378 Theories and techniques of oral implantology

signed to attach to most of the three-dimensional articulators (Fig. 9-145). After the wax-up had been tried and the occlusion carefully checked in the mouth, both dentures were processed. Final adjustments were made on the articulator, with minute adjustments made in the mouth (Fig. 9-146).

Cross-sectional occlusal films (Fig. 9-147), lateral plate roentgenograms (Fig. 9-148), and a posteroanterior film show these implants in position (Fig. 9-149).

Case 15

A permanent prosthesis for the completely edentulous mandible using post type implants

After careful examination to determine the feasibility of using all post type implants, impressions were taken. These included a lower alginate impression of the entire edentulous mandible (Fig. 9-150),

an opposing full upper alginate impression (irreversible hydrocolloid) of the maxillary teeth, and the proper wax inter-occlusal record of centric relation. The models were articulated, and a full lower temporary acrylic splint was fabricated (Fig. 9-151). The entire tissue-bearing surface of the splint was hollowed out. For splints that are not hollowed out, the following procedure is recommended.

The vertical post implants were set into the jaw one at a time (Fig. 9-152). After each implant was inserted, the occlusal surface of each post was marked with an indelible pencil (Fig. 9-153). The mark was transferred to the acrylic splint and a generous hole drilled to accept the implant. The acrylic splint was then replaced and adjusted so that no impingement prevented proper seating. Following this procedure, by the time the last implant was placed into the mandibular bone, only one adjust-

Fig. 9-145. A, Using a specially designed occlusal template attached to a Hanau articulator the lower teeth are waxed so that both occlusal planes are geometrically parallel. (Courtesy E. Glueck.) B to D, The upper teeth are then waxed up to the lower teeth.