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ePaper created 2016-06-01, 10:23:49 | version 1.38.0
10 I I C.E. article_ fixed and removable implant restorations implants 2_2016 will have on their speech and chewing capabilities. For this reason, it is important to make every effort to ensure that the patient leaves with functional appliances in place. Thus, traditional dentures were fabricated from preliminary impressions in advance of the surgical appointment for modification and delivery follow- ing placement of the implants (Fig. 6). Having achieved sufficient primary stability, the Inclusive Tapered Implants placed in the patient’s maxilla could be immediately loaded. Thus, the up- per denture was trimmed and modified chairside to connect to the multi-unit abutments through temporary cylinders (Figs. 7a, 7b). Thiswouldsatisfythepatient’sdesiretoleavethe surgical appointment with a fixed, fully functional maxillary prosthesis in place. Note that the two distal-most molars were removed to minimize the cantilevers and the forces transmitted to the im- plants during osseointegration. Healing abutments were placed in the mandibular implants to begin developing the transmucosal passages. The lower immediate denture was then modified and relined to seat over the implants during healing. This approach provided the patient with same- day temporary restorations, and he walked out of the office with properly functioning teeth for the first time in many years. The effect this had on the patient’s comfort, function and appearance was immediate and profound (Figs. 8a, 8b). The final radiograph taken after seating the temporary ap- pliances confirmed excellent positioning of the implants (Fig. 9). The patient returned after three and a half months of healing so the stability of the implants and health of the soft tissue could be evaluated. Removal of the temporary appliances revealed ex- cellent tissue health around the healing abutments of the mandible and multi-unit abutments of the maxilla (Figs. 10a, 10b). Vinyl polysiloxane (VPS) im- pressions were taken to begin the restorative proc- ess (Figs. 11a–11c). Because multi-unit abutments and healing abutments were placed on the day of surgery, the restorative process began above the tissuelevel,withoutanyneedforsecondarysurgery or anesthetization. The restorative protocol for both prostheses in- cludedwaxrimsandsetups,whichthelabproduced on the working casts fabricated from the impres- sions (Figs. 12a, 12b). The maxillary wax rim incor- porated temporary cylinders through which screws couldconnecttothedentalimplants.Thelowerwax rim was designed to seat over Locator attachments. At the next appointment, the wax rims were seated,thejawrelationshipwasrecordedusingcon- ventional denture technique, and a bite registration was taken (Figs. 13a, 13b). A VPS “wash” impression of the mandibular arch was also taken with the wax rims and Locator impression caps in place (Fig. 14). This would aid the lab in designing an overdenture that fully rests on the tissue instead of the implants. The case was returned to the lab, and wax setups Fig. 4b Fig. 4c Fig. 5 Figs. 4b–4c_The Inclusive Tapered Implants were threaded into place, achieving excellent initial stability. Fig. 5_Multi-unit abutment with carrier in place illustrates correction of the implant’s angulation to establish a uniform prosthetic platform around the arch. Fig. 6_Traditional dentures were fabricated in advance of the surgical appointment so they could be immediately converted to serve as temporary appliances during the healing phase. Figs. 7a, 7b_Same-day conversion of the maxillary denture to an immediate fixed prosthesis was achieved by adding multi-unit temporary cylinders using cold-cure acrylic and trimming the appliance into a horseshoe shape. Fig. 6 Fig. 7a Fig. 7b