CONSTRUCTION OF AN ABUTMENT FREE 5 IMPLANT FULL ARCH, HYBRID MAXILLARY PROSTHESIS USING CDI, DTF Ti CYLINDERS STEP 1 - A fixture head impression is taken and a model is poured. STEP 2 - Hexless titanium, direct-to-fixture (DTF) cylinders are made on a machine lathe. STEP 3 - The DTF cylinders are then screwed on to each fixture replica. STEP 4 - A metal indexing jig is made to slip loosely over the attached cylinders to allow the luting together of the cylinders in to a rigid framework using a dimensionally stable resin. STEP 5 - Two interim cylinders are fixed in to a hard, light cured base and a setup is prepared for try in. STEP 6a - At the next appointment with the patient, the dentist tries in the model setup. STEP 6b: removes the DTF cylinders from the model and places them in the mouth, and, using a rigid, dimensionally stable material (such as Duralay, or GC pattern resin), lutes the indexing jig to the cylinders. STEP 7 - The whole framework is removed and returned with the trial setup to the laboratory. STEP 8 - In the laboratory, new fixture replicas are attached and a new verification model is poured. It is on this model that the final frame- work of the appliance is constructed and the fit assessed. STEP 9 - On the original model titanium plate is cut and shaped and lightly laser-welded to the cylinders (two shots per join). STEP 10a - The whole assembly is then transferred on to the welding index, where more comprehensive welding is done, BUT only on one side of each piece of titanium plate. STEP 10b - At this stage, a framework has been produced that is strong enough for try-in verification of fit intra-orally, but is also able to be easily sectioned if necessary. STEP 11a - The framework is then tried in intra-orally and the fit verified. STEP 11b - If there is a discrepancy, the frame- work is easily sectioned and re-indexed. The verification model is then adjusted to accomodate the final index. STEP 12 - Once the final fit of the framework is satisfactory, it is fully welded and polished. The teeth from the trial set-up are then processed on to the framework using self cure acrylic. STEP 13a - Final fit is assessed on master model. STEP 14a & b - The final prosthesis is inserted in the mouth. ADVANTAGES OF THIS TECHNIQUE Traditional wax-up and casting methods have been superseded. Distortion, a perennial problem with these techniques is therefore eliminated. A framework is produced that gives a more accurate fit than has formerly been possible using traditional methods. Acrylic or porcelain can be readily bonded to the framework. the framework is much lighter than a conventional cast alloy framework. costs are considerably lower than those for a traditional cast alloy prosthesis.