A new smile in 2 visits
This method converts a full upper denture into an implant-supported bridge in just two appointments.
by Benjamin D. Oppenheimer, DDS; Adam J. Oppenheimer, MD; Joseph C.D. Gillespie, DDS; and Andrew Jakson
The field of oral implantology has recently undergone significant change. Minimally invasive surgery has become a central theme. Whereas subperiosteal implants were recommended for denture stabilization in the1940s, a denture now may be stabilized using small-diameter endosseus implants, which are available from several companies. This article describes a protocol for using Imtec Mini Dental Implants (MDI) (www.imtec.com) in conjunction with the Celara denture technique (www.celara.net) and the Fabricated Implant Restoration and Surgical Technique (F.I.R.S.T. Laboratory LLC, 877-4MDILAB). Implant placement and custom-fabricated, full-arch bridge restoration can be combined into one visit. The Imtec MDI system has FDA marketing approval for long-term use in fixed and removable applications. The advantages of using small-diameter implants over their larger-diameter counterparts include reduced bleeding, improved healing times, and decreased post-operative discomfort. Small-diameter implants also may be used in cases that have spatial limitations.
ASSESSMENT AND SELECTION
Two-visit, full-arch implant reconstruction is not suitable for every edentulous patient. Several overall health factors must be considered when deciding whether the procedure is appropriate (see “Good health a must for implant success,” page 98). In addition to acceptable health, the patient should have well-corticated bone with at least 5-mm width. Ideally, bone height should be at least 10 mm at any proposed implant site. In the distal maxilla, however, 10 mm may not be available. Similarly, mandibular bone resorption may provide only 8 mm of available bone above the mandibular canal. Although these are not contraindications, do avoid over-instrumentation; most importantly, avoid steps that could damage the inferior alveolar nerve or puncture the Schneiderian membrane. Use a panoramic radiograph to assess bone height. As part of the F.I.R.S.T. Laboratory procedure, a consulting dentist reviews the radiograph and recommends appropriate implant sizes and styles. (This protocol, however, can be handled by any laboratory experienced with small-diameter implant cases.)
CELARA + F.I.R.S.T. COMBO
The Celara denture technique is an ideal adjunct to F.I.R.S.T. in providing full-arch reconstruction. Celara uses existing dentures as a reference, eliminating preliminary impressions, custom trays, and wax rims. It allows accurate transfer of records, including vertical dimension of occlusion (VDO) as well as tooth position, size, and shape. This allows creation of the final restoration and delivery in two appointments with minimal effort on behalf of the practitioner. The following is a brief description of the procedure.¹
PATIENT VISIT NO. 1
The first step is to border-mold using a heavy-body polyvinylsiloxane (PVS). Dentures are removed and any excess impression material is carefully trimmed from the tissue surfaces, leaving an established border-molded periphery. Next, the patient should rinse with very cold water for one to two minutes to shrink the tissues and reduce inflammation. Dry the ridges and make the final impression using extra-light or light body wash. After initial impression-taking, remove all excess impression material fromthe facial surfaces of the teeth. The assistant then boxes the impressions and pours a cast using the Celara Arch Refill Kit. Immerse the denture (with impression) in the Celara Alginate teeth side-down, exposing only 1 to 2 mm of the border (Fig. 1). After the alginate sets, use a dull knife to trim all alginate away from the impressed surfaces. Place the upper container on top of the boxed impression in the lower container, and pour a cast using Celara Quick Set Stone. Using tap water, this sets within about five minutes. After the stone is set, open the container and remove the denture from the cast (Fig. 2). Remove debris and return the denture to the patient. Next, use the Celara Wax Injector to fabricate the Celara Wax Pattern (Fig. 3).The special Celara wax is injected directly over the cast, providing optimal fit and predictability. The wax pattern then is used as a custom rim for a try-in on the first patient visit (Fig. 4). The pattern is familiar and comfortable to the patient, and it provides a reference tool to communicate any necessary changes to the laboratory. If needed, mark changes in the wax to indicate the mid-line, vertical dimensions, tooth positions, planes of occlusion, or esthetics. By default, the impression technique increases the vertical height by 1 to 2 mm. This typically is desired for replacement cases and for the full-arch implant-retained bridge.
SENDING MATERIALS TO THE LAB
After recording any desired changes on the pattern, take a bite registration and place the wax pattern back on the cast. Send this and the opposing impression, a panoramic radiograph, and a completed lab slip to F.I.R.S.T. Laboratory LLC (or any lab experienced with small-diameter implant cases).
Patients leave the office after the first visit wearing their original denture. At F.I.R.S.T. Laboratory, a highly trained dentist plans the case. The laboratory creates a high-quality, customized, full-archporcelain-to-metal or zirconia bridge. The lab also fabricates a surgical template to properly position the implants in the final restoration. A certified technician and/or dentist reviewer is available to answer any questions. Cases usually are returned within three weeks after submission.
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