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.
screw prosthesis
Fig 23. The prosthesis is then screwed in place.
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).
loaded mandibular prosthesis
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

Commenter's Profile Image 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?
Commenter's Profile Image Andrew C.
March 21st, 2018
Ricardo that is an awesome explanation of the sequence of events.
Commenter's Profile Image 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!
Commenter's Profile Image 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!!