visible in the mirrored image.

Tryin.

Ready for cementation. The primary copings were seated with the help of the guide, most excess cement removed and then the overdenture was seated before the cement set completely.