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Revax
Retained Rigid Hybrid Prosthesis
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A bar supported removable
prosthesis (bridge) that is resilient or totally abutment supported
(rigid). |
Benefits:
- A patient removable bridge
- Provides for proper lip support and contours
- Bar provides for abutment splinting
- Tripodization provides for controlled implant
loading and prosthesis stability
- Provides for open palate
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Indications |
| When an adequate number of well integrated
implants are present in an arch, a traditional fixed bridge is the
prosthetic modality of choice. Often this is not an option in the
maxilla, due to combined vertical and horizontal resorption, quality of
bone, and position and/or flare of the implants. In this instance, a
traditional fixed bridge would not meet patient requirements for hygiene
maintenance, esthetics, phonetics, and comfort. The viable alternative
is the rigid supported Revax bar removable prosthesis. |
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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 support, lateral
stabilization, and retention. Each of these aspects may be altered
according to the individual situation without influencing the other aspects. |
| Support |
| Support is derived from three elevated
areas: on the midline and on the distal of a bar that primarily splints the
implants. |
| 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 Rigid
Hybrid Prosthesis
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25. A fixed bridge is the
preferred option when an adequate number of integrated implants are
available. The position of the implants and the horizontal resorption
of the maxilla often eliminate this option due to esthetic, phonetic, or
hygiene problems.
26. A rigid hybrid prosthesis is
often the best option in the maxilla providing esthetics, hygiene,
phonetics, serviceability, and comfort. This option is best suited to
opposing dentition which approximates the spread or position of the
implants.
27. With a labial index of the
esthetic set-up and try-in, the 8º tapered bar
is attached to the implant abutments as outlined in
steps 3-7 of the
resilient hybrid prosthesis instructions. The
amount of distal extension of the bar is determined by the number of
implants, implant length, width, and bone quality.
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28
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28.
The midline and two distal support elevations
are selected and elevated approximately 0.3mm. When possible, the
distal elevated support zones should oppose the most distal opposing
dentition. |
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29. The widening of the elevated median
support area will create a more laterally stable prosthesis. |
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30
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30.
Preferably 4 Ceka Revax attachments are incorporated in the bar. The
attachments should be placed as symmetrically as possible and by preference
in the premolar region. The initial retentive force may be reduced with the Ceka retention
adjustment tool. |
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31
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31. With the rigid hybrid prosthesis,
the space maintainer is used between the attachment male and female to position the
attachment resilient. The prosthesis will be rigid, but the
resilient attachment positioning is important for future servicing and/or
conversions. |
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32 |
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| 32. Proceed with the finish of
the prosthesis as outlined in
Figs 16-20 of the resilient
hybrid instructions. Even
without opposing dentition in the molar region, it is recommended to provide
acrylic resin coverage for the tuberosities and set up first molars for
esthetics and phonetics. |
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33.
Apply Ceka Bond to a mixing pad, and dip the threads of the male spring pin
into the adhesive and thread
it into the retention part. Ceka Bond will prevent the male spring pin
from loosening in the mouth. |
Conversion from Rigid to Resilient
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34 |
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35 |
| 34. If circumstances develop that make it
undesirable to load a distal implant(s), or one or more implants are lost,
this rigid prosthesis can be converted into a resilient prosthesis.
This procedure can be done together with a reline (Fig 37-39). |
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35.
Unscrew the bar. Apply a small amount of solder to the occlusal
surface of the bar (see Figs 8-9-10-11) to create new distal support zones.
Reduce the new support zones until 5 contact areas are present. Use
the implant analogues to hold the bar while checking fit.
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36 |
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| 36.
Now remove the distal support zones. Maintain only the male spring
pins distal to the new axis of rotation. Unused females may be filled
with composite. Replace the titanium females if overheated during
soldering. Ceka Site may be destroyed when overheated. |
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Relining
37. The relining technique for these types of hybrid
prostheses is very simple and accurate. Block out all undercuts, take
reline impression while pressing with the fingers within the triangle of the
support zones. |
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| 38.
Assemble the space maintainer and female dummy with the spring pin in the
prosthesis. Block out the complete bar section in the framework.
Pour the working
model. |
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39. Proceed with relining
procedure using the space maintainer at all times. |
Case Illustration of Revax Retained
Hybrid Bar
Prosthetic Concept of Resilient Construction
T0028.REV.00
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