How to Build a Fixed Ceramic-Acrylic Hybrid Bridge

Andrea Hegedus, CDT · Technical · Sep 2011

Andrea Hegedus, Owner of Great Lakes Smile Design Studio in Muskegon, MI, received international recognition at the IDS show in Cologne, Germany in March, winning second prize for Best Digital Documentation in Candulor's 9th KunstZahnWerk (the Art of Prosthetics) Competition. Candulor has been holding this biennial competition since 2001 and this year was the first time U.S. technicians were invited to participate. Hegedus also plans to participate in the company's first-ever North American competition in 2012; see Denture Technicians: Show Off Your Skills! to the left for more details.

Contestants received a competition kit, including Professor Gerber's technique guide to setting teeth, PhysioStar teeth, stone models, grading guidelines, patient history with photos and a description of the restorative challenge. The patient had been suffering with an ill-fitting denture and the treatment plan called for four mandibular implants with a fixed or removable hybrid prosthetic and fully customized maxillary denture with balanced occlusion and set to the patient's facial and smile line specifications. In addition to the prosthesis, participants had to submit written and photographic documentation of the case to demonstrate the reasoning behind their chosen technique and design.

Here, Hegedus offers a step-by-step look at the ceramic-acrylic hybrid bridge she fabricated for the competition.

© 2013 LMT Communications, Inc. · Articles may not be reprinted without the permission of LMT

Step-By-Step

  • Step 1 Models with the plaster wall were provided and I mounted them to a semi-adjustable Candulor Articulator and made Splash Putty Guides (from Discus Dental) that helped maintain the patient’s smile line and muscular facial parameters throughout the fabrication.

  • Step 2 I used the Gerber technique to establish proper occlusion with the PhysioStar teeth. I decided to make a fixed ceramic-acrylic hybrid bridge with no ridge lap on the multi-unit mandibular implants. I used a high noble, white gold ceramic alloy for optimal biocompatibility and to give the underbody of the bridge a hygienic, non-porous ceramic surface for long-term results.

    I opted for a ceramic hybrid bridge because it’s easier to maintain long term. The new light-cured gingival composites blend and bond beautifully to both the hard-packed, heat-cured denture acrylic and ceramic underbody, giving the dentist a cost-effective, easy way to repair or replace chipped denture teeth chairside. Plus, the patient won’t have to go without his teeth if a repair is needed.

  • Step 3 Using the Splash Putty Guides made from the wax setup, I created the internal cast framework using pattern resin and Camlog UCLA implant abutments.

  • Step 4 I reset the mandibular teeth over the ceramic cast framework with proper buccal support following the Splash Putty Guide.

  • Step 5 This is the customized full waxup with ceramic gingival body on the mandibular hybrid bridge. Next, I flasked the wax setup, boiled it out and hard packed it with heat-cured acrylic.

  • Step 6 I divested the prosthesis, adjusted the occlusion and customized the final denture base. Using Candulor’s Aesthetic Color Kit with cold-cure acrylic modifiers, I applied natural colors to the soft tissue. Next, I polished the prosthesis to a high luster to seal the pores of the acrylic base. To achieve healthy, natural-looking gingiva, I studied the texture and color patterns of gingiva from my collection of before-and-after ceramic veneer photos.

  • Step 7 I adjusted the final prosthesis for the prescribed working and balancing occlusal function.

  • Step 8 I mounted the final prosthetic on my Candulor Semi-Adjustable Articulator for final photos and presentation.

  • Step 9 For my digital documentation of the case, I selected the photos demonstrating each fabrication step and used Apple’s Keynote application to create the presentation.

    The competition was extremely challenging, knowing each fabrication step was going to be graded for quality and that I had to provide excellent, high-resolution, untouched photos for credibility. It was by far the most detailed learning experience I’ve ever had. The playing field quickly evened out because of the multiple steps you need to successfully complete; even the most experienced technician can make a catastrophic mistake. The ultimate heart and soul of the experience was to keep going even when I thought I had failed, because the final step was understanding my own potential to cross the finish line. The competition was a great way to push new ideas in a safe environment and to see all the fantastic results from other technicians around the world.

  • Andrea Hegedus, CDT, is the owner of Great Lakes Smile Design Studio, in Muskegon, MI. With 25 years of experience, she completed a B.S. with Honors in Prosthodontics from Ferris State University in 1990; is a memberå of the AACD, Francis B. Vedder Study Club, NADL and MACDL; and actively participates in the AACåD’s Give Back A Smile program for domestic abuse victims. She can be reached at Andrea@glsmiledesign.com, www.glsmiledesignstudio.com and via the Great Lakes Smile Design Studio page on Facebook.

About the Author
Andrea Hegedus, CDT

Lab Owner

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