Dental Tribune Asia Pacific Edition

implant finger driver was used to place the dental implants until increased torque was necessary. The ratchet wrench was then connected to the adapter and the implants torqued to final depths, reachingatorquelevelofapprox- imately 40–50 Ncm. Adequate implant fixation was further verified using an Osstell ISQ (implant stability quotient) meter, which uses resonance fre- quency analysis as a method of measurement (Fig. 8). Several studies have been conducted based on resonance frequency analysis measurements and the ISQ scale. They provide valid in- dications that the acceptable sta- bility range lies above 55 ISQ. Extended healing caps were hand tightened to the implants. A postoperative radiograph was taken of the implants and the healing caps to ensure complete seating. The immediate dentures were soft relined with a silicone- based soft denture relining ma- terial (Ufi Gel SC, VOCO). Some of the advantages I have personally experienced with this material are that it is biocompatible, taste- less and odourless. By using the extended healing caps with the soft reline, the immediate den- tures were much more retentive. The soft tissue and implants were evaluated clinically after one week. The patient stated that he had had very little postoperative discomfort or swelling. Within ten days, the patient returned to the practice. The soft tissue around the extended heal- ing caps had healed very nicely with a healthy pink colour. Using impression posts, full-arch im- pressionsweretakenwithInstant Custom C&B Trays (Good Fit). These custom trays can be adapted and fitted in minutes, eliminating the need for models, light-curedmaterials,monomers and extra laboratory time for custom impression tray fabrica- tion because they are made of a material (PMMA) that becomes mouldable when heated (Fig. 9) and maintains its shape while cooling. Once the trays had been mouldedforthepatient,full-arch impressions were taken using a polyvinyl siloxane impression material (Take 1 Advanced, Kerr; Fig.10).Biterelations,aswellasin- structions for size, shape and colour of the full-arch provision- als, were forwarded to the dental laboratory. With only a five-day turnaround, the custom abut- ments and provisionals were for- warded to the dental office and inserted. The patient was very pleased with the aesthetics and function of these provisional restorations. He was instructed abouttheircareanduseineating, speaking and biting. Approximately four months after the initial placement of the dental implants, the pa- tient returned for the definitive porcelain-fused-to-metal restora- tion impressions. The provisional restorations were removed using the Easy Pneumatic Crown and Bridge Remover (Dent Corp). Any temporary cement was removed and the abutments inspected. If there was any settling or re- cession of the gingival tissue, the abutments were modified using a carbide bur with copious amounts of water not to overheat theabutments.Thisway,themar- gins could be brought right to or to slightly below the free gingival margin. A full-arch impression was taken in a similar fashion for theabutmentsandtheprovision- als. In addition, the relations be- tween maxillary and mandibular arches were captured. Within three weeks, the porcelain-fused- to-metal restorations were in- serted and a panoramic radio- graph taken (Figs.11 & 12). In conclusion, an increasing number of patients are present- ing to dental practices who seem torequirethistypeofreconstruc- tion. By providing multiple serv- ices in a shorter number of visits with the use of CBCT and other technologies, the dental provider will find that more patients will accept treatment. In doing so, not only are you helping your pa- tients regain proper form and function,butyouarealsohelping them achieve a Total Dental So- lutions Reconstruction in fewer appointments. 13Dental TribuneAsia Pacific Edition | 12/2015 TRENDS&APPLICATIONS Dr Ara Nazarian maintains a pri- vate practice in Troy in Michi- gan in the US with an em- phasis on com- prehensive and restorative care. He has also con- ducted lectures and hands-on work- shopsonaestheticmaterialsanddental implants throughout the US, Europe, New Zealand and Australia. OPEN 3D DENTAL SCANNER Maestro 3D DENTAL System Innovative solutions for dental applications www.maestro3d.com Attachment designer Label designer Brackets module IPR Interproximal reduction Models Builder module Clear aligner module Crown & Bridge www.maestro3d.com AD

Dental Tribune Asia Pacific Edition

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