562 Theories and techniques of oral implantology

Fig. 12-80. The tissues were carefully sutured with mat-tress or purse-string suturing around each post, with interrupted surgical ties between them.

Fig. 12-81. The patient's old denture is sometimes used temporarily by first hollowing it out so it will not interfere with the four protruding posts and then relining with one of the soft reline materials, such as Hydro-Cast (Kay-See Dental Manufacturing Company) and Softtone (Bosworth Company).

the second surgical incision is made directly over the original incision and the implant is set over the bone (Fig. 12-79). Purse-string sutures are placed around each protruding post. As many surgical ties and mattress sutures as are needed are placed between the four abutment posts (Fig. 12-80).

The old denture in the area of the posts is hollowed out so that there is no interference (Fig. 12-81), and the denture is relined with the soft tissue conditioner. If the patient has no old denture, a new temporary denture is fabricated from the surgical bite and positioned directly over the implant framework. Postoperative instructions are once again given to the patient.

Fig. 12-82. The palateless implant denture is ready to be inserted after the healing is complete.

Fig. 12-83. The palateless denture is implant-borne and never touches the fibromucosal tissue.

The sutures are removed about 1 week later. Any necessary adjustments with the fit and occlusion of the temporary denture are made. When all healing has taken place (Fig. 12-82), the final palate-less implant denture is processed. The cast metal superstructure is placed over the implant posts, and a wax bite registration of centric relationship is taken. The superstructure is picked up with an elastic impression. The wax-up of the maxillary denture with acrylic teeth is tried in the mouth. (If the patient also has an edentulous lower jaw, the lower wax-up should be accomplished at the same time.) The completed denture is inserted and balanced (Fig. 12-83). A Panorex shows the finished case (Fig. 12-84).