186 Theories and techniques of oral implantology

Fig. 5-100. Here transfer paste has been used to mark the implant sites. The paste easily transfers to the prosthesis. (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. 5-101. An indicator stylus. This is set in the denture, and the denture is placed in the mouth. The resulting punched holes in the mucosa locate the exact button implant sites. (From Cranin, N.: Intramucosal insert—a method of maxillary denture stabilization, J.A.D.A. 57: 188, 1958. Copyright American Dental Association. Re-printed by permission.)

be incorrectly set. This may not only cause pain and discomfort but also incorrect fusion of the buttons to the denture.

The seats are then made carefully in the marked areas of the mucosa. A trephine is forced all the way through the mucoperiosteum. As it is withdrawn it should be twisted so that the plug of mucosal tissue will come out intact (Fig. 5-102). For cleaner removal of the mucosal plugs, Linkow uses a hollow-mill trephine that runs in a contra-angle instead (Fig. 5-103).

A small amount of cold cure acrylic is mixed and placed into the seats made in the denture. The intramucosal button implants are inserted into the denture, and the whole prosthesis is then seated while the patient bites into centric occlusion. After the acrylic hardens, the denture is removed and any excess is trimmed and polished (Fig. 5-104). Experience has shown that fourteen intramucosal inserts are usually required for the average size maxillary denture. Five are placed evenly on each side of the arch along the crest of the ridge and two on either side of the vault, 1 mm. from the crest.

The soft tissue healing period of about 10 days is so critical that the denture should never be removed during this time. To ensure that the denture is fixed as firmly as possible to the mucosal tissue, a variety of procedures has been devised. One method, used by Cranin, is to suture the denture into position with a 1-in., half round cutting edge needle and doubled 00 braided silk suture thread. Three retention sutures are placed through the buccal and pala-