Current implant techniques—an overview 23

placed over the sutured tissues and rearticulated for proper occlusion. Any high spots should be ground away. Relining the denture with a soft-tissue conditioner may prove quite helpful for rapid recovery of the soft tissues as well as the rapid healing of the incision. Sometimes it is better to leave the denture off until some initial healing takes place.

Second visit. Five to seven days later the sutures should be removed. The patient should then be dismissed until the tissues are completely healed, which may take from 2%2 to 4 weeks. It is imperative to give the tissue time to heal, for if the implant is covered by unhealthy tissues the sutures will probably not hold. The framework will become exposed and can usually never be covered successfully again. This point cannot be stressed strongly enough.

Third visit. The original incision line should be carefully duplicated with a scalpel. This line will still be evident after the 2- to 4-week lapse. However, when reflecting the tissues away from the incision, much less resistance will be noticed because the usual tenacious binding of the periosteum to the bone will not have had enough time to reseal. There-fore reflecting the tissues during the second surgical visit is much easier.

The exposed bone should be cleansed with a warm saline solution. The substructure as well as the attached superstructure, which is cast at the same time the substructure is cast (Fig. 1-60), should be taken out of the sterilizer or sterilizing solution and directly fitted into position (Fig. 1-61). The accuracy of fit can be determined by the close adaptation of the substructure to the important anatomic land-marks mentioned previously. Once the proper setting of the implant has been established, and if the

Fig. 1-59. After the impressions are taken, the incised tissues along the entire crest of the ridge are sutured together.

Fig. 1-60. A, From top to bottom are the basic components of this type of implant: the subperiosteal implant itself, three retention screws, and the superstructure. B, The super-structure, which fits over the four abutment posts of the implant, will hold the prosthesis. C, The temporary acrylic denture is fabricated at the same time that the implant is east.