Conversion Prosthesis For an Implant-Supported Fixed Dental Prosthesis

Immediate loading of a full arch implant-supported dental prosthesis is a popular and predictable therapeutic modality. This visual essay walks the reader through one possible sequence of handling this procedure, from implant placement to delivery of the provisional restoration.

edentulous mandibular ridge occlusion — Fig 1. Occlusal view of the edentulous mandibular ridge prior to implant placement.

mandibular implants — Fig 2. Six implants were placed in the mandible. Healing abutments were secured and sutured.

bite registration material — Fig 3. Bite registration material is syringed into the intaglio surface to capture the implant position.

low speed handpiece for implant sites — Fig 4. A low-speed hand piece carbide bur is used to hollow the implant sites.

bite registration material temporary cylinders — Fig 5. The bite registration material can now be removed and a scalpel blade is used to leave the retromolar pads and the anterior area between the most anterior implants in order to provide a stop during the relining/capturing of the temporary cylinders.

denture rubber dam — Fig 6-7. The denture is placed on top of a rubber dam and, utilizing a Sharpie marker, the outline of the denture is delineated.

denture outline delineated — Fig 6-7. The denture is placed on top of a rubber dam and, utilizing a Sharpie marker, the outline of the denture is delineated.

denture outline rubber dam — Fig 8. The center of each one of the implants is also outlined in the rubber dam.

cut denture outline — Fig 9. Utilizing sharp scissors, the outline is then cut.

rubber dam patch for implants — Fig 10. The implant sites are perforated utilizing a rubber dam punch.

temporary cylinders PMMA — Fig 11. Temporary cylinders are sandblasted and the “salt and pepper technique” is used to have a thin coat of PMMA.

teflon tape screw access holes — Fig 12. All cylinders are then screwed in place through the rubber dam, and Teflon tape is utilized to obliterate the screw access holes to avoid entrapment of the PMMA during pick up.

binding cylinders — Fig 13. The denture is tried on to confirm that none of the cylinders are binding and it is ready to go for reline.

mixing ppma temporary cylinders — Fig 14. Mixing PMMA is applied to the intaglio surface of the lower denture and is seated in order to capture the temporary cylinders. Utilizing copious irrigation, it is left to set intraorally.

screw prosthesis — Fig 15. Once the PMMA is fully set, the screws are all carefully unscrewed and the prosthesis is retrieved.

rubber dam intaglio — Fig 16. The rubber dam is then peeled away from the intaglio surface of the prosthesis.

registration material syringe — Fig 17. The registration material stop is removed and a mix of PMMA is syringed to fill the voids.

bend a brush pmma — Fig 18. Bend-a-brushes are utilized to add small increments of PMMA where needed.

cantilevered acrylic edges — Fig 19. The cantilevered portion is removed and additional acrylic is used to ensure there is a smooth and round edge.

pear shape carbide — Fig 20. Utilizing a pear-shaped carbide bur, the periphery of the provisional prosthesis is rounded.

polishing provisionals — Fig 21-22. The provisional is then polished utilizing a lathe and pumice powder.

polish provisional lathe and pumice powder — Fig 21-22. The provisional is then polished utilizing a lathe and pumice powder.

obliterate screw access holes teflon tape — Fig 24. The screw access holes are obliterated utilizing Teflon tape and a thin layer of light cured temporary restorative material (Systemp.inlay, Ivoclar Vivadent).

Fig 25. Frontal view of the immediate loaded mandibular prosthesis opposing a maxillary denture.

(Click this link for more dentistry articles by Dr. Ricardo Mitrani.)

Ricardo Mitrani, D.D.S., M.S.D., Spear Faculty and Contributing Author

Comments

Steven H.
March 21st, 2018

Great photo's and sequence of a conversion. Quick question Ricardo was any of the alveolar bone reduced vertically when the 6 implants were placed?

Ricardo M.
March 21st, 2018

Thanks Steven. We did not do any alveolar bone reduction for this patient. The patient had experienced advanced periodontal disease and there was no need to do any reduction. The definitive prosthesis for this patient was monolithic Zr screw retained fixed implant supported prosthesis.

Andrew C.
March 21st, 2018

Ricardo that is an awesome explanation of the sequence of events.

Ricardo M.
March 22nd, 2018

Thanks Andy !!

Brett T.
March 22nd, 2018

Thank you for this! Can you show a follow up showing the steps to convert to the Zr Denture? Did you take the final impression at this attachment appointment? What are your recommended time frames for replacing the transitional denture with the Zr? Thanks!

Ricardo M.
March 22nd, 2018

Thanks Brett, we sure will do another Visual Essay piece showing the steps towards the delivery for the final Zr reconstruction. As far as your impressions question, we did not make the final impression during this appointment, we normally wait a few months for soft tissue maturation before making the definitive impression. and ideally we like to see the patient´s performance with a provisional restoration for a few months prior to going for the final. Cheers Ricardo

Blake B.
March 26th, 2018

Ricardo thanks for the photos and the explanation. I am also a UW Grad Pros graduate, I finished in 2014. I have done this procedure a few times but I am curious what your PMMA of choice is for the intraoral reline/pickup procedure. I have tried a few options but I am curious what you prefer and what works well for you. Thanks for your help!!

Ricardo M.
March 26th, 2018

Hi Blake, Lately we have been utilizing " Quick- up" from Voco... It is a Self-cured composite luting material that works phenomenally well, The reality is that you can utilize any PMMA of your choice... The key, is to ensure that your temporary cylinders are free of saliva contamination.

Eric P.
January 17th, 2019

Hi Ricardo. Hey in Figure 3, before placing the bite registration paste, did you grind out any of the intaglio to accommodate the healing caps? Otherwise your denture might not seat completely?

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Conversion Prosthesis For an Implant-Supported Fixed Dental Prosthesis

Comments