Maxillary endosseous implant interventions 389

stone model and cast in gold. It was soldered to the veneer crown cuspid casting, which was then waxed for a veneer facing and processed.

On the third visit, the processed acrylic veneer cuspid crown with the attached template was tried in the mouth and adjusted (Fig. 10-2). An intraoral periapical radiograph, made using the long cone technique, was taken to show the relationship of the template to the maxillary sinus. From this x-ray guide, three holes were made in the template (Fig. 10-3). The holes were slightly wider than the pins to allow them to enter at oblique angles. The holes also helped guide the pins in their circumvention of the sinus.

The framework, which included the processed acrylic-and-gold veneer crown with the vertical post and template attached to it, was then permanently set into position by filling the cuspid crown with oxyphosphate of zinc cement. It was held firmly in place until the cement hardened, at which time the excess was removed.

The implant pins were driven through the three predetermined holes of the template and deep into the osseous structures, passing mesially and distally to the maxillary sinus (Fig. 10-4). The ends of the pins were built up with an acrylic core (Fig. 10-5), which was prepared for a full crown restoration (Fig. 10-6).

A wax interocclusal record of centric relation was made. An elastic impression of the left side, from

Fig. 10-10. A, The pins are driven through the scalloped template. B, The cemented superstructure.

the cuspid crown to the posterior acrylic core, was taken, making sure that there was no interference occlusally from the acrylic core when the patient bit into centric occlusion (Fig. 10-7) .

On the fourth, and final, visit, the posterior unilateral veneer type fixed partial denture, or super-structure, was fitted over the gold abutment post and the acrylic core abutment (Fig. 10-8) . It was checked for marginal adaptation and proper articulation (Fig. 10-9) and radiographed (Fig. 10-10).

The fixed partial denture was cemented permanently over both abutments. When the cement hardened, it was trimmed and the patient dismissed.

Case 2

Unilateral posterior free-end saddle restoration using the simplified template technique

To save the dentist and the patient an additional visit, the template and fixed partial denture can be completed together. To illustrate the technique, a case will be given in which a four-unit bridge using the two maxillary right bicuspids as the anterior abutments and replacing the two missing molars with a triplant was used.

On the first visit, the two anterior teeth were prepared for full crown coverage restorations (Fig. 10-11). At the next visit, the veneer crowns were tried in the mouth and properly balanced (Fig. 10-12) . A wax interocclusal record of centric relation was made and a plaster index was taken, making sure to include the edentulous area distal to the bicuspid as well as the castings themselves. From this impression and bite the entire prosthesis was fabricated.

The two castings were soldered together, and the

Fig. 10-11. Preoperative photograph showing the two bicuspid teeth and the edentulous area posterior to it.