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Revax
Retained Resilient Hybrid Prosthesis
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A bar supported removable
prosthesis that is bar and abutment supported in the anterior region, and
tissue supported in the posterior region. |
Benefits:
- Controlled abutment loading. Tripodization
provides function stability and eliminates prosthesis tipping or tilting
- Excellent prosthesis retention and stability
- Bar provides for abutment splinting
- Provides for open palate
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Indications |
| When a limited number of implants are
present in either the mandible or maxilla, the tissue supported overdenture
is a preferred prosthetic option to protect the implant abutments. |
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Prosthetic Concept |
| The goal of the prosthetic design is to
accomplish excellent esthetics, phonetics, and stabilization of the
prosthesis as well as to
ensure optimum conditions for oral hygiene and patient comfort.
The hybrid concept is to separate prosthesis support,
lateral stabilization, and retention. Each of these aspects may be altered
according to the individual situation without influencing the other aspects.
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| Support |
| Support is derived from three elevated
areas: on the midline and on the extensions of a bar that primarily splints
the implants. The distal support elevations are positioned in the axis of rotation of the resilient hybrid prosthesis. |
| Lateral Stabilization |
| Lateral Stability is achieved by
incorporating a cast frame into the removable prosthesis that closely fits
the bar in a passive state. |
| Retention |
| Retention is derived from 2 or 4 Ceka
Revax attachments with adjustable, serviceable retention without affecting
support or stability. |
The
Resilient Hybrid Prosthesis
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1. The concept is equally
applicable in the maxilla and mandible. The resilient hybrid
prosthesis may be considered with 2 or more abutments.
2. Implant length and diameter,
abutment length, and bone quality information is necessary information for
the prosthetic team to plan and design the loading, retention, and possible
axis of rotation for each individual patient.
3. Use a labial index of the
esthetic wax-up to visualize the tooth position in regard to the implant
position. The implants should be splinted rigidly with a conical or
tapered cast bar.
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4. The 8º
tapered Plasti-Wax bar is ideal, due to the conical sides for ease of
insertion and friction-free removal of the suprastructure. It may be
further shaped with carving instruments by hand, or by a milling machine or
wax milling burs (available
from Preat Corporation).
5. The 8º
tapered Plasti-Wax bar is specially designed for ease and speed of wax-up.
Bend and adapt in warm water. Cool in cold water and attach
(stress-free) with wax to gold or plastic cylinders.
6. The implants should be
connected rigidly with the 8º tapered bar.
The bar should be placed directly underneath the occlusal table of the tooth
setup for occlusal loading. Straight connections might create
unnatural contours to the hybrid prosthesis.
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| 7. Especially in an atrophied
maxilla, fixtures may be located palatal to the bar configuration.
Reduce the bar from the labial aspect and in the proximal areas of the
implants for good hygiene access. This reduction is preferably done
after casting. |
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8.
The support for the prosthesis is provided by 3 elevated (0.3mm) areas on
the bar construction: one on the midline, and two distal support areas.
Only these areas will make contact with the prosthesis. |
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| 9.
To provide posterior tissue support and implant protection from overloading,
the location of the distal elevated support zones is very important.
They will be the main loading area on the bar when load is
applied on the tissue born saddles. |
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10. The distal support zones may
be placed to control the implant loading:
- A) close to the long axis of fixtures
- B) between fixtures of equal stability
(length, width, bone quality)
- C) or closer to the stronger
implant
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| 11. The line connecting the two
distal elevated support zones is the axis of rotation of the
prosthesis and is recommended parallel to the condylar axis. Implant
length, width, location, and opposing dentition may alter the locations
illustrated in Figs 8-9-10. This
allows the prosthesis to rotate about the distal elevations and be tissue
supported in the posterior. It also eliminates destructive
cantelevered loads to the implants. |
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12. The distal support zones
should be placed at equal vertical distance from the occlusal plane.
This is determined with the labial index. |
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13. The retentive attachment of
the hybrid prosthesis should be placed in the premolar region, the
masticatory center where retention is needed most.
14. Select the appropriate
female keepers that best fit the ridge anatomy.
30º, 45º,
and 60º keepers are included in each
attachment kit.
15. Use the REP7 paralleling
mandrel to position the Revax female keepers parallel to each other and the
previously determined path of insertion. To allow free resilient
movement of the prosthesis, the females are positioned distal to the
axis of rotation. |
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16.
Cast the bar construction in a hard alloy. Do not polish the bar at this stage. The
titanium females are bonded in with Ceka Site after the try in. |
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17. The free resilient movement between the
male and female attachment will allow for compression and support from the
mucosa in the base extension regions. The prosthesis will rotate around the
planned axis of rotation without exerting leverage on the bar or implants. |
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18. Posterior lift off (forces away from the
ridge) is prevented by the adjustable direct retention of the Revax
attachments and the additional indirect retention of the median support
area. |
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19. The longer the distance between the Ceka
Revax attachment and the median support area, the more effective the
indirect retention. |
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20. Prepare the model for duplication.
Block out all undercuts and relieve (0.3mm) all occlusal surfaces of the bar
except for the support zones.
Do NOT relieve the inclined surfaces of the bar. |
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Select the desired method of
retaining the Revax male in the prosthesis. Refer to the instructions
for:
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Prosthetic
Concept of Rigid Construction
Laboratory Instructions for a Revax
Resilient Retained
Hybrid Bar
T0027.REV.00
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