Clinical
Fig 10 Prosthesis and lip repositioning
Fig 11 Completed smile
Fig 12 A very happy patient
Continued »
four or up to six implants. Although there is a lot of literature relating to “all- on-4” techniques, the author prefers where possible to place six implants due to the fact that if a failure occurs (it is currently accepted that two in every ı00 or 2 per cent will fail) there is a backup and one can still fabricate a reliable final prosthesis on five or four implants, if equally spread along the arch. One must also consider
the A-P (Anterior-Posterior) spread of the implants. In such cases there must be adequate A-P spread to allow for favour- able loading of the prosthesis as, using this technique cantilevering will be required in most cases.
Healing After placement of the six DIO SM dental implants a postoperative OPG was taken and the denture relined with soft reline material over the healing abutments. I opted for transmucosal healing as we achieved high levels of primary stability on all the implants. In this case the distal implant on the right side entered the sinus space and we performed a Summer’s Lift. The patient was allowed to heal for a period of five months with the temporary relined denture.
Prosthetic protocol After the healing period, all implants were checked using a periotest to measure osse- ointegration. The readings
52 Scottish Dental magazine
“For inexperienced implant dentists a surgical guide to triangulate this position exactly
is an absolute requirement” Dr Avik Dandapat
were as follows: • UR3 Implant = -7.0 • UR2 Implant = -6.9 • URı Implant = -5.0 • ULı Implant = -8.0 • UL2 Implant = -5.0 • UL3 Implant = -6.0 From the readings, we could
see that all implants had osse- ointegrated well and showed no pain, mobility, infection, loss of bone or exposed tita- nium intra orally. We then carried out the following sequence for restoration: ı. Fixture head impressions linked in a special tray. Using floss and GC pattern resin to link impression screws. 2. Try-in of the DIO Multi- Unit angled screw-retained abutments with lab-made positional jig to ensure abut- ments are parallel. 3. New impression of the Multi-Unit angled abutments and X-ray verification of correct seating. Again these are linked using GC pattern resin and also a verification jig made by the lab to verify accu- racy of model prior to metal framework construction. 4. The denture was relined again over the new abutments. 5. Metal framework try-in – screw retained and checked for passive fit using the Shef- field test. Re-verification of
the midline, re-bite registra- tion, a new face-bow record, intra-oral and extra oral photography to give the technician sufficient data to make the teeth and an idea of degree of soft tissue support required. 6. A hybrid acrylic-composite prosthesis was then placed and checked intra-orally for aesthetics, lip support and bite. I had decided to provide a balanced articulation type of occlusal scheme. 7. Final fixation of the pros- thesis and detailed written and oral instruction given to the patient. One must consider cleanable spaces and your lab must under- stand this and allow for the patient to be able to clean the spaces underneath the area around the implant heads. We provide a Waterpik and review the hygiene habits at three, six and ı2 months post placement. 8. The screw holes then filled with cotton wool followed by flowable composite. 9. Post operative follow ups at three, six and ı2 months with regular dental checks on lower dentition and follow- up x-rays yearly to determine bone levels after baseline OPG taken.
ABOUT THE AUTHOR
Dr Avik Jona- than Dandapat qualified from Birmingham University and went on to complete his MFGDP(UK), the Diploma and Advanced certifi- cate in dental Implantology from The Royal College of Surgeons of England in 2006 in Cohort 3 of the course. Avik has been an ADI mentor for the past eight years and a mentor for both DIO Implant and Ankylos. Avik actively lectures at the FGDP(UK), internationally for DIO Implants, ADI members forum, Ankylos Implant members forum and is active ADI study club lecturer in dental implantology. At present Avik runs two prac- tices in Reading, Berkshire and 121 Harley Street, London. His focus is solely on implant and reconstruc- tive dentistry. Currently Avik is studying toward his MSc in Implant dentistry from Manchester University. Avik would like to thank his Lab – Medimatch UK (
www.Medi-
match.co.uk) and the dental implant manufacturer – DIO Implants (www.DIOUK. com).
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