Immediate Fixed Implant Supported Hybrid Prosthesis (all-on-4 technique) from start to finish, a complete case

Part 7 - Final Seat

Instructors:

Mark Margolin, DDS

Mark Margolin, DDS

Currently in full time private practice at the Berland Bental Arts Center, which is a group practice providing comprehensive dental care in one location.  He provides the surgical and sedation aspect of the practice.

Lorin Berland, DDS

Lorin Berland, DDS

Dr. Berland is a Fellow of the American Academy of Cosmetic Dentistry (AACD), the co-creator of the Lorin Library Smile Style Guide, and the developer of the Web site , www.denturewearerscom.

Dr. Margolin and Dr. Berland seat the final restoration

So we're about six months now since we did our initial surgery extractions with immediate placement and our immediate temporary hybrids. Now we're already been through our impression to create our master cast and we did our metal bar try in for our CAD/CAM bar. Stack the teeth, verified and now we're ready for our final seat today. Mike's tissue looks very good. We did a little laser surgery and clean up some tissue around some of the abutments. But the tissue health looks very good. It's firm and pink around all the fixtures. Radiographically, all our implants look well integrated. You noticed we have four on the bottom which is the classic All on 4 technique. On the top we'll always try to get six. The reason being that maxillary bone is often very soft especially when you're doing immediate and quite often I won't hit that magic 35 N-cm number on my maxillary placement. And patients come in expecting to leave with teeth the same day. That's part of the magic of this, the teeth in the day aspect. And if you are going with four and you only hit your torque on three and they're leaving with the removable denture that takes some of the glamour away for them. So by placing six as we had with Michael, I believe we have to bury that one right there. We still have five to hold his temporary and now the six one had time to integrate. Now we actually have six to hold his maxillary final. And by placing the extras in the softer maxillary bone he was able to leave with his teeth that same day. So here is Mike's final mandibular prosthetic on four. And we will place that and Britney is going to give me my prosthetic screws. We use brand new prosthetic screws when we insert the final. What we'll do is we'll place them in at first hand tight before we torque them. Ideally for a final set you'll place these screws to 15 N-cm. I'm going to torque them till 10 today. That gives me the ability to take this off at will to clean necessary without having to worry about replacing the every time. Okay. So what we're doing now is we're going to try in Michael's upper and just put in hand tight so we can check his bite. Do any final adjustments in the lab. And then we'll do our final insertion. You might feel little pinches Michael cause there's a lot of tissue around some of these. So that's going all the way on the back here. Open real wide for me. Thank you. Okay. That's always a good sign. Okay. Let me get you Dr. Berland to check your bite then we can do any final adjustment and polishing. Okay. Now we're going to adjust the bite before we torque it. I think it might be easier if I do some adjusting in the mouth. I'm going to use a high speed football not to abrasive. Okay. Michael we're going to do our final torque to tighten up this upper and you are going to be done. We just got to put a little block out in there. But just like on the bottom we're going to go between 10 N-cm and 15N-cm on these so that they're retrievable. Okay. Last one. So now we're going to close the access. I like to put a little cotton pellet and then I used a condenser to push it away from the margins and into the socket to protect the implants. Open just a little please. And a lot of dentist they like to use composite to close the access. I used to do that. And now I prefer to use Systemp temporary filling material. It is a composite. It's a soft composite and when we want to go back and check things out, take everything off, clean it. Rather than having to drill, I usually can just take it right out with an explorer and maybe a spoon. Let's smooth it with alcohol and gauze. And I've been doing this for a couple of years and it works pretty well. I mean nobody like drilling even when you're drilling on plastic so using the explorer and spoon works much better to remove this. And there's less damage to the prosthesis if you can avoid drilling. Again I tuck the cotton, condensed and Systemp temporary composite. And let's see. Check for overfill. Go ahead and bite down please. Tap a few times. Thank you. You're in good shape. Okay. We just cure it. I have to tell you I'm just so, its not one thing that I'm most excited about. I'm excited that I'm going to be able to eat like a normal human being again and chew my food and hopefully never have indigestion again. And I am so excited to be able to smile and not be inhibited. You know I don't like smiling like this all the time. The other thing is I'm an auctioneer. I'm a professional auctioneer. So my teeth it will be much easier for me to call bids without trying to hide my teeth because they look so terrible. Now they look great. I'll be showing them off when I call bid. I'll be going 25, 50, 75, 100, I'm psyched. I can't wait.