The Full Arch Implant Supported VEICRR® Appliance

(Patent Pending 63/468,430)

Fotos, SG; Gorham, LD; Buist, C; Conard, G, Jr; Fotos, PG

OPA Dental, LLC, Huntington WV, 25701

Summary of Unique Aspects of VEICRR:

- Strong zirconia base/gingiva

- Compressive, resilient PMMA dentition

- Easier on the opposing dentition

- Easier on newly placed implants

- Replaceable/interchangeable PMMA

- Offered exclusively by Opa Dental
A New Idea

Contemporary complete or quadrant restorations supported by multiple implant placements commonly involve the use of occlusal components which are constructed of zirconia oxide materials. Despite durability advantages, such materials are often problematic in applications where decreased material resilience and high hardness can result in excessive wearing of opposing dentition, unfavorable stress on supporting implants, and restorative fractures. The present research introduces the clinical application of the VEICRR® prosthetic with a dentition/occlusal portion of alternate materials, which when supported by implants and a screw retained zirconia tissue/base, provides a solution to issues resulting from unfavorable occlusal stresses from the currently popular type of all-zirconia restoration. The full arch implant supported restoration is frequently the choice in current restorative dentistry. The occlusal prosthetic requirements are suitable for management utilization of this novel application and are appropriate for cases where dynamic restorative courses of treatment are anticipated (i.e., esthetic concerns, implant failures, regional changes in existing or prosthetic dentition).

Improved options for implant patients

Current trends in implant supported, full arch restorative dentistry usually result in the use of either the static/rigid attachment of an all-zirconia restoration using multi-unit abutments, or the all-acrylic denture affixed to implants utilizing resilient/non-rigid attachments. Both restorations have merits, but also deficiencies. Rigid attachment of all-zirconia restorations results in a robust restorative option, which can be ideal for patients exhibiting para forces and who tend to have failures with appliances fabricated with lower strength materials. The lack of resiliency, however, can be detrimental to long-term osseointegration of implants, and excessive wear of opposing dentition. Non- rigid/resilient attachment of all-acrylic appliances can put less stress on implants, but eventually the restoration is more prone to flexural fatigue and failure. As the industry attempts to ameliorate these failures, many new innovations have emerged, including refitting existing all-acrylic dentures to be rigidly attached to implants, and supporting substructure frames fabricated from titanium and polyether ketone (PEEK) over which several types of restorative materials are placed.

A better solution

Capitalizing upon the benefits of these approaches, while simultaneously avoiding the individual vulnerabilities and detractions, the Virtual Esthetics Implant Compressive Resilient Restoration, or VEICRR® (pronounced “vicker”) is proving to be a useful alternative. The VEICRR® restoration is comprised of a full zirconia base for the soft tissue component with rigid attachment to implants, combined with a mechanically retained non-zirconia material for the dentition/occlusal portion. The demonstrated advantage of a zirconia base is its strength, having relatively few in situ failures resulting from fractures of the zirconia. Additionally, its strength, combined with static/rigid attachment to implants, allows a much smaller amount of restorative material necessary for form and function (the absence of denture-like palates and flanges). This is also preferred by patients. Attempts have been made to convert existing acrylic dentures into this type of prosthetic, but with many observed failures, due to factors including the relative low strength of acrylic, especially in the modified form with palates and flanges removed, and the potential age and fatigue of a denture that can be many years old.

Occlusally, the VEICRR® prosthetic utilizes the benefits of non-zirconia restorative materials. All-zirconia restorations, with zirconia opposing natural dentition, have demonstrated excessive wear to the opposing teeth in some cases. Also, when zirconia occludes with opposing zirconia, it has been observed to have an undesirable “clacking” sound as stated by some patients. Non-zirconia dentition of the VEICRR® prosthetic provides several advantages related to these issues. For example, the use of polymethyl methacrylate (PMMA) for the dentition/occlusal portion of a VEICRR® appliance avoids excessive/detrimental wear of any opposing dentition and is not accompanied by “clacking”. The softer occlusal material also absorbs force, compresses, and demonstrates wear, thereby avoiding those stresses to implants and opposing natural dentition. Clinicians state that these are critical, beneficial attributes that contribute to the long-term success and acceptance of prescribed treatment plans.

The mechanical attachment of the VEICRR® zirconia tissue base to the non- zirconia dentition is another creative solution incorporated into this innovative prosthetic. We employ the use of concavity/convexity, posts and holes, and screws, either alone or in combination, depending upon specific attributes of the case, including the available height, width, and depth of the restorative space. Additionally, dual cure resin is used to join, fill, and seal the adjacent surfaces, which further adds retentive strength and serves a hygienic purpose. This particular aspect of the VEICRR® prosthetic enables another intriguing application: the interchangeability of the dentition/occlusal portion for maintenance, preference for an alternative type of restorative material, or eventual replacement if the purpose is to intentionally absorb stresses and wear, saving and extending the life of the opposing dentition and implants when warranted.