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Inside Dental Technology
March 2016
Volume 7, Issue 3
Peer-Reviewed
Fig 1. Professor Arnold Gaerny's concept involved paralleling fixed and removable milled work to avoid open interdental spaces.

Figure 1

Fig 2. From left, a patient presents with open interdental spaces and plaque accumulation, Gaerny's parallel milled solution closes off the interdental spaces, and Gaerny's CIS solution 13 years in situ.

Figure 2

Fig 3. A patient presents with five maxillary implants to which custom abutments are attached, supporting a cement-retained bridge, and two recently placed posterior implants that are not yet connected.

Figure 3

Fig 4 through Fig 8. Casts of the implant abutments, bridge in place, implant-level verified cast, and opposing cast.

Figure 4

Fig 4 through Fig 8. Casts of the implant abutments, bridge in place, implant-level verified cast, and opposing cast.

Figure 5

Fig 4 through Fig 8. Casts of the implant abutments, bridge in place, implant-level verified cast, and opposing cast.

Figure 6

Fig 4 through Fig 8. Casts of the implant abutments, bridge in place, implant-level verified cast, and opposing cast.

Figure 7

Fig 4 through Fig 8. Casts of the implant abutments, bridge in place, implant-level verified cast, and opposing cast.

Figure 8

Fig 9. An in-depth edentulous cast analysis reveals a large discrepancy between the tooth positions of the porcelain bridge and the proposed tooth positions.

Figure 9

Fig 10. Patient photos show a lack of any buccal corridor.

Figure 10

Fig 11. A cast transfer is made accurately and quickly by mounting the existing cast of the maxillary bridge against the antagonist cast and creating a silicone putty index.

Figure 11

Fig 12. The index is used to cross-mount the verified implant-level maxillary cast to the antagonist cast using the hard palate as a solid reference.

Figure 12

Fig 13 and Fig 14. A bilaterally screw-retained try-in with teeth in wax is performed at the second patient appointment, completely avoiding centric and vertical recording.

Figure 13

Fig 13 and Fig 14. A bilaterally screw-retained try-in with teeth in wax is performed at the second patient appointment, completely avoiding centric and vertical recording.

Figure 14

Fig 15 and Fig 16. A natural smile is restored, and natural-looking surface texture returns to the patient's smile.

Figure 15

Fig 15 and Fig 16. A natural smile is restored, and natural-looking surface texture returns to the patient's smile.

Figure 16

Fig 17. A double scan is carried out to enable design of the primary telescopic abutments within the volume of the approved tooth positions.

Figure 17

Fig 18 and Fig 19. The abutments are milled in zirconia, sintered, and hand-milled with a high-speed water turbine and a series of five progressive diamond milling burs down to 4 microns so that no microfracturing takes place.

Figure 18

Fig 18 and Fig 19. The abutments are milled in zirconia, sintered, and hand-milled with a high-speed water turbine and a series of five progressive diamond milling burs down to 4 microns so that no microfracturing takes place.

Figure 19

Fig 20. Once the Galvano process is completed, the electroformed abutments or dies are removed from the Galvano unit and separated.

Figure 20

Fig 21. The remaining silver lacquer residue is removed with 40% nitric acid solution under ultrasonic waves.

Figure 21

Fig 22. The secondary Galvano telescopes are refined and fit to the primary zirconia telescopic abutments.

Figure 22

Fig 23. A tertiary substructure is digitally designed within the volume of the approved prosthesis volume, which is checked in wax.

Figure 23

Fig 24. The selective laser melting process is completed, providing a very accurate tertiary structure with a perfect cement gap.

Figure 24

Fig 25 and Fig 26. The tertiary structure can be cemented on the verified cast or intraorally to the gold secondary copings.

Figure 25

Fig 25 and Fig 26. The tertiary structure can be cemented on the verified cast or intraorally to the gold secondary copings.

Figure 26

Fig 27. Utilizing disposable syringes in order to place the differing colors of acrylic exactly where desired.

Figure 27

Fig 28. The patient experiences a vast improvement in esthetics, comfort, and cleansability.

Figure 28

Fig 29. The acrylic only replaces the detention and structures that were lost.

Figure 29

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