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ePaper created 2016-09-14, 10:12:26 | version 1.38.0
| industry 24 implants 3 2016 Ourlabcourierdeliveredthedenturesandimpres- sions to the lab for the conversion to metal-rein- forced,screw-retainedprovisionals,whichwerede- liveredbacktotherestorativeofficewithin24hours. The next afternoon, the prostheses were inserted (Fig. 10) and panoramic radiographic confirmation of proper seating was obtained (Fig. 11). Any neces- saryocclusaladjustmentswerethencompleted.The patient was then seen every two to three weeks for deplaquingandplaquecontrolreviewperourearlier discussedprotocol.Theocclusionwasalsorefinedas needed. The patient’s TMJ symptoms were signifi- cantly reduced within the first three weeks. A water irrigationdevicewasgivenandreviewedatsixweeks post-surgery. As the patient was in Florida for the winter, and unable to come in after the typical 3 month protocol, she was seen 4 1/2 months after the surgery. At that time, periapical X-rays of each implant were done to confirm bone healing. The prostheses were removed and cleaned. GC verifica- tion jigs (Fig. 12), made on the original models and fabricated prior to the appointment, were tried in. If passivityisnotconfirmed,thentheGCjigcanbecut and re-indexed. Once the fit of the verification jigs was confirmed, customtrayswereusedtotransfertherelationships (Fig. 13). During the following appointments, OVD andcentricrelationswereobtained,andthewaxtry- ins were confirmed for aesthetics, phonetics, and occlusion prior to the milling of the framework (Fig. 14). It is important to confirm tooth location priortomillingtheframeworksothattheframework was designed within the parameters of the acrylic/ tooth borders. At the insertion appointment, the healing caps were removed and cleaned with chlor- hexidine.Figure15demonstratestheexcellentheal- ing of the soft tissue prior to insertion of the pros- thesis. Once inserted, aesthetics, phonetics, and OVDoftheprosthesiswereconfirmed.Theocclusion was adjusted as needed. Screws were tightened to 15 Ncm, screw access openings were filled with Tef- lon tape to within 2 mm of the surface, and a soft material such as Telio or Fermit was used to seal the Fig. 14 Fig. 16 Fig. 18 Fig. 13 Fig. 15 Fig. 17 Fig. 13: Custom trays to transfer the relationships. Fig. 14: OVD and centric relations were obtained, and the wax try-ins were confirmed for aesthetics, phonetics, and occlusion prior to the milling of the framework. Figs. 15–18: Completed case. 32016 3 month protocol, she was seen 41/2 months after