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. Fig 1. Occlusal view of the edentulous mandibular ridge prior to implant placement. Fig 2. Six implants were placed in the mandible. Healing abutments were secured and sutured. Fig 3. Bite registration material is syringed into the intaglio surface to capture the implant position. Fig 4. A low-speed hand piece carbide bur is used to hollow the implant sites. 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. 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. 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. Fig 8. The center of each one of the implants is also outlined in the rubber dam. Fig 9. Utilizing sharp scissors, the outline is then cut. Fig 10. The implant sites are perforated utilizing a rubber dam punch. Fig 11. Temporary cylinders are sandblasted and the “salt and pepper technique” is used to have a thin coat of PMMA. 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. Fig 13. The denture is tried on to confirm that none of the cylinders are binding and it is ready to go for reline. 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. Fig 15. Once the PMMA is fully set, the screws are all carefully unscrewed and the prosthesis is retrieved. Fig 16. The rubber dam is then peeled away from the intaglio surface of the prosthesis. Fig 17. The registration material stop is removed and a mix of PMMA is syringed to fill the voids. Fig 18. Bend-a-brushes are utilized to add small increments of PMMA where needed. Fig 19. The cantilevered portion is removed and additional acrylic is used to ensure there is a smooth and round edge. Fig 20. Utilizing a pear-shaped carbide bur, the periphery of the provisional prosthesis is rounded. Fig 21-22. The provisional is then polished utilizing a lathe and pumice powder. Fig 21-22. The provisional is then polished utilizing a lathe and pumice powder. Fig 23. The prosthesis is then screwed in place. 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.
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Ricardo Mitrani, D.D.S., M.S.D., Spear Faculty and Contributing Author