188 Theories and techniques of oral implantology

tal surfaces of the denture in both tuberosity areas by passing the silk through the fibrornucosal tissue between both surfaces of the denture. A fourth suture is passed anteriorly through the soft tissues just inferior to the nasal spine. Holes are cut in the denture with a round No. 8 bur, using the curve of the needle as a guide for the placement of the buccal and palatal openings (Fig. 5-105). The denture is again seated and the occlusion is checked before the sutures are tied (Fig. 5-106). Even the most difficult pa-

Fig. 5-105. To make sure that the denture does not move and disturb the healing tissues, it is sutured in place. (From Cranin, N.: Intramucosal insert—a method of maxillary denture stabilization, J.A.D.A. 57:188, 1958. Copyright American Dental Association. Reprinted by permission.)

Fig. 5-106. The denture sutured in place. (From Cranin, N.: Intramucosal insert—a method of maxillary denture stabilization, J.A.D.A. 57:188, 1958. Copyright American Dental Association. Reprinted by permission.)

tient would hesitate to remove a denture affixed in such a manner.

Linkow's method fixates the denture even more firmly. The first step is to make two horizontal holes with a No. 558 bur on opposite sides of the buccal flange of the denture, making sure that the holes are below the sinus in the bicuspid area. While the patient bites in centric relation, a pin implant in a special chuck and contra-angle is driven through the holes and horizontally into the bone until it reaches the tissue-bearing surface of the denture's palatal surface (Fig. 5-107). Any protruding excess pin is then cut flush with the buccal surface of the denture and locked with cold cure acrylic. This procedure gives the denture complete immobility and can be done in a few minutes. After the 10-day healing period, the periphery around each pin is drilled with a round bur until it can be gripped with a thin-nose pliers and pulled out. The two holes in the denture are filled with fast cure acrylic and the surface polished.

The healing implant sites epithelialize normally. The tissues constrict about the cervix of the insert, creating positive retention around each of the heads. When healing is complete, the tissues appear pink, moist, and healthy. An air syringe directed at each receptor site will reveal a barely visible but deep well-formed crypt.

Fig. 5-107. Another method of stabilizing a button implant denture until the sites heal, according to Linkow, is to drive pin implants horizontally into the bone (arrows), carefully avoiding the sinus. The protruding ends of the pins are cut flush with the pink acrylic and fastened to it with a drop of resin material. This gives the denture immediate stabilization.