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The process (in this case, multiple implants were placed):
1. A 3D cone beam Image is taken to evaluate treatment feasibility. Patient decided to go with a full lower fixed appliance over 6 Implants:
2. The "ALL-ON-6" Implants are planned using the computer software and 3D image, meanwhile, the patient is wearing a temporary lower denture:
3. A surgical guide is fabricated for implants placement. This typically takes two weeks
4. The final appliance is ready to place at the time of implant placement:
5- The implant attachment are relined into the pre-existing denture to turn the "removable complete denture" into a "fixed appliance".
6- Final fixed appliance is prepared before implants are even placed in the patient's mouth, reducing the duration of the surgery to a minimum.
7 - Patient comes in for a painless, short visit to have the implants placed and the final appliance delivered in ONE visit:
8 - Lower fixed appliance over 6 Implants in place:
The initial immediate appliance is made out of acrylic (plastic). After a period of 3-6 months and after a brief appointment to measure the 6 implants stability (called Ostell reading), a full final zirconia appliance is fabricated and cemented over custom made abutements. The appliance can either be screw retained or cemented, the case below was done using a cemented lower full arch fixed appliance.
9 - Post treatment 3D scan implants are at the same exact location they were planned to be:
10 - The same process can be utilized to precisely plan a computer guided implant as a single, multiple or full arch until Computer guided implant placement has greatly reduced the need for un-necessary and painful grafting procedures since implants can now be placed in very little remaining bone very accurately.
11-The final appliance:
Patient comes back for impressions using the impression implant parts that are fitted to the inside of the 6 implants, the procedure is competeley pain free and require no shots/anesthesia:
12- Registration of the patient bite is done so that the original vertical dimension of the face is maintained (or sometimes increased in case of worn dentition or to help eliminate facial wrinkles around the angles of the mouth), teeth in pink wax are used and final teeth shade is selected:
13-In the lab, the final custom made abutments are fabricated and a fixed bridge is milled from a single
zirconia (Bruxzir) unit, sometimes extra gum (pink) shading is added to the appliance for a more natural look in case the gums were part of the smile (no pink shade was choosen by this patient as the smile line was too high to show any gums):
The fixed bridge from the inside view:
14- Final abutments (custom made for this patient) are torqued to implant system manufacturer recommendation levels and the final appliance is cemented, this is the final none-removable unit:
The pink gum shading at the bottom of the appliance was not done since the smile line doesn`t show any gum tissues, gums are retracted below to show full appliance in place. Normal hygiene procedures like brushing and flossing are done like that of any other bridge. Follow up intervals are between 1-2 years to clean the appliance and possibly replace the retention screws and make any bite adjustments if needed. Uusally a night guard is recommended with those cases on the opposing (upper) teeth for long term protection:
15- A panoramic x-ray showing the same patient and the fixed appliance appliance at a 5-year follow up appointment with perfectly-placed parallel implants as seen in the x-ray (guided surgery). Patient was very happy with the esthetics and function, no adjustments were necessary:
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*All images are the property of Edgebrook Dental Associates
*Patient has given her consent for images to be used in this newsletter.