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.
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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:
The implant level impression
TMJ condyle relationship to the incisal edge
Accurate tissue impression
Shimbashi of conversion denture
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.
Steps for the First Post-Operative Appointment
- Using the conversion denture(s) that was placed at the surgery appointment, take a bite registration. (Figure 1)
- 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
- 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)
- 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)
- Attach analogs to the base of the conversion denture.
- Pour soft tissue model into impression prior to stone. (Figure 6)
- Pour a stone model into the pick-up impression. (Figure 7)
- Articulate upper model first using the Kois Bow mounting plate. (Figure 8)
- Mount lower to conversion denture to the upper using bite. (Figure 9)
- Record vertical of the conversion denture on the articulator. pin setting.
- 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)
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