392 Theories and techniques of oral implantology

Fig. 10-20. After the pins are fused together and to the template with acrylic, the superstructure is cemented.

Fig. 10-21. The occlusion, which was carefully balanced prior to the implant insertion, is again checked after the superstructure is cemented.

The postoperative x-ray shows the three pins circumventing the sinus floor (Fig. 10-22) .

Case 3

Full arch splint for a posterior unilaterally edentulous area using a triplant

This is an early case, done before the advent of the scalloped template. Here the pin implants were driven directly through the fibrornucosal tissue and into the bone. Today, when triplants are used, some type of template is added for extra stabilization. This case details the procedures involved in inserting a simple triplant. Except for the addition of a template, the procedures are similar to current techniques.

A 40-year-old woman, who was wearing a maxillary unilateral partial removable denture to replace the posterior left quadrant of teeth distal to the first bicuspid, desired a fixed denture.

Because a large anterior diastema existed between her two central incisors and because there was decay under an old fixed partial denture in her right posterior quadrant, a full arch splint was desirable. A triplant was planned to circumvent the sinus as the posterior abutment in the left edentulous side.

The teeth were prepared for veneer crown restorations. The crowns were carefully fitted over the prepared abutments and all necessary occlusal, gingival, and interproximal adjustments were made (Fig. 10-23) . With a slow-running contra-angle attached with a water attachment and special chuck, the first pin implant was slowly drilled through the fibromucosal tissue in a mesial direction through the center of the alveolar crest (Fig. 10-24). The angulation and depth of the pin relative to the anterior extent of the antral floor were radiographed as the pin was inserted.

Fig. 10-22. The completed case.

Fig. 10-23. The soldered castings are fitted and the occlusion carefully balanced.