A sideways approach

The next step in this case (see The Dentist, October 2010, page 104), with the lower was to produce a milled Coron chrome cobalt alloy structure using the Etkon scanner system (scanned by George Morgan of the Axom dental laboratory). See fig 8. Two lateral holes were prepared and tapped in the region of the first premolar through the milled framework and into the cast bar. The milled framework was prepared to accept ‘Ceramage’ teeth and gingiva as with the upper. Both structures were tried in the mouth to confirm fit, appearance and occlusal scheme prior to final finishing in the lab. A balanced occlusal scheme was produced to allow even spread of the occlusal forces, keeping the lower first molar teeth out of occlusion due to the length of the distal cantilevers (figs 9, 10, 11, 12 and 13). The angulation of the screw holes is critical in order that access is favourable for the placement of the tiny screws. The driver for these screws does not have a taper to grip the screw so a small piece of orthodontic wax was used to hold the two together. The driver was also modified to fit the end of a watch-makers screwdriver to ease handling when fitting. Due to the patient’s exciting gag reflex, a ‘safety net’ could not be used and so the above made the procedure much safer on fitting the bridges and saved my nurse’s nerves somewhat (and mine).