Maxillary endosseous implant interventions 425

and another set of copings, with roughened surfaces, would have been cast and fitted over the smooth copings.

After the plaster index is taken and the master model articulated with the model of the opposing jaw, it should contain the roughened gold copings as well as the duplicate implant shafts. The template is then designed with a pencil on the master model. It should extend to the roughened gold copings that are nearest the edentulous space, and it should be scalloped so that it follows the labiolingual and interproximal contours of the tissue-bearing surfaces of the restorations.

The wax template should fit snugly around the duplicate implant shafts that protrude out of the stone model. The wax-up should contain accurate insets for housing the heads of the set screws. This

Fig. 10-146. A cross-sectional occlusal film radiograph.

is easily accomplished by screwing the set screws through the wax template and into the hollow threaded duplicate implant shafts. By applying a little heat to the wax, a definite seat in it for the screw heads can be determined. The wax-up should also include a thin vertical bar, or strut, along its center buccolingually to act as a strengthening de-vice. The peripheral borders of the wax-up should be rolled to avoid any sharp line angles that would irritate the fibromucosal tissue.

Case 16

A full arch restoration for long edentulous spans using a removable partial denture and template

Sometimes, in order to psychologically satisfy a patient, the dentist must proceed with a completely atypical approach. Of course, this is done only if the results will benefit the patient.

In this case, done over 7 years ago, the patient claimed she was on the verge of committing suicide over her loose-fitting removable denture. Although she was originally advised to have the flabby tissues covering the resorbed alveolar crest around her en-tire arch removed and to have a new full denture fabricated, she refused adamantly. She was willing to take her chances on obtaining added retention for a removable prosthesis by the use of implants. She agreed to have her excess soft tissue removed, and complete healing took place before the implantation procedure was undertaken.

Only two teeth remained in the maxilla, both of which were second molars with some mobility

Fig. 10-147. The fixed prosthesis as compared to the large, bulky original removable prosthesis.

Fig. 10-148. Only two remaining teeth existed.