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ePaper created 2016-10-04, 09:33:57 | version 1.38.0
| ce article fixed and removable implant restorations 26 CAD/CAM 3 2016 holes of the eventual prosthesis toward the lingual aspect and allow fora molar-to-molar restoration (Fig. 5). Note that when patients present for treatment with terminal dentition, they are commonly an- xious about losing their teeth and the effect this 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 fabricatedfrompreliminaryimpressionsinadvance of the surgical appointment for modification and delivery following 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 upper denture was trimmed and modified chairside to connect to the multi-unit abutments through temporarycylinders(Figs.7a&b).Thiswouldsatisfy the patient’s desire to leave the surgical appoint- ment with a fixed, fully functional maxillary pros- thesisinplace.Notethatthetwodistal-mostmolars were removed to minimise the cantilevers and the forces transmitted to the implants during osseo- integration. Healing abutments were placed in the mandibularimplantstobegindevelopingthetrans- mucosal 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 & b). The final radiograph taken after seating the temporary ap- pliances confirmed excellent positioning of the implants (Fig. 9). 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 & b: 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. Figs. 8a & b: Note the dramatic change in the appearance of the patient, who left with chairside-converted dentures in place on the same day as surgery, including a screw-retained, fixed provisional for his upper arch. Fig. 5 Fig. 6 Fig. 7a Fig. 7b Fig. 8a Fig. 8b 32016