TOPICS OF IN TEREST

Evaluation of Interarch Space for Im plant

Restorations in Edentulous Patients: A
Laboratory Technique
NicolasF. AbuJamra, DDS, MS,1 MinosM. Stavridakis, DDS, MS,2
and R. BruceMiller, DDS, MS3

This article describes a laboratory procedure for the visual evaluation of interarch space and its
effect on implant prosthesis design. The method is applicable to patients presenting w ith
completely edentulous arches. Silicone impression material is used to form a resilient cast and an
external mold from an existing denture. The denture is duplicated using autopolymerizing acrylic
resin. The duplicate denture and resilient cast are mounted on an articulator. Spatial relationships
of anatomic landmarks can be evaluated, and a quantitative evaluation of available space can be
made. The duplicate denture can also be used as a surgical template to direct implant placement.
Reference tables are provided to serve as guidelines in the correlation betw een available space and
minimum space required for various implant-assisted restorations.
J Prosthod 2000;9:102-106. Copyright r 2000 by The American College of Prosthodontists.

INDEX WORDS: duplicate denture, surgical template, diagnostic aids

T HE USE OF implants in the treatment of

edentulism has quickly become part of most
prosthodontic practices.1 The reliability, predictabil-
ity, and performance of this treatment modality have
played significant roles in encouraging patients and
practitioners to use implants. As a result, clinicians
are faced with the need to effectively and efficiently
restore osseointegrated implants. Careful consider-
ation and deliberate planning become the keys to
realizing optimal function and esthetics in implant
therapy.
The planning phase of implant therapy includes
several critical steps. First, the practitioner must
understand the patient’s desires and expectations.
Second, the practitioner must carefully evaluate the
anatomic limitations of the patient. In addition, the
type of restoration to be used and the spatial arrange-
From theOhioStateUniversity Collegeof Dentistry, Columbus, OH.
1
Privatepractice, Green Bay, WI .
2
Resident, University of Switzerland, Geneva, Switzerland.
3
Assistant Professor, Department of RestorativeDentistry, Prosthodontics
and Endodontics.
Accepted March 28, 2000.
Presented at theannual meeting of theAmerican Collegeof Prosthodon-
tists, Orlando, FL, November 1997.
Correspondence to: Nicolas F. AbuJamra, DDS, MS, 704 South
Webster Avenue, Green Bay, WI 54301. E-mail: PN417@aol.com
Copyright r 2000 by TheAmerican Collegeof Prosthodontists
1059-941X/00/0902-0009$5.00/0
doi:10.1053/jpro.2000.9106
ment of the patient’s skeletal components must be
examined.2 A diagnostic mounting is of paramount
importance for the visualization and evaluation of
these relationships.
The primary purpose of this article is to describe a
laboratory technique that allows for a quick and
comprehensive survey of available interarch space
when at least one arch is edentulous. This technique
also facilitates the process of surgical template fabri-
cation. Secondarily, general guidelines regarding in-
terarch space requirements for various types of
implant restorations are delineated.
Technique
Diagnostic mounting and tooth arrangement procedures
for edentulous patients often require multiple appoint-
ments. When a dental patient presents with an adequately
restored edentulous arch, a more efficient procedure may
be applied. This process can be accomplished in a single
visit, and includes duplication of the patient’s prosthesis
and transfer onto an articulator. Duplicate dentures also
may be used as surgical templates.
The process described in this article can be divided into
3 phases: first, duplicating the patient’s denture (steps 1 to
9); second, obtaining transfer records (steps 10 and 11);
and finally, evaluating the mounting (steps 12 and 13).
1. Evaluate the patient’s existing denture(s). When proper
occlusal vertical dimension, stable tissue adaptation,
and acceptable esthetics are present, proceed to Step 2.
Otherwise, diagnostic impressions should be made,

102 Journal of Prosthodontics, Vol 9, No2 ( June), 2000: pp 102-105

 June2000, Volume9, Number 2 103

Figure 1. Putty cast of edentulous ridge. Figure 3. Wax sprues and orienting notches.

maxillo-mandibular jawrecords generated, and a defin-

3. Before encasing the denture and resilient cast for
itive tooth arrangement completed. Once these proce-
duplication, place wax sprues extending from the distal
dures have been accomplished, proceed to Step 2.
surface of the denture. These sprues permit resin
2. Mix polyvinyl siloxane putty(Lab-Putty; Coltene, Whale-
introduction and minimize air entrapment when dupli-
dent Inc, Mahwah, NJ), and place into the denture’s
cating the denture (Fig 3).5
intaglio. This will produce a resilient cast of individual
4. Cut index grooves into the putty cast to permit orienta-
arches (Fig 1).3,4 The puttycast can be directlymounted
tion of subsequent mold sections.
on the articulator if a mounting plate (Denar; Tele-
5. Apply a lubricant (petroleum jelly) to the putty cast.
dyne Water Pik, Fort Collins, CO) is used to place
6. Place a layer of putty onto the exposed denture surface
undercuts into the base while the putty is setting (Fig
(or cameo surfaces) to produce a mold of the prosthesis
2). Once the putty has set, remove the mounting plate
(Fig 4).
to expose the undercuts.
7. Separate the mold sections, and remove the denture.
Spray silicone separating medium (Dentsply Interna-

Figure 2. Imprint of mounting ring creating mechanical

undercuts. Figure 4. External surface form of mold cavity.
104 Evaluating Spacefor I mplant Restorations ● AbuJamra, Stavridakis, and Miller

Figure 6. Mounted duplicate dentures.

Figure 5. Polymerized, unfinished duplicate denture.

tional Inc, York, PA) over the putty. Reassemble the

mold sections, and secure with a rubber band.
8. Mix clear, autopolymerizing acrylic resin (Jet; Lang
Dental Manufacturing, Wheeling, IL) in a 2:1 powder
to liquid ratio (by volume). Pour acrylic into the mold
through one of the sprue channels. The other channel
serves as a vent. When filled, place the mold in a
pressurized curing tank in warm (115°F) water at 20
psi, and allow to cure for 20 minutes.4 Make certain the
exposed ends of the sprue channels face superiorly.
9. Separate the mold, and remove the duplicate denture Figure 7. Visualization of available interarch space.
(Fig 5). Using judicious grinding, remove excess acrylic
resin including sprues and occlusal nodules. Finish and
polish the duplicate denture(s) using established proce- provide criteria that can serve as guidelines in the
dures. decision-making process.
10. At this stage, insert the duplicate denture into the 13. The duplicate denture(s) can serve as surgical tem-
patient’s mouth. Verify that the proper occlusal verti- plates to guide implant placement.2-5
cal dimension, stability, and esthetics duplicate those
of the patient’s denture or diagnostic setup. Obtain a
facebow transfer and interocclusal records. D iscussion
11. Using the facebow transfer and interocclusal records,
mount maxillary and mandibular casts on an articula-
Treatment options for the restoration of edentulous
tor (Fig 6). Each resilient cast may be mechanically arches may include complete dentures stabilized by 2
retained using undercuts created by the mounting ring or more implants, or a completely implant-borne
(refer to Step 2). metal-ceramic prosthesis. When fabricating such
12. Remove duplicate denture(s) from resilient casts, and prostheses, specific minimum space requirements
evaluate interarch distance (Fig 7). Tables 1 and 2 must be met (see Tables 1 and 2).1,6 The use of

Table 1. Estimated Minimal Distances Needed for Adequate Implant Prosthesis Design
Typeof Prosthesis HygienicSpace6 Framework Thickness6 Tooth and Acrylic Totals

Hybrid 2 mm 11 mm 3-5 mm 16-17 mm

Implant-supported overprosthesis 2 mm 3 mm 6-8 mm 11-13 mm
 June2000, Volume9, Number 2
Table 2. Estimated Minimal Distances for Fixed Implant-Supported Prosthesis
Conical Abutment UCLA Abutment
Abutment 1 mm 1 3.5 mm 1
(screw height)
Gold cylinder 5.5 mm 1 — 3 mm 1
Restorative material .5-1.5 mm .5-1.2 mm
Total 7-8.0 mm 4.0-4.7 mm
mounted casts simplifies the evaluation of horizontal
and vertical relationships in the dental arches. Oc-
clusal requirements can be assessed and tooth ar-
rangement optimally planned.6 In addition, interarch
space may be evaluated to determine the feasibility
of one or more implant-supported prostheses. This
may be a critical component in patient treatment.
Careful evaluation may help identify the type of
prosthesis to be fabricated (eg, a fixed-detachable
denture v an implant-supported overdenture). Addi-
tionally, the amount of bony recontouring necessary
to accommodate the definitive prosthesis can be
planned.
Sum m ary
Benefits derived from proper planning emerge when
prosthesis design is determined before surgery.2,7
This determination may dictate the number and
location of endosteal implants to be placed. The
technique described provides an efficient and reliable
105
Standard Abutment Angulated Abutment PrepableAbutment
3 mm 1 9.0 mm 1 3.5 mm
(screw height)
— —
.5-1.2 mm .5-1.2 mm .5-1.2 mm
6.5-7.2 mm 9.5-10.2 mm 4.0-4.7 mm
method for such determinations, and allows the use
of duplicate dentures as surgical templates.
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