How we converted an InLink full mouth immediate load case to definitive bridges in ONE (not so simple) step!

Lab. Process

This case was unusual and important to get right and time was not on our side! Jon felt it necessary to attend the patient appointment at DrBK’s to get as much information as he could along with doing as many verification checks that he could during this one and only visit allowing the work to be done start to finish without any further appointments. I’m sure this way of working would make most technicians extremely nervous, to say the least!

The first thing to do was a bite registration, visual horizontal guide reference, measure OVD, incisal tip, and tooth show reference along with tooth and gum shades and photos for characteristics and documentation. We also took upper and lower alginates of the current temps in situ. Jon, Bob, and the patient discussed her likes/dislikes and what was possible, what to keep the same and/or what to improve on.

With this in mind the bridges were removed, copies made, open tray impressions taken, cast up, verification bars manufactured and checked in the mouth for model accuracy all during this one appointment. Fortunately, everything was fine, the temps replaced and the patient sends away until the definitive restorations were ready for fit.

Jon brought everything back to the lab to start the work. The copy dentures were retrofitted to the master casts, squash bite fitted and the case articulated on the SAM articulator so that the requested increase in OVD could be accommodated without affecting the overjet and bite guidance. Some tidying up of the copy dentures was done along with minor alterations before the Simeda Web Order was filled, the models and prosthetics boxed and collected for delivery to Simeda’s milling centre in Luxembourg.

Why Anthogyr InLink and Simeda Milling

Anthogyr’s InLink flat to flat tissue level connection was the perfect solution for this challenging case. With many systems, where a conical abutment is used, a path of insertion for the bridge would not be possible but by using the ingenious InLink connection this potential issue was easily and effectively overcome while still allowing the technician to place the screw channels in the most aesthetic position, some of these were placed to be in the gingiva with others coming out of the bar underneath the thimble crowns.

Simeda’s design team are all dental technicians so when it comes to framework designs they really understand what we’re looking for from the different types of supra structure we need. In this case, we decided to use, in the lower arch, a milled titanium bar with acrylic wrap. On the upper arch, we chose to design a chrome-cobalt bar for full contour zirconia thimble crowns and to support custom gingival composite layering.

On full mouth cases we always try to encourage the patient to have this combination of zirconia opposed by acrylic with the understanding that the lower bridge will be sacrificial and should a tooth be lost from the upper bridge the lab can be contacted, a new crown can be milled, coloured, sintered, characterised, glazed and despatched within twenty-four hours of notification to arrive ready for the surgeon to cement without, at this point, even having seen the patient take impressions or remove the bridge. Taking things like this into account it is no wonder that, although more expensive, this type of thimble bridge is becoming the preferred all on four restorations and with reliability, longevity and aesthetic results like this it really should not be a surprise. Obviously, there is no ‘perfect solution’ but in our observations this way forward seems to be giving us the best outcomes.

Our patient was “over the moon” and praised the treatment that she had received from the clinical and technical team. She has found new confidence and smiles “like I used to“ without putting a hand over her mouth. She doesn’t need to think about the food she eats now as there is no discomfort when she incises of chews food and was so very grateful that it could all be done in two appointments!

Clinical outcome

Fitting of the bridges was simple as the lab had used two InLink locating pins in each bar, they had also permanently bonded all the crowns that didn’t hide the access holes meaning that fixing of the other four crowns was simple as they were clearly marked and the composite notched for future removal when the bridge needed to be removed for periodic health checks, the gingival holes were filled with slightly lighter composite so these sites can also be easily uncovered. A slight space was left between the bridges and gingiva to allow for easy daily cleaning by the patient with SupaFloss.

These following photos evidence the aesthetics of the case. In the patient’s mouth all of the hard work had obviously paid off and the patient herself was delighted. The tooth library, size, and shade that was chosen harmonised with her facial features and general complexion. The tooth show and position was perfect, the increased occlusal vertical dimension allowed the lower jaw to drop slightly giving her a more youthful appearance this also changed the way in which she smiles by improving the movement and position of the oral commissures to now show a more natural buccal corridor of the new bridges which now stop her cheeks falling into the filled space.

Patient reaction

Our patient was “over the moon” and praised the treatment that she had received from the clinical and technical team. She has found new confidence and smiles “like I used to“ without putting a hand over her mouth. She doesn’t need to think about the food she eats now as there is no discomfort when she incises of chews food and was so very grateful that it could all be done in two appointments!

This case was exceptional and not the way CDL normally works and I understand that we were fortunate to get such good results. This, however, wasn’t by luck but through experience that the laboratory and technical team have gained through working closely on a daily basis with some of the best surgeons and Prosthodontists in the U.K.

Ceramic Designs Laboratory (Anthogyr Campus Training Centre U.K.)

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Winners of Best Dental Laboratory Award

Dec 20, 2022

We are proud to be winners in the category of Best Dental Laboratory at this year's Dentistry Awards. It is a great honour, and we thank everyone who has been a part of our journey. Thank you also to FMC and dentistry.co.uk for a great event! Jon Dolding, CDL...