404 Theories and techniques of oral implantology

Fig. 10.70. The anterior quadrant is cemented and the two templates are tried for accuracy.

Fig. 10-72. The two superstructures are then cemented over both templates.

necessary in case the implants had to be removed. The procedure was explained, with no promises as to longevity, and she agreed to it.

Her remaining six teeth--the maxillary right central and cuspid, left central and cuspid, and bicuspids   were prepared for full crown restorations. Metal castings were fabricated, fitted, and then soldered together. Included in the metal splint at the distoproximal ends of the right cuspid and left second bicuspid castings were two female precision attachments (Fig. 10-66). The soldered castings with the attachments were fitted in position over the pre-pared teeth (Fig. 10-67). A wax interocclusal record of centric relation and a full arch maxillary plaster index were taken. The completed prosthesis included the completely processed six teeth (porcelain over gold), the scalloped templates with male precision attachments, and the two superstructures, processed in porcelain over metal (Fig. 10-68) . The bilateral templates were attached to the anterior quadrant of teeth by the male attachments fitting into the female attachments, while the superstructures were easily fitted into position over the templates (Fig. 10-69).

The anterior restoration was cemented over the prepared abutment teeth with hard cement, and the two templates with holes for the triplant pins were placed into their correct positions (Fig. 10-70).

Pin implants were driven through the template and then locked with acrylic (Fig. 10-71). The superstructures were then cemented into position over the templates with soft cement (Fig. 10-72). By using soft cement, the superstructure need be re-moved only by tapping with a crown and bridge remover. A Panorex of the completed case appears in Fig. 10-73.

The precision attachments can be attached in a different manner, if desired. Instead of designing the prosthesis so that the template, or templates, is separate from the anterior quadrant of teeth, the template can be made a rigid part of the anterior quadrant by soldering it directly to the last abutment crown. However, the female precision attachment is also soldered on the distoproximal surface of the last crown so that it rests on the most anterior portion of the template (Fig. 10-74).

Case 9

Bilateral restorations when anterior teeth have been previously restored with fixed bridgework

To utilize a preexisting splint for the support of implants, the following procedures may be used. In this case, the patient had a seven-unit anterior porce-

Fig. 10-71. After the male attachments are inserted into the female attachments, the pin implants are driven through the template.