Chapter 2 Implant Laboratory Procedures PDF

Chapter 2 implant laboratory procedures **Introduction** - Mandibular two-implant overdentures have proven beneficial for improving denture retention, stability, and patient satisfaction. Implant-supported overdentures are particularly effective in cases of severe mandibular resorption where tradit...

Chapter 2 implant laboratory procedures **Introduction** - Mandibular two-implant overdentures have proven beneficial for improving denture retention, stability, and patient satisfaction. Implant-supported overdentures are particularly effective in cases of severe mandibular resorption where traditional dentures do not provide sufficient retention or stability. **Clinical Patient Presentation** - A typical patient might present with an edentulous mandible and an existing but unsatisfactory denture. They often express dissatisfaction with denture fit, retention, and comfort, which may have worsened over time due to bone resorption. Mandibular two-implant overdentures are recommended to improve these conditions. **Diagnosis and Assessment** - **Key Diagnoses**: - Edentulous maxillae or mandible. - Severe bone resorption in the mandible. - Ill-fitting dentures. - **Assessment**: - Clinical examination reveals significant resorption of the mandibular ridge. - Radiographic imaging (panoramic radiograph or CT scans) is used to assess the available bone for implant placement. - The treatment plan is discussed, considering two implants for overdenture retention as opposed to multiple implants for a fixed prosthesis. **Procedure Overview** 1. **Diagnostic Casts**: - Well-extended alginate impressions are taken to create diagnostic casts. These casts provide an accurate representation of the patient's anatomy for surgical and prosthetic planning. 2. **Custom Impression Trays**: - Custom trays are fabricated to obtain a more precise impression of the implant sites and adjacent tissue. This ensures the final prosthesis fits accurately. 3. **Implant Placement**: - Two implants are placed in the anterior mandible between the mental foramina (typically canine-to-canine). Implant surgery is carried out following the patient's anatomy and bone structure as analyzed during the assessment. 4. **Healing and Osseointegration**: - A healing period of several weeks (12weeks) is necessary to allow the implants to osseointegrate (bond with the bone). Healing abutments are placed during this time to shape the soft tissue around the future overdenture. 5. **Definitive Intraoral Impression**: - After osseointegration, a final impression is taken using Locator abutments, which are specific for overdenture retention. These abutments offer resilience and ease of use for both the clinician and the patient. 6. **Master Cast and Occlusion Records**: - A master cast is created from the definitive impression. Record bases and occlusion rims are fabricated to determine the correct vertical dimension and alignment of the future prosthesis. 7. **Wax Denture Try-In**: - Wax dentures are fabricated and tried in the patient's mouth to verify the fit, aesthetics, and function before final processing. 8. **Final Denture Processing and Insertion**: - The final overdenture is processed, adjusted, and inserted, attached securely to the Locator abutments. **Retention Systems and Attachments** - Locator attachments are commonly used for mandibular two-implant overdentures due to their durability and ease of maintenance. These attachments provide a stable connection between the denture and the implants, improving the patient's ability to speak, eat, and smile comfortably. **Follow-Up and Maintenance** - Regular follow-up appointments are essential to monitor the implants and prosthesis. Over time, the attachments may require replacement due to wear, but overall, the implant-supported overdenture is a predictable and long-lasting solution for edentulous patients.