Dental Tribune United Kingdom Edition

and 10 mm of bone height be- tween the canines in the max- illa, and 5mm of bone width and 8mm of bone height intra- foraminally in the mandible. For patients with significantly less bone we are working on protocol modifications which are already showing favour- able short term outcomes. For immediate loading we need at least 35Ncm of initial stabili- sation on at least four implants in both mandible and maxilla. ML: What is the patient’s post-op advice? SB: A softer foods diet for the first three months. At the two- week appointment we intro- duce a Waterpik to the hygiene regimen. We ourselves pay meticulous attention to the occlusal scheme and adjust it using the T-scan system at two and eight weeks. ML: What type of occlusal scheme are you seeking? SB: Our protocols require bi- lateral, simultaneous, equal intensity posterior contacts in the maximal intercuspation position (MIP). We try to avoid contact in the cantilever por- tion and premature contacts. ML: This sounds like a mu- tually protected occlusal scheme where when the teeth are in MIP there are posteri- or, equal intensity, simulta- neous contacts with little or no contacts to the anterior teeth. SB: In fact our protocols de- mand the front and back teeth contribute equally to MIP. ML: What if the patient pre- sents with existing denti- tion? SB: More than 60 per cent of our cases present with fail- ing teeth. We try to reduce the number of operations by extracting the teeth, imme- diately placing the implants, and immediately loading them with the Fixed Teeth in a Day all acrylic transitional pros- thesis. Provided the initial sta- bilisation parameters are met, Fig 2a Before Fig 2b After – Immediate Load Fig 3a Patient Before. Courtesy of Dr. Steven Bongard, Chrysalis Dental Centre, Toronto Fig 3a Patient Before. Courtesy of Dr. Steven Bongard, Chrysalis Dental Centre, Toronto Fig 3b Immediate Load. Day of Surgery Courtesy of Dr. Steven Bongard, Chrysalis Fig 4b Panoramic Radiograph – Final Prostheses Inserted. Courtesy of Dr. Steven Bongard, Chrysalis Dental Centre, Toronto Fig 5 Fixed Teeth in a Day acrylic temporary prosthesis Fig 6 Titanium milled bar Fig 7 Example of well-maintained tissue Table 1 from Malo et al JADA 2011;142(3):310-320) shows the cumulative success rate over ten years for Fixed Teeth in a Day mandibular implants ‘For patients with significantly less bone we are work- ing on protocol modifications which are already showing favourable short term out- comes’ page 15DTß January 21-27, 201316 Implant Tribune United Kingdom Edition