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science & practice18 EAO Annual Scientific Congress 2015 · 24 September the implants were begun with a 1.95mm pilot drill utilising the Mont Blanc surgical handpiece (Anthogyr) and Aseptico surgical motor (AEU 7000) at a speed of 1,200rpmwithcopiousamountsof sterile saline (Figs. 6 & 7). Paralleling pins were placed in the sites of the osteotomies to con- firm the accuracy of the surgical guide and radiographs were taken tochecktheangulationsofthepins within the maxilla and the mandible. Once the osteotomies were complete, an implant finger driverwasusedtoplacethedental implants until increased torque wasnecessary.Theratchetwrench was then connected to the adapter and the implants torqued to final depths, reaching a torque level of approximately 40–50Ncm. Adequate implant fixation was further verified using an Osstell ISQ(implantstabilityquotient)me- ter, which uses resonance fre- quency analysis as a method of measurement(Fig.8).Severalstud- ies have been conducted based on resonance frequency analysis measurements and the ISQ scale. Theyprovidevalidindicationsthat the acceptable stability range lies above 55 ISQ. Extended healing caps were hand tightened to the implants. A postoperative radiograph was taken of the implants and the heal- ing caps to ensure complete seat- ing. The immediate dentures were soft relined with a silicone-based soft denture relining material (Ufi Gel SC, VOCO). Some of the advan- tages I have personally experi- enced with this material are that it is biocompatible, tasteless and odourless. By using the extended healing caps with the soft reline, the immediate dentures were much more retentive. The soft tis- sue and implants were evaluated clinically after one week. The pa- tient stated that he had had very little postoperative discomfort or swelling. Within ten days, the patient re- turned to the practice. The soft tis- sue around the extended healing caps had healed very nicely with a healthy pink colour. Using impres- sion posts, full-arch impressions were taken with Instant Custom C&B Trays (Good Fit). These custom trays can be adapted and fitted in minutes, eliminating the need for models, light-cured materials, monomers and extra laboratory time for custom impression tray fabrication because they are made ofamaterial(PMMA)thatbecomes mouldablewhenheated(Fig.9)and maintains its shape while cooling. Once the trays had been moulded for the patient, full-arch impressions were taken using a polyvinyl siloxane impression ma- terial (Take 1 Advanced, Kerr; Fig. 10). Bite relations, as well as in- structions for size, shape and colourofthefull-archprovisionals, were forwarded to the dental labo- ratory. With only a five-day turn- around,thecustomabutmentsand provisionalswereforwardedtothe dental office and inserted. The pa- tient was very pleased with the aesthetics and function of these provisional restorations. He was instructedabouttheircareanduse in eating, speaking and biting. Approximately four months af- tertheinitialplacementoftheden- tal implants, the patient returned for the definitive porcelain-fused- to-metal restoration impressions. The provisional restorations were removedusingtheEasyPneumatic Crown and Bridge Remover (Dent Corp). Any temporary cement was removed and the abutments in- spected.Iftherewasanysettlingor recessionofthegingivaltissue,the abutments were modified using a carbide bur with copious amounts of water not to overheat the abut- ments.Thisway,themarginscould bebroughtrighttoortoslightlybe- lowthefreegingivalmargin.Afull- archimpressionwastakeninasim- ilar fashion for the abutments and the provisionals. In addition, the relations between maxillary and mandibular arches were captured. Within three weeks, the porcelain- fused-to-metal restorations were inserted and a panoramic radi- ograph taken (Figs. 11 & 12). In conclusion, an increasing number of patients are presenting to dental practices who seem to re- quire this type of reconstruction. Byprovidingmultipleservicesina shorter number of visits with the use of CBCT and other technolo- gies, the dental provider will find that more patients will accept treatment. In doing so, not only are you helping your patients regain proper form and function, but you are also helping them achieve a Total Dental Solutions Reconstruc- tion in fewer appointments. Dr Ara Nazarian maintains a pri- vate practice in Troy in Michigan in theUSwithanemphasisoncompre- hensiveandrestorativecare.Hehas also conducted lectures and hands- on workshops on aesthetic materi- als and dental implants throughout the US, Europe, New Zealand and Australia. You have the know-how. Now get the know-when. The Osstell IDx helps you to objectively determine implant stability and to assess the progress of osseointegration without jeopardizing the healing process. It is an accurate and non-invasive method that will provide the objectiveinformationneededtodeterminewhentoloadtheimplant. Less guesswork. More Insight. osstell.com New! Meet us in booth A01:04 EAO Congress | Stockholm, Sweden | September 24-26 AD