Clinical Steps in Fabrication of a two-implant Mandibular OD-2022.pdf

Advanced Prosthodontics L. Jahangiri Leila Jahangiri, BDS, DMD, MMSc Chair, Department of Prosthodontics NOTE: This lecture is supplementary to the simulation component of two-implant overdenture management. This is NOT available as a podcast. 1 Denture fabrication Implant placement 2 Abutment...

Advanced Prosthodontics L. Jahangiri Leila Jahangiri, BDS, DMD, MMSc Chair, Department of Prosthodontics NOTE: This lecture is supplementary to the simulation component of two-implant overdenture management. This is NOT available as a podcast. 1 Denture fabrication Implant placement 2 Abutment selection 3 Abutment connection and torque 4 Pick up of attachments 5 Occlusion 6 Recall and follow up 1 Advanced Prosthodontics L. Jahangiri 1 Denture fabrication 2 Advanced Prosthodontics L. Jahangiri 3 Advanced Prosthodontics L. Jahangiri 4 Advanced Prosthodontics L. Jahangiri 1 Implant placement Healing = osseintegration time 2-6 months- at which time remove Healing cap or healing abutment. 2 Weeks Post - Op 2 Abutment selection Measure from implant head to deepest tissue IMMEDIATELY replace the healing abutment 1mm 2mm 3mm 4mm Tissue height may be different on the right and left side. Make a note 5 Advanced Prosthodontics L. Jahangiri Three-in-one driver 3 Abutment connection Hand tighten the locator abutments and take an X-ray 6 Advanced Prosthodontics L. Jahangiri 3 Abutment connection and torque Locator Abutment After X-ray, torque tighten 3 Abutment connection Mechanism Metal Housing Male Processing Male Attachment Locator Abutment 7 Advanced Prosthodontics L. Jahangiri 3 Abutment torque 30 Ncm USED TO BE 20 NCm 4 Pick up of attachments CRITICAL STEP - Place White Spacer ring over the collar of the Locator Abutment 8 Advanced Prosthodontics L. Jahangiri 4 Pick up of attachments Place Housing with Black Processing Male over Locator Abutment- press and hear or feel a snap 4 Pick up of attachments Locator abutment Metal Housing White Spacer 9 Advanced Prosthodontics L. Jahangiri Place marking medium on Metal Housing, in order to locate implant/abutment position in underside (intaglio surface) of denture. Seat denture until contact is made between the Housing and the underside of the denture. 10 Advanced Prosthodontics L. Jahangiri Try-in the denture. Visualize attachments Dense Acrylic mix = Strong acrylic Proper Mix of Acrylic CUT  Cut the Monojet syringe tip (red line)  Mix as much powder into liquid as possible in a medicine dispenser. Mix should NOT be runny.  Put acrylic into syringe with a metal spatula 11 Advanced Prosthodontics L. Jahangiri  Apply lubricant Vaseline to teeth  Apply the dense acrylic around Housing and seat the denture If denture teeth are present over Locator… Adequate amount of denture base should be removed in order to NOT alter the existing vertical dimension in occlusion (VDO) during this process of pick up 12 Advanced Prosthodontics L. Jahangiri Seat denture in centric occlusion – instruct patient to bite down and when acrylic cures, Housing is picked up in the denture  Remove white ring and disinfect and keep  Lightly trim flashes of acrylic  If you have great retention: Leave BLACK processing male for 1 week  This assures a great transition for the patient 13 Advanced Prosthodontics L. Jahangiri  After 1 week proceed to remove black male processing  Replace with retentive male. Clear> Pink > Blue Seat Retention MALE into Housing with attachment insertion tool. SNAP! 14 Advanced Prosthodontics L. Jahangiri Effective 2013 Commission on Dental Accreditation (CODA) Mandated teaching and treatment of patients with dental implants 15