Fifth Clinical Appointment

Mandibular Framework Try-in
The healing caps are removed and the mandibular milled framework (Figure 15) is evaluated intraorally. The milled framework should passively seat on all the implants. One screw test is performed to verify the passivity of the framework. The distal-most screw is tightened completely first and a radiograph of the contralateral side is taken to ascertain that the framework is completely seated on the abutments on that side. A misfit indicates that the cast is inaccurate. In this instance, a new impression must be made and all the steps must be repeated from the impression making step. Hence, the cast verification step is critical to the success of the definitive prosthesis.

Figure 15.
Photo showing the milled mandibular framework placed on the cast.
Milled mandibular framework.

The maxillary framework, maxillary cast with locator attachment assembly, wax trial dentures, and mandibular cast with milled titanium framework are sent to the laboratory for processing the maxillary implant-supported overdenture and fabricating the fixed screw-retained mandibular complete denture (Figure 16). If another wax try-in procedure with the frameworks is required, the laboratory should be instructed accordingly. The laboratory should be provided with detailed instructions for prostheses fabrication.

Figure 16.
Photo showing the maxillary implant-supported overdenture and fabricating the fixed screw-retained mandibular complete denture.
Definitive Prostheses.