356 Theories and techniques of oral implantology

The restorative procedures required for the preparation of the teeth and the fabrication of the fixed partial dentures are relatively the same for almost all types of implants. The bridge should always be permanently affixed as rapidly as possible after implant insertion.

Case 8

Bilateral posterior restorations using a full arch splint and mixed implants

In this case a full arch splint was secured by mixed implants and natural tooth abutments. First, all remaining teeth in the arch were prepared for full crown restorations (Fig. 9-74). The necessary compound tube impressions, as well as the bite registrations and opposing jaw impressions, were taken (Fig. 9-75). From these impressions, the full crown restorations and the full arch temporary acrylic splint were made.

At the beginning of the next visit, the temporary acrylic splint was inserted, balanced, and equilibrated with the teeth of the opposing jaw. The castings were then placed over the prepared abutment teeth and checked for proper marginal adaptations, gingival contours, contact points, and articulation with the opposing teeth (Fig. 9-76). Another full mouth plaster index was taken, with the castings seated over the teeth, in order to solder them together. At this time, the implants could either be set into their predetermined locations or, preferably, implantation delayed until the bridge was completely prefabricated.

At the next visit, the soldered castings were tried in the mouth and again checked for any discrepancies. When everything was satisfactory, a wax bite and plaster index of the entire lower arch were taken and the prosthesis was fabricated in the laboratory (Fig. 9-77).

The implants were inserted into the right lower quadrant according to the methods already de-scribed. The burs were placed parallel to each other and to the prepared teeth (Fig. 9-78). They were replaced by three spiral-post type implants: a Chercheve implant (Fig. 9-79), a Muratori implant (Fig. 9-80), and a Sandhaus crystalline bone screw (CBS) (Fig. 9-81) . As each implant was inserted, the bridge was replaced by drilling a hole into the tissue-bearing surface of its corresponding pontic. The holes were made larger than the implant shafts to accommodate any lack of parallelism and to facilitate insertion (Fig. 9-82).

After the lower right implants were inserted and

Fig. 9-75. An impression of the upper edentulous maxilla is taken as well as a wax interocculusal record of centric relation.

Fig. 9-76. The castings are fitted and once again an inter-occlusal record of centric relation is taken.

Fig. 9-74. The remaining six anterior teeth are prepared.