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Implant Placement
The surgical index proved reliable in
accurately positioning the guide for
surgery (Fig. 16). After administering
mandibular anesthesia, the surgical
guide was placed with the aid of the
index, and fixation pins were installed
to hold the guide firmly in place to
begin the surgery.
After using a gingival tissue punch,
the guide was removed to facilitate
removal of tissue at the implant sites.
The index was again used to position
the guide following tissue removal,
and the fixation pins realigned to their
holes without incident. The surgical
guide was used to prepare the osteotomies
and guide the placement of four
4.7 mm implants. Primary stability of
all four implants was acceptable, and
multi-unit abutments were mounted
on top of the implants (Fig. 17).
The temporary prosthesis was held
in place with a luting index, and cold
cure acrylic was used to fix the prosthesis
to the multi-unit temporary
cylinders (Fig. 18). After curing, the
prosthesis was removed and finished
extraorally before being reattached to
the multi-unit abutments (Fig. 19).
Minimal occlusal adjustments were
made immediately after delivery of
the provisional prosthesis. Because
the patient was still under anesthesia,
obtaining an accurate, repeatable
centric occlusion proved challenging.
The patient’s bite was adjusted during
a routine postoperative check a
few days later, and by the third visit,
her bite was comfortable and stable
(Figs. 20a–20c).
The provisional was designed to
remain out of contact with the periimplant
tissue to allow for cleansing. It
also did not cantilever past the distalmost
implant. This abbreviated design
reduced the forces transmitted to the
implants, even though the patient’s
provisional prosthesis was opposed
Figure 16: Before installing the fixation pins, the
surgical index was used to help ensure accurate
positioning of the surgical guide.
Figure 18: A luting index was installed below the provisional
denture, and the prosthesis was processed
to the temporary cylinders with cold cure acrylic.
20a
20c
Figure 17: After verifying primary stability of the
implants, the multi-unit abutments were torqued into
place.
Figure 19: After being finished extraorally, the denture
was reattached to the multi-unit abutments,
serving the patient well as a fixed overdenture until
delivery of the final restoration.
20b
Figures 20a–20c: Retracted lateral and anterior
views of the patient’s mouth with adjusted provisional
denture in place exhibit the proper occlusion and
centric relation that were achieved by the third visit.
– Reducing Treatment Time with Digital Dentistry – 41