Fabrication of Milled Zirconia Screw-Retained Fixed Maxillary and Mandibular

Complete Dentures: Clinical and Laboratory Procedures

Baldwin W. Marchack, DDS, Shoko Sato, DDS, Tomikazu Tada, RDT,MDC
UNIVERSITY OF SOUTHERN CALIFORNIA SCHOOL OF DENTISTRY; SHOWA UNIVERSITY SCHOOL OF DENTISTRY.

Clinical Report
Some patients who are fully edentulous prefer fixed instead of removable
prostheses. Current choices for full arch frameworks for implant-supported fixed
prostheses are conventional cast metal, CADCAM milled titanium and
CADCAM milled zirconia. This clinical report describes the steps involved in the
fabrication of implant-supported milled zirconia fixed complete dentures for a
patient with both a fully edentulous maxilla and a fully edentulous mandible.

Summary

Resin patterns are scanned and milled zirconia frameworks are fabricated

The screw access channels are sealed with composite resin, rendering them easily
retrievable without destroying the prostheses. There are no concerns with
subgingival cement retention since they are screw retained. Use of gingival
colored porcelain avoids multiple surgical grafting procedures. The posterior
occlusion is first developed in group function, then the cuspids are designed for
immediate disclusion. Should wear occur on the cuspids the group function will
already have been prepared. In summary, a procedure for screw-retained implantsupported full dentures has been described.

Try-in of milled zirconia frameworks, changes marked, and centric relation

registration confirmed
Maxillary Implants

Initial Radiographs

Bisque bake try-in. Occlusion is finalized. Access for cleaning is confirmed

Mandibular Implants

Maxillary and mandibular resin patterns duplicating existing

removable full dentures

Completed prostheses attached with new abutment screws torqued to

35Ncm. Screw access channels are sealed with composite resin.
Radiographs to confirm fit of the milled zirconia frameworks

Tooth display and lip position upon spontaneous smiling

Maxillary and mandibular resin patterns completed to full contour

Resin patterns cut back to create space for veneering porcelain

Wax is applied directly to the zirconia frameworks as a mock-up.

Patient appproval is obtained.

The wax-up is duplicated, and models are fabricated as a guide for the
ceramist. Wax is removed & zirconia steam cleaned.

REFERENCES
1. Vagkopoulou T, Koutayas SO, Koidis P, Strub JR. Zirconia in dentistry:
Part 1. Discovering the nature of an upcoming bioceramic. Eur J
Esthet Dent. 2009 Summer;4(2):130-51.
2. Dunn DB. The use of a zirconia custom implant-supported fixed partial
denture prosthesis to treat implant failure in the anterior maxilla. J
Prosthet Dent. 2009; 100: 415421"
3. Sadan A, Blatz MB, Lang B. Clinical considerations for densely
sintered alumina and zirconia restorations: Part 1. Int J Periodontics
Restorative Dent 2005; 25:213 - 9