Save 2 to 3 Appointments on Your Full Arch Implant Prosthetic Workflow

Authors: David French and Vincent Nalbandian

In previous articles, we have discussed workflows for implant-supported edentulous cases. In this article, I have enlisted the expertise of Vincent Nalbandian to highlight a procedure that can potentially save 2 to 3 appointments in the whole process of completing an implant hybrid restoration.

The segment of the workflow that will be discussed in this article is the portion of the process that occurs post implant surgery after the tissue heals. This assumes that a conversion denture is delivered at surgical appoint.

What You Will Learn In This Article

Capture required patient records.
Multiple appointments that can be combined into one.
Steps for the first post-operative appointment.
Get new laminated Success Guide for Implant-Supported Edentulous Cases and the Burbank Blueprint Appointment.

The specific step in the workflow will involve procedures that can be used to capture required patient records in one appointment that usually would take three (3) appointments.

Following this procedure, you will capture the following patient records:

1
The implant level impression
2
Midline
3
Vertical
4
Occlusal relationship
5
TMJ condyle relationship to the incisal edge
6
Accurate tissue impression
7
Shimbashi of conversion denture
8
Photographic records of smile and lip at rest/repose smile

Done correctly and with accuracy, the records taken at this appointment will combine the following appointments into one appointment:

The initial impression appointment
Bite block & verification jig appointment
Wax set-up try-in appointment

It is conceivable that you could go straight to a finished prosthetic; however, we would advise that a PMMA provisional be placed prior to the final prosthetic.

It is important to note that this process will require an experienced technician or trained auxiliary are advisable to efficiently execute these procedures.

We call the following processes for the post-surgery implant level impression appointment The Burbank Blueprint for Implant Prosthetics.

Steps for the First Post-Operative Appointment

1. Take postoperative bite registration.

Using the conversion denture(s) that was placed at the surgery appointment, take a bite registration. (Figure 1)

Take postoperative bite registration

2. Using a Kois Facial Analyzer Facebow, take a facebow record. (Figure 2)

U'sing a Lois Facial Analyzer Facebow

The Kois Dento-Facial Analyzer is an elegantly simple instrument. Unlike other facebows, there is no ear bow, movable joints, or tightening screws.

The Kois Bow uniquely captures the condyle relationship -100-mm distance of the conditional hinge position.

Facial midline

Horizontal planes, both of the anterior smile line and the anterior-posterior plane of occlusion.
For more details, see this article: The Face Bow That Can Make a Difference

3. Take the following photos.

Full face smile (forehead to chin), lip at rest close-up, smile close-up

Incisal shade picture (shade tabs(s) incisal edge to incisal edge on the same vertical plane.)

Over-all shade picture (shade tab next to target shade tooth, oriented body-body, incisal to incisal) (Figure 3)

Figure 3

4. Pick-up impression of conversion denture using an open tray technique.

Be sure to thoroughly inject impression material under conversion denture to capture current tissue impression. You may also remove the prosthetic, syringe PVS directly onto tissue, screw the conversion denture down and then take the pick-up impression. (Figures 4 & 5)

Figure 4

Figure 5

5. Remove the pick-up impression.

Attach analogs to the base of the conversion denture.

Pour soft tissue model into impression prior to stone. (Figure 6)

Figure 6
Pour a stone model into the pick-up impression. (Figure 7)
Figure 7

6. Carefully remove conversion denture from the impression.

Articulate upper model first using the Kois Bow mounting plate. (Figure 8)
Figure 8
Mount lower to conversion denture to the upper using bite. (Figure 9)
Figure 9
Record vertical of the conversion denture on the articulator. pin setting.

7. Return conversion denture to the patient. (Figure 10)

Figure 10

8. Send articulated model to the lab.

The lab will create a new ideal set-up based on the vertical and occlusal relationship from the records taken. The set-up will be in harmony with the impression of conversion denture and incorporate any changes in smile display or VDO that were expressed at impression appointment. The lab will then fabricate a PMMA for delivery at the next appointment. (Figure 11)

Send articulated model to the lab.

Burbank Dental Lab is developing a new laminated success guide for implant supported edentulous cases. The new guide will include the Burbank Blueprint Appointment discussed in this article. It will be available on November 30th. Request now to order this free tool from Burbank Dental Lab.

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Save 2 to 3 Appointments on Your Full Arch Implant Prosthetic Workflow

What You Will Learn In This Article

Capture required patient records.

Multiple appointments that can be combined into one.

Steps for the first post-operative appointment.

Get new laminated Success Guide for Implant-Supported Edentulous Cases and the Burbank Blueprint Appointment.

Following this procedure, you will capture the following patient records:

Steps for the First Post-Operative Appointment

1. Take postoperative bite registration.

2. Using a Kois Facial Analyzer Facebow, take a facebow record. (Figure 2)

3. Take the following photos.

4. Pick-up impression of conversion denture using an open tray technique.

5. Remove the pick-up impression.

6. Carefully remove conversion denture from the impression.

7. Return conversion denture to the patient. (Figure 10)

8. Send articulated model to the lab.

REQUEST YOUR FREE IMPLANT SUCCESS GUIDE BELOW

Success Guides

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