CLINICAL

IMPRESSIONS:

• Place transfer copings on posts- screw down to seat with lower fastener nut.
• Block out with wax under fastener nut.
• Take a full arch impression with polyether or PVS impression material.
• Send impression to lab for pour up with all the prosthetic parts provided by the surgeon.
• Dr. can leave the transfer coping in the mouth as a comfort cap for patient; lab will use their set for pour up.

LABORATORY

BAR FABRICATION

• The lab will fabricate the gold bar according to protocol, laser weld, solder, and harden.
• Lab will also fabricate a temporary bar with stainless steel copings, soldered stainless
  wire and acrylic.
• Normal turn-around time: 1½ days.

CLINICAL

BAR VERIFICATION:

• Doctor will verify the fit of the bar by using one lock nut and going from one post to another verifying fit at each post.
• If the bar fits correctly, leave gold bar in place for 90 days.
• Should the gold bar not fit well, determine where the problem is and cut the bar close to the coping with the thinnest disk available.
• Lute all the parts together with Duralay or GC resin and return to the lab.
• At this point, the temporary bar will not fit so cut the temp bar in the center of the acrylic, reposition in the mouth, then lute together with Duralay or GC resin to keep posts in correct position.
• After the gold bar is returned from the lab, insert and let patient wear until denture fabrication.

CLINICAL

PROSTHETIC PROCEDURES:

• Prior to impression appointment construct a custom tray to fit over the gold bar and to capture all areas including the retro-molar pads.
• Block out all areas under the bar with wax or putty, load tray with polyether of PVS impression material, and take a complete impression of lower arch.
• Remove tray, verify quality of impressions and send to the lab with the gold bar, analogs and gold clip material for pour up and construction of the clear base.

OPTIONAL IMPRESSION METHOD:

• A custom tray can be made with an incisal window for removal of the lock nuts before removing the impression, thereby, eliminating the need for blockout under the bar.
• If a new upper denture is going to be done also, send a final model for a bite rim.

LABORATORY

CLEAR BASE FABRICATION:

• After fabrication of model, the clips are cut to size placed on the gold bar, and a clear base is made incorporating the clips. A bite rim is then attached to this base.
• The clear base is the final base for the lower denture and once the fit of the base and clips are verified in the mouth with a radiograph, this fit doesn't change.
• The clear base is returned to the doctor with an upper bite rim for centric relation bite.

CLINICAL

CENTRIC RELATION:

• The gold bar is seated, the lower base is seated, and normal procedures for upper and lower denture construction are performed with the bite rims for centric relation bite.
• Return all parts, models, and bites to the lab for denture setup.
• Other necessary items to return: tooth mold, shade and study model of old denture, etc.

LABORATORY

DENTURE SETUP:

• Proper placement of teeth will be done following Bosker protocol.
• Lower posterior teeth not be more than 10mm distal to distal copings (usually 1 bicuspid and 1 molar), lingualized occlusion with anteriors not touching in centric relation.
• The tissue surface of the clear base will not been relieved at this point.
• Case is returned to doctor for esthetics and bite verification.

CLINICAL

CENTRIC AND ESTHETIC VERIFICATION

• Gold bar is inserted, denture setups placed, and esthetics and bite are carefully checked.
• Any modifications necessary are noted and case returned to lab for reset or processing.

LABORATORY

DENTURE PROCESSING:

• Set-ups are checked before processing; lower will be processed on a duplicate model and returned on the master model with gold bar.
• After processing, the tissue surface on the lower is relieved 1-2 mm in all areas except the retromolar pad areas.
• The denture must contact only the five clips and the retromolar pads.
• Case is returned to the doctor's office for seating.

For more information, please visit Bosker TMI's Web site!

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